Proposing a standardized method for evaluating patient report of the intensity of dyspnea during exercise testing in COPD

Abstract

BackgroundMeasuring dyspnea intensity associated with exercise provides insights into dyspnea-limited exercise capacity, and has been used to evaluate treatment outcomes for chronic obstructive pulmonary disease (COPD). Three patient-reported outcome scales commonly cited for rating dyspnea during exercise are the modified Borg scale (MBS), numerical rating scale for dyspnea (NRS-D), and visual analogue scale for dyspnea (VAS-D). Various versions of each scale were found. Our objective was to evaluate the content validity of scales commonly used in COPD studies, to explore their ability to capture patients’ experiences of dyspnea during exercise, and to evaluate a standardized version of the MBS.MethodsA two-stage procedure was used, with each stage involving one-on-one interviews with COPD patients who had recently completed a clinic-based exercise event on a treadmill or cycle ergometer. An open-ended elicitation interview technique was used to understand patients’ experiences of exercise-induced dyspnea, followed by patients completing the three scales. The cognitive interviewing component of the study involved specific questions to evaluate the patients’ perspectives of the content and format of the scales. Results from Stage 1 were used to develop a standardized version of the MBS, which was then subjected to further content validity assessment during Stage 2.ResultsThirteen patients participated in the two-stage process (n = 6; n = 7). Mean forced expiratory volume in 1 second (FEV1) percent predicted was 40%, mean age 57 years, and 54% were male. Participants used a variety of terms to describe the intensity and variability of exercise-induced dyspnea. Subjects understood the instructions and format of the standardized MBS, and were able to easily select a response to report the level of dyspnea associated with their recent standardized exercise.ConclusionThis study provides initial evidence in support of using a standardized version of the MBS version for quantifying dyspnea intensity associated with exercise in patients with COPD.

Gender disparity of changes in heart rate during the six-minute walk test among patients with chronic obstructive airway disease

“…In contrast, we also found that the reduction in SpO2 was not significantly correlated with the Distance 6MWT, which is consistent with the findings of previous studies of World Medical Association (2013) and Camargo et al 7,12,13 The 6MWT includes two objective parameters: walk distance (6MWD) and oxygen saturation (SpO2). Georgiopoulou et al and Borghi-Silva et al, reported that under the influence of a pulmonary rehabilitation program, improve heart rate in exercise and lower heart rate at rest.…”

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

“…Procedure Dyspnoea is measured using either the 10-point Borg scale (CR-10) [153] or a 100-mm visual analogue scale (VAS) [154,155]. The CR-10 scale is derived from the original Borg 6-20-point perceived exertion scale (corresponding to a heart rate range of 60-200 bpm) [155,156], modified to an open-ended 10-point scale including written indicators of severity to anchor specific numbers on the scale [153].…”

“…The CR-10 scale is derived from the original Borg 6-20-point perceived exertion scale (corresponding to a heart rate range of 60-200 bpm) [155,156], modified to an open-ended 10-point scale including written indicators of severity to anchor specific numbers on the scale [153]. This was updated in 2010 with categories similar to the original 1982 scale, but having 19 points [155,156]. In addition, a "modified CR-10 Borg scale", which is not open-ended, is frequently used [155,156].…”

“…This was updated in 2010 with categories similar to the original 1982 scale, but having 19 points [155,156]. In addition, a "modified CR-10 Borg scale", which is not open-ended, is frequently used [155,156]. Readers should be aware that all of them are described (and frequently misquoted) as Borg or CR-10 scales in the literature [155].…”

“…Before exercise testing, subjects must be familiarised with the CR-10 or VAS, preferably by means of written instructions [154,155]. Dyspnoea should be measured at rest when the patient is ready to exercise, at least every 2 min during the test and at end-exercise [154,155].…”