Patient-reported chronic rhinosinusitis disease control is a valid measure of disease burden

Abstract

Background: Disease control is an important treatment goal for chronic uncurable conditions such as chronic rhinosinusitis (CRS). The objective of this study was to determine whether patient-reported CRS disease control is a valid reflection of disease burden. Methods: Prospective longitudinal study of 300 CRS patients (35% CRS with nasal polyps, 65% CRS without nasal polyps). At enrollment and at a subsequent follow-up timepoint, all participants were asked to rate their CRS disease control as “not at all,” “a little,” “somewhat,” “very,” or “completely”, as well as to complete a 22-item Sinonasal Outcome Test (SNOT-22) and the 5-dimension EuroQol general health questionnaire from which the visual analogue scale (EQ-5D VAS) was used. Results: At enrollment and follow-up timepoints, patient-reported CRS disease control was significantly correlated with SNOT-22 and EQ-5D VAS scores. The change in patient-reported CRS disease control was significantly correlated with change in SNOT-22 and change in EQ-5D VAS scores. There was significant cross-sectional and longitudinal correlation between patient-reported control and all SNOT-22 subdomain scores. A SNOT-22 score of ≤ 25 points or lower, or an EQ-5D VAS score of ≥77 was predictive of having well - (i.e. “very” or “completely”) controlled CRS. Conclusions: Patient-reported CRS disease control is a valid measure of CRS disease burden and general QOL. A patient-reported assessment of CRS disease control could be considered as a component of a more comprehensive measure of CRS disease control.

Five‐year EuroQol 5‐Dimension Outcomes After Endoscopic Sinus Surgery

“…Smith et al found that among 119 CRS patients, females experienced more severe pre‐ and postoperative quality of life as measured with the RSDI and CSS. Phillips et al 21 suggested the possibility of differential gender‐based disease perception in patients with CRS, 35 a factor which could be contributing to the current study findings in which female patients with CRS consistently reported more severe symptoms both before and after surgery.…”

Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control

“…The primary stakeholders in the determination of CRS control are clearly patients and healthcare providers. For patients, it has been shown that CRS control is reflective of CRS disease burden, quality of life, and functional impairment 18–21 . However, while the meaning of CRS control, as well as its determinants, has been well studied from the patient perspective, 8,9 the manner in which healthcare providers assess CRS control for their patients is not well‐studied and remains largely unknown.…”

“…Other CRS manifestations could certainly influence rhinologists’ assessments of CRS control. However, as the EPOS guideline criteria were developed through expert opinion and also found to be largely comprehensive of patients’ perspectives of their own CRS control while patient‐reported CRS control is a validated reflection of CRS disease burden, 7,21 it is likely that the relationships found here are accurately reflective of the participating rhinologists’ perspectives on CRS control.…”

“…For patients, it has been shown that CRS control is reflective of CRS disease burden, quality of life, and functional impairment. [18][19][20][21] However, while the meaning of CRS control, as well as its determinants, has been well studied from the patient perspective, 8,9 the manner in which healthcare providers assess CRS control for their patients is not well-studied and remains largely unknown. In this study, we sought to determine how healthcare providers assess CRS control by identifying CRS disease manifestations that were associated with how fifteen rhinologists of diverse backgrounds classified the control of two hundred real-world patients' CRS.…”

Defining ‘control’ of chronic rhinosinusitis

“…In another study, we validated patient-reported CRS control (i.e. simply asking patients to report their level of CRS control) as a measure of CRS disease burden, showing that patient-reported CRS control not only correlates with general health-related QOL and CRS symptom burden cross-sectionally, but changes in patient-reported control also correlated with changes in general health-related QOL and CRS symptom burden after treatment of CRS [17 ▪ ]. When we focused specifically on identifying the CRS symptoms that most associated with how patients assessed their CRS control, we found that nasal symptoms were most dominantly associated with how patients assessed their CRS control [18].…”