VCD Patient Reported Outcome Measures

The Vocal Cord Dysfunction Questionnaire or VCDQ is a valid and responsive tool suitable for measuring changes in symptoms in patients diagnosed with Vocal Cord Dysfunction or VCD. VCD is also commonly referred to in research as Paradoxical Vocal or Laryngeal Movement Disorder (PVFM) and now more commonly referred to as Induced Laryngeal Obstruction or ILO.

The VCDQ gives insight into which symptoms are important to patients and aids to guide future therapy refinements. The 12-item questionnaire rates the impact of each symptom using a 5-point Likert scale (total score range 12 to 60).

Future assessments of novel therapies for VCD should use an appropriately validated tool such as the VCDQ to measure response (Fowler, SJ, Thurston A, Chesworth B, Cheng V, Constantinou P, Vyas A, Lillie S, Haines J, 2015).

The subjective scale has been modified from original tool to include expanded terms and explainations to improve understanding and justification of VCD/ILO related symptoms. The scoring values remain unaltered.

Base your symptom score on how often or how severe symptoms are for you. Base today's score on your most recent event or attack.

Today's Date

Date

Name*

First NameLast Name

Date of birth

Date

Therapy Reporting Cycle

Instructions:

1) Complete only those forms which pertain exclusively to you and your symptoms.

2) After submitting the form return to main PROM form (220225152757148) to complete the remain forms.

Vocal Cord Dysfuction Questionnaire (Fowler, 2015)

Vocal Tract Discomfort Scale (Mathieson, 2009)

Newcastle Laryngeal Hypersensitivity Questionnaire (Vertigan, et al. 2014)

Dyspnea Index Score (Gartner-Schmidt, et al. 2014)

Cough Severity Index Score (Shembel, et al. 2013)

My VCD/ILO concerns include (check any or all that apply):

Do any of the above symptoms feel like they are caused by the structures of my throat, base of throat or UPPER chest area?

YesNo

How often do you experience symptoms that impact your throat, base of throat or UPPER chest areas:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Do you feel like you can't get breath to flow past a certain point in your upper airway?

YesNo

How often do you feel like you can't get breath past a certain point in your upper airway because of restriction:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Do you experiencing more difficulty getting a full breath IN rather than breathing OUT?

YesNo

How often do you experience this sensation of breathlessness while breathing IN:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Do the attacks or episodes come on suddenly or escalate quickly?

YesNo

How often do you experience these sudden attacks:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Do you ever feel a sensation of something stuck in your throat that you can't quite clear?

YesNo

How often do you feel this sensation of something stuck in your throat:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always or (every day or nearly every day, with a known or unknown trigger or activity)

Do you ever notice changes to your voice during or after an attack?

YesNo

How often do you notice changes to your voice during or just after an attack:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

During an attack or episodes, do you hear a loud wheezing sound or distressed breathing?

YesNo

How often do you observe noisy or distressed breathing:

None or (Not anymore or RARELY even with previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Are your attacks or episodes caused by known or specific trigger, event, activity or experience?

YesNo

How often do you experience attack or episodes that were triggered by a specific or known event, activity or experience:

None or (Not anymore or RARELY even with a previous VCD/ILO trigger or activity)Occasionally (1-3 times monthly, with a known or unknown trigger or activity)Sometimes (1-2 times a week, with a known or unknown trigger or activity)Often (3-5 times a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Do you experience attacks or episodes that come on "out of blue" or are spontaneous (no known triggers or activities)?

YesNo

How often do you experience spontaneous symptoms:

None or (Not anymore or RARELY)Occasionally (1-3 times monthly)Sometimes (1-2 times a week)Often (3-5 times a week)Always (every day or nearly every day)

Do the attacks or episodes cause a tickle, ache, pain, or itch in your throat?

YesNo

How often do you experience attacks or episodes that also cause the sensation of throat tickle, ache, pain, or itch:

None or (Not anymore or RARELY even with a previous VCD/ILO trigger or activity)Occasionally (1-3 monthly, with a known or unknown trigger or activity)Sometimes (1-2 a week, with a known or unknown trigger or activity)Often (3-5 a week, with a known or unknown trigger or activity)Always (every day or nearly every day, with a known or unknown trigger or activity)

Do you feel frustrated by your current care to manage these attacks or episodes?

YesNo

How often do you feel frustrated by your symptoms and the treatment designed to control or prevent these attacks or episodes:

None (Not anymore or RARELY do I feel frustrated by these symptoms)Occasionally I feel frustrated my current treatment(s) do not control or prevent symptomsSometimes I feel frustrated my current treatment(s) do not control or prevent symptomsOften I feel frustrated my current treatment(s) do not control or prevent symptomsAlways I feel frustrated my current treatment(s) do not control or prevent symptoms

Are you UNABLE to tolerate light pressure around the neck or certain posistioning of the neck?

YesNo

How often do you experience this intolerance to light pressure around the neck or bending the neck in certain positions:

None or (Never or RARELY do I feel this sensation)Occasionally (1-3 times monthly)Sometimes (1-2 times a week)Often (3-5 times a week)Always (This is a problem I experience every day or nearly every day)

Do these attacks or episodes negatively impact persona or social life, exercise, athletics or sports, hobbies and interests?

YesNo

How often do attacks or episodes interfere with your personal or social life, exercise, athletics or sports, hobbies and interests:

Never (VCD/ILO no longer or RARELY interferes with my pastimes or life)Occasionally (1-3 times monthly, VCD/ILO interferes with my pastimes or life)Sometimes (1-2 times a week, VCD/ILO interferes with my pastimes or life)Often (3-5 times a week, VCD/ILO interferes with my pastimes or life)Always (every day or nearly every day, VCD/ILO interferes with my pastimes or life)

Total Score or Sum

Severity Rating: Negative Impact on Life or Activities

A score of 12: My VCD does not have a significant impact on my life or activitiesA score of 13-28: My VCD has a MILD impact on my life or activitiesA score of 29-44: My VCD has a MODERATE impact on my life or activitiesA score of 44-60: My VCD has a SEVERE impact on my life or activities

Induced Laryngeal Obstruction or ILO Patient Reported Outcome Measures PROMs