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Cited by 8Health Education and ValidationRespiratory and Cough-Related ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Validity and reliability of outcome measures to assess dysfunctional breathing: a systematic review

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Mohan, Vikram, Rathinam, Chandrasekar, Yates, Derick, Paungmali, Aatit, Boos, Christopher·2024·BMJ Open Respiratory Research
DOI 10.1136/bmjresp-2023-001884PMC PMC11029193
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Abstract

Objective: This study aimed to systematically review the psychometric properties of outcome measures that assess dysfunctional breathing (DB) in adults. Methods: Studies on developing and evaluating measurement properties to assess DB were included. The study investigated the empirical research published between 1990 and February 2022, with an updated search in May 2023 in the Cochrane Library database of systematic reviews and the Cochrane Central Register of Controlled Trials, the Ovid Medline (full), the Ovid Excerta Medica Database, the Ovid allied and complementary medicines database, the Ebscohost Cumulative Index to Nursing and Allied Health Literature and the Physiotherapy Evidence Database. The included studies’ methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Data analysis and synthesis followed the COSMIN methodology for reviews of outcome measurement instruments. Results: Sixteen studies met the inclusion criteria, and 10 outcome measures were identified. The psychometric properties of these outcome measures were evaluated using COSMIN. The Nijmegen Questionnaire (NQ) is the only outcome measure with ‘sufficient’ ratings for content validity, internal consistency, reliability and construct validity. All other outcome measures did not report characteristics of content validity in the patients’ group. Discussion: The NQ showed high-quality evidence for validity and reliability in assessing DB. Our review suggests that using NQ to evaluate DB in people with bronchial asthma and hyperventilation syndrome is helpful. Further evaluation of the psychometric properties is needed for the remaining outcome measures before considering them for clinical use. PROSPERO registration number: CRD42021274960.

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  • Some authors argue that DB should be viewed as a multifactorial phenomenon, involving biomechanical, psychophysiological, and biochemical domains, which can independently or collectively contribute to its manifestation.

    “Some authors argue that the condition should be viewed as a multifactorial phenomenon, involving biomechanical, J o u r n a l P r e -p r o o f psychophysiological, and biochemical domains, which can independently or collectively contribute to its manifestation (20,21).”

    From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [21]

    The Introduction describes dysfunctional breathing as a deviation from normal biomechanical breathing and says a comprehensive evaluation should consider bodily biochemistry and psychological functioning. It does not say that these domains independently or collectively contribute to the condition’s manifestation; its statement about potential impacts runs in the other direction. (LLM, conf=0.79)

    Experimental — accuracy not yet measured

  • The breadth of symptomatology observed within the literature is in keeping with the multidimensional model proposed by Courtney.

    “This breadth of symptomatology observed within the literature is in keeping with the multidimensional model proposed by Courtney who recognised DB as a multidimensional construct, consisting of psychophysiological, biomechanical and biochemical domains (21).”

    From How is dysfunctional breathing characterised in the clinical literature? A scoping review (2026) · cites this paper as [21]

    The Introduction (page not available) describes varied symptoms of dysfunctional breathing and says a comprehensive evaluation should consider bodily biochemistry and psychological functioning; it also describes altered breathing biomechanics. This supports a multidimensional view, but our copy does not state that the breadth of symptoms accords with a model proposed by Courtney or identify the three named domains as Courtney’s model. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 34

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Authors
Mohan, V., Rathinam, C., Yates, D., Paungmali, A., & Boos, C.
Affiliations
  • Bournemouth University (GB)
  • Birmingham Women’s and Children’s NHS Foundation Trust (GB)
  • Chiang Mai University (TH)
  • Poole Hospital (GB)
Corresponding author
Rathinam, Chandrasekar
ORCID
Venue
BMJ Open Respiratory Research
Publisher
BMJ
Published
2024-04
Volume
11
Issue
1
Pages
e001884
ISSN
2052-4439 (ISSN-L)
DOI
10.1136/bmjresp-2023-001884
PMC
PMC11029193
OpenAlex
W4394859138
Cited by
8
References
45
Citations by year
2026: 4 · 2025: 3 · 2024: 1
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Respiratory Research (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Bournemouth University Research Online (Bournemouth University) (acceptedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Bournemouth University
Topics
  • Social Sciences › Education › Health Education and Validation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
dysfunctional breathing, outcome measures, psychometric properties, Nijmegen questionnaire, content validity, construct validity, internal consistency, reliability statistics, asthma, hyperventilation syndrome, measurement instruments
MeSH terms
Systematic Reviews as Topic, Adult, Humans, Psychometrics, Surveys and Questionnaires, Respiration Disorders, Reproducibility of Results, Outcome Assessment, Health Care

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