Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 6

Disability related to COPD tool (DIRECT): towards an assessment of COPD-related disability in routine practice

Authors Aguilaniu, Gonzalez-Bermejo J, Regnault A, Dias-Barbosa C, Arnould, Mueser, Granet, Bonnefoy M, Similowski T

Published 5 July 2011 Volume 2011:6 Pages 387—398


Review by Single-blind

Peer reviewer comments 2

B Aguilaniu1, J Gonzalez-Bermejo2, A Regnault3, C Dias Barbosa3, B Arnould3, M Mueser4, G Granet5, M Bonnefoy6, T Similowski2,7
1HYLAB, Physiologie Clinique, Grenoble, France; 2Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation, Paris, France; 3Mapi Values, Lyon, France; 4Formerly Boehringer Ingelheim, Paris, France; 5General Practitioner, Sainte-Foy-lès-Lyon, Paris, France; 6Centre Hospitalier Lyon Sud, Lyon, France; 7Université Paris 6 Pierre et Marie Curie, ER10, Paris, France

Background: Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health concern. It is also a major source of disability that is often overlooked, depriving patients of effective treatments. This study describes the development and validation of a questionnaire specifically assessing COPD-related disability.
Methods: The DIsability RElated to COPD Tool (DIRECT) was developed according to reference methods, including literature review, patient and clinician interviews and test in a pilot study. A 12-item questionnaire was included for finalization and validation in an observational cross-sectional study conducted by 60 French pulmonologists, who recruited 275 COPD patients of stage II, III and IV according to the GOLD classification. Rasch modeling was conducted and psychometric properties were assessed (internal consistency reliability; concurrent and clinical validity).
Results: The DIRECT score was built from the 10 items retained in the Rasch model. Their internal consistency reliability was excellent (Cronbach's alpha = 0.95). The score was highly correlated with the Saint George's Respiratory Questionnaire Activity score (r = 0.83) and the London Handicap Scale (r = 0.70), a generic disability measure. It was highly statistically significantly associated to four clinical parameters (P < 0.001): GOLD classification, BODE index, FEV1 and 6-minute walk distance.
Conclusion: DIRECT is a promising tool that could help enhance the management of COPD patients by integrating an evaluation of the COPD-related disability into daily practice.

Keywords: chronic obstructive pulmonary disease, daily medical practice, disability, disease management, questionnaires

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Readers of this article also read:

A bibliometric analysis of the 100 most influential papers on COPD

Gu WC, Yuan YP, Yang H, Qi GS, Jin XY, Yan J

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:667-676

Published Date: 25 March 2015

Length of stay of COPD hospital admissions between 2006 and 2010: a retrospective longitudinal study

Harries TH, Thornton HV, Crichton S, Schofield P, Gilkes A, White PT

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:603-611

Published Date: 18 March 2015

Interleukin 10-coated nanoparticle systems compared for molecular imaging of atherosclerotic lesions

Almer G, Summers KL, Scheicher B, Kellner J, Stelzer I, Leitinger G, Gries A, Prassl R, Zimmer A, Mangge H

International Journal of Nanomedicine 2014, 9:4211-4222

Published Date: 3 September 2014

Cytokine inhibition in the treatment of COPD

Caramori G, Adcock IM, Di Stefano A, Chung KF

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:397-412

Published Date: 28 April 2014

Factors associated with good self-rated health and quality of life in subjects with self-reported COPD

Arne M, Lundin F, Boman G, Janson C, Janson S, Emtner M

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:511-519

Published Date: 7 October 2011

Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users

M Bradley Drummond, Gregory D Kirk, Jacquie Astemborski, et al

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:89-95

Published Date: 19 January 2011