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Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12
Open accessAbstract
RATIONALE: Dyspnoea is a debilitating and distressing symptom that is reflected in different verbal descriptors. Evidence suggests that dyspnoea, like pain perception, consists of sensory quality and affective components. The objective of this study was to develop an instrument that measures overall dyspnoea severity using descriptors that reflect its different aspects. METHODS: 81 dyspnoea descriptors were administered to 123 patients with chronic obstructive pulmonary disease (COPD), 129 with interstitial lung disease and 106 with chronic heart failure. These were reduced to 34 items using hierarchical methods. Rasch analysis informed decisions regarding further item removal and fit to the unidimensional model. Principal component analysis (PCA) explored the underlying structure of the final item set. Validity and reliability of the new instrument were further assessed in a separate group of 53 patients with COPD. RESULTS: After removal of items with hierarchical methods (n = 47) and items that failed to fit the Rasch model (n = 22), 12 were retained. The "Dyspnoea-12" had good internal reliability (Cronbach's alpha = 0.9) and fit to the Rasch model (chi(2) p = 0.08). Items patterned into two groups called "physical"(n = 7) and "affective"(n = 5). In the separate validation study, Dyspnoea-12 correlated with the Hospital Anxiety and Depression Scale (anxiety r = 0.51; depression r = 0.44, p<0.001, respectively), 6-minute walk distance (r = -0.38, p<0.01) and MRC (Medical Research Council) grade (r = 0.48, p<0.01), and had good stability over time (intraclass correlation coefficient = 0.9, p<0.001). CONCLUSION: Dyspnoea-12 fulfills modern psychometric requirements for measurement. It provides a global score of breathlessness severity that incorporates both "physical" and "affective" aspects, and can measure dyspnoea in a variety of diseases.
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“Some patient- reported outcome measures are not validated in all presentations of BPD (NQ, 15 D- 12 29 ) or have limited validity (Short Evaluation of Breathing Questionniare 30 ).”
From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [29]
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“More recent instruments, such as Dyspnea-12 24 and the Multidimensional Dyspnea Profile, 25 permit the assessment of both the presence and intensity of the descriptor.”
From Cognitive behavioral therapy for management of dyspnea: A pilot study (2015) · cites this paper as [24]
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“D-12,46,58 used in our study, allows the assessment of the sensory and emotional components of dyspnoea, which is recommended by international scientific societies for dyspnea evaluation.59”
From Physiotherapy Education and Breathing Retraining for Patients With Hyperventilation Syndrome: An Observational Study (2026) · cites this paper as [58]
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Metadata
- Authors
- Yorke, J., Moosavi, S. H., Shuldham, C., & Jones, P. W.
- Affiliations
- University of Salford (GB)
- Charing Cross Hospital (GB)
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- St George's, University of London (GB)
- Corresponding author
- Yorke, J
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2009-12-08
- Volume
- 65
- Issue
- 1
- Pages
- 21-26
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC2795166
- OpenAlex
- W2101443745
- Cited by
- 369
- References
- 36
- Citations by year
- 2026: 30 · 2025: 38 · 2024: 26 · 2023: 34 · 2022: 36 · 2021: 41 · 2020: 17 · 2019: 22 · 2018: 20 · 2017: 16 · 2016: 20 · 2015: 18 · 2014: 7 · 2013: 10 · 2012: 12
- FWCI
- 9.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- University of Salford Institutional Repository (University of Salford) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Royal Brompton and Harefield NHS Foundation Trust
- Action Medical Research
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Nursing › Research and Theory › Health Education and Validation
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- dyspnea, symptom assessment, chronic obstructive pulmonary disease, interstitial lung disease, chronic heart failure, Rasch analysis, psychometric validation, anxiety and depression
- MeSH terms
- Aged, Anxiety Disorders, Chronic Disease, Depressive Disorder, Disability Evaluation, Dyspnea, Epidemiologic Methods, Female, Heart Failure, Humans, Male, Terminology as Topic, Psychometrics, Lung Diseases, Interstitial, Pulmonary Disease, Chronic Obstructive
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