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Dryden DM, Spooner CH, Stickland MK, et al. Exercise-Induced Bronchoconstriction and Asthma. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Jan. (Evidence Reports/Technology Assessments, No. 189.)

Cover of Exercise-Induced Bronchoconstriction and Asthma

Exercise-Induced Bronchoconstriction and Asthma.

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Appendix CForms

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Quality Assessment Form: Diagnosis of EIB/EIA review, QUADAS

1The spectrum of patients was representative of the patients who would receive the test in practice.YESNOUNCLEAR
2Were selection criteria clearly defined?YESNOUNCLEAR
3Is the reference standard likely to classify the condition correctly? (Reference standard was specified as part of inclusion criteria)YESNOUNCLEAR
4Is the time period between reference standard and index test appropriate to be reasonably sure that the target condition did not change between the two tests?YESNOUNCLEAR
5Did the whole sample or a random selection of the sample, receive verification using a reference standard (partial verification bias)?YESNOUNCLEAR
6Did patients receive the same reference standard regardless of the index test results (differential verification bias)?YESNOUNCLEAR
7Was the execution of the index test described in sufficient detail to permit replication of the test?YESNOUNCLEAR
8Was the execution of the reference test described in sufficient detail to permit replication of the test?YESNOUNCLEAR
9Were the index test results interpreted without knowledge of the results of the reference standard?YESNOUNCLEAR
10Were the reference standard results interpreted without knowledge of the results of the index test?YESNOUNCLEAR
11Were the same clinical data available when index test results were interpreted as would be available when the test is used in practice? (Only applicable to self-reported history and self-reported symptoms diary)YESNOUNCLEAR
12Were uninterpretable/intermediate test results reported?YESNOUNCLEAR
13Were withdrawals from the study explained?YESNOUNCLEAR

Guidelines for interpretation of QUADAS questions for EIB/EIA

  1. Was the spectrum of participants representative of the patients who would receive the test in practice?
    Answer YES if
    • - Unbiased recruitment methods: consecutively or randomly selected in a prospective way
    • - Characteristics of participants are presented: Age, comorbidity (e.g., asthma), where they were recruited from (e.g., school, clinic, sport team, etc.), all have suspected EIB
    Answer NO if
    • - Biased recruitment methods: volunteers, retrospective selection
    • - Participants include those with confirmed (not suspected) EIB
    • - Characteristics of participants are not reported
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No.
  2. Were selection criteria clearly defined?
    Answer YES if
    • - There is information on how participants were selected for inclusion including recruitment methods and inclusion/exclusion criteria (e.g., age, EIB status, setting (i.e., high school), recruitment method)
    Answer NO if
    • - There is no information regarding recruitment methods and inclusion/exclusion criteria
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No.
  3. Is the reference standard likely to classify the condition correctly?
    Answer YES
    • - Standardized exercise challenge (treadmill or cycle ergometry) that resulted in a drop of 10% in FEV1 as being acceptable.
    • - Age-specific heart rate achieved during exercise (>80% of predicted)
    • - Exercise duration 6 min
    • - Post exercise measure interval is approximately 2 min (i.e., 1, 3, 5, 7min)
    Answer UNCLEAR if
    • - The achieved age-specific HR or exercise duration are not mentioned
    • - The achieved age-specific HR is mentioned but less than 80%
    • - The exercise duration is mentioned but less than 6 min
    • - Post exercise measure interval is longer than 2 min (i.e, 1, 4, 8m post exercise)
  4. Is the time period between reference standard and index test appropriate to be reasonably sure that the target condition did not change between the 2 tests?
    Answer YES if
    • - There was an acceptable delay between the 2 tests; doesn’t apply to self report and a 2nd test (mark as NA where self report is the comparison test)
    • - We judged a time interval of at least 24 hours between tests as appropriate.
    Answer NO if
    • - If the period between the 2 tests does not fall within the time interval
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No.
  5. Did the whole sample or a random selection of the sample, receive verification using a reference standard (partial verification bias)?
    Answer YES if
    • - All participants received the reference test before receiving the index test; or
    • - In cases where the index test is given prior to the reference test, either all participants go on to receive the reference test or a random sample of participants receive the reference test
    Answer NO if
    • - Less than 90% of the participants who received the index test also received the reference test and the selection of this smaller group is based on a non-random method (such as results from the index test)
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No
  6. Did patients receive the same reference standard regardless of the index test results (differential verification)?
    Answer YES if
    • - All participants received the same reference test
    Answer NO if
    • - Some participants received verification of EIB using a different reference standard or some of the participants who received the index test did not have their true disease state verified.
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No
  7. Was the execution of the index test described in sufficient detail to permit replication of the test?
    Answer YES if …
    • - Details are provided about duration, dose, load, environmental conditions and other items relevant to the specific index test
    Answer NO if
    • - There are no details about the execution of the index test.
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No
  8. Was the reference standard described in sufficient detail to permit replication of the test?
    Answer YES if
    • - Information is reported on duration of challenge, % of maximal heart rate / workload, relative humidity, air temperature, or if a standardized protocol is referenced (i.e., AAS or similar).
    Answer NO if
    • - There is no information about how the exercise challenge was conducted.
    Answer UNCLEAR if
    • - There is not enough relevant information to score either a Yes or No
  9. Were the index test results interpreted without knowledge of the results of the reference standard?
  10. Were the reference standard results interpreted without knowledge of the results of the index test?
    Answer YES if
    • - The authors stated explicitly that the results of the index test were interpreted blind to the results of the exercise challenge, and vice versa
    Answer NO if
    • - If it does not seem likely that the test results were interpreted blind to the results of the other test
    Answer UNCLEAR if
    • - It is not reported in the study
  11. Were the same clinical data available when test results were interpreted as would be available when the test is used in practice?(Applicable only to Self reported history and Self reported symptoms diary)
    Answer YES if
    • - If the interpretation of the index test is fully automated and involves no interpretation
    • - If the index test is interpreted with additional clinical data in the study, while these same clinical data will also be available when the index test is performed in practice
    • - If the index test is interpreted without additional clinical data, and additional clinical data will also be unavailable when the index test is performed in practice
    Answer NO if
    • - If the interpretation of the index test is not fully automated and involves interpretation components which can be influenced by additional clinical data
    • - If the index test is interpreted with additional clinical data in the study, however, these clinical data will not be available when the index test is performed in practice
    • - If the index test is interpreted without additional clinical data, however, additional clinical data will be available when the index test is performed in practice
    Answer UNCLEAR if
    • - Not enough relevant information to score either a Yes or No
  12. Were uninterpretable/intermediate test results reported?
    Answer YES if
    • - It is clear that all test results are reported
    Answer NO if
    • - You suspect that uninterpretable/indeterminate/intermediate results occur but are not reported
    Answer UNCLEAR if
    • - There is no mention of whether such results occurred or how they were handled
  13. Were withdrawals from the study explained?
    Answer YES if
    • - All the participants enrolled are accounted for (i.e., a flow chart or description of reasons for dropouts or withdrawals)
    Answer NO if
    • - Some participants did not receive both tests and are not accounted for
    Answer UNCLEAR if
    • - It is not clear whether all participants who entered the study were accounted for

Note: We did not apply Item 7 (incorporation bias) from the original QUADAS tool as it does not apply to this review.

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