A critical review of the psychometric properties of the Nijmegen Questionnaire for hyperventilation syndrome
Open accessAbstract
The Nijmegen Questionnaire is commonly used by physiotherapists and other health professionals in clinical and research settings. This outcome measure was developed by researchers at the Nijmegen University in the Netherlands as a screening tool for the hyperventilation syndrome in the 1980s. However, the literature that supports the efficacy of its use is scarce. This paper examines the evidence in relation to the conceptual basis, validity, and reliability of the Nijmegen Questionnaire. A systematic review of the literature was carried out to identify studies that are related to the above measurement properties for the questionnaire. Studies identified were evaluated for their methodological qualities using the COSMIN checklist. The clinical utility of this instrument is also discussed. Issues associated with the development and validating process of this outcome measure are identified. There is also a lack of evidence in cultural validation given that the Nijmegen Questionnaire was developed in the Netherlands. While this is the only questionnaire currently available that is designed specifically for the screening of hyperventilation syndrome, administrators need to be aware of the issues identified in relation to validity and reliability when interpreting the results. Applying more robust validating processes to establish the efficacy of the Nijmegen Questionnaire appears to be a priority for researchers to improve the quality of health services for individuals suffering from hyperventilation syndrome.
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The Nijmegen Questionnaire has a documented cut-off score of 23/64 suggesting a positive diagnosis of HVS, which is widely applied.
“The cut-off score of 23/64 for the Nijmegen Questionnaire that suggests a positive diagnosis of HVS is documented48,49 and widely applied.50,51”
From Physiotherapy Education and Breathing Retraining for Patients With Hyperventilation Syndrome: An Observational Study (2026) · cites this paper as [50]
The Criterion validity section (p. 4) says the 23/64 cut-off is documented and applied in multidisciplinary health settings. However, the Introduction (p. 1) calls a score above 23/64 a positive *screening* result, and the Conclusion (p. 6) recommends interpreting it alongside other clinical assessments when diagnosing HVS. The source therefore supports the documented and applied cut-off, but not treating it alone as a positive diagnosis. (LLM, conf=0.85)
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Cites
Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome
van Dixhoorn, J., & Duivenvoorden, H. J. (1985) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(85)90042-x · Cited by 445 · see citing works
Hornsveld, H., Garssen, B., Dop, M. F., van Spiegel, P., & de Haes, J. (1996) · The Lancet · doi:10.1016/s0140-6736(96)02024-7 · Cited by 168 · see citing works
Diagnostic tests of hyperventilation syndrome
Vansteenkiste, J., Rochette, F., & Demedts, M. (1991) · European Respiratory Journal · doi:10.1183/09031936.93.04040393 · Cited by 103 · see citing works
Flagged first, then by citations
Research works printed but not linked: 19
- Bowling A (1997) Measuring Health: A Review of Quality of Life Measurement Scales (2nd edn). Buckingham: Open University Press.
- Bowling A (2001) Measuring Disease (2nd ed). Buckingham: Open University Press.
- Courtney R, Greenwood KM (2009) Preliminary investigation of a measure of dysfunctional breathing symptoms: The Self Evaluation of Breathing Questionnaire (SEBQ). International Journal of Osteopathic Medicine 12: 121-127. DOI: 10.1016/j.ijosm.2009.02.001 · DOI · Paper page
- Grossman P, de Swart J (1984) Diagnosis of hyperventilation syndrome on the basis of reported complaints. Journal of Psychosomatic Research 28: 97-104. DOI: 10.1016/0022-3999(84)90001-1 · DOI
- Hambleton R, Jones R (1993) An NCME instructional module on comparison of classical test theory and item response theory and their applications to test development. Educational Measurement: Issues and Practice 12: 3947. DOI: 10.1111/j.1745-3992.1993.tb00543.x · DOI
- Høegh M, Høegh SM (2009) Trans-adapting outcome measures in rehabilitation: Cross-cultural issues. Neuropsychological Rehabilitation 19: 955-970. DOI: 10.1080/09602010902995986 · DOI
- Laver Fawcett A (2007) Principles of Assessment and Outcome Measurement for Occupational Therapists and Physiotherapists: Theory, Skills and Application. West Sussex: John Wiley and Sons.
- Lum L (1975) Hyperventilation: The tip of the iceberg. Journal of Psychosomatic Research 19: 375-383. DOI: 10.1016/00223999(75)90017-3 · DOI
- McDowell I (2006) Measuring Health: A Guide to Rating Scales and Questionnaires (3rd edn). New York: Oxford University Press.
- Mokkink LB (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study. Quality of Life Research 19: 539-549. DOI: 10.1007/s11136-010-9606-8 · DOI · Paper page
- Mooney S, Candy S (2008) The real cost of effective treatment: A single case study of a patient with hyperventilation syndrome. New Zealand Journal of Physiotherapy 36: 88.
- Pallant J (2001) SPSS Survival Manual: A Step by Step Guide to Data Analysis Using SPSS. Berkshire: Open University Press.
- Rapee RM, Medoro L (1994) Fear of physical sensations and trait anxiety as mediators of the response to hyperventilation in nonclinical subjects. Journal of Abnormal Psychology 103: 693-699. DOI: 10.1037/0021843X.103.4.693 · DOI
- Rowley J, Nicholls DN (2006) Development of the RoBE self-efficacy scale for people with breathing pattern disorders. New Zealand Journal of Physiotherapy 34: 131-141.
- Scientific Advisory Committee of the Medical Outcomes Trust (2002) Assessing health status and quality-of-life instruments: Attributes and review criteria. Quality of Life Research 11: 193-205. DOI: 10.1023/A:1015291021312 · DOI
- Streiner D, Norman G (2008) Health Measurement Scales: A Practical Guide to Their Development and Use (4th edn). Oxford: Oxford University Press.
- Terwee CB, Mokkink LB, Knol DL, Ostelo R, Boutex LM, de Vet H (2012) Rating the methodological quality in systematic reviews of studies on measurement properties: A scoring system for the COSMIN checklist. Quality of Life Research 21: 651-657. DOI: 10.1007/s11136-011-9960-1 · DOI · Paper page
- Thomas M, McKinley R, Freeman E, Foy C, Prodger P , Price D (2003) Breathing retraining for dysfunctional breathing in asthma: A randomised controlled trial. Thorax 58: 110-115. DOI: 10.1136/thorax.58.2.110 · DOI · Paper page
- van Doorn P, Folgering H, Colla P (1982) Control of the end-tidal PCO2 in the hyperventilation syndrome: Effects of biofeedback and breathing insturctions compared. Bulletin Europeen De Physiotherpathologie Respiratoire 18: 829-836.
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Beaumont, M., Selleron, B., Passard, G., Karsandi, K., Proffit, M., Valentin, R., & Poncin, W. (2026) · Physiotherapy Canada · doi:10.3138/ptc-2024-0066
- Authors
- Ogilvie, V. L., & Kersten, P.
- Affiliations
- Middlemore Hospital (NZ)
- Venue
- New Zealand Journal of Physiotherapy
- Publisher
- Physiotherapy New Zealand
- Published
- 2015-03-01
- Volume
- 43
- Issue
- 1
- ISSN
- 0303-7193 (ISSN-L)
- 2230-4886
- OpenAlex
- W2321054043
- Cited by
- 10
- References
- 3
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2019: 2 · 2018: 1 · 2017: 1
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New Zealand Journal of Physiotherapy (publishedVersion)
- Tuwhera (Auckland University of Technology) (submittedVersion, other-oa)
- University of Brighton Repository (University of Brighton) (submittedVersion, other-oa)
- Funders
- Physiotherapy New Zealand
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Education › Health Education and Validation
- Keywords
- Nijmegen questionnaire, hyperventilation syndrome, psychometric properties, validity, reliability statistics, outcome measure validation, screening questionnaire, cultural validation, COSMIN checklist, clinical utility
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