Evaluation of Dyspnea During Physical and Speech Activities in Patients With Pulmonary Diseases

doi:10.1378/chest.113.3.625

Chest

Volume 113, Issue 3, March 1998, Pages 625-632

https://doi.org/10.1378/chest.113.3.625 Get rights and content

Study objectives

Dyspnea is most commonly assessed by questioning patients about their subjective perception of shortness of breath during physical exertion. Although speech production is altered by pulmonary disease, it has not been included in current dyspnea assessment tools. A questionnaire was developed to address reports of dyspnea during (1) physical activity, (2) speech activity, and (3) simultaneous speech and physical activity.

Design

An equal number of self- and experimenter-administered 30-item questionnaires was given to 203 patients with restrictive and obstructive pulmonary diseases. Their responses were analyzed statistically.

Results

The questionnaire had high internal consistency for individual items within each of the three sections. The sections were highly correlated but provided separate and distinct information. Factors extracted from each section were related to severity of dyspnea. Pairwise t tests demonstrated highly significant differences in subject responses to the three sections. The least dyspnea was experienced during speech activities, more during physical activities, and the most when speech and physical activities were combined.

Conclusions

The questionnaire proved to be a quickly administered tool for providing information about the effect of dyspnea on activities of daily living. Because of the emphasis on dyspnea during speech production, it may be particularly useful for assessing patients who rely extensively on speaking ability for their livelihood.

Section snippets

Questionnaire

The questionnaire items were divided into three categories of 10 questions each: breathlessness during physical activity, breathlessness during speaking activity, and breathlessness when speaking during a physical activity (Fig 1). Formation of questionnaire items was based, in part, on physical activities of daily living used in other scales of dyspnea and speech activities used in tools for assessment of speech. Other items were added to ensure that a wide variety would be included under each

Results

All statistical analyses were conducted through programs developed by one of two companies (SAS; SAS Institute Inc; Cary, NC; and SPSS-X; SPSS Inc; Chicago).

Discussion

Mahler²⁰ states that most patients with pulmonary diseases seek medical attention because of the sensation of breathlessness. Previous clinical methods used to measure dyspnea have focused on the magnitude of the physical task that causes it (eg, walking up stairs). For many patients, the ability to speak is equally or more important; speaking is expected to be altered not only by the respiratory muscle activity involved, but also by the changes in speech breathing patterns.18, 19 Although a

Acknowledgments

The authors are grateful to David Moore, PhD, and Ernest Weiler, PhD, who were consultants for the statistical analyses.

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Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief
2017, Journal of Pain and Symptom Management
Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level.
The objectives of this study are to 1) summarize palliative care assessment tools completed by or with patients or caregivers and 2) identify needs for future tool development and evaluation.
We completed 1) a systematic review of systematic reviews; 2) a supplemental search of previous reviews and Web sites, and/or 3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for Palliative Care and selected the most relevant, recent, and highest quality systematic review for each domain.
We included 10 systematic reviews and identified 152 tools (97 from systematic reviews and 55 from supplemental sources). Key gaps included no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience with end-of-life care. Psychometric information was available for many tools, but few studies evaluated responsiveness (sensitivity to change) and no studies compared tools.
Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience with end-of-life care. While some data exist on psychometric properties of tools, the responsiveness of different tools to change and/or comparisons between tools have not been evaluated. Future research should focus on developing or testing tools that address domains for which few tools exist, evaluating responsiveness, and comparing tools.
Development and validation of the Dyspnea Index (DI): A severity index for upper airway-related dyspnea
2014, Journal of Voice
Citation Excerpt :
Some of these questionnaires are disease-specific and target dyspneic-related disorders. However, most of these indices target general dyspnea,13,14 lower airway–related dyspnea (eg, asthma, Chronic Obstructive Pulmonary Disease, lung cancer),15–20 or one component disorder of typical upper airway presentations in the voice clinic (eg, PVFMD in athletes, stenosis).12,21 To date, there are no questionnaires that directly target the upper airway pathology population seen in an outpatient clinical setting.
To (1) develop and validate the Dyspnea Index (DI); (2) quantify severity of symptoms in upper airway dyspnea; and (3) validate the DI as an outcome measure.
Survey development and validation.
Three hundred sixty-nine participants were recruited for different phases of the study. Two hundred participants with chief complaints of dyspnea were given a 41-item questionnaire addressing common symptoms of dyspnea related to the upper airway. The questions were then reduced based on principal component analysis (PCA) and internal consistency resulting in a 10-item questionnaire. Cognitive interviews were conducted with 15 participants. Test-retest reliability and discriminant validity were measured from 51 participants. The DI was further validated by administering the index to 57 healthy controls (HC). Validation of the DI as a treatment outcome tool occurred with 46 participants' pre- and post-treatment scores.
PCA revealed that only a single factor was being measured in both the original 41- and 10-item questionnaires. Additional cognitive interviewing suggested that no modification was needed to the DI. Test-retest reliability was r = 0.83. Discriminant validity was r = 0.62. The Mann-Whitney test demonstrated significant differences between healthy/symptomatic participants. Scores from the HC cohort resulted in a mean of 3.12 (SEM = 0.484; SD = 3.65) for the normative values.
The DI is an effective and efficient instrument to quantify patients' symptoms of upper airway dyspnea. It is a statistically robust index, with significant reliability and validity, and can be dependably used as a treatment outcome measure.
Outcomes of a pulmonary rehabilitation program including singing training
2013, Revue des Maladies Respiratoires
L’éducation respiratoire par le chant peut être proposée au cours de la réhabilitation respiratoire (RR) pour aider au contrôle de la respiration et diminuer la dyspnée.
Nous avons réalisé une éducation à la pratique du chant lors de la RR à 45 malades, d’âge moyen 60,1 ± 10,0 ans, atteints de bronchopneumopathie chronique obstructive (BPCO) (n = 37) ou d’autres affections respiratoires chroniques (n = 8). Les paramètres recueillis au début et à la fin de la RR étaient les suivants : capacité vitale forcée, VEMS, capacité pulmonaire totale, volume résiduel, test de marche de six minutes (TM6), VO₂max, puissance maximale (Pmax), score de dyspnée du Medical Research Council (MRC), questionnaires de Cincinnati et Visual Simplified Respiratory Questionnaire (VSRQ).
Les principales variations significatives observées (valeur de début, % de variation, significativité) étaient les suivantes : TM6 (326 ± 114 m, +13,8 %, p = 0,006) ; VO₂max (18,1 ± 6,1 mL/kg/min, +8,3 %, p = 0,01) ; Pmax (75 ± 31 W, +14,7 %, p = 0,001) ; score MRC (2,3 ± 0,6, −21,7 %, p < 10⁻⁴) ; score VSRQ (34 ± 13, +50,0 %, p < 10⁻⁶). Il n’y avait pas de modification significative de la dyspnée évaluée par le score de Cincinnati.
Ces résultats sont en faveur de l’effet favorable de l’éducation au chant sur les résultats de la RR.
Respiratory education by singing may be considered in the course of pulmonary rehabilitation to help control breathing and reduce dyspnoea.
We have undertaken singing training during pulmonary rehabilitation in 45 patients, mean age 60.1 ± 10.0 years, suffering from COPD (n = 37) or other chronic respiratory disorders (n = 8). The parameters measured at the beginning and end of course of rehabilitation were: forced vital capacity, FEV1, total lung capacity, residual volume, 6 min walking distance, VO₂max, maximum pressure, MRC dyspnoea score, Cincinnati questionnaires and VSRQ (simplified visual respiratory questionnaire).
The following were the principal significant variations observed (initial value, % variation, significance): 6 minutes walk (326 ± 114 m, +13.8%, P = 0.006); VO₂max (18,1 ± 6.1 ml/kg/min, +8.3%, P = 0.01); P max (75 ± 31 W, +14.7%, P = 0.001); MRC score (2.3 ± 0.6, −21.7%, P < 10⁻⁴); VSRQ score (34 ± 13, +50.0%, P < 10⁻⁶). There was no significant change in the level of dyspnoea evaluated by the Cincinnati score.
These results are in favor of a beneficial effect of singing during pulmonary rehabilitation.
How about singing?
2013, Revue des Maladies Respiratoires
L’éducation respiratoire par le chant peut être proposée au cours de la réhabilitation respiratoire (RR) pour aider au contrôle de la respiration et diminuer la dyspnée.
Nous avons réalisé une éducation à la pratique du chant lors de la RR à 45 malades, d’âge moyen 60,1 ± 10,0 ans, atteints de bronchopneumopathie chronique obstructive (BPCO) (n = 37) ou d’autres affections respiratoires chroniques (n = 8). Les paramètres recueillis au début et à la fin de la RR étaient les suivants : capacité vitale forcée, VEMS, capacité pulmonaire totale, volume résiduel, test de marche de six minutes (TM6), VO₂max, puissance maximale (Pmax), score de dyspnée du Medical Research Council (MRC), questionnaires de Cincinnati et Visual Simplified Respiratory Questionnaire (VSRQ).
Les principales variations significatives observées (valeur de début, % de variation, significativité) étaient les suivantes : TM6 (326 ± 114 m, +13,8 %, p = 0,006) ; VO₂max (18,1 ± 6,1 mL/kg/min, +8,3 %, p = 0,01) ; Pmax (75 ± 31 W, +14,7 %, p = 0,001) ; score MRC (2,3 ± 0,6, −21,7 %, p < 10⁻⁴) ; score VSRQ (34 ± 13, +50,0 %, p < 10⁻⁶). Il n’y avait pas de modification significative de la dyspnée évaluée par le score de Cincinnati.
Ces résultats sont en faveur de l’effet favorable de l’éducation au chant sur les résultats de la RR.
Respiratory education by singing may be considered in the course of pulmonary rehabilitation to help control breathing and reduce dyspnoea.
We have undertaken singing training during pulmonary rehabilitation in 45 patients, mean age 60.1 ± 10.0 years, suffering from COPD (n = 37) or other chronic respiratory disorders (n = 8). The parameters measured at the beginning and end of course of rehabilitation were: forced vital capacity, FEV1, total lung capacity, residual volume, 6 min walking distance, VO₂max, maximum pressure, MRC dyspnoea score, Cincinnati questionnaires and VSRQ (simplified visual respiratory questionnaire).
The following were the principal significant variations observed (initial value, % variation, significance): 6 minutes walk (326 ± 114 m, +13.8%, P = 0.006); VO₂max (18,1 ± 6.1 ml/kg/min, +8.3%, P = 0.01); P max (75 ± 31 W, +14.7%, P = 0.001); MRC score (2.3 ± 0.6, −21.7%, P < 10⁻⁴); VSRQ score (34 ± 13, +50.0%, P < 10⁻⁶). There was no significant change in the level of dyspnoea evaluated by the Cincinnati score.
These results are in favor of a beneficial effect of singing during pulmonary rehabilitation.
Development of a conceptual framework and calibrated item banks to measure patient-reported dyspnea severity and related functional limitations
2011, Value in Health
Citation Excerpt :
Through this process, seven questionnaires were identified and retained for further review. These included: 1) Pulmonary Functional Status & Dyspnea Questionnaire - Original [19] and Pulmonary Functional Status & Dyspnea Questionnaire - Modified [20]; 2) The Breathlessness, Cough, and Sputum Scale [21]; 3) London Chest Activity Daily Living Scale [22]; 4) University of Cincinnati Dyspnea Questionnaire [23]; 5) University of California - San Diego Shortness of Breath Questionnaire [24]; 6) Chronic Respiratory Questionnaire - Self-Administered Individualized and Self-Administered Standardized (CRQ-SAS) [25]; and 7) St. George's Respiratory Questionnaire - American translation [26]. These seven questionnaires contributed 364 items into the library.
Chronic obstructive pulmonary disease is a major global health problem. Although several patient-reported outcome (PRO) measures of chronic obstructive pulmonary disease exist, none were developed using patient-driven concept development. We developed an item bank for dyspnea severity and related functional limitations on the basis of a PRO conceptual framework derived from patient input.
We identified a large pool of existing items based on a conceptual framework and literature review. Using patient and expert review panels and an item refinement/modification process, we developed an item bank aligned with the conceptual framework, which subsequently underwent psychometric testing via an online Internet panel of dyspnea patients (N = 608).
Exploratory factor analysis suggested a dominant first factor accounting for about 78% of the total variance. Confirmatory factor analysis supported a unidimensional model. Item response theory analysis demonstrated good model fit, and differential item functioning analyses indicated that the 33-item scale showed potential for measurement equivalence across sex. A 10-item short form produced comparable scores (r = 0.98) and a computerized adaptive-testing simulation indicated efficient measurement with fewer items (mean 4.65 items).
An efficient patient-reported measure of dyspnea severity and related functional limitations, based on a patient-driven PRO conceptual framework, is now available for further validation and use.
Outcome measurement for COPD: Reliability and validity of the Dyspnea Management Questionnaire
2011, Respiratory Medicine
Citation Excerpt :
Existing dyspnea scales are very limited in their scope and comprehensiveness. Most measure either dyspnea intensity with physical activities or dyspnea self-efficacy perceptions.16–20 Current COPD instruments do not comprehensively capture the psychological, social and behavioral impact of dyspnea.
The Dyspnea Management Questionnaire (DMQ) is a measure of the psychosocial and behavioral responses to dyspnea for adults with COPD. The research objectives were to evaluate the reliability and validity of an expanded DMQ item pool, as a preliminary step for developing a computer adaptive test.
The original 66 items of the DMQ were used for the analyses. The sample included 63 women and 44 men with COPD (n = 107) recruited from two urban medical centers. We used confirmatory factor analysis to test the factor structure of the DMQ and its underlying cognitive-behavioral theoretical base. The internal consistency and test–retest reliability, and breadth of coverage of the expanded DMQ item bank were also evaluated.
Five distinct dyspnea domains were confirmed using 56 original items of the DMQ: dyspnea intensity, dyspnea anxiety, activity avoidance, activity self-efficacy, and strategy satisfaction. Overall, the breadth of items was excellent with a good match between sample scores and item difficulty. The DMQ-56 showed good internal consistency reliability (α = 0.85–to 0.96) and good preliminary test–retest reliability over a 3-week interval (ICC = 0.69–0.92).
The DMQ demonstrated acceptable levels of reliability and validity for measuring multidimensional dyspnea outcomes after medical, psychological, and behavioral interventions for adults with COPD.

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^†: Currently at NuMed Rehab, Inc, Cincinnati (Ms. Friesen) and IHS of Sarasota, Sarasota Fla (Ms. Lambert).

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Chest

Clinical Investigations: DyspneaEvaluation of Dyspnea During Physical and Speech Activities in Patients With Pulmonary Diseases

Study objectives

Design

Results

Conclusions

Section snippets

Questionnaire

Results

Discussion

Acknowledgments

Chest

J Chronic Dis

Chest

Clin Chest Med

Chest

J Clin Epidemiol

Control Clin Trials

Br J Dis Chest

Dorland's medical dictionary

Effect of attitudes and beliefs on exercise tolerance in chronic bronchitis

BMJ

Clinical measurement of dyspnea

Operationalizing dyspnea: focus on measurement

Heart Lung

Psychophysical bases of perceived exertion

Med Sci Sports Exerc

Dyspnea, disability and distance walked: comparison of estimates of exercise performance in respiratory disease

BMJ

Clinical Investigations: Dyspnea
Evaluation of Dyspnea During Physical and Speech Activities in Patients With Pulmonary Diseases