Visual analogue scale for sino-nasal symptoms severity correlates with sino-nasal outcome test 22: paving the way for a simple outcome tool of CRS burden

Research Open Access Visual analogue scale for sino-nasal symptoms severity correlates with sino-nasal outcome test 22: paving the way for a simple outcome tool of CRS burden Maria Doulaptsi1, 2Email authorView ORCID ID profile, Emmanuel Prokopakis2, Sven Seys1, Benoit Pugin1, Brecht Steelant1 and Peter Hellings1, 3 Clinical and Translational Allergy20188:32 https://doi.org/10.1186/s13601-018-0219-6 ©  The Author(s) 2018 Received: 18 March 2018Accepted: 14 July 2018Published: 3 September 2018 Abstract Background A visual analogue scale (VAS) is a psychometric instrument widely used in the Rhinology field to subjectively quantify patient’s symptoms severity. In allergic rhinitis, VAS has been found to correlate well with the allergic rhinitis and its impact on asthma severity classification, as well as with rhinoconjunctivitis quality of life questionnaire. In chronic rhinosinusitis (CRS), total VAS score are often used to classify disease burden into mild, moderate, and severe, with few studies correlating VAS scores with more complex and validated instruments assessing disease-specific burden like Sino-Nasal Outcome Test (SNOT)-22. Methods We correlated VAS scores for total and individual sino-nasal symptom with SNOT-22 scores in a randomly selected group of 180 CRS patients. Pearson’s rho was selected as a correlation coefficient for analysis. Results VAS scores for total nasal symptom score and individual symptoms correlated significantly with SNOT-22, irrespective of VAS based subclasses for sino-nasal, ocular, and bronchial symptoms. Conclusions VAS for total sino-nasal symptom severity might be used for assessing disease severity, monitoring the course of the disease, and can be used for treatment decisions and disease burden. Keywords Chronic rhinosinusitisPatient reported outcome measuresQuality of lifeSNOT-22VAS Background Chronic rhinosinusitis (CRS), with or without nasal polyps, is defined as an inflammation of nose and paranasal sinuses lasting for at least 12 weeks [1]. It is characterized by two or more symptoms, one of which should be either nasal blockage/obstruction or nasal secretions (anterior/posterior nasal drip). Other symptoms might be facial pain/pressure and hyposmia/anosmia. The prevalence of CRS in the European adult population is estimated by GA(2)LEN study to be around 11.9%, while in the USA it is considered even higher [2, 3]. The burden of disease and the impact on patients’ every day activity, work productivity, and overall Quality of Life (QoL) cannot be underestimated, especially in difficult-to-treat cases [4]. The direct cost of CRS in the United States is estimated at $8.6 billion/year, while societal indirect costs from productivity loss are approximately $10,077 per patient each year [5]. Interestingly, general health of CRS patients was worse compared to patients with congestive heart failure, Chronic Obstructive Pulmonary Disease (COPD), and Parkinson disease, using generic health-state utility scores [6]. To accurately assess the burden of disease in CRS patients, multiple disease-specific QoL questionnaires were designed and validated over the past years [7–10]. These questionnaires focus on symptoms and how they affect patients’ daily life, emotional condition, and overall QoL. These instruments are designed to have a strong association with principal disease characteristics and the ability to reflect response to treatment. Among different disease-specific outcome measurements in CRS, the Sino-Nasal Outcome Test (SNOT)-22 is widely accepted and has been used in several studies even before its validation by Hopkins et al., in 2009. SNOT-22 is a reliable questionnaire, can be used to facilitate clinical practice, and validated in multiple languages [8]. Visual analogue scale (VAS) is a psychometric measurement instrument widely used in the Rhinology field and beyond to subjectively quantify patients’ symptoms severity. Originally designed to evaluate workers productivity by senior personnel, VAS gained more attention in the sixties in medicine, social science, and market research [11]. It represents a horizontal line of 10 cm with word anchors at each end representing the extreme feelings. Patients are instructed to indicate the point on the line that best corresponds to their status for the particular characteristic being evaluated. In addition to its high sensitivity, reliability and reproducibility, VAS is easy and simple to use by patients and health care providers [11]. It also does not require training, making VAS a highly valuable tool not only for everyday clinical practice, but also for real-life studies [11]. In allergic disease, VAS was found to correlate well with the Allergic Rhinitis and its Impact on Asthma (ARIA) severity classification system and QoL measurement instruments such as Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) [12]. Additionally, VAS is utilized to monitor the course of the disease, to assess treatment outcomes, to obtain self-assessments, and to define the level of control in allergic patients by MACVIA-ARIA project [13]. Lately, VAS has been incorporated into the MASK Allergy Diary mobile app, a clinical decision support system assessing allergic rhinitis (AR) severity for feedback to the patient and the doctor on level of disease control [14]. In CRS, VAS for total nasal symptom score (TNSS) is part of routine clinical practice to classify disease as mild, moderate, and severe. In research, VAS for TNSS and individual symptoms are frequently incorporated into studies as an instrument for estimating symptoms severity and burden of disease [15]. In contrast to allergy, correlations between VAS scores with more complex instruments assessing disease-specific burden like SNOT-22 in CRS are scarce [16, 17]. Toma and Hopkins, demonstrated a strong correlation between VAS and SNOT-22 in 65 CRS patients and they further attempted to stratify SNOT-22 score based on disease severity [17]. Here, we aim to study VAS scores for TNSS and individual sino-nasal symptoms in relation to SNOT-22 scores in a larger randomly selected group of CRS patients. In addition, correlation between VAS and SNOT-22 scores is explored in different CRS phenotypes (with/without nasal polyps, controlled/partly controlled/uncontrolled disease). Methods Study population A postal questionnaire survey was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospitals of Leuven in Belgium. Subjects who visited the outpatient clinic and coded as CRS between January and May of 2016 were isolated from the clinical workstation. Evaluation of full medical records was performed by an ENT specialist to confirm the coded diagnosis based on EPOS defining criteria for CRS (symptoms, compatible endoscopic findings and/or computed tomography abnormalities when imaging was available). Patients younger than 16 years, those with primary immunod (...truncated)