The relationship between subjective assessment instruments in chronic rhinosinusitis

Problem: To provide an evidence-based definition for the relationship between three subjective instrtiments for assessing severiry of chronic rhinosinusitis-visual analogue scale, 'mild', 'moderate' and 'severe' (MMS) classfiication and perception of whether quality of life (QoL) is affected. Method of study: One hundred sixteen subjects with chronic rhinosinusitis filled in a questionnaire rating simultaneously their perception of disease severity based (1) upon visual analogue scale, (2) MMS classification and (3) stating whether they felt their QoL was affected. Main results: The mean age of subjects was 50. The inter-quartile range of VAS scores for the respective MMS groups were: Mild 0.80-3.50, Moderate 4.40-6.33, Severe 7.70-9.50. In the group who perceived effects on QoL, the inter-quartile range for VAS scores was 5.10-8.68. This range was 1.53-4.57 in the other group with no effects on QoL. 30.3% of patients in the 'mild' category, 79.6% in the 'moderate' category and 97.4% in the 'severe' category felt that their QoL was affected. Principle conclusions: We propose a statistically validated definition of the relationship between MMS classification and VAS scoring. Based on our study we would define 'mild' as being 0- 3 inclusive, 'moderate', as > 3- 7 inclusive and 'severe' as > 7- 10 inclusive on the VAS scoring system. We further pro pose that in general QoL is more likely to be affected with VAS scores of 5 or more.