Abstract
Dyspnea, the clinical term for shortness of breath, is the primary symptom and an important outcome measure in evaluations of patients with lung disease. It is a subjective symptom that has proved difficult to quantify. Many dyspnea measures are available, yet it is difficult, based on the existing literature, to determine the most reliable and valid. In this study, we evaluated 6 measures of dyspnea for reliability and validity: (a) Baseline Dyspnea Index (BDI) and Transition Dyspnea Index, (b) UCSD Shortness of Breath Questionnaire (SOBQ), (c) American Thoracic Society Dyspnea Scale, (d) Oxygen Cost Diagram, (e) Visual Analog Scale, and (f) Borg Scale. Subjects were 143 patients (74 women and 69 men) with obstructive lung disease, ages 40 to 86, FEV., 0.36 to 3.53 L, FVC 1.07 to 5.74 L. Dyspnea measures were assessed for test-retest reliability, internal consistency, interrater reliability, and construct validity (i.e.. correlations among dyspnea measures and correlations of dyspnea measures with exercise tolerance, health-related quality of life, lung function, anxiety, and depression). Results suggest that the SOBQ and BDI demonstrated the highest levels of reliability and validity among the dyspnea measures examined.
Similar content being viewed by others
References
Aitken, R. B. (1969). A growing edge of measurement of feelings. Proceedilings of the Royal Society of Medicine. 62. 989–993.
American Thoracic Society. (1978). Recommended respiratory disease questionnaires for use with adults and children in epidemiological research. American Review of Respiratory Disease. 118. 7–35.
American Thoracic Society. (1987). Standardization of spirometry—update. American Review of Respiratory Disease. 136. 1285–1296.
Archibald, C. J., & Guidotli, T. L. (1987). Degree of objectivity measured impairment and perceived shortness of breath with activities of daily living in patients with chronic obstructive pulmonary disease. Canadian Journal of Rehabilitation. 1(1), 45–54.
Belman, M. J., Brooks, L. R., Ross, D. J., & Mohsenifar, Z. (1991). Variability of brealhlessness measurement in patients with chronic obstructive pulmonary disease. Chest. 99. 566–571.
Borg, G. (1970). Perceived exertion as an indicator of somatic stress. Scandinavian Journal of Rehabilitation Medicine. 2(3), 92–98.
Borg, G. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise. 14(5), 377–381.
Burns, B. H.. & Howell, J. B. L. (1969). Disproportionately severe breathlessness in chronic bronchitis. Quarterly Journal of Medicine. 151. 277–294.
Burrows, B., Niden, A. H., Barclay, W. R., & Kasik, J. E. (1965). Chronic obstructive lung disease: II. Relationship of clinical and physiologic findings to the severity of airways obstruction. American Review of Respiratory Disease. 91, 665–678.
Carrieri, V. K., Janson-Bjerklie, S., & Jacobs, S. (1984). The sensation of dyspnea: A review. Heart & Lung. 13(4), 416–447,
Clausen, J. L., & Zarins, L. P. (1982). Pulmonary function testing guidelines and controversies: Equipment, methods, and normal values. New York: Academic.
Cronbach, L. J. (1984). Essential of psychological testing (4th ed.) New York: Harper & Row.
Dudley, D. L., Glaser, E. M., Jorgenson, B. N., & Logan, D. L. (1980). Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease: Part 1. Psychosocial and psychological considerations. Chest. 77, 413–420.
Dudley, D. L., Martin, C. J., & Holmes, T. H. (1968). Dyspnea: Psychologic and physiologic observations. Journal of Psychosomatic Research. 11, 325–339.
Eakin, E. G., Kaplan, R. M., & Ries, A. L. (1993). Measurement of dyspnea in chronic obstructive pulmonary disease. Quality of Life Research. 2, 181–191.
Eakin, E. G., Prewilt, L. M., Ries, A. L., & Kaplan, R. M. (1994) Validation of the UCSD Shortness of Breath Questionniare [abstract]. Journal of Cardiopulmonary Rehabilitation. 14(5), 322.
Fletcher, C. M. (1952). The clinical diagnosis of pulmonary emphysema—an experimental study. Proceedings of the Royal Society of Medicine. 45. 577–584.
Gift, A. G., Plaut, S. M., & Jacox, A, (1986). Psychologic and physiologic factors related to dyspnea in subjects with chronic obstructive pulmonary disease. Heart & Lung. 15(6). 595–601
Guyatt, G. H., Berman, L. B., Townsend, M. Pugsley, S. O., & Chambers, L. W. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax. 42. 773–778.
Guyatt, G. H., Pugsley, S. O., Sullivan, M. J., Thompson, P. J., Berman, L. B., Jones, N. L., Fallen, E. L., & Taylor, D. W. (1984). Walking test performance: The effect of encouragement. Thorax. 39, 818–822.
Guyatt, G. H., Thompson, P. J., Berman, L. B., Sullivan, M. J., Townsend, M., Jones, N. L., & Pugsley, S. O. (1985). How should we measure function in patients with chronic heart and lung disease? Journal of Chronic Disease. 38(6). 517–524.
Higgins, M. W. (1989). Chronic airways disease in the United States: Trends and determinant. Chest. 96(Suppl.), 328s-334s.
Kaplan, R. M., & Anderson, J. P. (1988). The quality of well-being scale: Rationale for a single quality of life index. In S. R. Walker & R. M. Rosser (Eds.), Quality of life: Assessment and application (pp. 51–77), London: MTP.
Kaplan, R. M., & Anderson, J. P. (1990). The general health policy model: An integrated approach. In B. Spiker (Ed.), Quality of life assessments in clinical trials (pp. 131–49). New York: Raven.
Kaplan, R. M., Atkins, C. J., & Timms. R, (1984). Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease. Journal of Chronic Disease. 37(2). 85–95.
Kaplan, R. M., Ries, A., & Atkins, C. J. (1985). Behavioral issues in the management of chronic obstructive pulmonary disease. Annals of Behavioral Medicine. 7(4), 5–9.
Kinsman, R. A., Yaroush, R. A., Fernandez, R. A., Dirks, J. F., Sehnocket, M., & Fukuhara, J. (1983). Symptoms and experiences in chronic bronchitis and emphysema. Chest. 5. 755–761.
Mahler, D. A. & Harver, A. (1990). Clinical Measurement of Dyspnea. In D. A. Mahler (Ed.). Dyspnea (pp. 75–126). New York: Futura.
Mahler, D. A., & Harver, A. (1992). A factor analysis of dyspnea ratings, respiratory muscle strength, and lung function in patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease. 145, 467–470.
Mahler, D. A., Weinberg, D. H., Wells, C. K., & Feinslein, A. R. (1984). The measurement of dyspnea: Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest. 85, 751–758,
Mahler, D. A., & Wells, C. K. (1988). Evaluation of clinical methods for rating dyspnea. Chest, 93, 580–586.
McGavin, C. R., Artvinli, M., & McHardy, G. J. R. (1978). Dyspnoea, disability, and distance walked: Comparison of estimates of exercise performance in respiratory disease. British Medical Journal. 2, 241–243.
Moody, L., McCormick, K., & Williams, A. (1990). Disease and symptom severity, functional status, and quality of life in chronic bronchitis and emphysema (CBE). Journal of Behavioral Medicine. 13(3), 297–306.
Mungall, I. P. F., & Hainsworth, R. (1979). Assessment of respiratory function in chronic obstructive airway disease, Thorax. 34. 254–258.
National Center for Health Statistics, Centers for Disease Control (1994). Mortality Patterns— United States. 1992. Morbidity and Mortality Weekly Report. 43, 916–921.
Nunnalty, J. C. (1978). Psychometric theory. New York: McGraw-Hill.
Pennebaker, J. W. (1982). The psychology of physical symptoms. New York: Springer-Verlag.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401
Renfroe, K. L. (1988). Effect on progressive relaxation on dyspnea and state anxiety in palients with chronic obstructive pulmonary disease. Heart & Lung. 17. 403–413.
Sassi-Dambron, D. E., Eakin, E. G., Ries, A. L., & Kaplan, R. M. (1995). Treatment of dyspnea in chronic obstructive pulmonary disease: A controlled clinical trial of dyspnea management strategies. Chest. 107, 724–729.
Spielberger, C. D., Gorsuch, R. L., Lushenc, R. E., Vagg, P. R. & Jacobs, G. A. (1983). State-trait anxiety inventory (Farm Y), Palo Alto, CA: Consulting Psychologists.
Wilson, R. C. & Jones, P. W. (1989). A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnea during exercise. Clinical Science. 76. 277–282.
Author information
Authors and Affiliations
Additional information
This research was supported by University of California Tobacco Related Disease Research Program Grant 2RT026S, National Heart. Lung, and Blood Institute Grant HL 34732 to Robert M. Kaplan, and National Institutes of Health NHLBI Preventive Pulmonary Academic Award No. HL02215 to Andrew L. Ries.
We thank Lela Prewill. Jan Jasiewicz, and Jay Yancey for their invaluable assistance in this study, and Donald Mahler for his hetpful comments on a previous draft of this article
Rights and permissions
About this article
Cite this article
Eakin, E.G., Sassi-Dambron, D.E., Ries, A.L. et al. Reliability and validity of dyspnea measures in patients with obstructive lung disease. Int. J. Behav. Med. 2, 118–134 (1995). https://doi.org/10.1207/s15327558ijbm0202_3
Issue Date:
DOI: https://doi.org/10.1207/s15327558ijbm0202_3