Perez Thierry, Roche Nicolas, Nunes Hilario, Burgel Pierre-Régis, Chaouat Ari, Surpas Pascale, Herengt Frédéric, Garcia Gilles, Grosbois Jean-Marie, Stelianides Sandrine, de Rigal Philippe, Guérin Philippe, Arnould Benoît, Coste Joël
CHU de Lille, Service de Pneumologie et Immuno-allergologie, Service d'Explorations Fonctionnelles Respiratoires, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France.
Hôpital Cochin, Service de Pneumologie, APHP, Paris, France.
Respir Med. 2023 Oct;217:107309. doi: 10.1016/j.rmed.2023.107309. Epub 2023 Jun 30.
Few questionnaires are available for routine assessment of dyspnea. The study aimed to design a self-administered questionnaire assessing the impact of chronic dyspnea on daily activities, named DYSLIM (Dyspnea-induced Limitation).
The development followed 4 steps: 1: selection of relevant activities and related questions (focus groups); 2: clinical study: internal and concurrent validity vs. modified Medical Research Council (mMRC), Baseline Dyspnea Index (BDI) and Saint George Respiratory Questionnaire (SGRQ); 3: item reduction; 4: responsiveness. Eighteen activities (from eating to climbing stairs) were considered with 5 modalities for each: doing the task slowly, taking breaks, seeking assistance, changing habits, and activity avoidance. Each modality was graded from 5 (never) to 1 (very often). Validation study included 194 patients: COPD (FEV1 ≥ 50% pred: n = 40; FEV1 < 50% pred: n = 65); cystic fibrosis (n = 30), interstitial lung disease (n = 30), pulmonary hypertension (n = 29). Responsiveness was evaluated by post-pulmonary rehabilitation data in 52 COPD patients.
Acceptability was high and short term (7 days) reproducibility was satisfactory (Kappa mostly above 0.7). Concurrent validity was high vs. mMRC (Spearman correlation coefficient, r = 0.71), BDI (r = - 0.75) and SGRQ (r = - 0.79). The reduced questionnaire with 8 activities (from cleaning to climbing stairs) and 3 modalities (slowly, seeking help, changing habits) showed a comparable validity and was chosen as the final short version. Effect size of rehabilitation was good for both the full (0.57) and short (0.51) versions. A significant correlation was also found between changes of SGRQ and DYSLIM post rehabilitation: r = - 0.68 and r = - 0.60 for full and reduced questionnaires, respectively.
The DYSLIM questionnaire appears promising for the evaluation of dyspnea-induced limitations in chronic respiratory diseases and seems suitable for use in various contexts.
用于日常呼吸困难评估的问卷较少。本研究旨在设计一份自我管理问卷，以评估慢性呼吸困难对日常活动的影响，即呼吸困难导致的活动受限问卷（DYSLIM）。
问卷开发遵循4个步骤：1：选择相关活动及相关问题（焦点小组）；2：临床研究：与改良医学研究委员会（mMRC）、基线呼吸困难指数（BDI）和圣乔治呼吸问卷（SGRQ）相比，评估内部效度和同时效度；3：条目删减；4：反应度评估。考虑了18项活动（从进食到爬楼梯），每项活动有5种情况：缓慢进行任务、休息、寻求帮助、改变习惯和避免活动。每种情况从5分（从不）到1分（非常频繁）进行评分。验证研究纳入了194例患者：慢性阻塞性肺疾病（COPD）（FEV1≥预计值的50%：n = 40；FEV1<预计值的50%：n = 65）；囊性纤维化（n = 30），间质性肺疾病（n = 30），肺动脉高压（n = 29）。通过52例COPD患者肺康复后的数据评估反应度。
问卷的可接受性高，短期（7天）重复性良好（kappa值大多高于0.7）。与mMRC（斯皮尔曼相关系数，r = 0.71）、BDI（r = - 0.75）和SGRQ（r = - 0.79）相比，同时效度高。包含8项活动（从清洁到爬楼梯）和3种情况（缓慢、寻求帮助、改变习惯）的简化问卷显示出相当的效度，并被选为最终的简短版本。康复对完整版（效应量为0.57）和简短版（效应量为0.51）的效果均良好。康复后SGRQ和DYSLIM的变化之间也存在显著相关性：完整版和简化版问卷的r分别为 - 0.68和 - 0.60。
DYSLIM问卷在评估慢性呼吸系统疾病中呼吸困难导致的活动受限方面似乎很有前景，且似乎适用于各种情况。
