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Which measurement scales should we use to measure breathlessness in palliative care? A systematic review

Dorman, S., Byrne, A., and Edwards, A.
Introduction: There is no universally accepted measurement scale to assess breathlessness in adult palliative care patients. This significantly hampers clinical practice and research into effective interventions. The aim is to systematically identify and appraise breathlessness measurement scales, which are validated for use in palliative care or which show potential for use. Methods: We undertook systematic searches of electronic databases (Cochrane databases 2005, MEDLINE 1966-2005, OLDMEDLINE 1950-1965, EMBASE 1980-2005, PsycINFO 1872-2005, AMED 1985-2005, CINAHL 1982-2005, SIGLE 1980-2005) with follow-up searches (reference lists of included papers, handsearches of relevant journals). The basic search strategy was 'breathlessness (etc.) AND measurement (scales, validation etc.) AND palliative care/cardiac failure/respiratory disease/neoplasm etc.', modified for each database, without language restriction. Patient-based scales with evaluations of at least two psychometric characteristics were included. Exercise-based tests were excluded. Scales were appraised with particular emphasis on construct validity and responsiveness.Results: We identified 29 scales: six to measure breathlessness severity, four to assess breathlessness descriptions, and 19 to measure functional impact of breathlessness.Severity: The Numeric Rating Scale (NRS) and modified Borg Scale have been evaluated in COPD (the NRS has also been evaluated in cancer). Both require further assessment of responsiveness and test-retest reliability over time intervals relevant to palliative care. Visual Analogue Scales have also been evaluated, but require larger sample sizes than NRS for evidence of intervention effectiveness. Descriptions: The Japanese Cancer Dyspnoea Scale (CDS) has been evaluated in patients with cancer, but requires further assessment of construct validity and responsiveness. Functional impact: The Chronic Respiratory Questionnaire dyspnoea subscale (CRQ-D) has been evaluated in chronic lung diseases and heart failure; the MND Respiratory Scale is similar. CRQ-D has face and construct validity, test-retest reliability and responsiveness, and shows promise for palliative care. Conclusion: The NRS, modified Borg, CRQ-D and CDS appear most suitable for use in palliative care, but further evaluation is required before adopting any scale as standard. This review has been registered with the Cochrane collaboration and will be published and updated as a Cochrane review
Publication year:
Symptom status:
Physical state
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism
Diseases of and symptoms related to the respiratory system
Neoplasms and related symptoms
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
6 - Clinical rating scales
7 - Observations
ALSFRS-R - revised ALS Functional Rating Scale
ATS-DLD-78 - American Thoracic Society Respiratory Questionnaire 78 items
BCSS - Breathlessness, Cough and Sputum Scale
CHQ-D - Chronic Heart Failure Questionnaire-dyspnea subscale
Chronic lung disease (CLD) severity index
CLASP - Cardiovascular Limitations and Symptoms Profile
CRQ-D - Chronic Repiratory (disease) Questionnaire-dyspnea subscale
CRQ-IAS-D - Chronic Repiratory (disease) Questionnaire self-interviewer administered-dyspnea subscale
CRQ-SAI-D - Chronic Repiratory (disease) Questionnaireself-administered-dyspnea subscale
DAQ - Dyspnea Assessment Questionnaire
DDQ (COPD) - Dyspnea Descriptor Questionnaire (COPD)
DDQ(heart failure) - Dyspnea Descriptor Questionnaire (heart failure)
DNS - Dyspnoea Numeric Scale
EORTC QLQ-LC13 - European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire in patients with Lung cancer 13 item
Faces Scale
Global SOB - Global Shortness of Breath Question
LCADL - London Chest Activity of Daily Living Scale
mBORG - modified BORG scale
MDRS-D - Motor Neurone Disease Dyspnoea Scale-Dyspnoea subscale
mMRC - Modified Medical Research Council Dyspnea Scale
MRC Dyspnoea Scale - Medical Research Council Dyspnoea Scale   
NRS - Numeric Rating Scale (versions: NRS-6; NRS-11; NRS-21)   
OCD - Oxygen Cost Diagram
PFSDQ - Pulmonary Functional Status & Dyspnea Questionnaire (versions: PFSDQm)
RAND - Rand Instrument shortness of breath battery from the MedicaL History Questionnaire
SGRQ - St. George's Respiratory Questionnaire (versions: SGRQ-C - SGRQ-COPD)   
SS(SOBS) - Symptom Scale (Shortness of Breath Subscale)
UCDQ - Universitiy of Cincinnati Dyspnea Questionnaire
UCDS - University of California St.Diego (UCDS) Shortness of Breath Questionnaire
VAS - Visual Analogue Scale (versions: vertical; horizontal)