Sgrq c%20 manual%202008

ST GEORGE’S RESPIRATORY QUESTIONNAIRE FOR
COPD PATIENTS (SGRQ-C)

MANUAL

Professor Paul Jones
Division of Cardiac and Vascular Science
St George’s, University of London
London SW17 0RE
UK

Paul W. Jones
Yvonne Forde

Tel +44 (0) 208 725 5371
Fax +44 (0) 208 725 5955 Version No.1.1
Email: yforde@sgul.ac.uk 11 December 2008

CONTENTS

Page

1. The SGRQ 2

2. Differences from the SGRQ 2

3. Structure of SGRQ 2

4. Administration 3-4

5. Item Weights 5-7

6. Scoring Algorithm 8-9

7. Excel-based scoring system 9

8. SGRQ scores in healthy subjects 9-10

9. Clinically significant difference in 10
SGRQ score

10. List of languages - SGRQ-C 11

11. List of languages – SGRQ 12

12. Selected bibliography 13-14

2

1. THE SGRQ

The SGRQ-C was developed from the SGRQ which was designed to measure health
impairment in patients with asthma and COPD. The SGRQ is also valid for use in
bronchiectasis and post tuberculosis and has been used successfully in patients with
kyphoscoliosis, sarcoidosis. It is not suitable for cystic fibrosis. It is in two parts. Part
I produces the Symptoms score, and Part 2 the Activity and Impacts scores. A Total
score is also produced.

2. SGRQ-C: DIFFERENCES FROM THE SGRQ

The SGRQ-C is a shorter version derived from the original version following detailed
analysis of data from large studies in COPD. The intention was to remove the items
with the weakest measurement properties in the original instrument, but at the same
time ensure that its scores were directly comparable with the original SGRQ. A full
description of this process and validation studies has been published in Chest
(Meguro et al. Chest 2006;132: 456-463). The accompanying on-line supplement
gives additional details concerning its development and the differences from the
original. (http://chestjournal.org/cgi/content/full/chest.06-0702/DC1).

The SGRQ-C has been developed using COPD data only, so is valid for this disease.
The validity for its use in other conditions has yet to be established, but it is unlikely
to perform very differently from the SGRQ.

The principal differences are:

1. Smaller number of items (40 compared with the original 50).
2. In a small number of items there is a reduction in the number of response
categories.
3. Change in the wording of Part 1. No specific recall period is used except for
one item.

3. STRUCTURE OF SGRQ

Part 1 (Questions 1-7) addresses the frequency of respiratory symptoms. It is not
designed to be a precise epidemiological tool, but to assess the patient’s perception
of their recent respiratory problems.

Part 2 (Questions 8-14) addresses the patient’s current state (i.e. how they are
these days). The Activity score measures disturbances to daily physical activity. The
Impacts score covers a range of disturbances of psycho-social function. Validation
studies for the original SGRQ showed that this component relates in part to
respiratory symptoms, but it also correlates quite strongly with exercise performance
(6-minute walking test), breathlessness in daily life (MRC breathlessness score) and
disturbances of mood (anxiety and depression). The Impacts score is, therefore, the
broadest component of the questionnaires, covering the whole range of disturbances
that respiratory patients experience in their lives.

Note: the general scale on the front page is not part of the SGRQ or SGRQ-C, but
some investigators find it useful as an additional global measure.

3

4. ADMINISTRATION

The questionnaire should be completed in a quiet area, free from distraction and the
patient should ideally be sitting at a desk or table. Explain to the patient why they are
completing it, and how important it is for clinicians and researchers to understand
how their illness affects them and their daily life. Ask him or her to complete the
questionnaire as honestly as they can and stress that there are no right or wrong
answers, simply the answer that they feel best applies to them. Explain that they
must answer every question and that someone will be close at hand to answer any
queries about how to complete the questionnaire.

It is designed for supervised self-administration. This means that the patients should
complete the questionnaire themselves, but someone should be available to give
advice if required. It is designed to elicit the patient’s opinion of his/her health, not
someone else’s opinion of it, so family, friends or members of staff should not
influence the patient’s responses. If the spouse or partner has accompanied the
patient they should be asked to wait in a separate area. Similarly, do not allow
patients to take the SGRQ-C home to be completed since you cannot be sure that it
will be completed without the help of family or friends. A recent study of the use of
surrogates to complete the questionnaire has shown small but significant differences
in scores obtained from the patients themselves (Santiveri et al Respiratory Medicine
(2007) 101, 439–445)

Once the patient has finished, it is very important that you check the questionnaire to
make sure a response has been given to every question. If they have missed an item
return it to the patient for completion, before they leave.

Telephone administration of the SGRQ has been validated (Anie et al J Clin
Epidemiol 1996;49:653-6.), as has computer based presentation (Meguro and Jones,
unpublished), but postal administration has not.

Responding to a patient’s queries regarding completion of the questionnaire

If a patient asks for help with a question, do not provide an answer for them. The
questionnaire is designed to get an understanding of how the patient views his or her
illness. It is appropriate to clarify a question but not to provide an answer. Questions
may be read aloud if patients have difficulty with reading, but the responses must be
theirs alone. If a patient gives an answer you disagree with it is not appropriate to
challenge their response or to query it. It is their view of their condition we are
interested in – no matter how strange the response!

The following are notes that may help you explain to patients what is required

1. In Part 1 of the questionnaire, emphasise to patients that you are interested in
how much chest trouble they have recently. The exact period is not important.
We are looking for an impression or perception of health.

2. An attack of chest trouble (Part 1, Question 5) is any episode of worse
symptoms that constitutes an attack in the patient’s own judgement. Not just
severe attacks as judged by medical staff.

3. COPD can vary day-to-day. Part 2 is concerned with the patient’s current state
(i.e. on average over ‘these days’), not necessarily just today.

4. For Part 1 Question 6, emphasise that you are interested in the number of good
days that they have had.

4

5. In Part 2, Questions 8 and 14 require a single response, but Questions 9 to 13
require a response to every question. It may be worth emphasising this to the
patient.

6. Many patients do not engage in physical activity. It is important to determine
whether this is because they do not wish to (in which case the answer would be
‘False’) or cannot engage in these activities because of their chest trouble (in
which case the answer would be ‘True’).

7. Responses to Questions 12 and 13 concern limitations due to breathing
difficulties and not any other problems. If the patient does not engage in an
activity for another reason, they should tick ‘False’.

5

5. ITEM WEIGHTS

Each questionnaire response has a unique empirically derived 'weight' (Quirk et al
Clin Sci 1990;79:17-21; Quirk et al Eur Respir J 1991;4:167-71).The lowest possible
weight is zero and the highest is 100. Note that, in cases where the two response
options to an item in the original SGRQ were combined in the SGRQ-C, the weight
for the new response option was calculated from the mean of the two that were
combined.
(Note: the wording is abbreviated from that used in the questionnaire.)

PART 1
Question 1: I cough:
Most days 80.6
Several days 46.3
With chest infections 28.1
Not at all 0.0
Question 2: I bring up phlegm (sputum):
Most days 76.8
Several days 47.0
With chest infections 30.2
Not at all 0.0
Question 3: I have shortness of breath:
Most days 87.2
Several days 50.3
Not at all 0.0
Question 4: I have attacks of wheezing:
Most days 86.2
Several days 71.0
A few days 45.6
With chest infection 36.4
Not at all 0.0
Question 5:How many attacks of chest trouble have you had
3 or more 80.1
1 or 2 attacks 52.3
None 0.0
Question 6: How often do you have good days (with little chest trouble)?
None 93.3
A few 76.6
Most are good 38.5
Every day 0.0
Question 7: If you have a wheeze, is it worse in the morning?
No 0.0
Yes 62.0

6

PART 2

Question 8: How would you describe your chest condition?
The most important problem I have 82.9
Causes me a few problems 34.6
Causes no problem 0.0

Question 9: Questions about what activities usually make you feel breathless.
Getting washed or dressed 82.8
Walking around the home 80.2
Walking outside on the level 81.4
Walking up a flight of stairs 76.1
Walking up hills 75.1

Question 10: More questions about your cough and breathlessness.
My cough hurts 81.1
My cough makes me tired 79.1
I get breathless when I talk 84.5
I get breathless when I bend over 76.8
My cough or breathing disturbs my sleep 87.9
I get exhausted easily 84.0

Question 11: Questions about other effects your chest trouble may have on you.
My cough or breathing is embarrassing in public 74.1
My chest trouble is a nuisance to my family, friends or neighbours 79.1
I get afraid or panic when I cannot get my breath 87.7
I feel that I am not in control of my chest problem 90.1
I have become frail or an invalid because of my chest 89.9

Exercise is not safe for me 75.7

Everything seems too much of an effort 84.5

Question 12: Questions about how activities may be affected by your breathing.
I take a long time to get washed or dressed 74.2
I cannot take a bath or shower, or I take a long time 81.0
I walk more slowly than other people, or I stop for rests 71.7
Jobs such as housework take a long time, or I have to stop for rests 70.6
If I walk up one flight of stairs, I have to go slowly or stop 71.6
If I hurry or walk fast, I have to stop or slow down 72.3
My breathing makes it difficult to do things such as walk up hills, carry things up
stairs, light gardening such as weeding, dance, play bowls or play golf 74.5
My breathing makes it difficult to do things such as carry heavy loads, dig the
garden or shovel snow, jog or walk at 5 miles per hour, play tennis or swim 71.4

7

Question 13: We would like to know how your chest trouble usually affects your daily life.
I cannot play sports or games 64.8
I cannot go out for entertainment or recreation 79.8
I cannot go out of the house to do the shopping 81.0
I cannot do housework 79.1
I cannot move far from my bed or chair 94.0

Question 14: Tick the statement which you think best describes how your chest affects
you.
It does not stop me doing anything I would like to do 0.0
It stops me doing one or two things I would like to do 42.0
It stops me doing most of the things I would like to do 84.2
It stops me doing everything I would like to do 96.7

8

6. SCORING ALGORITHM

A Total and three component scores are calculated: Symptoms; Activity; Impacts.
Each component of the questionnaire is scored separately:

6.1 Sum the weights for all items with a positive response
SYMPTOMS COMPONENT

This consists of all the questions in Part 1. The weights for Questions 1-7 are
summed. A single response is required to each item. If multiple responses are given
to an item, the weights for the multiple positive responses should be averaged then
added to the sum. This is a better approach than losing the data set and this
technique was for calculating scores used in the original validation studies for
patients who gave multiple responses. (Clearly a better approach is to prevent such
multiple responses occurring).

ACTIVITY COMPONENT

This is calculated from the summed weights for the positive responses to items
Questions 9 and 12 in Part 2 of the questionnaire.

IMPACTS COMPONENT

This is calculated from Questions 8, 10, 11, 13, 14 in Part 2 of the questionnaire. The
weights for all positive responses to items in Questions 10, 11, 13 are summed
together with the responses to the single item that should have been checked
(ticked) in Questions 8 and 14. In the case of multiple responses to either of these
items, the average weight for the item should be calculated.

TOTAL SCORE
The Total score is calculated by summing the weights to all the positive responses in
each component.

6.2 Calculate the score
The score for each component is calculated separately by dividing the summed
weights by the maximum possible weight for that component and expressing the
result as a percentage:

Score = 100 x Summed weights from all positive items in that component
Sum of weights for all items in that component

The Total score is calculated in similar way:

Score = 100 x Summed weights from all positive items in the questionnaire
Sum of weights for all items in the questionnaire

Sum of maximum possible weights for each component and Total:

Symptoms 566.2
Activity 982.9
Impacts 1652.8
Total (sum of maximum for all three components) 3201.9

9

(Note: these are the maximum possible weights that could be obtained for the worst
possible state of the patient).

6.3 Handling missing items

It is better not to miss items and any missing items are the fault of the investigator,
not the patient. We have examined the effect of missing items and recommend the
following methods:

Part 1

Missed items are treated as if the answer was in the negative. A maximum of one
missed item is permitted for this section.

Part 2

The following approach may be used. Items in Questions 9, 10, 11, 12, 13 all require
a response of either ‘True’ or ‘False’. If neither box is ticked, the item should be
coded as ‘missing’. The weight for that item should then be removed from the total
possible for that component (and the total score). Based on an analysis of the effect
of missing data on calculated scores in the original SGRQ, this method will be
reliable for handling up to 3 missed items for the Activity component (items in
Questions 9 and 12) and up to 5 items for the Impacts component (items in
Questions 8, 10, 11, 13, 14).

6.4 Converting SGRQ-C scores to be comparable to SGRQ scores

Scores for SGRQ-C, calculated as described above, need a small arithmetic
adjustment to make them directly comparable to those obtained with the SGRQ.

The adjustment is:
Symptoms: SGRQ score = (SGRQ-C x 0.99) + 0.94 units
Activity: SGRQ score = (SGRQ-C x 0.87) +7.01 units
Impacts: SGRQ score = (SGRQ-C x 0.88) +2.18 units
Total: SGRQ score = (SGRQ-C x 0.90) + 3.10 units

7. EXCEL-BASED SCORING SYSTEM
This is not yet available

8. SGRQ SCORES IN HEALTHY SUBJECTS

Means (95% confidence intervals) for SGRQ scores in normal subjects with no
history of respiratory disease

N Age - years FEV1 as % Symptoms Activity Impacts Total
predicted Score Score Score Score

74 46 95 12 9 2 6
range 17-80 (91-99) (9-15) (7-12) (1-3) (5-7)

10

A full range of normative values for a general population studied in Spain can be
found in Ferrer et al Eur Respir J 2002;19:405-413.

9. CLINICALLY SIGNIFICANT DIFFERENCE IN SGRQ SCORE

The threshold for a clinically significant difference between groups of patients and for
changes within groups of patients is four units. Note this is an indicative value (the
threshold is not 4.0). As with all measurements there is biological variation, sampling
error and measurement error. Four units is an average value obtained in different
groups of patients. Estimation of clinical thresholds, their use and implications are
discussed in much greater detail in Jones P.W. Eur Respir J 2002;19:398-404 and
Jones P.W. Journal of COPD 2005;2:75-79.

Note: A responder analysis using the 4 unit threshold may be suitable in some
analyses. Such estimates, including the Number Needed to Treat (NNT), appear to
be relatively insensitive to small differences in the value used for the threshold for
clinical significance. (Jones P.W. Eur Respir J 2002;19:398-404 and Norman et al
Med Care 2001;39:1039-47).

11

10. LIST OF SGRQ-C TRANSLATIONS AVAILABLE FROM SGUL

SGRQ-C translations have been produced as a result of collaboration between
St George’s University of London and the following agencies:- (1) MAPI Research
Institute * (www.mapi-institute.com) and (2) Oxford Outcomes ◊
(www.oxfordoutcomes.com)

America India Sweden *
English for USA ◊ English for India *
Spanish for USA ◊ Hindi * Turkey *
Tamil *
Argentina Telugu * Ukraine
Spanish for Argentina * Ukrainian ◊
Italy * Russian for Ukraine ◊
Australia
English for Australia * Korea *

Belgium Latvia
French for Belgium * Latvian *
Dutch for Belgium *
Lithuania
Brazil Lithuanian *
Portuguese * Russian for Lithuania *

Bulgaria ◊ Mexico
Spanish for Mexico *
Canada
French for Canada * ◊ Netherlands
English for Canada ◊ Dutch for
Netherlands ◊
Chile
Spanish for Chile ◊ New Zealand
English for NZ ◊
Czech ◊
Norway ◊
Denmark ◊
Philippines *
English
Poland *
Estonia
Estonian ◊ Portugal *
Russian for Estonia ◊
Russia ◊
Finland
Finnish * Slovakia *
Swedish for Finland *
Slovenia ◊
France *
South Africa
Germany * English for SA *
Afrikaans*
Greece *
Spain ◊
Hungary *

12

11. LIST OF SGRQ TRANSLATIONS AVAILABLE FROM SGUL - This list is given since
where no SGRQ-C version is available, only a small amount of additional translation would be
necessary.

Most of the translations have been produced as a result of collaboration between
St George’s University of London and the following agencies:- (1) MAPI Research Institute*
(www.mapi-institute.com) (2) Health Research Associates (www.hrainc.net)
(3)  these translations have followed the backtranslation process but have not been through
full international harmonisation (4) ◊ Translated and validated by Dr. Mohamed Metwally,
MD, FCCP, Assistant Professor of Chest Diseases, Assiut University, Egypt

America French* New Zealand
English for USA* English for NZ*
Spanish for USA* German*
Norwegian*
Arabic ◊ Greek*
PDF only Philippines*
Hungarian*
Australia Polish*
English for Australia* Icelandic*
Portuguese*
Austria India
German* Bengali* Romanian*
Gujarati*
Belgium Hindi* Russian*
Dutch for Belgium* Kannada*
French for Belgium* Malayalam Serbian*
Flemish Marathi*
Punjabi* Singapore
Brazil Tamil Mandarin Chinese*
Portuguese* Telugu*
Urdu* Slovakian*
Bulgarian*
Indonesian Slovenian*
Canada Hard copy only
French for Canada* South Africa
English for Canada* Israel Afrikaans*
Hebrew* English for SA*
Chinese Russian for Israel*
Mandarin* Spanish for
Hong Kong* Italian* Argentina*
Chile*
Croatian* Japanese* Colombia*
Mexico*
Czech* Korean* Peru*
Spain*
Danish* Latvia
Latvian* Swedish*
English (UK) Russian for Latvia*
Thailand*
Estonia Lithuanian*
Estonian* Turkish*
Russian for Estonia* Malaysia
Malay* Ukrainian*
Farsi  Mandarin Chinese*
PDF only Vietnamese 
Netherlands
Finnish* Dutch*

13

12. SELECTED BIBLIOGRAPHY

Major source references
1. Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire.
Respir Med 1991;85(Suppl B):25-31.
2. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure for
chronic airflow limitation - the St George's Respiratory Questionnaire. Am Rev Respir Dis
1992;145:1321-7.
3. Meguro M, Barley EA, Spencer S, Jones PW. Development and validation of an
improved COPD-specific version of the St George's Respiratory Questionnaire. Chest
2006;132: 456-463.

Other references
4. Quirk FH, Jones PW. Patients' perception of distress due to symptoms and effects of
asthma on daily living and an investigation of possible influential factors. Clin Sci
1990;79:17-21.
5. Quirk FH, Baveystock CM, Wilson RC, Jones PW. Influence of demographic and
disease related factors on the degree of distress associated with symptoms and restrictions
on daily living due to asthma in six countries. Eur Respir J 1991;4:167-71.
6. Jones PW, the Nedocromil Sodium Quality of Life Study Group. Quality of Life,
symptoms and pulmonary function in asthma: long-term treatment with nedocromil sodium
examined in a controlled multicentre trial. Eur Respir J 1994;7:55-62.
7. Anie KA, Jones PW, Hilton SR, Anderson HR. A computer-assisted telephone
interview technique for assessment of asthma morbidity and drug use in adult asthma. J
Clin Epidemiol 1996;49:653-6.
8. Ketelaars CAJ, Sclösser MAG, Mostert R, Huyer Abu-Saad H, Halfens RJG, Wouters
EFM. Determinants of health-related quality of life in patients with chronic obstructive
pulmonary disease. Thorax 1996;51:39-43.
9. Okubadejo AA, Jones PW, Wedzicha JA. Quality of life in patients with chronic
obstructive pulmonary disease and severe hypoxaemia. Thorax 1996;51(1):44-7.
10. Renwick DS, Connolly MJ. Impact of obstructive airways disease on quality of life in
older adults. Thorax 1996;51:520-5.
11. Jones PW, Bosh TK. Changes in quality of life in COPD patients treated with
salmeterol. Am J Resp Crit Care Med 1997;155:1283-9.
12. Wilson CB, Jones PW, O'Leary CJ, Cole PJ, Wilson R. Validation of the St George's
Respiratory Questionnaire in Bronchiectasis. AJRCCM 1997;156:536-41.
13. Osman LM, Godden DJ, Friend JAR, Legge JS, Douglas JG. Quality of life and
hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax
1997;52:67-71.
14. Hajiro T, Nishimura K, Tsukino M, Ikeda A, Koyama H, Izumi T. Comparison of
discriminative properties among disease-specific questionnaires for measuring health-
related quality of life in patients with chronic obstructive pulmonary disease. American
Journal of Respiratory & Critical Care Medicine 1998;157(3 Pt 1):785-90.
15. Seemungal TAR, Donaldson GC, Paul EA, Bestall JC, Jefferies DJ, Wedzicha JA.
Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary
disease. Am J Respir Crit Care Med 1998;157:1418-22.
16. Wijkstra PJ, Jones PW. Quality of life in patients with chronic obstructive pulmonary
disease. Eur Respir Monogr 1998;3(7):235-46.

17. Barley EA, Jones PW. A comparison of global questions versus health status
questionnaires as measures of the severity and impact of asthma. European Respiratory
Journal 1999;14(3):591-6.
18. Carone M, Bertolotti G, Anchisi F, Zotti AM, Donner PW, Jones PW. Analysis of factors
that chararacterize health impairment in patients with chronic respiratory failure. Eur Respir
J 1999;13:1293-300.
19. Jones PW. Health status in chronic obstructive pulmonary disease. Eur Respir Rev
1999;9:169-72.
20. Burge PS, Calverley PMA, Jones PW, Spencer PW, Anderson JA, Maslen TK.
Randomised, double blind, placebo controlled study of fluticasone proprionate in patients
with moderate to severe chronic obstructive pulmonary disease. BMJ 2000;320:1297-303.
21. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results
at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled
trial. Lancet 2000;355(9201):362-8.
22. Jones PW. Impact of lower respiratory tract infections on health status. Seminars in
Respiratory and Critical Medicine 2000;21:107-11.
23. Spencer S, Calverley PMA, Burge PS and Jones PW. Health status deterioration in
patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med
2001;163:122-8.
24. Jones PW. Health status measurement in chronic obstructive pulmonary disease.
Thorax 2001;56:880-7.
25. Jones PW. Interpreting thresholds for a clinically significant changes in health status in
asthma and COPD. Eur Respir J 2002;19:398-404.
26. Ferrer M, Villasante C, Alonso J, Sobradillo V, Gabriel R, Vilagut G, et al.
Interpretation of quality of life scores from the St. George’s Respiratory Questionnaire. Eur
Respir J 2002;19:405-413.
27. Domingo-Salvany A, Lamarca R, Ferrer M, Garcia-Aymerich J, Alonso J, Félez M, et
al. Health-related quality of life and mortality in male patients with chronic obstructive
pulmonary disease. Am J Respir Crit Care Med 2002;166:680-685.
28. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to
mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med
2003;167:544-549.
29. Stolk J, Ng WH, Bakker ME, Reiber JHC, Rabe KF, Putter H. Stoel BC. Correlation
between annual change in health status and computer tomography derived lung density in
subjects with alpha1-antitrypsin deficiency. Thorax 2003, 58: 1027-30
30. Gudmundsson G, Gislason T, Janson C, Lindberg E, Hallin R, Ulrik CS, Brøndum E,
Nieminen MM, Aine T and Bakke P. Risk factors for rehospitalisation in COPD: role of
health status, anxiety and depression. Eur Respir J 2005; 26: 414–419
31. Jones PW. St George's Respiratory Questionnaire: MCID. Journal of COPD 2005;2:75-
79.
32. Broekhuizen, R. Wouters EFM, Creutzberg E.C. Schols A.M.W.J. Raised CRP levels
mark metabolic and functional impairment in advanced COPD. Thorax 2006; 61: 17-22
33. Santiveri C, Espinalt M, Carrasco FXD, Marin A, Miguel E, Jones PW. Evaluation of
male COPD patients’ health status by proxies. Respir Med;101:439-445.

1

Sgrq c%20 manual%202008

More Related Content

What's hot (20)

Similar to Sgrq c%20 manual%202008 (20)

More from Dr Amolkumar W Diwan (20)

Recently uploaded (20)

Sgrq c%20 manual%202008