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The Community-Acquired Pneumonia Symptom Questionnaire^*

A New, Patient-Based Outcome Measure To Evaluate Symptoms in Patients With Community-Acquired Pneumonia

^* From the Health Services Research Unit (Drs. Lamping and Schroter), Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; MAPI Values (Dr. Marquis and Ms. Marrel), Lyon, France; and Bayer plc and Drs. Duprat-Lomon and Sagnier), Stoke Court, UK.

Correspondence to: Donna L. Lamping, PhD, Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom; e-mail: donna.lamping{at}lshtm.ac.uk

Study objectives: To develop and validate a patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia (CAP).

Design: A psychometric study within an international, prospective, randomized, double-blind study. The CAP-symptom questionnaire (CAP-Sym) is a new, 18-item, patient-reported outcome measure that evaluates the bothersomeness of CAP-related symptoms during the past 24 h using a 6-point Likert scale. We used "gold standard" psychometric methods to comprehensively evaluate the acceptability, reliability, validity, and responsiveness of the CAP-Sym.

Setting: Sixty-four centers in 13 countries (France, Germany, Hungary, Israel, Italy, Norway, Poland, Portugal, South Africa, Spain, Sweden, Switzerland, United Kingdom).

Patients: Five hundred fifty-six patients with CAP, recruited from outpatient clinics, general practice, and hospital centers.

Interventions: Randomization 1:1 to moxifloxacin (400 mg once daily), oral or standard oral treatment (amoxicillin, 1 g tid, or clarithromycin, 500 mg bid), alone or in combination, for up to 14 days.

Results: Standard psychometric tests confirmed the acceptability (item nonresponse, item-endorsement frequencies, item/scale floor and ceiling effects), reliability (internal consistency, item-total and inter-item correlations, test-retest reliability), validity (content, construct, convergent, discriminant, known groups), and responsiveness of the CAP-Sym.

Conclusions: The CAP-Sym is a practical and scientifically sound patient-based outcome measure of CAP-related symptoms that has been developed using "gold standard" methods. As the only fully validated measure of symptoms in patients with CAP, which is quick and easy to administer and is more responsive than the generic Medical Outcomes Study 36-Item Short-Form Health Survey, the CAP-Sym provides a practical and rigorous method for improving the evaluation of outcomes in clinical trials and audit.

Key Words: community-acquired pneumonia • outcomes • patient-based assessment • questionnaire • symptoms

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