Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12

Abstract

Rationale:Dyspnoea is a debilitating and distressing symptom that is reflected in different verbal descriptors. Evidence suggests that dyspnoea, like pain perception, consists of sensory quality and affective components. The objective of this study was to develop an instrument that measures overall dyspnoea severity using descriptors that reflect its different aspects.Methods:81 dyspnoea descriptors were administered to 123 patients with chronic obstructive pulmonary disease (COPD), 129 with interstitial lung disease and 106 with chronic heart failure. These were reduced to 34 items using hierarchical methods. Rasch analysis informed decisions regarding further item removal and fit to the unidimensional model. Principal component analysis (PCA) explored the underlying structure of the final item set. Validity and reliability of the new instrument were further assessed in a separate group of 53 patients with COPD.Results:After removal of items with hierarchical methods (n = 47) and items that failed to fit the Rasch model (n = 22), 12 were retained. The “Dyspnoea-12” had good internal reliability (Cronbach’s alpha = 0.9) and fit to the Rasch model (χ2 p = 0.08). Items patterned into two groups called “physical”(n = 7) and “affective”(n = 5). In the separate validation study, Dyspnoea-12 correlated with the Hospital Anxiety and Depression Scale (anxiety r = 0.51; depression r = 0.44, p<0.001, respectively), 6-minute walk distance (r = −0.38, p<0.01) and MRC (Medical Research Council) grade (r = 0.48, p<0.01), and had good stability over time (intraclass correlation coefficient = 0.9, p<0.001).Conclusion:Dyspnoea-12 fulfills modern psychometric requirements for measurement. It provides a global score of breathlessness severity that incorporates both “physical” and “affective” aspects, and can measure dyspnoea in a variety of diseases.

Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire

“…Our findings support this statement as significant correlations were shown between D-12 and LCSS. Factor analysis supported very good construct validity of the D-12, which was highly consistent with the factor analysis result during the development stage of the D-12 [20].…”

“…Breathlessness is quantified by using 12 descriptors to cover both its physical and psychological dimensions [20]. The D-12 has established its validity and reliability in COPD [20], asthma [21], interstitial lung disease [22] and pulmonary hypertension [23], which indicates its promising role for measuring breathlessness in a wide range of conditions. Psychometric properties of the D- 12 have not yet been assessed in lung cancer.…”

“…The Dyspnoea-12 (D-12) is a convenient patient-reported scale for measuring the severity of breathlessness [20]. Breathlessness is quantified by using 12 descriptors to cover both its physical and psychological dimensions [20].…”

Recent Advances in Assessment of Dyspnea

“…12 Therefore, recent studies emphasized that multidimensional nature of dyspnea in the sensory-perceptual (intensity and quality) are effective against distress and impact domains. 4 In multidimensional ratings to measure dyspnea, there are currently three available methods that consist of Multidimensional Dyspnea Profile (MDP), 13 Dyspnea-12 (D-12) 14 and Cancer Dyspnea Scale. 15 The MDP evaluates dyspnea during a specific time or a particular activity and is designed to examine individual items.…”

Exploring the Waveform Characteristics of Tidal Breathing Carbon Dioxide, Measured Using the N-Tidal C Device in Different Breathing Conditions (The General Breathing Record Study): Protocol for an Observational, Longitudinal Study (Preprint)

“…The patient is asked to tick the box that best reflects their breathing 'these days', on a 4 point Likert scale (none, mild, moderate and severe) [22].…”