1
|
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.
Collapse
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
| |
Collapse
|
2
|
Matsuda Y, Yamaguchi T, Matsumoto Y, Ishiki H, Usui Y, Kako J, Suzuki K, Matsunuma R, Mori M, Watanabe H, Zenda S. Research policy in supportive care and palliative care for cancer dyspnea. Jpn J Clin Oncol 2021; 52:260-265. [PMID: 34894136 PMCID: PMC8894919 DOI: 10.1093/jjco/hyab193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dyspnea is a common and distressing symptom in patients with cancer. To improve its management, multicenter confirmatory studies are necessary. Research policy would be useful in conducting these studies. Here, we propose a new research policy for the management of dyspnea in patients with cancer. METHODS The first draft was developed by a policy working group of 11 specialists in the field of supportive care or palliative care for dyspnea. Then, a provisional draft was developed after review by a research support group (the Japanese Supportive, Palliative and Psychosocial Care Study Group) and five Japanese scientific societies (Japanese Association of Supportive Care in Cancer, Japanese Society of Medical Oncology, Japanese Society of Palliative Medicine, Japanese Association of Rehabilitation Medicine and Japanese Society of Clinical Oncology), and receipt of public comments. RESULTS The policy includes the following components of research policy on dyspnea: (i) definition of dyspnea, (ii) scale for assessment of dyspnea, (iii) reason for dyspnea or factors associated with dyspnea and (iv) treatment effectiveness outcomes/adverse events. The final policy (Ver1.0) was completed on 1 March 2021. CONCLUSIONS This policy could help researchers plan and conduct studies on the management of cancer dyspnea.
Collapse
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Medical Center, Kobe, Japan.,Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Usui
- Division of Palliative Therapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryo Matsunuma
- Division of Palliative Care, Department of Medicine, Konan Medical Center, Kobe, Japan.,Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
3
|
Chen H, Li Y, Wang W, Zhang H, Nie N, Ou J, Li L. Reliability and validity of the multidimensional dyspnea profile in hospitalized Chinese patients with respiratory diseases. SAGE Open Med 2021; 9:2050312120965336. [PMID: 34589220 PMCID: PMC8474346 DOI: 10.1177/2050312120965336] [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] [Received: 05/13/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Dyspnea is a multidimensional experience similar to pain and is one of the
most common clinical presentations in patients with respiratory diseases.
Accurately evaluating the experience of dyspnea allows nurses and physicians
to deliver better medical services to patients. The multidimensional dyspnea
profile emphasizes the psychosocial factors of dyspnea and assesses
immediate discomfort, sensory qualities, and the emotional responses of
patients with dyspnea. At present, the validity, reliability, and
test–retest reliability of the multidimensional dyspnea profile in patients
with respiratory diseases in China are unclear. Objectives: The aim of this study was to investigate the validity, reliability, and
test–retest reliability of the Chinese version of the multidimensional
dyspnea profile and to assess the convergent validity between the Chinese
version of the multidimensional dyspnea profile and the modified Medical
Research Council Dyspnea Scale. Methods: The factorial construct, intraclass correlations, internal consistency, and
convergent validity of the Chinese version of the multidimensional dyspnea
profile was evaluated using data from 231 inpatients with dyspnea from the
respiratory department of a hospital. In the principal component analysis
stage, 131 inpatients were evaluated. In the test–retest reliability
analysis stage, 50 out of the 131 patients responded to the questionnaire
again. In the confirmatory factor analysis, 100 inpatients from an
independent sample were assessed. Results: The principal component analysis showed that the Chinese version of the
multidimensional dyspnea profile had a two-factor structure: the immediate
perceptual-related problem factor (6 items) and the emotional
response-related problem factor (5 items). The convergent validity between
the Chinese version of the multidimensional dyspnea profile and the modified
Medical Research Council Dyspnea Scale was significant and acceptable based
on the average variance extracted (r = .56, p < .001). The confirmatory
factor analysis revealed a good model fit and provided support for the
construct validity of the Chinese version of the multidimensional dyspnea
profile. Overall, the internal consistency and intraclass correlation
coefficient of the Chinese version of the multidimensional dyspnea profile
were good. Conclusion: The 11-item Chinese version of the multidimensional dyspnea profile has
acceptable validity and reliability in patients with respiratory diseases in
China. In the future, more studies should be performed to further explore
its clinical application.
Collapse
Affiliation(s)
- Huaying Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Wang
- Nursing Teaching and Research Section, Medical College, Hunan Normal University, Changsha, China
| | - Huilin Zhang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Na Nie
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinnan Ou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lezhi Li
- Xiangya Nursing School, Central South University, Changsha, China
| |
Collapse
|
4
|
Hegendörfer E, Doukhopelnikoff A, Degryse JM. Validity and reliability of the Multidimensional Dyspnoea Profile in older adults. ERJ Open Res 2021; 7:00606-2020. [PMID: 33855062 PMCID: PMC8039901 DOI: 10.1183/23120541.00606-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Breathlessness is a common and distressing symptom in older adults and an independent predictor of adverse outcomes and yet its multidimensional assessment has not been validated in older adults. We apply and validate the Multidimensional Dyspnoea Profile (MDP) in a sample of adults 75 years and older in Belgium. Breathlessness was rated with the MDP, the modified Borg Dyspnoea Scale (mBDS), the Short Physical Performance Battery (SPPB, a numerical rating scale for intensity and unpleasantness both before and after exertion), as well as with the Medical Research Council (MRC) Dyspnoea Scale. The Hospital Anxiety and Depression Scale (HADS) assessed the affective status. Factor structure was analysed with exploratory principal components analysis, internal consistency with Cronbach's alpha and concurrent validity with Spearman's correlation coefficients with other breathlessness scales, HADS and SPPB scores. In 96 participants (mean age 85 years; 34% men) who rated breathlessness at both assessment points, exploratory principal components analysis identified two components: Immediate Perception (IP) and Emotional Reaction (ER), explaining most of the MDP item variance (65.37% before and 71.32% after exertion). Internal consistency was moderate to high for MDP-IP (Cronbach's alpha = 0.86 before and 0.89 after exertion) and MDP-ER (Cronbach's alpha = 0.89 before and 0.91 after exertion). The correlation patterns of MDP-IP and MDP-ER with other tests confirmed concurrent validity. The domain structure, reliability and concurrent validity of MDP for breathlessness before and after exertion were confirmed in a sample of adults 75 years and older, supporting its use and further research for the multidimensional profiling of breathlessness in older adults. Domain structure, reliability and concurrent validity of the MDP were confirmed in a sample of adults aged ≥75 years before and after exertion, supporting its use for the multidimensional assessment of breathlessness in this age grouphttps://bit.ly/3emiNRW
Collapse
Affiliation(s)
- Eralda Hegendörfer
- Dept of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Belgium.,Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Belgium
| | | | - Jean-Marie Degryse
- Dept of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Belgium.,Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Belgium
| |
Collapse
|
5
|
Özcan Kahraman B, Kahraman T, Özsoy İ, Tanrıverdi A, Papurcu A, Sezgin NH, Polat K, Acar S, Özgen Alpaydın A, Sevinç C, Savcı S. Validity and reliability of the Turkish version of the Multidimensional Dyspnea Profile in outpatients with respiratory disease. Turk J Med Sci 2020; 50:1930-1940. [PMID: 32682356 PMCID: PMC7775683 DOI: 10.3906/sag-2001-155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/15/2020] [Indexed: 11/12/2022] Open
Abstract
Background/aim Dyspnea is the subjective feeling of breathing discomfort, which is a significant problem for patients with heart and respiratory disease and also an important determinant of exercise tolerance, quality of life, and mortality in various diseases. Most of the scales are not enough to investigate the multidimensional effects of dyspnea; therefore, the Multidimensional Dyspnea Profile (MDP) was developed and validated in many languages. This study aimed to translate and culturally adapt the MDP into Turkish and investigate the psychometric properties of this adapted version in outpatients with respiratory disease. Materials and methods The MDP was translated and culturally adapted into Turkish following published guidelines. A total of 170 outpatients with respiratory disease were included to assess psychometric properties. The factorial structure was investigated using a principal component analysis. Two situations were used in this study evaluating dyspnea in activity-related and resting conditions. We formulated 17 hypotheses for each MDP domain (in total 68) to assess construct validity, and correlations were investigated between the MDP and measures of body mass index, pulmonary function test, other dyspnea assessments, anxiety, depression, and health-related quality of life. To investigate the test-retest reliability, the MDP was administered again after 1-h and 1 week. Results Internal consistency of the MDP was excellent (Cronbach’s alpha coefficients ranged from 0.89 to 0.93). The exploratory factor analysis revealed 2 components explaining a 70% and 76% variance. Overall, 64 of the 68 predetermined hypotheses (94%) were confirmed to test construct validity. The MDP showed excellent test-retest reliability for a 1-hperiod (intraclass correlation coefficient values ranged from 0.98 to 0.99). However, test-retest reliability decreased moderate-to-high after 1 week (0.53–0.80). Conclusion The MDP was successfully translated and culturally adapted into Turkish and this version showed good psychometric properties including the factorial structure, internal consistency, test-retest reliability, and construct validity to assess multidimensional aspects of dyspnea.
Collapse
Affiliation(s)
- Buse Özcan Kahraman
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation,Dokuz Eylül University, İzmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - İsmaİl Özsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University, Konya, Turkey
| | - Aylin Tanrıverdi
- Department of Physical Therapy and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Aslı Papurcu
- Department of Physical Therapy and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Nazenin Hande Sezgin
- Department of Physical Therapy and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Karya Polat
- Department of Physical Therapy and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Serap Acar
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation,Dokuz Eylül University, İzmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Chest Disease, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Can Sevinç
- Department of Chest Disease, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Sema Savcı
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation,Dokuz Eylül University, İzmir, Turkey
| |
Collapse
|
6
|
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: 21] [Impact Index Per Article: 5.3] [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.
Collapse
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
| |
Collapse
|
7
|
Ekström M, Bornefalk H, Sköld M, Janson C, Blomberg A, Sandberg J, Bornefalk-Hermansson A, Igelström H, Sundh J. Validation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease. BMJ Open Respir Res 2019; 6:e000381. [PMID: 31681476 PMCID: PMC6797429 DOI: 10.1136/bmjresp-2018-000381] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/27/2019] [Accepted: 08/15/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Breathlessness is a cardinal symptom in cardiorespiratory disease. An instrument for measuring different aspects of breathlessness was recently developed, the Multidimensional Dyspnea Profile (MDP). This study aimed to validate the MDP in terms of the underlying factor structure, internal consistency, test-retest reliability and concurrent validity in Swedish outpatients with cardiorespiratory disease. Methods Outpatients with stable cardiorespiratory disease and breathlessness in daily life were recruited. Factor structure of MDP was analysed using confirmatory factor analysis; internal consistency was analysed using Cronbach's alpha; and test-retest reliability was analysed using intraclass correlation coefficients (ICCs) for patients with unchanged breathlessness between assessments (baseline, after 30-90 min and 2 weeks). Concurrent validity was evaluated using correlations with validated scales of breathlessness, anxiety, depression and health-related quality of life. Results In total, 182 outpatients with cardiorespiratory disease and breathlessness in daily life were included; 53.3% were women; main diagnoses were chronic obstructive pulmonary disease (24.7%), asthma (21.4%), heart failure (19.2%) and idiopathic pulmonary fibrosis (18.7%). The MDP total, immediate perception and emotional response scores, and individual item scores showed expected factor structure and acceptable measurement properties: internal consistency (Cronbach's alpha, range 0.80-0.93); test-retest reliability at 30-90 min and 2 weeks (ICC, range 0.67-0.91); and concurrent validity. There was no evidence of a learning effect. Findings were similar between diagnoses. Discussion MDP is a valid instrument for multidimensional measurement of breathlessness in Swedish outpatients across cardiorespiratory diseases.
Collapse
Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences, Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Medicine, Blekinge Hospital, Karlskrona, Sweden
| | | | - 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 Medicine, Uppsala University, Uppsala, Sweden
| | - Anders Blomberg
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jacob Sandberg
- Jämjö Primary Health Care Central, Karlskrona, Sweden
- Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
| | | | | | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
8
|
A Multidimensional Profile of Dyspnea in Hospitalized Patients. Chest 2019; 156:507-517. [PMID: 31128117 DOI: 10.1016/j.chest.2019.04.128] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital. METHODS We selected patients who reported breathing discomfort of at least 4/10 on admission (10 = unbearable). Research staff recruited 156 patients within 24 hours of admission and evaluated daily patients' current and worst dyspnea with the Multidimensional Dyspnea Profile; patients participated in the study 2.6 days on average. The Multidimensional Dyspnea Profile assesses overall breathing discomfort (A1), intensity of five sensory qualities of dyspnea, and 5 negative emotional responses to dyspnea. Patients were also asked to rate whether current levels of dyspnea were "acceptable." RESULTS At the time of the first research interview, patients reported slight to moderate dyspnea (A1 median 4); however, most patients reported experiencing severe dyspnea in the 24 hours before the interview (A1 mean 7.8). A total of 54% of patients with dyspnea ≥4 on day 1 found the symptom unacceptable. The worst dyspnea each day in the prior 24 hours usually occurred at rest. Dyspnea declined but persisted through hospitalization for most patients. "Air hunger" was the dominant sensation, especially when dyspnea was strong (>4). Anxiety and frustration were the dominant emotions associated with dyspnea. CONCLUSIONS This first multidimensional portrait of dyspnea in a general inpatient population characterizes the sensations and emotions dyspneic patients endure. The finding that air hunger is the dominant sensation of severe dyspnea has implications for design of laboratory models of these sensations and may have implications for targets of palliation of symptoms.
Collapse
|
9
|
Morélot-Panzini C, Perez T, Sedkaoui K, de Bock E, Aguilaniu B, Devillier P, Pignier C, Arnould B, Bruneteau G, Similowski T. The multidimensional nature of dyspnoea in amyotrophic lateral sclerosis patients with chronic respiratory failure: Air hunger, anxiety and fear. Respir Med 2018; 145:1-7. [DOI: 10.1016/j.rmed.2018.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023]
|
10
|
Stevens JP, Dechen T, Schwartzstein R, O'Donnell C, Baker K, Howell MD, Banzett RB. Prevalence of Dyspnea Among Hospitalized Patients at the Time of Admission. J Pain Symptom Manage 2018; 56:15-22.e2. [PMID: 29476798 PMCID: PMC6317868 DOI: 10.1016/j.jpainsymman.2018.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 11/22/2022]
Abstract
CONTEXT Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. OBJECTIVES There is no large-scale study of the prevalence and intensity of patient-reported dyspnea at the time of admission to the hospital. METHODS Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's 1) current level of dyspnea on a 0-10 scale with 10 anchored at "unbearable," 2) worst dyspnea in the past 24 hours before arrival at the hospital on the same 0-10 scale, and 3) activities that were associated with dyspnea before admission. The prevalence of dyspnea was identified, and tests of difference were performed across patient characteristics. RESULTS We analyzed 67,362 patients, 12% of whom were obstetric patients. Fifty percent of patients were admitted to a medical-surgical unit after treatment in the emergency department. Among all noncritically ill inpatients, 16% of patients experienced dyspnea in the 24 hours before the admission. Twenty-three percent of patients admitted through the emergency department reported any dyspnea in the past 24 hours. Eleven percent experienced some current dyspnea when interviewed within 12 hours of admission with 4% of patients experiencing dyspnea that was rated 4 or greater. Dyspnea of 4 or more was present in 43% of patients admitted with respiratory diagnoses and 25% of patients with cardiovascular diagnoses. After multivariable adjustment for severity of illness and patient comorbidities, patients admitted on the weekend or during the overnight nursing shift were more likely to report dyspnea on admission. CONCLUSION Dyspnea is a common symptom among all hospitalized patients. Routine documentation of dyspnea is feasible in a large tertiary care center.
Collapse
Affiliation(s)
- Jennifer P Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Tenzin Dechen
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Richard Schwartzstein
- Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Carl O'Donnell
- Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Kathy Baker
- Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael D Howell
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois, USA; Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Robert B Banzett
- Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Wade J, Mendonca S, Booth S, Ewing G, Gardener AC, Farquhar M. Are within-person Numerical Rating Scale (NRS) ratings of breathlessness 'on average' valid in advanced disease for patients and for patients' informal carers? BMJ Open Respir Res 2017; 4:e000235. [PMID: 29071084 PMCID: PMC5652535 DOI: 10.1136/bmjresp-2017-000235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Numerical Rating Scale (NRS) is frequently used to assess patient-reported breathlessness in both a research and clinical context. A subgroup of patients report average breathlessness as worse than their worst breathlessness in the last 24 hours (paradoxical average). The Peak/End rule describes how the most extreme and current breathlessness influence reported average. This study seeks to highlight the existence of a subpopulation who give 'paradoxical averages using the NRS, to characterise this group and to investigate the explanatory relevance of the 'Peak/End' rule. METHODS Data were collected within mixed method face-to-face interviews for three studies: the Living with Breathlessness Study and the two subprotocols of the Breathlessness Intervention Service phase III randomised controlled trial. Key variables from the three datasets were pooled (n=561), and cases where participants reported a paradoxical average (n=45) were identified. These were compared with non-cases and interview transcripts interrogated. NRS ratings of average breathlessness were assessed for fit to Peak/End rule. RESULTS Patients in the paradoxical average group had higher Chronic Respiratory Questionnaire physical domain scores on average p=0.042). Peak/End rule analysis showed high positive correlation (Spearman's rho=0.756, p<0.001). CONCLUSIONS The NRS requires further standardisation with reporting of question order and construction of scale used to enable informed interpretation. The application of the Peak/End rule demonstrates fallibility of NRS-Average as a construct as it is affected by current breathlessness. Measurement of breathlessness is important for both clinical management and research, but standardisation and transparency are required for meaningful results.
Collapse
Affiliation(s)
- Joshua Wade
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Silvia Mendonca
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Sara Booth
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - A Carole Gardener
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- University of East Anglia, School of Health Sciences, Norwich, UK
| |
Collapse
|
12
|
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
| |
Collapse
|
13
|
Williams MT, John D, Frith P. Comparison of the Dyspnoea-12 and Multidimensional Dyspnoea Profile in people with COPD. Eur Respir J 2016; 49:13993003.00773-2016. [DOI: 10.1183/13993003.00773-2016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/26/2016] [Indexed: 11/05/2022]
Abstract
We directly compared convergent, discriminant and concurrent validity of the Dyspnoea-12 (D-12) and Multidimensional Dyspnoea Profile (MDP) in people with chronic obstructive pulmonary disease.Breathlessness measures (D-12, MDP, visual analogue scales and descriptors) were completed for two focal periods (daily life and end of walk test). Instrument structure (D-12 and MDP item grouping) was assessed with factor analysis. Differences between airflow severity stage and focal periods (ANOVA, t-test and Chi-squared test), associations between D-12 and MDP (r, r2 for static pulmonary function, 6-min walk test and self-reported measures of impairment) and individual consistency for comparable items of the D-12 and MDP (McNemar's test) were assessed.In 84 participants (mean±sd age 70±9 years, 47 males, forced expiratory volume in 1 s 48±17% predicted), item groupings were confirmed for both focal periods. Developer-recommended single and subdomain scores were highly correlated, and demonstrated similar convergent, discriminant and concurrent validity. Individual consistency differed between the D-12 and MDP according to item/item groups.At the level of developer-recommended single and subdomain scores, the D-12 and MDP share similar psychometric properties, but these instruments serve different purposes, do not assess the same sensations or emotions and are not interchangeable.
Collapse
|
14
|
Ekström M, Sundh J. Swedish translation and linguistic validation of the multidimensional dyspnoea profile. Eur Clin Respir J 2016; 3:32665. [PMID: 27834177 PMCID: PMC5103669 DOI: 10.3402/ecrj.v3.32665] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dyspnoea, the feeling of breathing discomfort, consists of multiple dimensions that can vary in intensity, including the level of unpleasantness, qualities or descriptors of the sensation, emotional responses, and impact on function. No validated instrument for multidimensional measurement of dyspnoea is available in Swedish. The Multidimensional Dyspnea Profile (MDP) was recently developed to measure the unpleasantness, sensory qualities, and emotional responses of dyspnoea across diseases and settings. We aimed to take forward a Swedish version of the MDP. METHODS Translation and linguistic validation of the MDP was conducted in collaboration with a specialised company in the field (Mapi, Lyon, France). The structured process involved forward and backward translations by two independent certified translators, input from an in-country linguistic consultant, the developers, and three respiratory physicians. Understandability and acceptability were evaluated through in-depth interviews with five patients with dyspnoea in accordance with international guidelines. RESULTS AND CONCLUSION A Swedish version of the MDP was obtained and linguistically validated. The MDP includes 11 rated items: the immediate unpleasantness of the sensation, the presence and intensity of five sensory qualities, and the intensity of five emotional responses to dyspnoea. The time period of measurement is specified by the user. The MDP is copyrighted by the developers but can be used free of charge in the context of non-funded academic research. CONCLUSION The MDP is the first instrument for measuring multiple dimensions of dyspnoea available in Swedish and should be validated across diseases and settings. Multidimensional measurement is essential for improved assessment and management of dyspnoea in research and clinical care.
Collapse
Affiliation(s)
- Magnus Ekström
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden;
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
15
|
Dubé BP, Vermeulen F, Laveneziana P. Exertional Dyspnoea in Chronic Respiratory Diseases: From Physiology to Clinical Application. Arch Bronconeumol 2016; 53:62-70. [PMID: 27818024 DOI: 10.1016/j.arbres.2016.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 11/16/2022]
Abstract
Dyspnoea is a complex, highly personalized and multidimensional sensory experience, and its underlying cause and mechanisms are still being investigated. Exertional dyspnoea is one of the most frequently encountered symptoms of patients with cardiopulmonary diseases, and is a common reason for seeking medical help. As the symptom usually progresses with the underlying disease, it can lead to an avoidance of physical activity, peripheral muscle deconditioning and decreased quality of life. Dyspnoea is closely associated with quality of life, exercise (in)tolerance and prognosis in various conditions, including chronic obstructive pulmonary disease, heart failure, interstitial lung disease and pulmonary hypertension, and is therefore an important therapeutic target. Effective management and treatment of dyspnoea is an important challenge for caregivers, and therapeutic options that attempt to reverse its underlying cause have been only partially successful This "review" will attempt to shed light on the physiological mechanisms underlying dyspnoea during exercise and to translate/apply them to a broad clinical spectrum of cardio-respiratory disorders.
Collapse
Affiliation(s)
- Bruno-Pierre Dubé
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canadá
| | | | - Pierantonio Laveneziana
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, París, Francia; Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département «R3S», Pôle PRAGUES), París, Francia.
| |
Collapse
|
16
|
Zimmerman L, Pozehl B, Vuckovic K, Barnason S, Schulz P, Seo Y, Ryan CJ, Zerwic JJ, DeVon HA. Selecting symptom instruments for cardiovascular populations. Heart Lung 2016; 45:475-496. [PMID: 27686695 DOI: 10.1016/j.hrtlng.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/11/2023]
Abstract
The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.
Collapse
Affiliation(s)
- Lani Zimmerman
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA.
| | - Bunny Pozehl
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Karen Vuckovic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Susan Barnason
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Paula Schulz
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Yaewon Seo
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Catherine J Ryan
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Julie J Zerwic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Holli A DeVon
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| |
Collapse
|
17
|
Morélot-Panzini C, Gilet H, Aguilaniu B, Devillier P, Didier A, Perez T, Pignier C, Arnould B, Similowski T. Real-life assessment of the multidimensional nature of dyspnoea in COPD outpatients. Eur Respir J 2016; 47:1668-79. [PMID: 27076585 DOI: 10.1183/13993003.01998-2015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/20/2016] [Indexed: 11/05/2022]
Abstract
Dyspnoea is a prominent symptom of chronic obstructive pulmonary disease (COPD). Recent multidimensional dyspnoea questionnaires like the Multidimensional Dyspnea Profile (MDP) individualise the sensory and affective dimensions of dyspnoea. We tested the MDP in COPD outpatients based on the hypothesis that the importance of the affective dimension of dyspnoea would vary according to clinical characteristics.A multicentre, prospective, observational, real-life study was conducted in 276 patients. MDP data were compared across various categories of patients (modified Medical Research Council (mMRC) dyspnoea score, COPD Assessment Test (CAT) score, Global Initiative for Chronic Obstructive Lung Disease (GOLD) airflow obstruction categories, GOLD "ABCD" categories, and Hospital Anxiety and Depression Scale (HADS)). Univariate and multivariate regressions were conducted to explore factors influencing the affective dimension of dyspnoea. Cluster analysis was conducted to create homogeneous patient profiles.The MDP identified a more marked affective dimension of dyspnoea with more severe mMRC, CAT, 12-item Short-Form Health Survey mental component, airflow obstruction and HADS. Multivariate analysis identified airflow obstruction, depressive symptoms and physical activity as determinants of the affective dimension of dyspnoea. Patients clustered into an "elderly, ex-smoker, severe disease, no rehabilitation" group exhibited the most marked affective dimension of dyspnoea.An affective/emotional dimension of dyspnoea can be identified in routine clinical practice. It can contribute to the phenotypic description of patients. Studies are needed to determine whether targeted therapeutic interventions can be designed and whether they are useful.
Collapse
Affiliation(s)
- Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie respiratoire expérimentale et clinique", Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | | | | | | | - Alain Didier
- Service de Pneumologie, Hôpital Larrey, Centre Hospitalier Régional et Universitaire de Toulouse, Toulouse, France
| | - Thierry Perez
- Clinique des Maladies Respiratoires, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | | | | | - Thomas Similowski
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 "Neurophysiologie respiratoire expérimentale et clinique", Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| |
Collapse
|
18
|
Johnson MJ, Kanaan M, Richardson G, Nabb S, Torgerson D, English A, Barton R, Booth S. A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease. BMC Med 2015; 13:213. [PMID: 26345362 PMCID: PMC4562360 DOI: 10.1186/s12916-015-0453-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/14/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND About 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population. METHODS This is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis ≥3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours ('worst'), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) 'worst' from baseline to 4 weeks. All analyses were by intention to treat. RESULTS Between April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the 'worst' score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (-2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference -0.006, 95 % CIs -0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of £20,000 per QALY) was over 80 %. CONCLUSIONS There was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden. TRIAL REGISTRATION Registry: ISRCTN; TRIAL REGISTRATION NUMBER ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307 ; registration date: 25/01/2011.
Collapse
Affiliation(s)
- Miriam J Johnson
- Hull York Medical School, Hertford Building, University of Hull, Hull, HU6 7RX, UK.
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK.
| | | | - Samantha Nabb
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK.
| | - David Torgerson
- Department of Health Sciences, University of York, York, UK.
| | - Anne English
- Dove House Hospice, Hull, UK. .,Humber NHS Foundation Trust, Willerby, UK.
| | | | - Sara Booth
- University of Cambridge, Cambridge, UK. .,Palliative Care Service, Cambridge University Hospitals NHS Trust, Cambridge, UK.
| |
Collapse
|
19
|
|
20
|
Banzett RB, O'Donnell CR, Guilfoyle TE, Parshall MB, Schwartzstein RM, Meek PM, Gracely RH, Lansing RW. Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research. Eur Respir J 2015; 45:1681-91. [PMID: 25792641 PMCID: PMC4450151 DOI: 10.1183/09031936.00038914] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 12/19/2014] [Indexed: 12/02/2022]
Abstract
There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea Profile (MDP) assesses overall breathing discomfort, sensory qualities, and emotional responses in laboratory and clinical settings. Here we provide the MDP, review published evidence regarding its measurement properties and discuss its use and interpretation. The MDP assesses dyspnoea during a specific time or a particular activity (focus period) and is designed to examine individual items that are theoretically aligned with separate mechanisms. In contrast, other multidimensional dyspnoea scales assess recalled recent dyspnoea over a period of days using aggregate scores. Previous psychophysical and psychometric studies using the MDP show that: 1) subjects exposed to different laboratory stimuli could discriminate between air hunger and work/effort sensation, and found air hunger more unpleasant; 2) the MDP immediate unpleasantness scale (A1) was convergent with common dyspnoea scales; 3) in emergency department patients, two domains were distinguished (immediate perception, emotional response); 4) test–retest reliability over hours was high; 5) the instrument responded to opioid treatment of experimental dyspnoea and to clinical improvement; 6) convergent validity with common instruments was good; and 7) items responded differently from one another as predicted for multiple dimensions. The Multidimensional Dyspnea Profile provides a unified, reliable instrument for both clinical and laboratory researchhttp://ow.ly/Ix8ic
Collapse
Affiliation(s)
- Robert B Banzett
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carl R O'Donnell
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Tegan E Guilfoyle
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mark B Parshall
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | - Richard M Schwartzstein
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Paula M Meek
- College of Nursing, University of Colorado, Denver, Aurora, CO, USA
| | - Richard H Gracely
- Department of Endodontics, UNC School of Dentistry, Center for Neurosensory Disorders, University of North Carolina, Chapel Hill, NC, USA
| | - Robert W Lansing
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
21
|
|
22
|
Experience-oriented tobacco-use prevention lecture using a COPD-simulation mask for junior high school students. Respir Physiol Neurobiol 2014; 209:28-32. [PMID: 25266392 DOI: 10.1016/j.resp.2014.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 11/21/2022]
Abstract
We recently developed a mask that simulates the experience of having one of the major diseases caused by tobacco smoking: chronic obstructive pulmonary disease (COPD). Here we examined the effects of a tobacco-use prevention lecture accompanied by a pseudo-COPD experience created with this mask on adolescents' attitude toward smoking. Junior high school students (12-13 years old, n=165) in Japan were the subjects. The students attended a 30-min tobacco-use prevention lecture with slides and movie clips and engaged in a light exercise session wearing the COPD-simulation mask for 15min. Before and after the lecture, the students' attitudes toward smoking were evaluated by the Kano test for social nicotine dependence (KTSND). The total KTSND scores decreased significantly from 9.9±4.4 (mean±SD, n=149) to 7.5±5.3 (n=144). Ninety-eight students wore the COPD mask, and their modified Borg scale scores increased significantly from 0.7±1.0 to 3.2±2.1 after exercise (P<0.0001). To the questionnaire item "Do you think you understand the suffering of individuals with COPD?", 24 and 51 students answered "definitely yes" and "yes", whereas 16, 4 and 1 answered "Cannot say," "no" and "definitely no", respectively. The KTSND scores were significantly smaller in the former affirmative group compared to the latter negative group (P<0.05). Of the 98 students who wore the simulation mask, 83 reported being satisfied with this pseudo-COPD experience. The tobacco-use prevention lecture with the pseudo-COPD experience created by the simulation mask was effective and safe.
Collapse
|
23
|
Abstract
In the assessment of dyspnea one has to take into account both the patient's own experience of the symptom and the clinicians observations of breathing rates, sounds and effort to get a complete picture. In addition, to choose appropriate treatment, the underlying cause of dyspnea needs to be assessed. While tools for clinical evaluation of heart failure have gained great interest in research and found a place in guidelines and clinical practice, the same cannot be said for instruments to assess patient self-reported dyspnea. To date, no specific dyspnea rating tool has been recommend over another. Reports from clinical practice are lacking and large; international studies in this field are warranted.
Collapse
Affiliation(s)
- Barbro Kjellström
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | |
Collapse
|
24
|
Dyspnea-12-Arabic: testing of an instrument to measure breathlessness in Arabic patients with chronic obstructive pulmonary disease. Heart Lung 2014; 43:244-8. [PMID: 24613748 DOI: 10.1016/j.hrtlng.2014.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/03/2014] [Accepted: 02/04/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to develop the Dyspnoea-12-Arabic (D-12-A) questionnaire and test its reliability and validity for the assessment of breathlessness in Arabic speaking patients with chronic obstructive pulmonary disease (COPD) in Jordan. BACKGROUND Breathlessness is a complex multidimensional symptom which incorporates physiology and psychology. METHODS The D-12-A, Hospital Anxiety and Depression Scale (HADS), and Quality of Life Index pulmonary version (QLI-P) were completed by 67 Jordanian patients with COPD. Cronbach alpha was used to assess internal consistency, and Pearson product-moment correlation calculated for construct validity. RESULTS The D-12-A and its sub-components ('physical' and 'affective') demonstrated excellent internal reliability (Cronbach alpha range from 0.88 to 0.91). D-12-A scores correlated significantly with other relevant outcome measures and demonstrated good construct validity. CONCLUSIONS The D-12-A should provide clinicians and researchers with a useful tool for the assessment of breathlessness in Arabic speaking patients with COPD.
Collapse
|
25
|
Johnson MJ, Currow DC, Booth S. Prevalence and assessment of breathlessness in the clinical setting. Expert Rev Respir Med 2014; 8:151-61. [DOI: 10.1586/17476348.2014.879530] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Banzett RB, Adams L, O'Donnell CR, Gilman SA, Lansing RW, Schwartzstein RM. Using laboratory models to test treatment: morphine reduces dyspnea and hypercapnic ventilatory response. Am J Respir Crit Care Med 2011; 184:920-7. [PMID: 21778294 PMCID: PMC3208656 DOI: 10.1164/rccm.201101-0005oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 07/06/2011] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Opioids are commonly used to relieve dyspnea, but clinical data are mixed and practice varies widely. OBJECTIVES Evaluate the effect of morphine on dyspnea and ventilatory drive under well-controlled laboratory conditions. METHODS Six healthy volunteers received morphine (0.07 mg/kg) and placebo intravenously on separate days (randomized, blinded). We measured two responses to a CO(2) stimulus: (1) perceptual response (breathing discomfort; described by subjects as "air hunger") induced by increasing partial pressure of end-tidal carbon dioxide (Pet(CO2)) during restricted ventilation, measured with a visual analog scale (range, "neutral" to "intolerable"); and (2) ventilatory response, measured in separate trials during unrestricted breathing. MEASUREMENTS AND MAIN RESULTS We determined the Pet(CO2) that produced a 60% breathing discomfort rating in each subject before morphine (median, 8.5 mm Hg above resting Pet(CO2)). At the same Pet(CO2) after morphine administration, median breathing discomfort was reduced by 65% of its pretreatment value; P < 0.001. Ventilation fell 28% at the same Pet(CO2); P < 0.01. The effect of morphine on breathing discomfort was not significantly correlated with the effect on ventilatory response. Placebo had no effect. CONCLUSIONS (1) A moderate morphine dose produced substantial relief of laboratory dyspnea, with a smaller reduction of ventilation. (2) In contrast to an earlier laboratory model of breathing effort, this laboratory model of air hunger established a highly significant treatment effect consistent in magnitude with clinical studies of opioids. Laboratory studies require fewer subjects and enable physiological measurements that are difficult to make in a clinical setting. Within-subject comparison of the response to carefully controlled laboratory stimuli can be an efficient means to optimize treatments before clinical trials.
Collapse
Affiliation(s)
- Robert B Banzett
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | | | | | | | | | | |
Collapse
|