8.1.2 Development of the multi-dimensional dyspnoea questionnaire (125)

Janelle Yorke, Lecturer, Salford Centre for Nursing Midwifery and Collaborative Health Care, IHSCR Salford University, Salford, United Kingdom Co authors: Shakeeb Moosavi, Caroline Shuldham, Carol Haigh, Margaret Lau-Walker, Peter Barnes & Paul Jone j.yorke@salford.ac.uk

Abstract:

Background:

In cardiopulmonary disease, dyspnoea can be severely debilitating and distressing. Dyspnoea, like pain, is subjective and consists of: intensity, quality, and affective components. However, measurement generally focuses on intensity; in part because no available tool measures the multidimensionality of dyspnoea. This paper presents development of the Multi-Dimensional Dyspnoea Questionnaire (MDDQ).

Aim:

To develop an instrument that captures multiple dimensions of dyspnoea.

Methods:

81 items were assembled into a list and administered in 2007 to 123 patients with COPD; 129 patients with interstitial lung disease; 106 patients with chronic heart failure. Patients were asked to respond to each item using: none, mild, moderate, or severe. Hierarchical method of item reduction was used to exclude items if ¡Ý60% of patients from each group rated them as ¡®none¡¯ or if they were influenced by age or gender. Item response theory (IRT) was applied to the remaining items. Principal components analysis (PCA) was then used to test for the presence of different domains and test internal consistency.

Results:

24 items were removed because of low response rate or gender or age bias. IRT removed a further 22 items. PCA of the retained 35 items produced a 3-component solution (Cronbach's alpha = 0.964). Component 1 (n = 17) related to various qualities of dyspnoea e.g.: ¡®laboured breathing¡¯; Component 2 (n = 10) related to affect e.g.: ¡®panicky¡¯; Component 3 (n = 4) related to a mixed item collection e.g.: ¡®light-headedness¡¯. Four items did not reach the pre-specified >0.5 factor loading threshold onto any of the 3 components e.g.: ¡®puffed¡¯.

Conclusion:

Dyspnoea is multidimensional. The MDDQ will have significant clinical utility in the assessment of dyspnoea and evaluation of therapeutic interventions. Providing clinicians with an instrument that measures multiply dimensions of dyspnoea will enable patients¡¯ to be evaluated and managed holistically.

Recommended reading list:

  • Banzett RB & Moosavi SH. Dyspnea and pain: Similarities and contrasts between two very unpleasant sensations. Amer Pain Society Bulletin 2001; 11:1 (and 6-8)
  • von Leupoldt A, Ambruzsova R, Nordmeyer S, Jeske N, Dahme B. Sensory and affective aspects of dyspnoea contribute differentially to the Borg scale¡¯s measurement of dyspnoea. Respiration 2006; 73(6):762-8

Source of Funding: UK - Health Service (Local)

Amount in Funding: 10,001 - 50,000

Biography:

Janelle is a lecturer in Adult Nursing at the University of Salford. She has special research interests in respiratory disease and patients¡¯ experience of dyspnoea; the subject of her PhD. Her PhD project relates to multi-dimensional dyspnoea assessment with the aim of developing a new tool. Janelle completed her Masters Research and Graduate Diploma (Cardio-thoracic Nursing) in Australia. She was formally the Editor of the Transplant Nurses Journal and sits on the Editorial Committee of other journals. Recent publications include a number of Cochrane systematic reviews relating to psychological interventions and family therapy for people with asthma.