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Heredia-Ciuró A, Quero-Valenzuela F, Martín-Núñez J, Calvache-Mateo A, Valenza-Peña G, López-López L, Valenza MC. Physical Deconditioning in Lung Cancer Patients Who Underwent Lung Resection Surgery in Spain: A Prospective Observational Study. Cancers (Basel) 2024; 16:2790. [PMID: 39199563 PMCID: PMC11353127 DOI: 10.3390/cancers16162790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Lung resection represents the main curative treatment modality for lung cancer. These patients present with physical deterioration that has been studied previously using objective variables; however, no previous studies have evaluated the self-perceived physical fitness of these patients. For these reasons, to increase the current knowledge on lung cancer patients' impairment, the aim of this study was to characterize the self-perceived physical deconditioning of lung cancer patients undergoing lung resection in the short and medium term after surgery. METHODS A longitudinal, observational, prospective cohort study was performed in the Thoracic Surgery Service of the Hospital Virgen de las Nieves (Granada). Symptoms (pain, fatigue, cough and dyspnea) and physical fitness (upper and lower limbs) were assessed before surgery, at discharge and at one month after discharge. RESULTS Among the total of 88 patients that we included in our study, significant differences were found at discharge in symptoms (p < 0.05) and physical fitness (p < 0.05). One month after surgery, higher levels of pain (p = 0,002) and dyspnea (p = 0.007) were observed, as well as poorer results in the upper (p = 0.023) and lower limbs' physical fitness, with regard to the initial values. CONCLUSIONS Patients undergoing lung resection present an increase in symptoms and physical fitness deterioration at discharge, which is maintained one month after surgery.
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Affiliation(s)
- Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.H.-C.); (J.M.-N.); (A.C.-M.); (G.V.-P.); (M.C.V.)
| | | | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.H.-C.); (J.M.-N.); (A.C.-M.); (G.V.-P.); (M.C.V.)
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.H.-C.); (J.M.-N.); (A.C.-M.); (G.V.-P.); (M.C.V.)
| | - Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.H.-C.); (J.M.-N.); (A.C.-M.); (G.V.-P.); (M.C.V.)
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.H.-C.); (J.M.-N.); (A.C.-M.); (G.V.-P.); (M.C.V.)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (A.H.-C.); (J.M.-N.); (A.C.-M.); (G.V.-P.); (M.C.V.)
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2
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Shin J, Hammer M, Cooley ME, Cooper BA, Paul SM, Cartwright F, Kober KM, Conley YP, Levine JD, Miaskowski C. Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients. Cancer Med 2024; 13:e7013. [PMID: 38400684 PMCID: PMC10891479 DOI: 10.1002/cam4.7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. METHODS Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. CONCLUSIONS Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.
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Affiliation(s)
- Joosun Shin
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Bruce A. Cooper
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Steven M. Paul
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Kord M. Kober
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yvette P. Conley
- School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jon D. Levine
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Christine Miaskowski
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Yorke J, Johnson MJ, Punnett G, Smith J, Blackhall F, Lloyd Williams M, Mackereth P, Haines J, Ryder D, Krishan A, Davies L, Khan A, Molassiotis A. Respiratory distress symptom intervention for non-pharmacological management of the lung cancer breathlessness-cough-fatigue symptom cluster: randomised controlled trial. BMJ Support Palliat Care 2024; 13:e1181-e1190. [PMID: 36283797 PMCID: PMC10850726 DOI: 10.1136/spcare-2022-003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES In lung cancer, three prominent symptoms, such as breathlessness, cough and fatigue, are closely related with each other forming a 'respiratory distress symptom cluster'. The aim of this study was to determine the clinical and cost-effectiveness of the respiratory distress symptom intervention (RDSI) for the management of this symptom cluster in people with lung cancer. METHODS A single blind, pragmatic, randomised controlled trial conducted in eight centres in England, UK. A total of 263 patients with lung cancer were randomised, including 132 who received RDSI and 131 who received standard care. To be eligible, participants self-reported adverse impact in daily life from at least two of the three symptoms, in any combination. Outcomes were change at 12 weeks for each symptom within the cluster, including Dyspnoea-12 (D-12), Manchester Cough in Lung Cancer (MCLC) and Functional Assessment of Chronic Illness-Fatigue. RESULTS At baseline, nearly 60% of participants reported all three symptoms. At trial completion the total trial attrition was 109 (41.4%). Compared with the control group, the RDSI group demonstrated a statistically significant improvement in D-12 (p=0.007) and MCLC (p<0.001). The minimal clinically important difference MCID) was achieved for each outcome: D-12 -4.13 (MCID >3), MCLC -5.49 (MCID >3) and FACIT-F 4.91 (MCID >4). CONCLUSION RDSI is a clinically effective, low-risk intervention to support the management of the respiratory distress symptom cluster in lung cancer. However, the study did experience high attrition, which needs to be taken onto consideration when interpreting these results. TRIAL REGISTRATION NUMBER NCT03223805.
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Affiliation(s)
- Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Grant Punnett
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Jaclyn Smith
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
- Christie Patient Centred Research, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fiona Blackhall
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
| | | | - Peter Mackereth
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Jemma Haines
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
| | - David Ryder
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
| | - Ashma Krishan
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
| | - Linda Davies
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
| | - Aysha Khan
- Faculty of Health Sciences, The University of Manchester, Manchester, UK
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Sakaguchi T. Cancer-related breathlessness: opioids other than morphine - comprehensive literature review. BMJ Support Palliat Care 2024; 13:e715-e729. [PMID: 37468224 DOI: 10.1136/spcare-2022-004115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Although there is low-quality evidence, there has been an increase in publications on the experience of evaluating and managing cancer-related breathlessness using opioids other than morphine. METHODS The author conducted a non-systematic literature review in the PubMed/Medline and Embase until 4 October 2022. Eligible studies have evaluated the efficacy of opioids other than morphine for cancer-related breathlessness. Studies focused on sedation, anaesthesia, paediatric patients, opioid toxicity or basic research were excluded. Reviews/meta-analyses and non-English language publications were also excluded. RESULTS A total of 1556 records were identified, of which 23 studies including 469 patients who were treated with fentanyl (n=223), oxycodone (n=171) and hydromorphone (n=75) were considered eligible. Six phase II randomised clinical trials (RCTs), four observational studies and four case reports of fentanyl were found. For breathlessness on exertion, fentanyl yielded promising results, but no RCT showed significant superiority of fentanyl to placebo or morphine. For terminal breathlessness, three RCTs, five non-randomised or observational studies and one case report on oxycodone or hydromorphone were found. Although the results of the observational studies suggested that oxycodone and hydromorphone might be effective alternatives to morphine, the superiority over placebo or non-inferiority to morphine had not been demonstrated in the RCTs. CONCLUSION As an alternative to morphine, the author recommends fentanyl for breathless crisis or breathlessness on exertion, and oxycodone or hydromorphone for terminal breathlessness in advanced cancer. Larger and well-designed studies based on firm research policies are needed to confirm this current knowledge.
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Affiliation(s)
- Tatsuma Sakaguchi
- Department of Palliative Care, Kitano Hospital, Osaka, Japan
- Palliative Care Centre, Aichi Medical University, Nagakute, Japan
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Shin J, Kober K, Yates P, Wong ML, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Wright F, Miaskowski C. Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath. Semin Oncol Nurs 2023; 39:151471. [PMID: 37500312 DOI: 10.1016/j.soncn.2023.151471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Among four classes of patients with distinct shortness of breath profiles, evaluate for differences in levels of global, cancer-specific, and cumulative life stress, as well as resilience; evaluate for differences in the occurrence rates for various stressful life events, and evaluate for differences in the severity of common co-occurring symptoms. DATA SOURCES Outpatients (N = 1338) completed questionnaires six times over two cycles of chemotherapy. The occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. Differences among the classes were evaluated using parametric and nonparametric tests. CONCLUSION Shortness of breath classes were labeled based on their distinct occurrence trajectories: None (70.5%), Decreasing (8.2%), Increasing (7.8%), and High (13.5%). Compared to None class, Decreasing and High classes had higher global and cancer-specific stress scores. The High class reported higher occurrence rates for several adverse childhood experiences. Compared to None class, Decreasing and High classes had higher depression, anxiety, and morning fatigue scores and lower morning energy and cognitive function scores. IMPLICATIONS FOR NURSING PRACTICE Given the additive or synergistic relationships between stress, co-occurring symptoms, and shortness of breath, multimodal interventions that include stress management, exercise training, and/or symptom management may decrease shortness of breath in oncology patients.
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Affiliation(s)
- Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kord Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melisa L Wong
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Marilyn Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia, School of Nursing and School of Medicine, University of California, San Francisco, California.
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Hensley A, Campbell T, Gonzales C. Using Patient-Reported Outcomes Measurement Information System® (PROMIS) to Identify Physical and Psychosocial Quality of Life Issues in Lung Cancer Survivors. J Dr Nurs Pract 2023; 16:22-35. [PMID: 36918282 DOI: 10.1891/jdnp-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background: Lung cancer survivors (LCS) are living longer due to improved screening and treatment but often experience long-term treatment effects. Due to a traditionally poor prognosis, research related to LCS symptomology and associated quality of life (QOL) is lacking. Objective: The objective of this study was to develop a process for identifying symptomology and unmet needs affecting QOL in LCS. Methods: A literature review identified recommended methods of implementing a QOL screening program in LCS. Training guidelines using the best evidence were presented to the survivorship clinic (SC) staff. The Patient-Reported Outcomes Measurement Information System® (PROMIS-29) profile was used to collect data from LCS. The experience of the SC staff (N = 2) and providers (N = 2) in implementing the QOL screening program in LCS was assessed. Results: A 100% compliance rate in completing the PROMIS-29 profile was achieved. Physical function and pain interference were the most impacted QOL domains identified by LCS, while depression was the least. No challenges were identified in assisting LCS with profile completion. Providers agreed that the PROMIS-29 was instrumental in identifying QOL issues. Conclusion: A QOL screening program tailored to LCS-improved compliance and reliability in identifying QOL issues. Implications for Nursing: A QOL screening program using the PROMIS-29 may improve patient-provider interactions and value-based oncology care.
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Affiliation(s)
- Amy Hensley
- Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Tracy Campbell
- Forsyth Technical Community College, Clemmons, North Carolina, USA
| | - Clifford Gonzales
- Department of Academic Nursing, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Beaumont M, Latiers AC, Prieur G. [The role of the physiotherapist in the assessment and management of dyspnea]. Rev Mal Respir 2023; 40:169-187. [PMID: 36682956 DOI: 10.1016/j.rmr.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
The role of the physiotherapist in the assessment and management of dyspnea. Dyspnea is the most common symptom in cardio-respiratory diseases. Recently improved comprehension of dyspnea mechanisms have underlined the need for three-faceted assessment. The three key aspects correspond to the "breathing, thinking, functioning" clinical model, which proposes a multidimensional - respiratory, emotional and functional - approach. Before initiating treatment, it is essential for several reasons to assess each specific case, determining the type of dyspnea affecting the patient, appraising the impact of shortness of breath, and estimating the effectiveness of the treatment applied. The physiotherapist has a major role to assume in the care of dyspneic patients, not only in assessment followed by treatment but also as a major collaborator in a multidisciplinary team, especially with regard to pulmonary rehabilitation. The aim of this review is to inventory the existing assessment tools and the possible physiotherapies for dyspnea, using a holistic approach designed to facilitate the choice of techniques and to improve quality of care by fully addressing the patient's needs.
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Affiliation(s)
- M Beaumont
- Service de réadaptation respiratoire, Centre Hospitalier des Pays de Morlaix, Morlaix, France; Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France.
| | - A C Latiers
- Service ORL, Stomatologie et Soins Continus, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgique
| | - G Prieur
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, 1200 Brussels, Belgique; Université de Normandie, UNIROUEN, EA3830-GRHV, 76000 Rouen, France; Groupe Hospitalier du Havre, Service de pneumologie et de réadaptation respiratoire, avenue Pierre Mendes France, 76290 Montivilliers, France; Institut de Recherche et Innovation en Biomédecine (IRIB), 76000 Rouen, France
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8
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Shin J, Kober K, Wong ML, Yates P, Miaskowski C. Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients. Crit Rev Oncol Hematol 2023; 181:103870. [PMID: 36375635 DOI: 10.1016/j.critrevonc.2022.103870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common and distressing symptom for oncology patients.However, dyspnea is not well-characterized and often underestimated by clinicians. This systematic review summarizes the prevalence, intensity, distress, and impact of dyspnea in oncology patients and identifies research gaps. METHODS A search of all of the relevant databases was done from 2009 to May 2022. A qualitative synthesis of the extant literature was performed using established guidelines. RESULTS One hundred-seventeen studies met inclusion criteria. Weighted grand mean prevalence of dyspnea in patients with advanced cancer was 58.0%. Intensity of dyspnea was most common dimension evaluated, followed by the impact and distress. Depression and anxiety were the most common symptoms that co-occurred with dyspnea. CONCLUSION Numerous methodologic challenges were evident across studies. Future studies need to use valid and reliable measures; evaluate the impact of dyspnea; and determine biomarkers for dyspnea.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Division of Hematology/Oncology, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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Kako J, Kobayashi M, Kajiwara K, Kimura Y, Oosono Y, Takegata M, Nakano K, Matsuda Y, Nakamura N, Kawashima N, Hirano Y, Kitae M, Yamaguchi K, Iwamoto H, Hattori N, Sawatari H, Shiono S, Ogino H, Nishioka Y, Amano K, Yorke J. Validity and Reliability of the Japanese Version of the Dyspnea-12 Questionnaire in Patients With Lung Cancer. J Pain Symptom Manage 2022; 64:e83-e89. [PMID: 35452793 DOI: 10.1016/j.jpainsymman.2022.04.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The Dyspnea-12 questionnaire is a simple tool to assess dyspnea using qualitative descriptors that include both physical and emotional domains. However, the reliability and validity of the Japanese version in patients with lung cancer have not been assessed. OBJECTIVE To determine the reliability and validity of the Japanese version of the Dyspnea-12 questionnaire in patients with lung cancer. METHODS The assessment was based on the numerical rating scale (NRS), cancer dyspnea scale (CDS), and hospital anxiety and depression scale (HADS). Spearman's correlation assessed the convergent validity of Dyspnea-12 using these three scales. Exploratory factor analysis examined the construct validity. The reliability was verified using Cronbach's alpha. Anxiety, depression, clinical dyspnea, presence of chronic obstructive pulmonary disease (COPD), and patient status were identified by discriminating performance. RESULTS The analysis included 113 patients with lung cancer. A significant positive correlation was found between Dyspnea-12 and NRS, CDS, and HADS scores. Similar to the original version, factor analysis clearly classified Dyspnea-12 into two components (physical and emotional), thereby confirming its construct validity. Cronbach's alpha values for the total Dyspnea-12 and its physical and emotional components were 0.97, 0.95, and 0.96, respectively. Patients with anxiety, depression, and clinical dyspnea and those in the palliative phase had significantly higher Dyspnea-12 scores than their respective counterparts. The Dyspnea-12 scores of patients with and without COPD were similar. CONCLUSION The Japanese version of the Dyspnea-12 questionnaire is a useful and reliable tool to assess the multi-dimensional aspects of dyspnea in patients with lung cancer.
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Affiliation(s)
- Jun Kako
- College of Nursing Art and Science (J.K.), University of Hyogo, Akashi, Japan.
| | - Masamitsu Kobayashi
- Faculty of Nursing, National Defense Medical College (M.K.), Tokorozawa, Japan
| | - Kohei Kajiwara
- Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing (K.K.), Munakata, Japan
| | | | - Yasufumi Oosono
- Faculty of Nursing (Y.O.), Mejiro University, Saitama, Japan
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institution of Tropical Medicine (M.T.), Nagasaki University, Nagasaki, Japan
| | - Kimiko Nakano
- Clinical Research Center for Developmental Therapeutics (K.N.), Tokushima University Hospital, Tokushima, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center (Y.M.), Sakai, Japan
| | - Naomi Nakamura
- Department of Nursing, National Hospital Organization Kinki-Chuo Chest Medical Center (N.N.), Sakai, Japan
| | - Natsuki Kawashima
- Department of Nursing, National Cancer Center Hospital East (N.K., Y.H.), Kashiwa, Japan
| | - Yuta Hirano
- Department of Nursing, National Cancer Center Hospital East (N.K., Y.H.), Kashiwa, Japan
| | - Misako Kitae
- Faculty of Nursing (M.K.), Tokyo Healthcare University, Wakayama, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences (K.Y., H.I., N.H.), Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences (K.Y., H.I., N.H.), Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences (K.Y., H.I., N.H.), Hiroshima University, Hiroshima, Japan
| | | | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital (S.S.), Yamagata, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences (H.O., Y.N.), Tokushima University, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences (H.O., Y.N.), Tokushima University, Tokushima, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital (K.A.), Tokyo, Japan
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health (J.Y.), University of Manchester, Manchester M13 9PL, and The Christie NHS Foundation Trust, Manchester, United Kingdom
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Ha DM, Deng LR, Lange AV, Swigris JJ, Bekelman DB. Reliability, Validity, and Responsiveness of the DEG, a Three-Item Dyspnea Measure. J Gen Intern Med 2022; 37:2541-2547. [PMID: 34981344 PMCID: PMC9360273 DOI: 10.1007/s11606-021-07307-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dyspnea is a common and debilitating symptom that affects many different patient populations. Dyspnea measures should assess multiple domains. OBJECTIVE To evaluate the reliability, validity, and responsiveness of an ultra-brief, multi-dimensional dyspnea measure. DESIGN We adapted the DEG from the PEG, a valid 3-item pain measure, to assess average dyspnea intensity (D), interference with enjoyment of life (E), and dyspnea burden with general activity (G). PARTICIPANTS We used data from a multi-site randomized clinical trial among outpatients with heart failure. MAIN MEASURES We evaluated reliability (Cronbach's alpha), concurrent validity with the Memorial-Symptom-Assessment-Scale (MSAS) shortness-of-breath distress-orbothersome item and 7-item Generalized-Anxiety-Disorder (GAD-7) scale, knowngroups validity with New-York-Heart-Association-Functional-Classification (NYHA) 1-2 or 3-4 and presence or absence of comorbid chronic obstructive pulmonary disease (COPD), responsiveness with the MSAS item as an anchor, and calculated a minimal clinically important difference (MCID) using distribution methods. KEY RESULTS Among 312 participants, the DEG was reliable (Cronbach's alpha 0.92). The mean (standard deviation) DEG score was 5.26 (2.36) (range 0-10) points. DEG scores correlated strongly with the MSAS shortness of breath distress-or-bothersome item (r=0.66) and moderately with GAD-7 categories (ρ=0.36). DEG scores were statistically significantly lower among patients with NYHA 1-2 compared to 3-4 [mean difference (standard error): 1.22 (0.27) points, p<0.01], and those without compared to with comorbid COPD [0.87 (0.27) points, p<0.01]. The DEG was highly sensitive to change, with MCID of 0.59-1.34 points, or 11-25% change. CONCLUSIONS The novel, ultra-brief DEG measure is reliable, valid, and highly responsive. Future studies should evaluate the DEG's sensitivity to interventions, use anchor-based methods to triangulate MCID estimates, and determine its prognostic usefulness among patients with chronic cardiopulmonary and other diseases.
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Affiliation(s)
- Duc M Ha
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling Street, Aurora, CO, 80045, USA. .,Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. .,Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Lubin R Deng
- Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Allison V Lange
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - David B Bekelman
- Medical Service, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling Street, Aurora, CO, 80045, USA.,Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.,Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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11
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Garratt AM, Nerheim EM, Einvik G, Stavem K, Edvardsen A. Evaluation of the Norwegian version of the Dyspnoea-12 questionnaire in patients with COPD. BMJ Open Respir Res 2022; 9:9/1/e001262. [PMID: 35609940 PMCID: PMC9131054 DOI: 10.1136/bmjresp-2022-001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Dyspnoea-12 (D-12) questionnaire is widely used and tested in patients with breathing difficulties. The objective of this study was to translate and undertake the first evaluation of the measurement properties of the Norwegian version of the D-12 in patients with chronic obstructive pulmonary disease (COPD) attending a 4-week inpatient pulmonary rehabilitation programme. METHODS Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, sex and comorbidity. Based on a priori hypotheses, validity was assessed through comparisons with scores for the COPD Assessment Test (CAT), Hospital Anxiety and Depression Scales (HADS) and clinical variables. RESULTS There were 203 (86%) respondents with a mean age (SD) of 65.2 (9.0) years, and 49% were female. The D-12 showed satisfactory structural validity including presence of physical and affective domains. There was acceptable fit to Rasch model including unidimensionality for the two domains, and no evidence of DIF. Correlations with scores for the CAT, HADS and clinical variables were as hypothesised and highest for domains assessing similar aspects of health. CONCLUSIONS The Norwegian version of the D-12 showed good evidence for validity and internal consistency in this group of patients with COPD, including support for two separate domains. Further testing for these measurement properties is recommended in other Norwegian patients with dyspnoea.
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Affiliation(s)
| | | | - Gunnar Einvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Anne Edvardsen
- LHL Hospital Gardermoen, Jessheim, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
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12
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Williams MT, Lewthwaite H, Paquet C, Johnston K, Olsson M, Belo LF, Pitta F, Morelot-Panzini C, Ekström M. Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties. J Pain Symptom Manage 2022; 63:e75-e87. [PMID: 34273524 DOI: 10.1016/j.jpainsymman.2021.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT The Dyspnoea-12 (D-12) and Multidimensional Dyspnea Profile (MDP) were specifically developed for assessment of multiple sensations of breathlessness. OBJECTIVES This systematic review aimed to identify the use and measurement properties of the D-12 and MDP across populations, settings and languages. METHODS Electronic databases were searched for primary studies (2008-2020) reporting use of the D-12 or MDP in adults. Two independent reviewers completed screening and data extraction. Study and participant characteristics, instrument use, reported scores and minimal clinical important differences (MCID) were evaluated. Data on internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient, ICC) were pooled using random effects models between settings and languages. RESULTS A total 75 publications reported use of D-12 (n = 35), MDP (n = 37) or both (n = 3), reflecting 16 chronic conditions. Synthesis confirmed two factor structure, internal consistency (Cronbach's α mean, 95% CI: D-12 Total = 0.93, 0.91-0.94; MDP Immediate Perception [IP] = 0.88, 0.85-0.90; MDP Emotional Response [ER] = 0.86, 0.82-0.89) and 14 day test-rest reliability (ICC: D-12 Total = 0.91, 0.88-0.94; MDP IP = 0.85, 0.70-0.93; MDP ER = 0.84, 0.73-0.90) across settings and languages. MCID estimates for clinical interventions ranged between -3 and -6 points (D-12 Total) with small variability in scores over 2 weeks (D-12 Total 2.8 (95% CI: 2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1) and six months (D-12 Total 2.9 (2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1)). CONCLUSION D-12 and MDP are widely used, reliable, valid and responsive across various chronic conditions, settings and languages, and could be considered standard instruments for measuring dimensions of breathlessness in international trials.
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Affiliation(s)
- Marie T Williams
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Hayley Lewthwaite
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada; College of Engineering, Science and Environment, School of Environmental & Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Catherine Paquet
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Faculté des Sciences de l'Administration, Université Laval, Québec (Québec) , Canada
| | - Kylie Johnston
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Max Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
| | - Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Groupe Hospitalo-Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
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13
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Tinti S, Parati M, De Maria B, Urbano N, Sardo V, Falcone G, Terzoni S, Alberti A, Destrebecq A. Multi-Dimensional Dyspnea-Related Scales Validated in Individuals With Cardio-Respiratory and Cancer Diseases. A Systematic Review of Psychometric Properties. J Pain Symptom Manage 2022; 63:e46-e58. [PMID: 34358643 DOI: 10.1016/j.jpainsymman.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT In order to examine the multi-dimensional nature of dyspnea and its impact on the activities of daily living (ADLs) in patients with cardio-respiratory and cancer diseases, validated measures are needed. OBJECTIVES Our aim was to identify all the multi-dimensional clinical scales assessing dyspnea and its impact on ADLs in patients with cardio-respiratory and cancer diseases, and to critically appraise their psychometric properties. METHODS Five databases were systematically searched up to July 2020. Eligible criteria were: the examination of at least one psychometric property, and the recruitment of adults with a cardio-respiratory or cancer disease in non-emergency settings. The characteristics and psychometric properties of the studies included were presented through a narrative synthesis. The methodological quality of the studies and evidence synthesis were rated using the "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" criteria. RESULTS Forty-three studies, for which eight assessment scales had been identified, were included in the review. At the time of the review, three multi-dimensional assessment scales were available for assessing dyspnea symptoms, and five multi-dimensional scales were available to examine the impact of dyspnea on ADLs. Although the use of these scales has rapidly grown, evidence of psychometric properties has been reported as limited in most of the scales. CONCLUSION Despite the potential of the identified scales, further studies are needed to strength evidence on the validity and reliability of the multi-dimensional dyspnea scales. Furthermore, more studies appraising the content validity and responsiveness of the scales are specifically recommended.
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Affiliation(s)
- Stefania Tinti
- Department of Biomedicine and Prevention (S.T.), University of Rome ''Tor Vergata'', Rome, Italy.
| | - Monica Parati
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory (M.P.), Politecnico di Milano, Milan, Italy; IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri (M.P., B.D.M.), Milan, Italy
| | - Nicla Urbano
- ASST-Rhodense (N.U.), Garbagnate Milanese, Milan, Italy
| | - Vivian Sardo
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Graziella Falcone
- ASST-Rhodense, Palliative Care and Pain Therapy Department (V.S., G.F.), Garbagnate Milanese, Milan, Italy
| | - Stefano Terzoni
- ASST-Santi Paolo e Carlo (S.T.), University of Milan, Milan, Italy
| | - Annalisa Alberti
- ASST-Rhodense Bachelor School of Nursing (A.A.), Rho, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health (A.D.), University of Milan, Milan, Italy
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14
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Hentsch L, Cocetta S, Allali G, Santana I, Eason R, Adam E, Janssens JP. Breathlessness and COVID-19: A Call for Research. Respiration 2021; 100:1016-1026. [PMID: 34333497 PMCID: PMC8450822 DOI: 10.1159/000517400] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
Breathlessness, also known as dyspnoea, is a debilitating and frequent symptom. Several reports have highlighted the lack of dyspnoea in a subgroup of patients suffering from COVID-19, sometimes referred to as “silent” or “happy hypoxaemia.” Reports have also mentioned the absence of a clear relationship between the clinical severity of the disease and levels of breathlessness reported by patients. The cerebral complications of COVID-19 have been largely demonstrated with a high prevalence of an acute encephalopathy that could possibly affect the processing of afferent signals or top-down modulation of breathlessness signals. In this review, we aim to highlight the mechanisms involved in breathlessness and summarize the pathophysiology of COVID-19 and its known effects on the brain-lung interaction. We then offer hypotheses for the alteration of breathlessness perception in COVID-19 patients and suggest ways of further researching this phenomenon.
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Affiliation(s)
- Lisa Hentsch
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Gilles Allali
- Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
| | | | - Rowena Eason
- Phyllis Tuckwell Hospice Care, Surrey, United Kingdom
| | - Emily Adam
- Independent Researcher, London, United Kingdom
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland
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15
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Nishimura K, Oga T, Nakayasu K, Taniguchi H, Ogawa T, Watanabe F, Arizono S, Kusunose M, Sanda R, Shibayama A, Okamoto S, Yorke J. Comparison between tools for measuring breathlessness: Cross-sectional validation of the Japanese version of the Dyspnoea-12. CLINICAL RESPIRATORY JOURNAL 2021; 15:1201-1209. [PMID: 34288426 DOI: 10.1111/crj.13427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Dyspnoea-12 (D-12) is a brief, easy to complete questionnaire for measuring breathlessness. OBJECTIVES To facilitate further efforts to measure dyspnoea in real clinical settings, the authors aimed to develop and validate a Japanese version of the D-12 and also compare the D-12 with the Baseline Dyspnea Index (BDI) and the Activity component of the St. George's Respiratory Questionnaire (SGRQ). METHODS The standardized procedure in accordance with international guidelines was used to create the translation. A validation study with a cross-sectional observational design was conducted on 122 subjects with stable chronic obstructive pulmonary disease (COPD). RESULTS The internal consistency of the D-12 was high (Cronbach's coefficient α = 0.883) and similar to that of the BDI (α = 0.824) and SGRQ Activity (α = 0.872). The relationships between tools were statistically significant (|Rs | = 0.53 to 0.66). Although the scores obtained from all three tools were skewed toward the milder end of the respective scales, this deviation was most prominent in the D-12 with a floor effect of 48.4%. CONCLUSION The Japanese version of the D-12 was successfully validated, but we should be careful of any floor effect and marked skew to the mild end of the scale, especially in subjects with mild COPD.
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Affiliation(s)
- Koichi Nishimura
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | | | - Tomoya Ogawa
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - Fumiko Watanabe
- Department of Rehabilitation, Tosei General Hospital, Seto, Japan
| | - Shinichi Arizono
- School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan
| | - Masaaki Kusunose
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ryo Sanda
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ayumi Shibayama
- Department of Nursing, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sawako Okamoto
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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16
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Choi TCM, Chan LLY, Tsang HC, Vong YP, Cheng YK, To YL, Choo KL, Yorke J. Adaptation and validation of the Chinese version of Dyspnoea-12 scale in individuals with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2021; 15:1081-1087. [PMID: 34145767 PMCID: PMC8518647 DOI: 10.1111/crj.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
Introduction Dyspnoea‐12 scale is a validated assessment tool, capturing the perception of dyspnoea and its physical and affective effects in individuals with chronic obstructive pulmonary disease (COPD). A validated version for the Chinese‐speaking population has been unavailable. Objective To develop a Chinese version of D‐12 (D‐12‐C) scale and evaluate its validity and reliability. Methods D‐12 was translated from English to traditional Chinese in collaboration with a physician and a linguist. Back translation was adopted to ensure accuracy of the translation. A total of 155 COPD patients were recruited to test the reliability and validity of the D‐12‐C scale. Internal reliability and test‐retest reliability were measured with Cronbach's alpha coefficient and intra‐class correlation coefficient, respectively. Construct validity was assessed through exploratory factor analysis (EFA). Concurrent validity was assessed by the correlation of D‐12‐C total score and sub‐scores and the Chinese version of Saint George's Respiratory Questionnaire (SGRQ), 36‐Item Short Form Health Survey (SF‐36), COPD Assessment Test (CAT) and Hospital Anxiety and Depression Scale (HADS) total score and sub‐scores. Results The two‐factor structure of D‐12‐C was confirmed by EFA. D‐12‐C and its sub‐scores demonstrated high level of internal reliability (Cronbach's alpha = 0.88) and moderate level of test‐retest reliability. D‐12‐C total score, physical and affective sub‐scores were significantly correlated to SGRQ total score (rs = 0.59, p < 0.001) and activity sub‐score (rs = 0.38, p = 0.006), SF‐36 mental health sub‐score (rs = −0.36, p < 0.001), CAT (rs = 0.56, p < 0.001), HADS anxiety (rs = 0.51, p < 0.001) and depression sub‐scores (rs = 0.44, p < 0.001). Conclusion D‐12‐C scale was developed, which demonstrated satisfactory reliability and validity in measuring dyspnoea among COPD patients.
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Affiliation(s)
- Tiffany Ching Man Choi
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Lloyd Long Yu Chan
- Neuroscience Research Australia, School of Population Health, The University of New South Wales, Randwick, New South Wales, Australia
| | - Hin Cheung Tsang
- Department of Physiotherapy, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Yee Ping Vong
- Department of Physiotherapy, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Yui Kwan Cheng
- Department of Physiotherapy, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Yuk Ling To
- Department of Physiotherapy, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
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17
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Lewthwaite H, Jensen D, Ekström M. How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:1581-1598. [PMID: 34113091 PMCID: PMC8184148 DOI: 10.2147/copd.s277523] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assessment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multidimensional instruments are available. Borg's 0-10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field-based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assessment in daily life and in relation to exertion in people with COPD.
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Affiliation(s)
- Hayley Lewthwaite
- School of Environmental & Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, Australia
- UniSA: Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, Australia
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada
- Research Institute of the McGill University Health Centre, Faculty of Medicine, McGill University, Montréal, Québec, Canada
- Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Canada
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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18
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Beaumont M, Le Garrec M, Péran L, Berriet AC, Le Ber C, Pichon R, Cabillic M. Determination of the minimal important difference for Dyspnoea-12 questionnaire in patients with COPD, after pulmonary rehabilitation. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:413-419. [PMID: 33277761 DOI: 10.1111/crj.13318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The authors of the international task force about the management of Dyspnoea recommend assessing sensory and affective components of dyspnoea. The Dyspnoea-12 questionnaire (D-12) allows to assess both components of dyspnoea. D-12 is valid and reliable but its sensitivity to pulmonary rehabilitation was not studied. The aim of this study was to estimate the minimal important difference (MID) for D-12 in COPD patients undergoing a pulmonary rehabilitation programme (PRP). METHODS Severe or very severe COPD patients undergoing a PRP were included. Dyspnoea was assessed using D-12, MMRC dyspnoea scale, London chest of Activity of Daily Living questionnaire (LCADL). Quality of life was assessed using Saint-George respiratory questionnaire (SGRQ) and COPD assessment Test (CAT); exercise capacity using 6-Minute walk Test (6MWT) and 1-minute sit to-stand test (1STST). The MID was evaluated using distribution and anchor-based methods. RESULTS Sixty patients (age: 64.4 ± 8.2; FEV1 (%): 28.6 ± 8.1) were included. At the end of the PRP, patients had significantly decreased their dyspnoea measured with D-12, MMRC, LCADL (D-12:23.9 ± 8.9 to 17.6 ± 9.4; MMRC: 3 ± 0.7 to 2.2 ± 1.1, LCADL: 38 ± 13.9 to 31.6 ± 11; p < 0.0001). Using the distribution-based analysis, MID of -2.67 (standard error of measurement) or -4.45 (standard deviation) was found. According to methodology, we could only use SGRQ as anchor. With SGRQ as anchor, the receiver operating characteristic curve identified MID for the change in D-12 at -6.1 (sensibility: 58%, specificity: 79%). The correlation with SGRQ was modest (r = 0.33), so the calculated MID should be interpreted with caution. CONCLUSION D-12 is a good tool to assess the decrease of dyspnoea after PR. We propose MID of -6 points. However, Future estimates of MID for the D-12 should use anchors that are more strongly correlated with it.
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Affiliation(s)
- Marc Beaumont
- Pulmonary rehabilitation unit, Morlaix Hospital Centre, Morlaix, France
- European University of Occidental Brittany, EA3878, Brest, France
| | - Mélanie Le Garrec
- Institut de formation en Pédicurie-Podologie, Ergothérapie, Masso-Kinésithérapie (IFEPK), Rennes, France
| | - Loic Péran
- Pulmonary rehabilitation unit, Morlaix Hospital Centre, Morlaix, France
| | | | - Catherine Le Ber
- Pulmonary rehabilitation unit, Morlaix Hospital Centre, Morlaix, France
| | - Romain Pichon
- Institut de formation en Pédicurie-Podologie, Ergothérapie, Masso-Kinésithérapie (IFEPK), Rennes, France
- Université de Rennes 2 UFR APS, M2S - EA 7470, Rennes, France
| | - Michel Cabillic
- Institut régional de formations aux métiers de la rééducation et de la réadaptation des Pays-de-la-Loire, Saint-Sébastien-sur-Loire, France
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Ekström MP, Bornefalk H, Sköld CM, Janson C, Blomberg A, Bornefalk-Hermansson A, Igelström H, Sandberg J, Sundh J. Minimal Clinically Important Differences and Feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in Cardiorespiratory Disease. J Pain Symptom Manage 2020; 60:968-975.e1. [PMID: 32512047 DOI: 10.1016/j.jpainsymman.2020.05.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Breathlessness is a cardinal symptom in cardiorespiratory disease and consists of multiple dimensions that can be measured using the instruments Dyspnea-12 (D12) and the Multidimensional Dyspnea Profile (MDP). OBJECTIVES The objective of the study is to determine the minimal clinically important differences (MCIDs) of all D12 and MDP summary and subdomain scores as well as the instruments' feasibility in patients with cardiorespiratory disease. METHODS Prospective multicenter cohort study of outpatients with diagnosed cardiorespiratory disease and breathlessness in daily life. D12 and MDP were assessed at baseline, after 30-90 minutes and two weeks. MCIDs were calculated using anchor-based and distributional methods for summary and subdomain scores. Feasibility was assessed as rate of missing data, help required, self-reported difficulty, and completion time. RESULTS A total 182 outpatients (53.3% women) were included; main diagnoses were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%), and idiopathic pulmonary fibrosis (19%). Anchor-based MCIDs were for D12 total score 2.83 (95% CI 1.99-3.66); D12 physical 1.81 (1.29-2.34); D12 affective 1.07 (0.64-1.49); MDP A1 unpleasantness 0.82 (0.56-1.08); MDP perception 4.63 (3.21-6.05), and MDP emotional score 2.37 (1.10-3.64). The estimates were consistent with small-to-moderate effect sizes using distributional analysis, and MCIDs were similar between COPD and non-COPD patients. The instruments were generally feasible and quick to use. CONCLUSION D12 and MDP are responsive to change and feasible for use for assessing multidimensional breathlessness in outpatients with cardiorespiratory disease. MCIDs were determined for use as endpoints in clinical trials.
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Affiliation(s)
- Magnus P Ekström
- Faculty of Medicine, Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden.
| | | | - C Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | | | | | - Jacob Sandberg
- Faculty of Medicine, Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Josefin Sundh
- Faculty of Medicine and Health, Department of Respiratory Medicine, Örebro University, Örebro, Sweden
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Koller M, Shamieh O, Hjermstad MJ, Hornslien K, Young T, Chalk T, Ioannidis G, Harle A, Johnson CD, Tomaszewski KA, Serpentini S, Pinto M, van der Weijst L, Janssens A, Morag O, Chie WC, Arraras JI, Pompili C, Jungraithmayr W, Hechtner M, Katsochi D, Müller K, Gräfenstein L, Schulz C, Bottomley A. Psychometric properties of the updated EORTC module for assessing quality of life in patients with lung cancer (QLQ-LC29): an international, observational field study. Lancet Oncol 2020; 21:723-732. [PMID: 32213338 DOI: 10.1016/s1470-2045(20)30093-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) assesses quality of life (QOL) in patients with lung cancer and was the first EORTC module developed for use in international clinical trials. Since its publication in 1994, major treatment advances with possible effects on QOL have occurred. These changes called for an update of the module and its international psychometric validation. We aimed to investigate the scale structure and psychometric properties of the updated lung cancer module, QLQ-LC29, in patients with lung cancer. METHODS This international, observational field study was done in 19 hospitals across 12 countries. Patients aged older than 18 years with a confirmed diagnosis of lung cancer and no other previous primary tumour, and who were mentally fit with sufficient language skills to understand and complete the questionnaire were included. Patients were asked during a hospital visit to fill in the paper versions of the core questionnaire EORTC QLQ-C30 plus QLQ-LC29, and investigators selected half of these patients to complete the questionnaire again 2-4 weeks later. Our primary aim was to assess the scale structure and psychometric properties of EORTC QLQ-LC29. We analysed scale structure using confirmatory factor analysis; reliability using Cronbach's α value (internal consistency) and intra-class coefficient (test-retest reliability); sensitivity using independent t tests stratified by Karnofsky performance status; and responsiveness to change over time by ANOVA. This study is registered with ClinicalTrials.gov, NCT02745691. FINDINGS Between April 12, 2016, and Sept 26, 2018, 523 patients with a confirmed diagnosis of either non-small-cell lung cancer (n=442) or small-cell lung cancer (n=81) were recruited. Confirmatory factor analysis provided a solution composed of five multi-item scales (coughing, shortness of breath, fear of progression, hair problems, and surgery-related symptoms) plus 15 single symptom or side-effect items: χ2=370·233, root mean square error of approximation=0·075, and comparative-fit index=0·901. Cronbach's α for internal consistencies of all multi-item scales were above the threshold of 0·70. Intra-class coefficients for test-retest reliabilities ranged between 0·82 and 0·97. Three (shortness of breath, fear of progression, and hair problems) of the five multi-item scales showed responsiveness to change over time (p values <0·05), as did nine of 15 single symptom items. Four (coughing, shortness of breath, fear of progression, and surgery-related symptoms) of the five multi-item scales and ten of the 15 single symptom items were sensitive to known group differences (ie, lower vs higher Karnofsky performance status). INTERPRETATION Results determined the psychometric properties of the updated lung cancer module, which is ready for use in international clinical studies. FUNDING EORTC Quality of Life Group.
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Affiliation(s)
- Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Marianne J Hjermstad
- Regional Advisory Unit for Palliative Care and European Palliative Care Research Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Teresa Young
- East and North Hertfordshire NHS Trust, Mount Vernon Cancer Centre, London, UK
| | - Tara Chalk
- East and North Hertfordshire NHS Trust, Mount Vernon Cancer Centre, London, UK
| | | | | | | | - Krzysztof A Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Samantha Serpentini
- Veneto Institute of Oncology IOV-IRCCS Comprehensive Cancer Center, Padova, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Department of Supportive Care, Istituto Nazionale Tumori - IRCCS- Fondazione G Pascale, Naples, Italy
| | | | - Annelies Janssens
- Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Ofir Morag
- Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Juan I Arraras
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Cecilia Pompili
- Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Marlene Hechtner
- University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Despina Katsochi
- Department of Radiation Oncology, Hygeia Hospital, Athens, Greece
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Laura Gräfenstein
- Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schulz
- Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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Nemoto Y, Suzuki S, Okauchi S, Kagohashi K, Satoh H. Terminological Usage Related to Dyspnea by Nursing Staff: A Cross-Sectional Questionnaire Survey. Asian Pac Isl Nurs J 2020; 4:144-150. [PMID: 32055682 PMCID: PMC7014382 DOI: 10.31372/20190404.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In recent years, additional expressions such as 'sensation of breathing discomfort' and 'discomfort of dyspnea' are being used in daily nursing care in Japan. To better understand the current status of the use of these terms by nurses, and to ascertain what the term 'dyspnea' may not express, we designed an original questionnaire and conducted a study with all nurses at our hospital. The questionnaire included questions to determine if nurses used these terms, and in what context. Of the 279 nurses in our hospital, 225 (80.6%) responded. Three-quarters of nurses indicated that they use these terms in clinical nursing practice. There was no difference in the usage of these terms between nurses who had or had not worked in a respiratory outpatients/ward. However, the percentage of nurses using these terms was higher amongst those with 10 years or less nursing experience compared with those with more than 10 years' experience. Open-ended questions revealed that these terms were used to communicate information between nurses and between nurses and patients' families. Our observations need to be verified in large-scale studies to determine if these terms are meaningful for nursing practice in that they describe something not expressed with 'dyspnea'. There is the possibility of confusion due to the use of inappropriate terms and a lack of education on the subject. Many nurses used these terms, and there may be things that the term 'dyspnea' could not express. The results of this study can be used to identify something that is lacking in communication about dyspnea between nurses, nurses and patients, and nurses and patients' families.
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Affiliation(s)
- Yuko Nemoto
- University of Tsukuba-Mito Kyodo General Hospital, Japan
| | - Sayuri Suzuki
- University of Tsukuba-Mito Kyodo General Hospital, Japan
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Sundh J, Bornefalk H, Sköld CM, Janson C, Blomberg A, Sandberg J, Bornefalk-Hermansson A, Igelström H, Ekström M. Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease. BMJ Open Respir Res 2019; 6:e000418. [PMID: 31673362 PMCID: PMC6797319 DOI: 10.1136/bmjresp-2019-000418] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Breathlessness is the cardinal symptom in both cardiac and respiratory diseases, and includes multiple dimensions. The multidimensional instrument Dyspnoea-12 has been developed to assess both physical and affective components of breathlessness. This study aimed to perform a clinical validation of the Swedish version of Dyspnoea-12 in outpatients with cardiorespiratory disease. Methods Stable outpatients with cardiorespiratory disease and self-reported breathlessness in daily life were recruited from five Swedish centres. Assessments of Dyspnoea-12 were performed at baseline, after 30-90 min and after 2 weeks. Factor structure was tested using confirmatory factor analysis and internal consistency using Cronbach's alpha. Test-retest reliability was analysed using intraclass correlation coefficients (ICCs). Concurrent validity at baseline was evaluated by examining correlations with lung function and several instruments for the assessment of symptoms and health status. Results In total, 182 patients were included: with the mean age of 69 years and 53% women. The main causes of breathlessness were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%) and idiopathic pulmonary fibrosis (19%). Factor analysis confirmed the expected underlying two-component structure with two subdomains. The Dyspnoea-12 total score, physical subdomain score and affective subdomain scores showed high internal consistency (Cronbach's alpha 0.94, 0.84 and 0.80, respectively) and acceptable reliability after 2 weeks (ICC total scores 0.81, 0.79 and 0.73). Dyspnoea-12 showed concurrent validity with the instruments modified Medical Research Council scale, COPD Assessment Test, European Quality of Life-Five Dimensions-Five levels, the Functional Assessment of Chronic Illness Therapy-Fatigue, the Hospital Anxiety and Depression Scale, and with forced expiratory volume in 1 s in percentage of predicted value. The results were consistent across different cardiorespiratory conditions. Conclusion The Dyspnoea-12 is a valid instrument for multidimensional assessment of breathlessness in Swedish patients with cardiorespiratory diseases.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Carl Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Jacob Sandberg
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
| | | | | | - Magnus Ekström
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Lovell N, Etkind SN, Bajwah S, Maddocks M, Higginson IJ. To What Extent Do the NRS and CRQ Capture Change in Patients' Experience of Breathlessness in Advanced Disease? Findings From a Mixed-Methods Double-Blind Randomized Feasibility Trial. J Pain Symptom Manage 2019; 58:369-381.e7. [PMID: 31201877 DOI: 10.1016/j.jpainsymman.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
CONTEXT Chronic or refractory breathlessness is common and distressing. To evaluate new treatments, outcome measures that capture change in patients' experience are needed. OBJECTIVES To explore the extent to which the numerical rating scale (NRS) worst and average, and the Chronic Respiratory Questionnaire capture change in patients' experience during a trial of mirtazapine for refractory breathlessness. METHODS Convergent mixed-methods design embedded within a randomized trial comprising 1) semi-structured qualitative interviews (considered to be the gold standard) and 2) outcome measure data collected pre- and post-intervention. Data were integrated, exploring examples where findings agreed and disagreed. Adults with advanced cancer, chronic obstructive pulmonary disease, interstitial lung disease, or chronic heart failure, with a modified Medical Research Council dyspnea scale grade 3 or 4 were recruited from three U.K. sites. RESULTS Data were collected for 22 participants. Eleven had a diagnosis of chronic obstructive pulmonary disease, eight interstitial lung disease, two chronic heart failure, and one cancer. Median age was 71 (56-84) years. Sixteen participants were men. Changes in the qualitative data were commonly captured in the NRS (worst and average) and the Chronic Respiratory Questionnaire. The NRS worst captured change most frequently. Improvement in the emotional domain was associated with physical changes, improved confidence, and control. CONCLUSION This study found that the NRS using the question "How bad has your breathlessness felt at its worst over the past 24 hours?" captured change across multiple domains, and therefore may be an appropriate primary outcome measure in trials in this population. Future work should confirm the construct validity of this question.
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Affiliation(s)
- Natasha Lovell
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
| | - Simon Noah Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Irene Julie Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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Booth S, Chin C, Spathis A, Maddocks M, Yorke J, Burkin J, Moffat C, Farquhar M, Bausewein C. Non-pharmacological interventions for breathlessness in people with cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1524708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Booth
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | - Chloe Chin
- Consultant in Palliative Medicine, Camden, Islington, ELiPSE and UCLH & HCA
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie Burkin
- Associate Lecturer University of Cambridge, Cambridge Breathlessness Intervention Service (CBIS), Cambridge, UK
| | | | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, München, Germany
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Amado Diago CA, Puente Maestu L, Abascal Bolado B, Agüero Calvo J, Hernando Hernando M, Puente Bats I, Agüero Balbín R. Translation and Validation of the Multidimensional Dyspnea-12 Questionnaire. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2017.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Caruso R, Arrigoni C, Groppelli K, Magon A, Dellafiore F, Pittella F, Grugnetti AM, Chessa M, Yorke J. Italian version of Dyspnoea-12: cultural-linguistic validation, quantitative and qualitative content validity study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:426-434. [PMID: 29350656 PMCID: PMC6166160 DOI: 10.23750/abm.v88i4.6341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/27/2017] [Indexed: 11/23/2022]
Abstract
Background: Dyspnoea-12 is a valid and reliable scale to assess dyspneic symptom, considering its severity, physical and emotional components. However, it is not available in Italian version due to it was not yet translated and validated. For this reason, the aim of this study was to develop an Italian version Dyspnoea-12, providing a cultural and linguistic validation, supported by the quantitative and qualitative content validity. Methods: This was a methodological study, divided into two phases: phase one is related to the cultural and linguistic validation, phase two is related to test the quantitative and qualitative content validity. Linguistic validation followed a standardized translation process. Quantitative content validity was assessed computing content validity ratio (CVR) and index (I-CVIs and S-CVI) from expert panellists response. Qualitative content validity was assessed by the narrative analysis on the answers of three open-ended questions to the expert panellists, aimed to investigate the clarity and the pertinence of the Italian items. Results: The translation process found a good agreement in considering clear the items in both the six involved bilingual expert translators and among the ten voluntary involved patients. CVR, I-CVIs and S-CVI were satisfactory for all the translated items. Conclusions: This study has represented a pivotal step to use Dyspnoea-12 amongst Italian patients. Future researches are needed to deeply investigate the Italian version of Dyspnoea-12 construct validity and its reliability, and to describe how dyspnoea components (i.e. physical and emotional) impact the life of patients with cardiorespiratory diseases. (www.actabiomedica.it)
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Affiliation(s)
- Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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Amado Diago CA, Puente Maestu L, Abascal Bolado B, Agüero Calvo J, Hernando Hernando M, Puente Bats I, Agüero Balbín R. Translation and Validation of the Multidimensional Dyspnea-12 Questionnaire. Arch Bronconeumol 2017; 54:74-78. [PMID: 29122333 DOI: 10.1016/j.arbres.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Dyspnea is a multidimensional symptom, but this multidimensionality is not considered in most dyspnea questionnaires. The Dyspnea-12 takes a multidimensional approach to the assessment of dyspnea, specifically the sensory and the affective response. The objective of this study was to translate into Spanish and validate the Dyspnea-12 questionnaire. METHODS The original English version of the Dyspnea-12 questionnaire was translated into Spanish and backtranslated to analyze its equivalence. Comprehension of the text was verified by analyzing the responses of 10 patients. Reliability and validation of the questionnaire were studied in an independent group of COPD patients attending the pulmonology clinics of Hospital Universitario Marqués de Valdecilla, diagnosed and categorized according to GOLD guidelines. RESULTS The mean age of the group (n=51) was 65 years and mean FEV1 was 50%. All patients understood all questions of the translated version of Dyspnea-12. Internal consistency of the questionnaire was α=0.937 and intraclass correlation coefficient was=.969; P<.001. Statistically significant correlations were found with HADS (anxiety r=.608 and depression r=.615), mMRC dyspnea (r=.592), 6MWT (r=-0.445), FEV1 (r=-0.312), all dimensions of CRQ-SAS (dyspnea r=-0.626; fatigue r=-0.718; emotional function r=-0.663; mastery r=-0.740), CAT (r=0.669), and baseline dyspnea index (r=-0.615). Dyspnea-12 scores were 10.32 points higher in symptomatic GOLD groups (B and D) (P<.001). CONCLUSION The Spanish version of Dyspnea-12 is a valid and reliable instrument to study the multidimensional nature of dyspnea.
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Affiliation(s)
- Carlos Antonio Amado Diago
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo Emergente de EPOC SEPAR, Madrid, España.
| | - Luis Puente Maestu
- Servicio de Neumología, Hospital Universitario Gregorio Marañón, Madrid, España; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Beatriz Abascal Bolado
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo Emergente de EPOC SEPAR, Madrid, España
| | - Juan Agüero Calvo
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - Irene Puente Bats
- Departamento de Traducción e Interpretación, Universidad Europea del Atlántico, Santander, España
| | - Ramón Agüero Balbín
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España; Universidad de Cantabria, Santander, España
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Banzett RB, Moosavi SH. Measuring dyspnoea: new multidimensional instruments to match our 21st century understanding. Eur Respir J 2017; 49:49/3/1602473. [PMID: 28254768 DOI: 10.1183/13993003.02473-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/14/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Robert B Banzett
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA .,Dept of Medicine, Harvard Medical School Boston, Boston, MA, USA
| | - Shakeeb H Moosavi
- Dept of Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
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