Department of Medicine, Pulmonary Division, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
Faculty of Education, University of Alberta, Edmonton, Canada.
Am J Hosp Palliat Care. 2024 Mar;41(3):253-261. doi: 10.1177/10499091231167879. Epub 2023 Mar 28.
xamine the validity of a novel dyspnea scale, Edmonton Dyspnea Inventory in idiopathic pulmonary fibrosis (IPF). Edmonton Dyspnea Inventory (EDI), is a clinical instrument to measure dyspnea severity with activities of daily living, exercise and rest using a numeric rating scale (0 -10). Consecutive IPF patients (2012-2018) with baseline MRC and EDI were included. To validate EDI, psychometric analysis was conducted. Correlations between EDI, MRC and lung function were examined. Group-based trajectory modeling was used to group patients based on dyspnea severity. Net Reclassification Improvement (NRI) was calculated to assess the improvement in 1-year mortality prediction by adding trajectory groups to MRC grade. 100 consecutive IPF patients were identified; mean age 73 years (SD = 9) and 65% males; 73% were in MRC grades ≥3. Item analysis showed all 8 EDI components have excellent discrimination power with ability to differentiate patients with varying dyspnea severity. EDI has good internal consistency (Cronbach α = .92). Exploratory factor analysis showed a one-factor solution with loadings from .66 to .89 suggesting 8 EDI components measured essentially one dimension of dyspnea. All EDI components were correlated with MRC and some with lung function. Modeling data identified three EDI dyspnea severity groups with differing mortality ( = .009). The addition of EDI dyspnea severity groups to the MRC score improved 1-year mortality prediction (NRI = .66; 95% CI, .18-1.14). EDI is a valid dyspnea instrument, correlated with MRC and lung function. It can categorize IPF patients into 3 dyspnea severity groups associated with increased mortality. We describe the development of a novel scale, Edmonton Dyspnea Inventory, that facilitates measurement of dyspnea severity in the context of daily activities in patients with IPF. The results indicate that the new instrument is valid and correlated to MRC. It identifies 3 categories of severity not recognized by MRC with impact on mortality. Knowledge of dyspnea severity can help triage patients and assign appropriate therapies.
研究一种新型呼吸困难量表，埃德蒙顿呼吸困难量表在特发性肺纤维化（IPF）中的有效性。埃德蒙顿呼吸困难量表（EDI）是一种临床工具，使用数字评分量表（0-10）测量日常生活、运动和休息时的呼吸困难严重程度。纳入了 2012-2018 年基线 MRC 和 EDI 的连续 IPF 患者。为了验证 EDI，进行了心理测量分析。检查了 EDI、MRC 和肺功能之间的相关性。使用基于组的轨迹建模根据呼吸困难严重程度对患者进行分组。计算净重新分类改善（NRI），以评估通过向 MRC 分级添加轨迹组来改善 1 年死亡率预测。确定了 100 例连续 IPF 患者；平均年龄 73 岁（标准差=9），65%为男性；73%的 MRC 分级≥3。项目分析表明，所有 8 个 EDI 分量都具有出色的区分能力，能够区分不同呼吸困难严重程度的患者。EDI 具有良好的内部一致性（Cronbach α=0.92）。探索性因子分析显示，一个因素解决方案的负荷从 0.66 到 0.89，表明 8 个 EDI 分量基本上测量了呼吸困难的一个维度。所有 EDI 分量与 MRC 相关，有些与肺功能相关。数据建模确定了三个 EDI 呼吸困难严重程度组，死亡率不同（=0.009）。将 EDI 呼吸困难严重程度组添加到 MRC 评分中可提高 1 年死亡率预测（NRI=0.66；95%CI，0.18-1.14）。EDI 是一种有效的呼吸困难工具，与 MRC 和肺功能相关。它可以将 IPF 患者分为 3 个呼吸困难严重程度组，与死亡率增加相关。我们描述了一种新型量表的开发，即埃德蒙顿呼吸困难量表，该量表便于在 IPF 患者的日常活动中测量呼吸困难严重程度。结果表明，新仪器是有效的，与 MRC 相关。它确定了 3 个 MRC 未识别的严重程度类别，对死亡率有影响。了解呼吸困难的严重程度可以帮助分诊患者并分配适当的治疗方法。
