Validation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease

Ekström, Magnus; Bornefalk, Hans; Sköld, Magnus; Janson, Christer; Blomberg, Anders; Sandberg, Jacob; Bornefalk-Hermansson, Anna; Igelström, Helena; Sundh, Josefin

doi:10.1136/bmjresp-2018-000381

Cited by 27 publications

(63 citation statements)

References 30 publications

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“…Mean age of the study population was 69 years, 53% were women and 10% were current daily smokers. Further details of the study population have been presented elsewhere 26. The mean D-12 total score (±SD) was 16.0 (±9.2), the mean physical domain score was 9.8±5.3 and the mean affective domain score was 6.1 (±4.4).…”

Section: Resultsmentioning

confidence: 99%

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Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease

Sundh

Bornefalk²,

Sköld

et al. 2019

BMJ Open Resp Res

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IntroductionBreathlessness is the cardinal symptom in both cardiac and respiratory diseases, and includes multiple dimensions. The multidimensional instrument Dyspnoea-12 has been developed to assess both physical and affective components of breathlessness. This study aimed to perform a clinical validation of the Swedish version of Dyspnoea-12 in outpatients with cardiorespiratory disease.MethodsStable outpatients with cardiorespiratory disease and self-reported breathlessness in daily life were recruited from five Swedish centres. Assessments of Dyspnoea-12 were performed at baseline, after 30–90 min and after 2 weeks. Factor structure was tested using confirmatory factor analysis and internal consistency using Cronbach’s alpha. Test–retest reliability was analysed using intraclass correlation coefficients (ICCs). Concurrent validity at baseline was evaluated by examining correlations with lung function and several instruments for the assessment of symptoms and health status.ResultsIn total, 182 patients were included: with the mean age of 69 years and 53% women. The main causes of breathlessness were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%) and idiopathic pulmonary fibrosis (19%). Factor analysis confirmed the expected underlying two-component structure with two subdomains. The Dyspnoea-12 total score, physical subdomain score and affective subdomain scores showed high internal consistency (Cronbach’s alpha 0.94, 0.84 and 0.80, respectively) and acceptable reliability after 2 weeks (ICC total scores 0.81, 0.79 and 0.73). Dyspnoea-12 showed concurrent validity with the instruments modified Medical Research Council scale, COPD Assessment Test, European Quality of Life-Five Dimensions-Five levels, the Functional Assessment of Chronic Illness Therapy-Fatigue, the Hospital Anxiety and Depression Scale, and with forced expiratory volume in 1 s in percentage of predicted value. The results were consistent across different cardiorespiratory conditions.ConclusionThe Dyspnoea-12 is a valid instrument for multidimensional assessment of breathlessness in Swedish patients with cardiorespiratory diseases.

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Section: Resultsmentioning

confidence: 99%

“…The cohort was created with the primary aim of clinically validating the Swedish versions of the two multidimensional instruments D-12 and Multidimensional Dyspnoea Profile (MDP) against other existing instruments. The clinical validation of the MDP is reported elsewhere 26…”

Section: Methodsmentioning

confidence: 99%

Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease

Sundh

Bornefalk²,

Sköld

et al. 2019

BMJ Open Resp Res

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“…24e27 Patients were recruited at five outpatient clinics (Blekinge Hospital, Karlskrona; Karolinska University Hospital in Solna, Stockholm; University Hospital, Ume a; Uppsala University Hospital, Uppsala; and € Orebro University Hospital, € Orebro). The present database was used to validate the factor structure, reliability, and concurrent validity of the Swedish D12 and MDP, 20,21 but the present analyses have not been previously reported. This study was conducted in accordance with the amended Declaration of Helsinki.…”

Section: Design and Populationmentioning

confidence: 99%

Minimal Clinically Important Differences and Feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in Cardiorespiratory Disease

Ekström

Bornefalk²,

Sköld

et al. 2020

Journal of Pain and Symptom Management

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Context. Breathlessness is a cardinal symptom in cardiorespiratory disease and consists of multiple dimensions that can be measured using the instruments Dyspnea-12 (D12) and the Multidimensional Dyspnea Profile (MDP). Objectives. The objective of the study is to determine the minimal clinically important differences (MCIDs) of all D12 and MDP summary and subdomain scores as well as the instruments' feasibility in patients with cardiorespiratory disease. Methods. Prospective multicenter cohort study of outpatients with diagnosed cardiorespiratory disease and breathlessness in daily life. D12 and MDP were assessed at baseline, after 30e90 minutes and two weeks. MCIDs were calculated using anchorbased and distributional methods for summary and subdomain scores. Feasibility was assessed as rate of missing data, help required, self-reported difficulty, and completion time. Results. A total 182 outpatients (53.3% women) were included; main diagnoses were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%), and idiopathic pulmonary fibrosis (19%). Anchor-based MCIDs were for D12 total score 2.83 (95% CI 1.99e3.66); D12 physical 1.81 (1.29e2.34); D12 affective 1.07 (0.64e1.49); MDP A1 unpleasantness 0.82 (0.56e1.08); MDP perception 4.63 (3.21e6.05), and MDP emotional score 2.37 (1.10e3.64). The estimates were consistent with small-to-moderate effect sizes using distributional analysis, and MCIDs were similar between COPD and non-COPD patients. The instruments were generally feasible and quick to use. Conclusion. D12 and MDP are responsive to change and feasible for use for assessing multidimensional breathlessness in outpatients with cardiorespiratory disease. MCIDs were determined for use as endpoints in clinical trials. J Pain Symptom Manage 2020;60:968e975.

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“…This was an analysis of data from a longitudinal study of patients suffering from cardiorespiratory disease and breathlessness in everyday life. This body of work uses the dataset of which parts were used in published validation of the Swedish Multidimensional Dyspnea Profile (MDP) [21], the Dyspnoea-12 [22], and the instruments' clinical feasibility and minimal clinically important differences [23]. The present analyses are novel and not previously reported.…”

Section: Methodsmentioning

confidence: 99%

“…Also, the stability of such models over time is unknown. Using a well characterised longitudinal dataset [21] of 182 patients with asthma, COPD, heart failure, idiopathic pulmonary fibrosis, other interstitial lung disease and "other diagnoses" including depression, cancer, diabetes and renal failure we addressed the following aims:…”

Section: Introductionmentioning

confidence: 99%

A common model for the breathlessness experience

Finnegan

Pattinson

Sundh

et al. 2020

Preprint

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Introduction: Chronic breathlessness occurs across many different diseases, independently of severity. Yet, despite being strongly linked to adverse outcomes, chronic breathlessness is generally not considered a stand-alone treatment target. Here we move focus from identifying the "best" measurement tool and use data-driven techniques to identify and confirm the stability of underlying features (factors) driving breathlessness across different cardiorespiratory diseases. Such frameworks could provide an opportunity to address the underlying mechanisms of breathlessness and over-come issues with co-morbidities, particularly when medical therapies have been optimised. Methods: Longitudinal study of questionnaire data on 182 participants with main diagnoses of asthma (21.4%), COPD (24.7%), heart failure (19.2%), idiopathic pulmonary fibrosis (18.7%), other interstitial lung disease (5.5%), and "other diagnoses" (8.8%) were entered into an exploratory factor analysis (EFA). Participants were stratified based on their EFA factor scores, allowing us to examine whether the breathlessness experience differed across disease diagnosis. We then examined model stability after six months and established through an iterative process the most compact, and therefore least burdensome assessment tool. Results: From the 25 input measures, 16 measures were retained for model validation. The resulting model contained four factors to which we assigned the following descriptive labels: 1) body burden, 2) affect/mood, 3) breathing burden and 4) anger/frustration. Stratifying patients by their scores across the four factors revealed two groups corresponding to high and low burden. These were not found to be predictive of primary disease diagnosis and did remain stable after six months. Conclusions: We have identified four stable and disease-independent factors that seem to underlie the experience of breathlessness. We suggest that interventions may target factors within this framework to answer the question of whether they are also driving the experience itself.

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Validation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease

Cited by 27 publications

References 30 publications

Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease

Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease

Minimal Clinically Important Differences and Feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in Cardiorespiratory Disease

A common model for the breathlessness experience

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