Test–retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

Abstract

BackgroundDyspnea is among the most common reasons for emergency department (ED) visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients.MethodsPatients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154) completed the Multidimensional Dyspnea Profile (MDP) several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68). The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP) or at the time of administration (“now” MDP). The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA) with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficients (ICCs) for absolute agreement for individual items and domains.ResultsPCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach’s alpha = .89 to .94; Emotional Response, 5 items; Cronbach’s alpha = .81 to .85). Test–retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66) and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively).ConclusionsDuring an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for individual items and the two domains, that a time lag between arrival and questionnaire administration does not critically affect recall of perceptual and emotional characteristics immediately prior to the visit. However, test–retest reliability of recall over a 4- to 6-week interval is poor for individual items and significantly attenuated for the two domains.

Real-life assessment of the multidimensional nature of dyspnoea in COPD outpatients

“…In addition, de novo psychometric validation of the MDP (see supplement S3) was conducted in order to verify that its previously described properties held true in our study population [11,13,14]. We acknowledge that the study also has several weaknesses.…”

“…This slightly deviates from the MDP doctrine because it introduces some recall subjectivity regarding "the event", but this was a constraint of our "real-life" preoccupation (it would have been somewhat artificial to designate a unique dyspnoea-triggering activity for all the patients, clinically too vague to "lump" the last 2 weeks together, and too restrictive to focus on the day before the visit). Insofar as previous data have shown that the test-retest reliability of the MDP can be weak for recall periods of 4-6 weeks [13], we took the precaution to limit our recall period to 2 weeks. Reassuringly from a methodological standpoint, the test-retest reliability of the MDP applied with these choices was good in our population (supplement S3, table S5), and we found test-retest intraclass correlation coefficients similar to those obtained by PARSHALL et al [13] over a very short recall period (during the emergency department visit) and way above those reported by the same authors over a 4-6-week interval.…”

“…Insofar as previous data have shown that the test-retest reliability of the MDP can be weak for recall periods of 4-6 weeks [13], we took the precaution to limit our recall period to 2 weeks. Reassuringly from a methodological standpoint, the test-retest reliability of the MDP applied with these choices was good in our population (supplement S3, table S5), and we found test-retest intraclass correlation coefficients similar to those obtained by PARSHALL et al [13] over a very short recall period (during the emergency department visit) and way above those reported by the same authors over a 4-6-week interval.…”

“…Multidimensional tools have been proposed to address this issue, including the Dyspnoea-12 score [8], to a certain extent the Cancer Dyspnoea Scale [9] and, more specifically, the Multidimensional Dyspnea Profile (MDP) [10][11][12][13] (see extensive review in [14]). The MDP is derived from a conceptual model largely accepted to study pain.…”

“…Published evidence suggests that the MDP is appropriate for use in clinical settings (e.g. in patients admitted to an emergency department [11]) and in experimental settings [10,15], where it is able to distinguish immediate perception and emotional response; that it is reproducible [13]; and that it is responsive to treatment and to clinical improvement [11,15].…”