Outcome Measures

Learning Outcomes

In addition to the physiological changes of improved exercise capacity, pulmonary rehabilitation (PR) needs to combine self-management support with motivating and empowering participants.  The education component in PR needs to focus on developing self-management skills and promoting behavior change.  To be able to focus on development of the necessary capabilities, understanding the level the patient is at is the first step needed.  This is achieved through baseline measures of knowledge, skills and motivation. Determining the impact of the intervention can also be achieved through follow-up of assessment of change in knowledge, skills and motivation. Appropriate educational outcome measures are needed to effectively evaluate the changes in behavior before and after completion of pulmonary rehabilitation.  To support healthcare professionals, this website provides guidance in which measures can be used to evaluate baseline and follow-up knowledge, skills and motivations for planning program education and measuring impact.

  • Healthy Education Impact Questionnaire
    collated by Dr. Felicity Blackstock (School of Health Science, Western Sydney University, New South Wales, Australia)

  • Lung Information Needs Questionnaire
    collated by Dr Nicola Roberts (Nursing and Community Health/School of Health and Life Sciences Glasgow Caledonian University, Glasgow, Scotland, United Kingdom)

  • Bristol COPD Knowledge Questionnaire
    collated by Dr Nicola Roberts (Nursing and Community Health/School of Health and Life Sciences Glasgow Caledonian University, Glasgow, Scotland, United Kingdom)


Healthy Education Impact Questionnaire

Name of Questionnaire Healthy Education Impact Questionnaire
Abbreviation/ Alternate Name heiQ™
Description: Assesses impact of educational interventions for people with chronic conditions.
Developer R Osborne et al 1
E-mail richardo@unimelb.edu.au
Cost On application
License required Yes, contact author.
Administration Self-administered
Time to complete Not known
Number of items 42 items
Domains/categories (#) 8
Name of domains/categories 1.Positive and active engagement in life 2.Health directed behavior 3.Skill and technique acquisition 4.Constructive attitudes and approaches 5.Self-monitoring and insight 6.Health services navigation 7.Social integration and support 8.Emotional wellbeing
Scaling of items 6-point Likert scale (strongly disagree to strongly agree)
Scoring All domains positive score, except emotional wellbeing where reverse scored. Each domain assessed individually.
Test-retest/reproducibility Cronbach’s α 0.70 to 0.89 each domain. Positive and Active Engagement in Life α = 0.86; Health Directed Behavior α = 0.80; Skill and Technique Acquisition α = 0.81; Constructive Attitudes and Approaches α = 0.81; Self-Monitoring and Insight α = 0.70; Health Service Navigation α = 0.82; Social Integration and Support α = 0.86; and Emotional Wellbeing α = 0.89. 1
Validity Confirmatory factor analysis: SatorraBentler Scaled (robust) x2 = 1420, d.f. 791, p = 0.0; RMSEA = 0.037 (90% confidence intervals 0.033–0.040); CFI = 0.99. 1
Responsiveness to PR Trend toward improvement 2
MCID No specific score, however, effect size of 0.5 considered clinically important. 1
Languages and cultural adaptation 18 including: Bulgarian 3, Italian 4, Japanese 5, Dutch, German & French 6, French Canadian 7
Reference 1.Osborne RH et al. Patient Educ Couns. 2007; 66: 192-201. 2.Blackstock FC et al. Respirology. 2014; 19:193-202. 3.Todorova E et al. University of National and World Economy, Sofia, Bulgaria. 2018; (1): 157-170. 4.Pozza A et al. Psychol Res Behav Management. 2020; 13:459-471. 5.Morita R et al. Japan J Nurs Science. 2013; 10:255. 6.Ammerlaan J et al. Health Quality of Life Outcomes. 2017; 15:28. 7.Maunsell E et al. Cancer. 2014; 120:3228–3236.
Date of most recent changes September 22, 2020 

Abbreviations: CFI = Comparative Fit Index; MCID = Minimally Important Difference; PR=Pulmonary Rehabilitation; RMSEA= Root mean square error of approximation


Lung Information Needs Questionnaire

Name of Questionnaire Lung Information Needs Questionnaire 1
Abbreviation/ Alternate Name LINQ
Description: Assesses patients’ need for information about their COPD to guide clinical encounters. http://www.linq.org.uk/LINQhome.htm
Developers Rupert C M Jones, Michael E Hyland
E-mail rupert.jones@pms.ac.uk , mhyland@plymouth.ac.uk
Cost Free for clinical use and not-for-profit research
License required For-profit research
Administration Self-complete
Time to complete 6 minutes
Number of items 16-22 depending upon version
Domains/categories (#) Assesses patients’ need for information about their COPD to guide clinical encounters.
Name of domains/categories Six domains include: disease knowledge; medicines; self-management; smoking; exercise; and diet.
Scaling of items N/A
Scoring Scoring based on summing items from each domain. Range 0–25/32. Higher scores indicate higher need for information.
Test-retest/ reproducibility Cronbach’s α= 0.62 2 Test retest each domain r=0.66–0.98 2
Validity Significant correlations with SWT between change in medicine domain scores & change scores (p=0.04). No correlations found between changes in LINQ total and domain scores and changes in dyspnoea, SWT and HADS domain scores. 2
Responsiveness to PR LINQ total score post-PR improved significantly with a large effect size [t(114)=11.83, p<0.001, r=0.74]. All domain scores improved significantly, with a medium to large effect size, with exception of smoking. Diet and exercise improved the most, followed by self-management, disease knowledge and medicine domains. 2
MCID Informal assessment suggests a change of 1 point a significant change as perceived by patients with COPD. 3
Languages English, Bulgarian, Chinese, Dutch, French, German, Italian, Japanese, Portuguese, Russian, Spanish 4
References 1.Hyland ME e. al. Respir Med. 2006; 100:1807–1816. 2.Jones RC et al. Respir Med. 2008; 102:1439–1445. 3.Lung Information Needs Questionnaire http://www.linq.org.uk/ LINQusing.htm 4.www.linq.org.uk/LINQscoring.htm
Date of most recent changes September 23, 2020

Abbreviations: HADS=Hospital Anxiety & Depression Scale; MCID=Minimal clinically important difference; SWT=Shuttle Walking Test.


Bristol COPD Knowledge Questionnaire

Name of Questionnaire Bristol COPD Knowledge Questionnaire
Abbreviation/Alternate Name BCKQ
Description: Assesses patient’s knowledge about topics related to COPD.
Developer Roger White
E-mail roger.white4@virgin.net
Cost Freely available from Dr Roger White
License required No
Administration Self-administered
Time to complete 15–20 minutes
Number of items 65
Domains/categories (#) 13 categories
Name of domains/categories The questionnaire contains 13 topics, each with five statements giving a total of 65 questions. These topics covered epidemiology and physiology, aetiology, common symptoms, breathlessness, phlegm, chest infections, exercise, smoking, immunization, inhaled bronchodilators, antibiotics, oral steroids and inhaled steroids
Scaling of items True, False, Don’t know
Scoring Correct =1, incorrect =0. No mark awarded for a ‘don’t know’. Scoring based on percentage of items answered correctly.
Test-retest/reproducibility Test retest r= 0.71 1
Validity Content 1
Responsiveness to PR Mean change score of 10.64 pre/post pulmonary rehabilitation program (p<0.001) 2 Education only program, total BCKQ score increased from baseline of 27.6±8.7 to 36.5±7.7 points (p<0.001) 3
Languages English
Reference 1.White R et al. Chron Respir Dis. 2006; 3:123–131 2.Cosgrove et al. BMC Pulm Med. 2013; 13: 50. 3.Hill K et al. Patient Educ Couns 2010; 81:14–18.
Date of most recent changes September 23, 2020

Abbreviations: MCID: Minimal Clinically Important Difference; N/A=not available; PR=Pulmonary Rehabilitation