Mahler Donald A, Witek Theodore J
Dartmouth Medical School, Lebanon, New Hampshire 03656-0001, USA.
COPD. 2005 Mar;2(1):99-103. doi: 10.1081/copd-200050666.
The Baseline (BDI) and Transition (TDI) Dyspnea Indexes provide interview-based measurements of breathlessness related to activities of daily living. The BDI is a discriminative instrument that includes specific criteria for each of three components at a single point in time. The TDI is an evaluative instrument that includes specific criteria for each of three components to measure changes from a baseline state. Observational studies have shown that patients with COPD generally experience a gradual progression of breathing difficulty as measured by the TDI over time. Randomized controlled trials have demonstrated excellent measurement characteristics of the TDI; these include responsiveness (ability to detect change) and construct validity (a change in the TDI correlates with changes in other variables). Supporting evidence for one unit as the minimal clinically important difference (MCID) of the TDI is based on: expert preference; use of the physician's global evaluation score as an anchor; and distribution estimates (standard error of measurement and 0.5 of the standard deviation). As an alternative to the interview process, self-administered computerized (SAC) versions of the BDI/TDI have been developed to provide direct patient-reported ratings of dyspnea. To further establish the MCID of the interview-administered and/or the SAC TDI, we recommend that a patient's report of global ratings of change by used as an independent standard or anchor.
基线（BDI）和过渡（TDI）呼吸困难指数提供了基于访谈的与日常生活活动相关的呼吸急促测量方法。BDI是一种判别工具，在单个时间点对三个组成部分中的每一个都包含特定标准。TDI是一种评估工具，对三个组成部分中的每一个都包含特定标准，以测量相对于基线状态的变化。观察性研究表明，慢性阻塞性肺疾病（COPD）患者随着时间推移，通过TDI测量的呼吸困难通常会逐渐加重。随机对照试验已证明TDI具有出色的测量特性；这些特性包括反应性（检测变化的能力）和结构效度（TDI的变化与其他变量的变化相关）。将一个单位作为TDI最小临床重要差异（MCID）的支持证据基于：专家偏好；将医生的整体评估评分用作对照；以及分布估计（测量标准误差和标准差的0.5）。作为访谈过程的替代方法，已开发出BDI/TDI的自我管理计算机化（SAC）版本，以提供患者直接报告的呼吸困难评分。为了进一步确定访谈管理的和/或SAC TDI的MCID，我们建议将患者报告的整体变化评分用作独立标准或对照。
