title: Verbal numerical scales are as reliable and sensitive as visual analog scales for rating dyspnea in young and older subjects Measuring health status in chronic airflow limitation. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Does oxygen help dyspnea in patients with cancer? Validation and clinical application of the german version of the palliative care outcome scale. Measuring functional status in chronic lung disease: conclusions from a randomized control trial. Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group. Use of upper limb exercise to assess breathlessness in patients with cancer: tolerability, repeatability, and sensitivity. A measure of quality of life for clinical trials in chronic lung disease. Establishing the minimal number of items for a responsive, valid, health-related quality of life instrument.
abstract: This study compared the use of a simple verbal 0 - 10 numerical rating scale ( verbal NRS ) and a visual analog scale ( VAS ) for the rating of dyspnea during exercise in a group of young and older subjects . Twelve younger ( 32+/-9 yr ) and 12 older ( 71+/-7 yr ) subjects used either the verbal NRS or the VAS in a r and omised fashion to rate dyspnea during 60 s of uphill treadmill walking ( range 5.6 - 8.8 km h(-1 ) ) performed at either a low ( 17 % grade ) or high workload ( 26 % grade ) and then during recovery . Rating scales were evaluated twice on separate days ( day 1 and day 2 ) at each workload . While the verbal NRS scores proved to be reliable throughout exercise and recovery , VAS scores were significantly ( p<0.05 ) lower on day 2 during the low workload test ( younger group ) and the high workload test ( older group ) . Verbal NRS ratings were consistently greater than VAS ratings at both workloads ( p<0.001 ) for both young and older groups . The intra-class correlation coefficients for rating peak dyspnea using either the VAS or verbal NRS were consistently lower for the older subjects ( range : r=0.54 - 0.67 ) than the younger subjects ( range : r=0.70 - 0.86 ) . Overall , subjects preferred the verbal NRS to the VAS . These results suggest that the verbal NRS compares favourably with the VAS for rating dyspnea during exercise without mask or mouthpiece . However , when rating peak dyspnea both scales appear less reliable when used by the older compared to young subjects A health status instrument for use in clinical trials must be valid ( measuring what it is supposed to measure ) and responsive ( able to detect clinical ly important change ) . Approaches to measuring health status in clinical trials include using a battery of instruments , a general instrument which provides a profile of the patient 's health , an instrument that generates a health utility , or an instrument that focuses on the problems associated with a particular disease . Disease-specific instruments have been used in clinical trials in chronic airflow limitation ( CAL ) . The Oxygen Cost Diagram is simple and easy to administer , but responsiveness and validity are unproven . The Transition Dyspnoea Index is valid and responsive , but is difficult to use in trials in which multiple measurements are desired . The Chronic Respiratory Disease Question naire has proved valid and responsive in controlled trials in CAL patients .  Health status measures  should be included in all clinical trials in CAL 1 . The intensity of breathlessness during exercise was measured in ten normal subjects using a visual analogue scale ( VAS ) and a Borg scale to compare the use of the scales and their repeatability , both within the duration of a period of exercise and between tests . For each scale , subjects performed two exercise tests separated by a period of 2 - 6 weeks . Each exercise test consisted of two cycles of progressively increasing and decreasing workload . 2 . All subjects felt confidently able to use both scales to quantify their feelings of breathlessness exclusively of other sensation . Equal preference was expressed for use of a particular scale . 3 . With both scales there was a large intersubject variation in the relationship between dyspnoea score and minute ventilation ( VE ) ( P less than 0.01 ) , and in the range of the scale used . 4 . There was a good correlation between the VAS and Borg scores at each level of VE ( r2 = 0.71 ) , but the VAS score was used over a wider range than the Borg score . 5 . The relationship between VE and the dyspnoea score measured by the two techniques was predominantly linear . The mean r2 for VAS score/VE was 0.68 ( SD 0.19 ) and for Borg score/VE the mean r2 was 0.75 ( SD 0.13 ) . 6 . The relationships VAS score/VE and Borg score/VE were unaffected by the direction in which the workload was varied ( P greater than 0.05 ) . 7 . VE , measured at each work rate , did not differ between the two cycles ( P greater than 0.05 ) or between the 2 days ( P greater than 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Dyspnea in patients with advanced cancer is a common symptom that is difficult to treat . This study investigated whether oxygen helps to relieve rest dyspnea in patients with advanced cancer . In a single-blind controlled trial , oxygen and air were administered in r and om order to hospice patients reporting dyspnea at rest . Measurements of arterial oxygen saturation , lung function , and dyspnea ( using a visual analogue scale [ VAS ] and Borg score ) were made before and after each gas had been given for 15 min . Data from 38 patients were used : analysis of variance revealed that mean VAS levels during baseline conditions , breathing room air ( 59 mm ) , were significantly reduced after administration of either air ( 48 mm ; p < 0.001 ) or oxygen ( 45 mm ; p < 0.001 ) ; there was no significant difference for the mean VAS scores between oxygen and air administration . There was no statistically significant order of treatment effect . There was no difference in the response to oxygen or air in patients with a history of cardiopulmonary disease . The improvement in dyspnea with oxygen could not be predicted from a subject 's initial level of hypoxia . Results suggested that benzodiazepines may potentiate the effect of oxygen . The overall conclusion is that oxygen and air can have a significant effect in reducing dyspnea at rest in patients with advanced cancer The Palliative Care Outcome Scale ( POS ) is a multidimensional instrument covering physical , psychosocial , spiritual , organizational , and practical concerns . This study vali date d the German version of the POS and used the tool in different palliative care setting s in Germany and Austria . Patients and staff were asked to complete the POS three times and evaluate the question naire and the translation afterwards . One hundred eighteen patients ( 44 male , 74 female , mean age 63 years , all suffering from advanced cancer ) completed the POS one time , 55 patients two times , and 36 patients three times . Spearman 's rho was highly significant for pain , other symptoms , anxiety , and life worthwhile in the first two assessment s. The third assessment showed significant correlations for pain , other symptoms , anxiety , and family anxiety . Seventy-seven of 87 patients answered questions regarding the scale and the translation . All questions other than " Over the past 3 days , have you felt good about yourself ? " were underst and able for patients . Almost half of the staff was undecided whether the tool was reflecting the patients ' condition . In contrast , the majority of patients liked it . Thus , the German version of the POS is well accepted by patients and staff and appears to be valid , although there are some areas where the scale would benefit from expansion to more closely capture staff and patient concerns The optimal method of assessing the effect of treatment on the day-to-day function of patients with chronic airflow limitation is not established . Therefore , we examined the performance of the Six Minute Walk test , a rating of dyspnea following the test and three different question naires measuring dyspnea in daily activities , in a controlled trial of inhaled salbutamol and oral theophylline in 24 patients with primarily fixed chronic airflow limitation . Clinical ly important and statistically significant effects of salbutamol and theophylline on dyspnea during day-to-day activities were detected by each measure , but the Chronic Respiratory Question naire ( CRQ ) appeared more powerful than either the Oxygen Cost Diagram or the Medical Research Council Dyspnea Question naire as modified by the R and Corporation . Changes in the CRQ dyspnea score showed a higher correlation with changes in spirometry , walk test score , dyspnea following the walk test , and global ratings of dyspnea than did the other two measures . Results of the walk test demonstrated statistically significant salbutamol and theophylline effects , but suggested that no added benefit could be obtained with both drugs ; the rating of dyspnea following the walk test , however , was consistent with an additive effect . We conclude that the CRQ is a responsive , valid measure of functional status for clinical trials in chronic lung disease , and that when the six minute walk is used as a measure of outcome , dyspnea following the walk test should be measured OBJECTIVES : To develop an outcome measure for patients with advanced cancer and their families which would cover more than either physical symptoms or quality of life related questions . To vali date the measure in various specialist and non-specialist palliative care setting s throughout the UK . DESIGN : A systematic literature review of measures appropriate for use in palliative care setting s was conducted . In conjunction with a multidisciplinary project advisory group , questions were chosen for inclusion into the scale based on whether they measured aspects of physical , psychological , or spiritual domains pertinent to palliative care , and whether similar items had shown to be valid as part of another measure . A staff completed version was developed to facilitate data collection on all patients throughout their care , and a patient completed version was design ed to enable the patient to contribute to the assessment of their outcomes when possible . A full validation study was conducted to evaluate construct validity , internal consistency , responsiveness to change over time , and test-retest reliability . Assessment s were timed . SETTING : Eight centres in Engl and and Scotl and providing palliative care , including inpatient care , outpatient care , day care , home care , and primary care . PATIENTS : A total of 450 patients entered care during the study period . Staff collected data routinely on patients in care long enough to be assessed ( n = 337 ) . Of these , 262 were eligible for patient participation ; 148 ( 33 % ) went on to complete a question naire . MAIN MEASURES : The Palliative Care Outcome Scale ( POS ) , the European Organisation for Research on Cancer Treatment , and the Support Team Assessment Schedule . RESULTS : The POS consists of two almost identical measures , one of which is completed by staff , the other by patients . Agreement between staff and patient ratings was found to be acceptable for eight out of 10 items at the first assessment . The measure demonstrated construct validity ( Spearman rho = 0.43 to 0.80 ) . Test/re-test reliability was acceptable for seven items . Internal consistency was good ( Cronbach 's alpha = 0.65 ( patients ) , 0.70 ( staff ) ) . Change over time was shown , but did not reach statistical significance . The question naire did not take more than 10 minutes to complete by staff or patients . CONCLUSION : The POS has acceptable validity and reliability . It can be used to assess prospect ively palliative care for patients with advanced cancer We report the development of an arm exercise test to assess breathlessness in patients with lung cancer who are breathless at low levels of exertion .  Exercise consisted of raising the arm over 40 cm , either the dominant arm only ( n=10 ) or both arms alternating at minute intervals ( n=12 ) . Subjects breathed through a mouthpiece , and ventilation ( VE ) and oxygen uptake ( VO(2 ) ) were measured . Following familiarization , three tests were performed over one week to explore repeatability , and sensitivity was assessed in a fourth test . Arm exercise was generally well tolerated and increased breathlessness , VE , and VO(2 ) . The commonest factor limiting exercise was arm fatigue , although four patients in the two-arm test also reported breathlessness . Repeatability for breathlessness score and VE was best in the two-arm test . The added resistance used to assess sensitivity could not be detected . The two-arm test offers a potential means of assessing the effects of an intervention on breathlessness and E in patients for whom a cycle or treadmill exercise test is unsuitable Since the relationships between pulmonary function , exercise capacity , and functional state or quality of life are generally weak , a self report question naire has been developed to determine the effect of treatment on quality of life in clinical trials . One hundred patients with chronic airflow limitation were asked how their quality of life was affected by their illness , and how important their symptoms and limitations were . The most frequent and important items were used to construct a question naire evaluating four dimensions : dyspnoea , fatigue , emotional function , and the patient 's feeling of control over the disease ( mastery ) . Reproducibility , tested by repeated administration to patients in a stable condition , was excellent : the coefficient of variation was less than 12 % for all four dimensions . Responsiveness ( sensitivity to change ) was tested by administering the question naire to 13 patients before and after optimisation of their drug treatment and to another 28 before and after participation in a respiratory rehabilitation programme .  In both cases large , statistically significant improvements in all four dimensions were noted . Changes in question naire score were correlated with changes in spirometric values , exercise capacity , and patients ' and physicians ' global ratings . Thus it has been shown that the question naire is precise , valid , and responsive . It can therefore serve as a useful disease specific measure of quality of life for clinical trials Reducing the number of items in a health-related quality of life instrument will enhance efficiency . However , it is important to maintain measurement properties . We determined the effect of reducing items from each domain ( dyspnea , fatigue , emotion and mastery ) of the 20-item Chronic Respiratory Question naire ( CRQ ) .  Three r and omized trials of respiratory rehabilitation provided data . We removed items one at a time from each domain in three orders : by item impact , item responsiveness , and at r and om . Responsiveness , test-retest reliability and construct validity were evaluated at each step . Responsiveness and reliability , evaluated by intraclass correlation coefficients ( ICC ) , were reduced marginally as the number of items was reduced to two items per domain . The deterioration was greatest when reducing from two items to one . To detect a particular effect , sample size would increase by about 10 % when reducing the number of items in a domain to 2 . Construct validity showed a more marked deterioration . Reducing to two items per domain would maintain responsiveness and reliability of the CRQ at an acceptable level , with a trade-off of reduced construct validity and increase in sample size requirements
target: SUMMARY Despite a variety of measurement tools none can be recommended as gold st and ard for the assessment of dyspnoea .
  A combination of unidimensional and multidimensional tools seems to be the best for clinical assessment .
background: PURPOSE OF REVIEW Refractory dyspnoea is a common and difficult to treat symptom in advanced disease .
  Accurate assessment helps to guide treatment and prognosis .
  RECENT FINDINGS The absence of commonly agreed assessment tools has been a significant barrier to improving care through inhibition of clinical research and limitation of clinicians ' ability to assess the effectiveness of their interventions .
  Two recently published systematic review s on measurement tools for breathlessness identified a variety of tools but none could be recommended as gold st and ard .
  For clinical purpose s , the combination of a unidimensional tool to assess dyspnoea severity and a multidimensional tool to evaluate the impact on a person 's quality of life seem most appropriate .
  This review discusses the present evidence and puts forward a strategy for assessment and measurement of the symptom in clinical practice .