Appendix F: Summary <strong>of</strong> <strong>Dyspnea</strong> Assessment ToolsPresent <strong>Dyspnea</strong> Scales SourceReliability and ValidityCommentsVisualAnalogue Scale(VAS)Gift, 1989Grant, Aitchison.Henderson,Christie Zare,McMurray et al.,1999Correlation <strong>of</strong> vertical VAS <strong>with</strong> horizontalVAS was r=.97 and <strong>with</strong> Peak ExpiratoryFlow Rate (PEFR) r=.85 <strong>in</strong> asthmaticpatients; n=15. Construct validity wasestablished by hav<strong>in</strong>g subjects <strong>with</strong> asthmaand <strong>with</strong> COPD rate dyspnea dur<strong>in</strong>g times<strong>of</strong> severe and little airway obstruction;N=20. (Gift, 1989)Both concurrent and construct validity established.Useful for measurement <strong>of</strong> multiple sensationsassociated <strong>with</strong> dyspnea.Better reproducibility and sensitivity than Borg Scale<strong>in</strong> normal subjects.Reproducibility coefficients as high as 78%.Sensitivity ratio was 2.7 (Grant et al., 1999)NumericRat<strong>in</strong>g Scale(NRS)Gift & Narsavage,1998High correlation <strong>of</strong> NRS scores<strong>with</strong> VASScores for present dyspnea poorly correlated <strong>with</strong>usual dyspnea, therefore seen as a different construct.Low correlation between dyspnea scores and FEV 1Modified BorgScale(MBS)Kendrick, Baxi &Smith, 2000Retrospective correlational study;correlation between PEFR, Sa0 2 andModified Borg Scale pre- and post-therapy.N = 102Correlation between change <strong>in</strong> PEFR and MBS was-.42, p
Present <strong>Dyspnea</strong> ScalesBasel<strong>in</strong>e <strong>Dyspnea</strong>Index (BDI) andTransitional<strong>Dyspnea</strong> Index (TDI)97Oxygen Cost DiagramBreathlessness,Cough andSputum Scale (BCSS)University <strong>of</strong> Californiaat San DiegoShortness <strong>of</strong> BreathQuestionnaire(SOBQ)Quality <strong>of</strong> Life ScalesChronic RespiratoryQuestionnaire (CRQ)and ChronicRespiratoryQuestionnaireSelf-report (CRQ – SR)SourceAaron,Vandemheen,Cl<strong>in</strong>ch, Ahuja,Brison, Dick<strong>in</strong>sonet al., 2002Mahler, We<strong>in</strong>berg,Wells & Fe<strong>in</strong>ste<strong>in</strong>,1984Witek & Mahler,2003a; 2003bOga, Nishimura,Tsuk<strong>in</strong>o, Hajiro,Ikeda &Mishiman, 2002.Celli, Halp<strong>in</strong>,Hepburn, Byrne,Keat<strong>in</strong>g &Goldman, 2003Leidy, Schmier,Jones, Lloyd &Rocchiccioli, 2003Eak<strong>in</strong>, Resnik<strong>of</strong>f,Prewitt, Ries &Kaplan, 1998Hajiro, Nishimura,Tsuk<strong>in</strong>o, Ikeda,Koyama & Izumi,1998Reliability and Validity<strong>Sign</strong>ificantly correlated <strong>with</strong> the dyspneadiary score and the symptom and activitycomponent <strong>of</strong> the St. George’s respiratoryquestionnaire, establish<strong>in</strong>g concurrentvalidity. Association between basel<strong>in</strong>e FEV 1and BDI and change <strong>in</strong> FEV 1 and TDIestablished construct validity.TDI showed significant positive correlation<strong>with</strong> changes <strong>in</strong> cl<strong>in</strong>ical status and all fourdoma<strong>in</strong>s <strong>of</strong> the chronic respiratory disease<strong>in</strong>dex questionnaire.Correlated significantly <strong>with</strong> exercisecapacity.Mean changes <strong>in</strong> BCSS score were compared<strong>with</strong> percentage change <strong>in</strong> symptoms,change <strong>in</strong> FEV1, and change <strong>in</strong> St. GeorgeRespiratory Questionnaire (SGRQ).N=2971(Leidy et al., 2003).N=28 subjects <strong>with</strong> COPD. Excellent <strong>in</strong>ternalconsistency demonstrated. <strong>Sign</strong>ificantcorrelations <strong>with</strong> exercise tolerance.N=52. <strong>The</strong>re were no statistically significantdifferences between CRQ and CRQ-SR <strong>in</strong>doma<strong>in</strong>s <strong>of</strong> mastery and fatigue; nocl<strong>in</strong>ically significant differences <strong>in</strong> doma<strong>in</strong>s<strong>of</strong> dyspnea and emotional function. Testretestreliability high <strong>in</strong> CRQ-SR.CommentsValidity established <strong>in</strong> both English and non-Englishspeakers. A 1-unit change <strong>in</strong> the TDI score isconsidered cl<strong>in</strong>ically significant.Found to be an important predictor <strong>of</strong> exercisecapacity, especially the walk<strong>in</strong>g test.Patient reported daily symptom data (BCSS) are sensitiveto change and useful for both observational studiesand controlled cl<strong>in</strong>ical trials <strong>of</strong> patients <strong>with</strong> COPD(Leidy et al., 2003). Scale useful for cl<strong>in</strong>ical evaluation<strong>of</strong> new drugs for the treatment <strong>of</strong> COPD (Celli et al., 2003).BCSS is a reliable, valid and responsive patientreportedoutcome measure <strong>of</strong> symptom severity <strong>in</strong>patients <strong>with</strong> COPD (Leidy et al., 2003).Conclude that it is a valuable assessment tool <strong>in</strong> bothcl<strong>in</strong>ical practice and research.CRQ-SR is a reproducible, reliable and stable measure<strong>of</strong> health status that is quick to adm<strong>in</strong>ister.Description <strong>of</strong> ToolAn observer scores the patient’sseverity <strong>of</strong> breathlessness for each <strong>of</strong>the three dimensions, based onresponses to various questions for theBDI. <strong>The</strong> TDI is used to denotechanges from the <strong>in</strong>itial assessment.VAS <strong>with</strong> 13 daily activities rankedalong the 100 mm vertical l<strong>in</strong>e <strong>in</strong>proportion to their associated oxygencost. <strong>The</strong> patient marks the po<strong>in</strong>tabove which a task would have to bestopped because <strong>of</strong> breathlessness(Carone et al., 2001).Daily diary <strong>in</strong> which subjects recordthe severity <strong>of</strong> three symptoms <strong>of</strong>COPD: breathlessness, cough, andsputum on a 5-po<strong>in</strong>t Likert scale.24-item questionnaire measur<strong>in</strong>g dyspneadur<strong>in</strong>g the past week; patients are askedabout the frequency <strong>of</strong> dyspnea whenperform<strong>in</strong>g 21 different activities on a6-po<strong>in</strong>t rat<strong>in</strong>g scale (Carone et al., 2001).CRQ: Interviewer adm<strong>in</strong>isteredquestionnaire measur<strong>in</strong>g severity <strong>of</strong>dyspnea on a 1 (extremely short <strong>of</strong>breath) to 7 (not at all short <strong>of</strong> breath)scale on the 5 most bothersomeactivities that elicited breathlessnessdur<strong>in</strong>g the last 2 weeks as selected bythe patient (Carone et al., 2001).CRQ-SR is similar to CRQ; format waschanged to make it easier for patientsto complete.97
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