Measuring quality of life: for chronic pulmonary and chronic cardiac rehabilitation-responsiveness

Background: Chronic cardiac (CR) and chronic pulmonary (PR) rehabilitation programs have been shown to reduce the symptoms of disease, as well as reducing health-care utilisation. To ensure the continuation of these programs Patient Outcome Measures (POMs) are essential to map treatment effectiveness. Aim: This project initially aimed to investigate the current literature pertaining to cardiac (CR) and pulmonary (PR) rehabilitation for the investigation of responsiveness. A comparative literature review, a quality assessment of the literature and a statistical assessment of POMs were undertaken. The second (qualitative) component of the project asked patients and staff about how they thought CR and PR changed patient health status over the time of the rehabilitation program to formulate new domains for a POM. Study Design: This project used a convergent mixed methods approach which included a quantitative competent and a qualitative component. The combination of the results of these two aspects of the study provided the groundwork for a new POM. Results: The quantitative study found that POMs, in particular the SF-36 were not as responsive to CR and PR as initially thought. The qualitative study of patient and staff interviews and focus groups defined domains for a new POM: independence, confidence, motivation, physical function and social function. Conclusion: The qualitative study found that for patients in CR and PR programs their aspirations did not always meet up to the actuality of their experience. A new POM based on the Patient Generated Index (PGI) has provided the framework to assesses a patient’s quality of life firstly by the determination of how each domain is currently impacting them and secondly by assessing the current importance of each domain.