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Validation of the Dyspnea Exertion Scale of Breathlessness in People With Life-Limiting Illness

Sandberg, Jacob LU ; Johnson, Miriam J.; Currow, David C. and Ekström, Magnus LU (2018) In Journal of Pain and Symptom Management 56(3). p.2-435
Abstract

Background: Although chronic breathlessness is common in life-limiting illnesses, validated feasible instruments to measure functional impact of the symptom in this population are scarce. We aimed to validate the Dyspnea Exertion Scale (DES) compared with the modified Medical Research Council (mMRC) breathlessness scale for test-retest reliability, concurrent validity, and responsiveness in people with life-limiting illness. Methods: A total of 188 participants, 66% males, with chronic breathlessness, mostly (70%) because of chronic pulmonary disease (chronic obstructive pulmonary disease) self-reported evening scores of mMRC, DES, Numerical Rating Scale (NRS), and Eastern Cooperative Oncology Group during nine days. Results: About 44%... (More)

Background: Although chronic breathlessness is common in life-limiting illnesses, validated feasible instruments to measure functional impact of the symptom in this population are scarce. We aimed to validate the Dyspnea Exertion Scale (DES) compared with the modified Medical Research Council (mMRC) breathlessness scale for test-retest reliability, concurrent validity, and responsiveness in people with life-limiting illness. Methods: A total of 188 participants, 66% males, with chronic breathlessness, mostly (70%) because of chronic pulmonary disease (chronic obstructive pulmonary disease) self-reported evening scores of mMRC, DES, Numerical Rating Scale (NRS), and Eastern Cooperative Oncology Group during nine days. Results: About 44% (n = 81) scored the highest score on mMRC indicating a ceiling effect not seen with DES. Both scales had moderate-to-good test-retest agreement (89% DES; 84% mMRC; P < 0.001 for both). Analyses for concurrent validity showed that higher DES and mMRC scores were correlated with higher NRS breathlessness intensity scores and Eastern Cooperative Oncology Group scores throughout the nine days. In longitudinal analyses, DES (r = 0.30; P < 0.001) was more responsive to change in NRS score during nine days than the mMRC (r = 0.16; P = 0.03). Conclusion: Compared with mMRC, DES had comparable or better measurement properties in terms of test-retest reliability and concurrent validity and could be used as a discriminative tool in this population, but both scales are too insensitive to change to be used as an outcome in clinical trials.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breathlessness, DES, Dyspnea Exertion Scale (DES), measurement, Medical Research Council breathlessness scale, mMRC, validation
in
Journal of Pain and Symptom Management
volume
56
issue
3
pages
2 - 435
publisher
Elsevier
external identifiers
  • scopus:85048540689
ISSN
0885-3924
DOI
10.1016/j.jpainsymman.2018.05.002
language
English
LU publication?
yes
id
1a523f19-6f2a-4077-9f4d-13a622fb37eb
date added to LUP
2018-07-03 10:57:19
date last changed
2019-01-14 15:56:10
@article{1a523f19-6f2a-4077-9f4d-13a622fb37eb,
  abstract     = {<p>Background: Although chronic breathlessness is common in life-limiting illnesses, validated feasible instruments to measure functional impact of the symptom in this population are scarce. We aimed to validate the Dyspnea Exertion Scale (DES) compared with the modified Medical Research Council (mMRC) breathlessness scale for test-retest reliability, concurrent validity, and responsiveness in people with life-limiting illness. Methods: A total of 188 participants, 66% males, with chronic breathlessness, mostly (70%) because of chronic pulmonary disease (chronic obstructive pulmonary disease) self-reported evening scores of mMRC, DES, Numerical Rating Scale (NRS), and Eastern Cooperative Oncology Group during nine days. Results: About 44% (n = 81) scored the highest score on mMRC indicating a ceiling effect not seen with DES. Both scales had moderate-to-good test-retest agreement (89% DES; 84% mMRC; P &lt; 0.001 for both). Analyses for concurrent validity showed that higher DES and mMRC scores were correlated with higher NRS breathlessness intensity scores and Eastern Cooperative Oncology Group scores throughout the nine days. In longitudinal analyses, DES (r = 0.30; P &lt; 0.001) was more responsive to change in NRS score during nine days than the mMRC (r = 0.16; P = 0.03). Conclusion: Compared with mMRC, DES had comparable or better measurement properties in terms of test-retest reliability and concurrent validity and could be used as a discriminative tool in this population, but both scales are too insensitive to change to be used as an outcome in clinical trials.</p>},
  author       = {Sandberg, Jacob and Johnson, Miriam J. and Currow, David C. and Ekström, Magnus},
  issn         = {0885-3924},
  keyword      = {Breathlessness,DES,Dyspnea Exertion Scale (DES),measurement,Medical Research Council breathlessness scale,mMRC,validation},
  language     = {eng},
  month        = {01},
  number       = {3},
  pages        = {2--435},
  publisher    = {Elsevier},
  series       = {Journal of Pain and Symptom Management},
  title        = {Validation of the Dyspnea Exertion Scale of Breathlessness in People With Life-Limiting Illness},
  url          = {http://dx.doi.org/10.1016/j.jpainsymman.2018.05.002},
  volume       = {56},
  year         = {2018},
}