The Hospital Anxiety and Depression Scale (HADS) in Bronchiectasis: Response to pulmonary rehabilitation (PR) and Minimum Clinically Important Difference (MCID)

Background: The HADS is a brief questionnaire, comprising two subscales (anxiety: HADS-A and depression: HADS-D) that is widely used to measure the effects of PR on mood disorder. However, limited data exist in bronchiectasis. We aimed to: 1) assess the responsiveness of HADS to PR in patients with bronchiectasis and symptoms of anxiety and/or depression (HADS-A or HADS-D≥8); and 2) provide MCID estimates for the HADS subscales. Method: HADS, Medical Research Council (MRC) Dyspnoea scale, Chronic Respiratory Questionnaire (CRQ) and Incremental Shuttle Walk (ISW) were measured before and after an 8-week PR programme. Anchor-and distribution-based methods were used to estimate the MCID of HADS-A and HADS-D. Results: The response to PR is described in Table 1 with HADS-A and HADS-D showing effect sizes of 0.40 and 0.32 respectively. Using 11 and 17 different estimates for HADS-A and HADS-D respectively, the MCID for both subscales was -2. Conclusion: The HADS is responsive to PR in bronchiectasis patients with symptoms of mood disorder, with an MCID of -2 for each subscale.