Chest
Volume 141, Issue 6, June 2012, Pages 1546-1553
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Original Research
Signs and Symptoms of Chest Diseases
Reliability and Validity of the Multidimensional Dyspnea Profile

https://doi.org/10.1378/chest.11-1087Get rights and content

Background

Most measures of dyspnea assess a single aspect (intensity or distress) of the symptom. We developed the Multidimensional Dyspnea Profile (MDP) to measure qualities and intensities of the sensory dimension and components of the affective dimension. The MDP is not indexed to a particular activity and can be applied at rest, during exertion, or during clinical care. We report on the development and testing of the MDP in patients with a variety of acute and chronic cardiopulmonary conditions.

Methods

One hundred fifty-one adults admitted to the ED with breathing symptoms completed the MDP three times in the ED, twice at least 1 h apart (T1, T2), and near discharge from the ED (T3). Measures were repeated in 68 patients twice in a follow-up session 4 to 6 weeks later (T4-T5). The ED sample was 56% men with a mean age of 53 ± 15 years; the follow-up sample was similar.

Results

Factor analysis resulted in a two-factor solution with a total explained variance of 63%, 74%, and 72% at T1, T2, and T3, respectively. One domain related to primary sensory qualities and immediate unpleasantness, and the second encompassed emotional response. For the two domains, Cronbach α ranged from 0.82 to 0.95, and the intraclass correlation coefficient ranged from 0.91 to 0.98. Repeated-measures analysis was significant for change (T1, T3, T4), showing responsiveness to change in MDP domains with treatment (F[2,66] = 19.67, P > .001).

Conclusions

These analyses support the reliability, validity, and responsiveness to clinical change of the MDP with two domains in an acute care and follow-up setting.

Section snippets

Instrument Development and Content Validity

The MDP was developed from existing instruments for pain and dyspnea and subsequently refined through laboratory work.14 It comprises 12 items (Fig 1): an immediate sensory intensity item, an immediate unpleasantness item, five items addressing sensory qualities (eg, tightness, muscle work), and five emotional response items (eg, frustration, anxiety). Sensory qualities of dyspnea were reduced from a list of 19 descriptors8 to five descriptor groups based on previous factor analysis in patients

Sample

A total of 151 adults with cardiac or respiratory disease who came to the ED with breathing complaints completed the MDP at T1, with 146 completing the tool at T2 and 131 at T3. Sixty-eight of these subjects completed the MDP again 4 to 6 weeks after the ED visit (T4, T5). The majority of individuals took between 2 and 5 min to complete the MDP, regardless of setting. The sample at T1 was 56% men with a mean ± SD age of 53 ± 15 years. Most participants had asthma, COPD, pneumonia, or congestive

Discussion

The results show that the MDP is internally consistent, has a stable factor structure, and has subject ratings that are reliable over time. In the ED, the test-retest interval was short to assess stability in an acute, rapidly changing clinical setting. Test-retest reliability was assessed during the follow-up interval as well, with the results again supporting stability. We presented evidence of the construct and structural validity of the MDP using factor analysis at three different time

Acknowledgments

Author contributions: Dr Meek had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Meek: contributed to the final development of the MDP, study concept and design, analysis and interpretation of data, psychometric and statistical analysis, drafting the manuscript, and critical revision of the manuscript for important intellectual content.

Dr Banzett: contributed to the original and final development of the

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    Funding/Support: This work was supported by the National Institutes of Health [Grant NR010006].

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