Chest
Volume 139, Issue 1, January 2011, Pages 159-164
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Original Research
Signs and Symptoms of Chest Diseases
Dyspnea-12 Is a Valid and Reliable Measure of Breathlessness in Patients With Interstitial Lung Disease

https://doi.org/10.1378/chest.10-0693Get rights and content

Objective

In this study, we aimed to determine the validity and reliability of the Dyspnea-12 questionnaire (D-12) for the assessment of breathlessness in patients with interstitial lung disease (ILD).

Methods

A total of 101 patients with ILD completed the D-12 (scale range, 0-36, with a high score indicating worse dyspnea), Medical Research Council (MRC) dyspnea scale, St. George Respiratory Questionnaire (SGRQ), and Hospital Anxiety and Depression Scale (HADS) at baseline, and 84 patients completed the D-12 and a global health transition score at follow-up 2 weeks later. D-12 psychometric properties, including floor and ceiling effects, internal consistency, test-retest reliability, and construct validity were examined.

Results

The D-12 showed good internal consistency (Cronbach α, 0.93) and repeatability (intraclass correlation coefficient, 0.94). Its scores were significantly associated with MRC grade (r = 0.59; P < .001), SGRQ (symptoms, r = 0.57; activities, r = 0.78; impacts, r = 0.75; total, r = 0.79; P < .001). Factor analysis confirmed the previously determined structure of the D-12 in this patient group.

Conclusion

In patients with ILD, the D-12, a patient-reported measure of dyspnea severity that requires no reference to activity, is a reliable and valid instrument. It is short, simple to complete, and easy to score.

Section snippets

Subjects

All patients with documented ILD attending specialist outpatient clinics in northwest England between February 2008 and August 2009 were asked to participate. A total of 120 eligible patients were identified, and 101 participated after providing informed written consent. The study was approved by the Salford and Trafford (Greater Manchester, North West, England) Research Ethics Committee (07/H1004/168).

Study Design

For test-retest reliability, participants completed a set of four questionnaires, including

Subject Details

A total of 101 subjects completed the questionnaires at study baseline and 84 at follow-up. Etiologies of ILD were idiopathic pulmonary fibrosis (IPF) (n = 67), asbestosis (n = 18), sarcoidosis (n = 10), connective tissue disease (n = 2), amiodarone toxicity (n = 2), pulmonary Langerhans cell histocytosis (n = 1), and nonspecific interstitial pneumonia (n = 1). The mean ± SD and range of the physiologic and patient-reported outcomes for the study population are summarized in Table 1.

D-12 Scores

There were

Discussion

In this study, we examined the psychometric properties of the D-12 in a cohort of patients with ILD. We found the D-12 to possess excellent test-retest and internal consistency, and its scores correlated significantly and in the expected directions with other patient-reported outcome measures that assess HRQL or psychologic distress.

The results support the validity of the D-12 for assessing dyspnea at baseline and over time in this patient population. The D-12 is short and simple to use,

Acknowledgments

Author contributions: Dr Yorke: contributed to the study concept and design, statistical analysis, and manuscript preparation. She had full access to the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Swigris: contributed to the statistical analyses and manuscript preparation.

Ms Russell: contributed to the study concept and design, data collection, and manuscript preparation.

Dr Moosavi: contributed to the study concept and design.

Dr Ng Man

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Funding/Support: This study was funded by Action Medical Research, England. Dr Swigris is supported in part by a Career Development Award from the National Institutes of Health (K23 HL092227).

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