Photo Credit: Lidiia Moor
Assessing outcome measures for dysfunctional breathing, which is characterized by deviations from normal breathing patterns manifesting in respiratory and non-respiratory symptoms.
Dysfunctional breathing (DB) is characterized by deviations from normal breathing patterns, manifesting in various respiratory and non-respiratory symptoms. Despite the clinical importance of evaluating DB, no comprehensive review has assessed the psychometric properties of the various outcome measures used to diagnose and monitor this condition.
Clinicians commonly use multiple outcome measures, including subjective and objective methods, to assess DB. However, previous studies have not thoroughly evaluated the reliability and validity of these measures. This gap hinders the establishment of standardized assessment protocols for DB, which is crucial for accurate diagnosis and effective treatment.
A recent study systematically reviewed the psychometric properties of existing DB outcome measures in adults. The Nijmegen Questionnaire (NQ) emerged as the highest-quality tool evaluated by the COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) guidelines, according to the study authors.
Before most DB outcome measures can be considered for routine clinical use, their content validity and other psychometric properties need thorough establishment. The NQ, given its robust psychometric properties, is recommended for assessing DB in adults.
DB involves alterations in normal biomechanical breathing patterns, leading to various symptoms such as breathlessness, chest tightness, and anxiety. It is prevalent in the general population and among those with respiratory conditions like asthma and COPD. DB can significantly impact QOL, necessitating accurate assessment and appropriate management.
The study followed the COSMIN guidelines and PRISMA recommendations for systematic reviews. A comprehensive search was conducted across multiple databases, and the review protocol was registered on PROSPERO. The authors included studies that assessed the validity and reliability of DB outcome measures in adults.
Out of 1881 references screened, 16 studies met the inclusion criteria. The review identified ten outcome measures for DB, including:
- The NQ
- Breathing Vigilance Questionnaire (Breathe-VQ)
- Manual Assessment of Respiratory Motion (MARM)
- Breathing Pattern Assessment Tool (BPAT)
- Total Faulty Breathing Scale (TFBS)
- Self-Evaluation of Breathing Questionnaire (SEBQ)
- Clinical assessments of increased work of breathing
- Milstein Breathing Pattern Assessment Index (M-BPAI)
- Hi-Lo test (excluded as not primary for DB)
- Dyspnoea-12 (excluded as not primary for DB)
The NQ stood out due to its extensive evaluation and strong psychometric properties, including content validity, internal consistency, and reliability. It is particularly noted for its application in conditions like bronchial asthma and hyperventilation syndrome. However, some aspects, such as certain items’ relevance and structural validity, need refinement.
Breathe-VQ shows promise for assessing excessive conscious breathing, though it requires further validation. BPAT, suitable for evaluating breathing irregularities, is still under trial and needs more extensive research before clinical application.
Other outcome measures, such as MARM and TFBS, have limited psychometric evaluation. They cannot be recommended for clinical use until their properties are further validated.
The review excluded non-English studies and grey literature, potentially missing relevant research. Additionally, the reviewers relied on clinical and scholarly experience rather than formal COSMIN training, which might influence quality ratings.
Future research should focus on thoroughly evaluating all psychometric properties of existing outcome measures or developing new ones following COSMIN guidelines. For new measures, detailed reporting of the development process and content validity is crucial.
The NQ is currently the most robust tool for assessing DB, showing high-quality evidence for its internal consistency and construct validity. However, most other measures lack comprehensive psychometric evaluation. Further research is essential to ensure these tools’ reliability and validity and enhance their utility in clinical practice.
