Real-Time Symptom Ratings Using Ecological Momentary Assessment Versus Traditional Questionnaires in Patients With Chronic Obstructive Pulmonary Disease: Observational Study

Abstract

Background: Questionnaires assessing symptoms in chronic obstructive pulmonary disease (COPD) rely on retrospective reporting, introducing recall bias and missing symptom variability. Ecological momentary assessment (EMA) addresses these limitations by capturing real-time symptom data. Objective: The aim of this study was to compare EMA symptom ratings with traditional questionnaires in patients with COPD. Methods: A subsample from the FAntasTIGUE study rated symptoms using questionnaires (visual analog scale, modified Medical Research Council Dyspnea Scale, Physical Activity Rating Scale-Dyspnea Questionnaire, Checklist Individual Strength-subscale Subjective Fatigue, Hospital Anxiety and Depression Scale, and COPD Assessment Test) and EMA. Participants rated breathlessness, fatigue, anxiety, and energy level on a 7-point Likert scale during 8 random EMA prompts daily for 5 days. Results: Among 54 participants (mean age 67, SD 7 y; forced expiratory volume in 1 s 53%, SD 20% predicted; n=35, 65% men), the EMA response rate was 76.1%. EMA scores were moderately to strongly correlated with questionnaire scores (rs=0.49-0.78, all P<.05) and varied across severity groups (all P<.05). EMA captured significant intraday and interday symptom variability. Conclusions: EMA is a valid tool for COPD symptom assessment, capturing real-time fluctuations to improve symptom management.