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Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease
  1. Josefin Sundh1,
  2. Hans Bornefalk2,
  3. Carl Magnus Sköld3,
  4. Christer Janson4,
  5. Anders Blomberg5,
  6. Jacob Sandberg6,7,
  7. Anna Bornefalk-Hermansson8,
  8. Helena Igelström9 and
  9. Magnus Ekström10
  1. 1Department of Respiratory Medicine, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
  2. 2Hans Bornefalk AB, Vallentuna, Sweden
  3. 3Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  5. 5Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
  6. 6Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
  7. 7Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
  8. 8Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
  9. 9Department of Neuroscience, Uppsala University, Uppsala, Sweden
  10. 10Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
  1. Correspondence to Dr Josefin Sundh; josefin.sundh{at}


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.

  • dyspnoea
  • breathlessness
  • multidimensional
  • COPD
  • asthma
  • idiopathic pulmonary fibrosis
  • heart failure
  • internal consistency, reliability, concurrent validity

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  • Contributors Conception and design: ME; Data collection: ME, MS, CJ, AB, JaS, HI, JoS; Statistical analysis: HB, AB-H; First draft: JoS; Interpretation, revision for important intellectual content and approval of the version to be published: all authors.

  • Funding The translation was funded by unrestricted grants from the Swedish Respiratory Society, the Swedish Heart−Lung Foundation and the Swedish Society for Medical Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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