Martinez J A, Straccia L, Sobrani E, Silva G A, Vianna E O, Filho J T
Department of Medicine, University of São Paulo-Medical School of Ribeirão Preto, Brazil.
Am J Med Sci. 2000 Oct;320(4):240-3. doi: 10.1097/00000441-200010000-00003.
Multiple physiological, psychological, social and environmental factors may affect the perception of dyspnea. Although different scales have been used to record the severity of dyspnea in subjects with chronic obstructive pulmonary disease (COPD), none has reported evaluating the properties of such tools in illiterate patients. The objective of this study was to evaluate the reliability and features of concurrent validity of 4 dyspnea scales in illiterate (IL) subjects with COPD.
One hundred COPD patients submitted to spirometry and were asked to score their breathlessness using a visual analogue scale (VAS), a numerical rating scale (NRS), the Borg scale (BS), and the basal dyspnea index (BDI). Each scale was presented to the patients before and after they had performed spirometry and measurement of residual volume. The obtained scores were analyzed according to the literacy status of the patients.
Thirty-three patients were classified as IL and 67 as literate (L). Both groups showed similar respiratory impairment and median scores of dyspnea (VAS, L = 45.0, IL = 49.0; NRS, L = 5.0, IL = 5.0; BS, L = 3.0, IL = 3.0; BDI, L = 5.0, IL = 4.0). No significant differences were found between the dyspnea scores obtained before and after spirometry for all scales in both groups. The degree of correlation between forced expiratory volume in 1 second (FEV1) and usual dyspnea evaluated by BDI did not show a statistical difference between the two groups (L, r = 0.37; IL, r = 0.51).
The employed dyspnea scales showed comparable reliability in both L and IL COPD subjects.
多种生理、心理、社会和环境因素可能影响呼吸困难的感知。尽管已使用不同量表记录慢性阻塞性肺疾病（COPD）患者的呼吸困难严重程度，但尚无研究报告评估这些工具在文盲患者中的特性。本研究的目的是评估4种呼吸困难量表在文盲（IL）COPD患者中的信度和同时效度特征。
100例接受肺活量测定的COPD患者，被要求使用视觉模拟量表（VAS）、数字评定量表（NRS）、博格量表（BS）和基础呼吸困难指数（BDI）对其呼吸困难程度进行评分。在患者进行肺活量测定和残气量测量前后分别呈现每种量表。根据患者的识字状况对获得的评分进行分析。
33例患者被归类为文盲，67例为识字（L）。两组的呼吸功能损害和呼吸困难中位数评分相似（VAS，识字组=45.0，文盲组=49.0；NRS，识字组=5.0，文盲组=5.0；BS，识字组=3.0，文盲组=3.0；BDI，识字组=5.0，文盲组=4.0）。两组所有量表在肺活量测定前后获得的呼吸困难评分之间均未发现显著差异。两组之间，1秒用力呼气量（FEV1）与BDI评估的日常呼吸困难之间的相关程度无统计学差异（识字组，r = 0.37；文盲组，r = 0.51）。
所采用的呼吸困难量表在识字和文盲COPD患者中显示出相当的信度。
