Breathing intensity and word use in individuals with COPD.

Shifts in natural or spontaneous language have been reported with psychological and physical changes, as well as shifts in predetermined words selected to describe dyspnea. Less evidence exists for natural language shifts and breathing intensity, particularly for everyday life and for negative emotion. Therefore, this study purpose was to describe the relationship between levels of everyday breathing intensity and the natural language word categories used in describing breathing, including a negative emotion category. A longitudinal descriptive research design and a convenience sample of 45 individuals were used. Natural language was analyzed as rates of word used based on three levels of breathing intensity. Non-parametric statistics were used to test differences between rates of word use and non-use on low, moderate, and high breathing intensity days, as well as correlations to subscales that measured negative emotion on the Bronchitis-Emphysema Symptom Checklist (BESC) and the Breathing Standard Index. Statistically significant associations were reported between level of breathing intensity and negative emotion, anger, cause, insight, time, and body words. Several significant correlations were reported with the psychosocial measures, including negative emotion and anxiety words with the BESC hopelessness/helplessness, time subscale, and negative emotion words with the inverse of typical breathing (i.e., atypical breathing). By showing significant associations between key word categories, in particular negative emotion and anger word use, levels of breathing intensity, and selected psychosocial measures, this study contributes to the body of knowledge about the influence of levels of breathing intensity on natural word use in everyday life.

Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you?

AIMS: Dyspnea is the most common symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and is linked to decreases in patient activity levels and quality of life. Use of standardized tools to measure dyspnea has a long history in respiratory care. However, in many cases it is not clear what is being quantified when using a particular tool. This review will consider the definition of and mechanisms believed to contribute to dyspnea, attempting to clarify what is being quantified in common tools currently available for dyspnea measurement.

Memory for symptoms in COPD patients: how accurate are their reports?

The purpose of this study was to examine the accuracy of self-reports of symptom intensity in patients with chronic obstructive pulmonary disease (COPD) and factors that might influence recall of that intensity. Thirty COPD (forced expiratory volume in one second (FEV1) 36 +/- 17% predicted) subjects recorded their dyspnoea and fatigue intensity scores on a 0-10 scale for 14 consecutive days. On the fourteenth day, subjects recalled their average, greatest and least symptom intensity for the previous 14 days. General cognitive function, spirometry, and oxygenation were also measured. No significant differences were found between actual and recalled scores for dyspnoea or fatigue. General cognitive function, measured by the Mini Mental State Exam, correlated with the greatest and least dyspnoea and average fatigue difference scores (recall-actual) and contributed to the variance in the average and least dyspnoea recalled scores. The greatest contributor to the variance in the recall scores of both symptoms was the symptom intensity level on the day of recall. These results highlight the importance of current levels of symptom intensity and cognitive function when appraising symptoms in chronic obstructive pulmonary disease patients.

Psychometric testing of fatigue instruments for use with cancer patients.

BACKGROUND: Cancer treatment-related fatigue (CRF) is a common side effect of cancer treatment. A problem identified in most reviews of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state. The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study. The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment. OBJECTIVES: The aims of this study were to determine the reliability, validity, and responsiveness of each instrument and to determine the ability of each instrument to capture CRF. METHODS: Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale (F_POMS-sf), Multidimensional Assessment of Fatigue (MAF), Lee Fatigue Scale (LFS), and the Multidimensional Fatigue Inventory (MFI). Data were collected at a university-based clinical cancer center and a freestanding comprehensive cancer center. Subjects completed all study instruments, which were presented in random order, at a time when CRF was expected to be high and again when it was expected to be low. A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data. RESULTS: Reliability estimates using Cronbach's alpha indicated that all instruments examined had good internal consistency. Test-retest correlations showed good stability for total scores on all the instruments, but some subscales of the LFS and MFI had marginal stability. Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity. All of the instruments showed responsiveness to changes in CRF related to treatment. CONCLUSIONS: The results of the study provide researchers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF.

Influence of attention and judgment on perception of breathlessness in healthy individuals and patients with chronic obstructive pulmonary disease.

BACKGROUND: Cognitive processes mediate judgments of sensation intensity and the perception of breathlessness. These processes depend on focused attention to make a determination, which has not been systematically investigated. OBJECTIVE: To examine the effect of attention on the perception of breathlessness given alterations in attentional focus based on the subject's experience with the perception. METHODS: Magnitude estimation techniques with inspiratory airflow resistance were used to examine the influence of variations in attentional focus on the judgments associated with the perception of breathlessness. Two experimental magnitude estimation conditions were used to alter the focus of attention and compare it with traditional techniques as a control condition (CC). The subject's typical breathing pattern (EXP-T) and clearest memory of breathlessness (EXP-M) were used as references in the experimental conditions. RESULTS: Findings revealed a significant main effect for condition (CC vs. EXP-T: F= 4.82, p < .01; CC vs. EXP-M: F= 14.82, p < .01) and an interaction effect for group by condition (CC vs. EXP-T: F = 4.82, p < .03; CC vs. EXP-M: F = 5.15, p < .03). Post hoc analysis revealed significant differences only for the chronic obstructive pulmonary disease (COPD) group in both comparisons. CONCLUSIONS: Findings indicate that different focuses of attention based on previous exposure to sensations have an impact on judgments used to determine the intensity of a sensation given similar presentation of stimuli, and thus contribute to alterations in the perception of breathlessness.

Dyspnea in patients with chronic obstructive pulmonary disease: does dyspnea worsen longitudinally in the presence of declining lung function?

OBJECTIVE: To determine the direction and rate of change in the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD) whose lung function has worsened over time. DESIGN: Secondary analysis of a longitudinal data set. SETTING: Outpatient clinic. PATIENTS: Thirty-four medically stable male subjects with chronic obstructive pulmonary disease studied for 5.3 +/- 3.5 years, with a mean reduction in FEV1 over the period studied of 330.9 +/- 288.0 mL. Subjects were 63.3 +/- 5.5 years of age at entry into the study. OUTCOME MEASURES: Dyspnea and functional status scores were obtained using the Pulmonary Functional Status and Dyspnea Questionnaire. RESULTS: There was no significant difference in reports of dyspnea from the beginning to the end of the study, despite significant reductions in lung function. Of all activities studied, dyspnea when raising arms overhead was the only activity showing a relationship to the slope of change in FEV1 %. CONCLUSION: These findings suggest that, although patients with chronic lung disease experience varying degrees of deterioration in lung function longitudinally, there is no evidence that they report worsening of dyspnea in tandem with these physiologic changes. In this study, patient ratings of dyspnea longitudinally were not directly linked to changes in lung impairment.

Planning and conducting a multi-institutional project on fatigue.

PURPOSE/OBJECTIVES: To describe the process used in proposal development and study implementation for a complex multisite project on cancer treatment-related fatigue (CRF), identify strategies used to manage the project, and provide recommendations for teams planning multisite research. DATA SOURCES: Information derived from project team meeting records, correspondence, proposals, and personal recollection. DATA SYNTHESIS: The project was built on preexisting relationships among the three site investigators who then built a team including faculty, research coordinators, staff nurses, and students. Study sites had a range of organizational models, and the proposal was designed to capitalize on the organizational and resource strengths of each setting. Three team members drawn from outside oncology nursing provided expertise in measurement and experience with fatigue in other populations. Planning meetings were critical to the success of the project. Conference calls, fax technology, and electronic mail were used for communication. Flexibility was important in managing crises and shifting responsibility for specific components of the work. The team documented and evaluated the process used for multisite research, completed a major instrumentation study, and developed a cognitive-behavioral intervention for CRF. CONCLUSIONS: Accomplishments during the one-year planning grant exceeded initial expectations. The process of conducting multisite research is complex, especially when the starting point is a planning grant with specific research protocols to be developed and implemented over one year. Explicit planning for decision-making processes to be used throughout the project, acknowledging the differences among the study settings and planning the protocols to capitalize upon those differences, and recruiting a strong research team that included a member with planning grant and team-building expertise were essential elements for success. IMPLICATIONS FOR NURSING PRACTICE: Specific recommendations for others planning multisite research are related to team-building, team membership, communication, behavioral norms, role flexibility, resources, feedback, problem management, and shared recognition.

Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M).

OBJECTIVE: Describe the process of development and testing to reduce the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) from 164 items to a modified questionnaire (the PFSDQ-M) consisting of 40 items. DESIGN: Instrument development and testing for reliability, validity, and practicality. SETTING: Hospital-based outpatients. PATIENTS: Testing was done on three groups of clinically stable patients with chronic obstructive pulmonary disease: a secondary analysis of 131 subjects for item selection, reliability, and validity; 50 additional subjects evaluating the PFSDQ-M for internal consistency, test-retest correlations, and construct validity; and 34 subjects from a longitudinal study for responsiveness. OUTCOME MEASURES: PFSDQ, PFSDQ-M, and spirometry. RESULTS: The practicality of the PFSDQ-M was supported by its sixth- to seventh-grade reading level, ease of reading (Flesch-Kincaid 69.5), self-administration, brief period for testing (7 minutes initially, 6 minutes on repeated testing), and limited missing data (< 8%). Reliability of the three components was supported by internal consistency alpha = 0.93 for change experienced by the patient with activities (CA), 0.95 for dyspnea with activities (DA), and 0.95 for fatigue with activities (FA). Good stability of the PFSDQ-M was demonstrated on test-retest; r = 0.70 for change, 0.83 for dyspnea, and 0.79 for fatigue (with activities). The usefulness of the PFSDQ-M in discriminating between dyspnea scores in patients based on their rate of deterioration in lung function was demonstrated. CONCLUSIONS: The PFSDQ was modified by reducing the number of activities evaluated, standardizing scaling formats, and adding a fatigue component. Findings suggest that the PFSDQ-M demonstrates initial reliability; good validity estimates, as seen with the factor analysis, and the dyspnea and activity scores appear responsive to physiologic changes in lung function over time.

Functional status instruments: outcome measure in the evaluation of patients with chronic obstructive pulmonary disease.

The purpose of this article is to review the instruments developed to measure functional status in patients with chronic obstructive pulmonary disease. Because the ability to carry out day-to-day activities is of primary importance to patients with chronic obstructive pulmonary disease, it is necessary for clinicians to understand which instruments provide the best measures of patient activity levels. Furthermore, as a critical outcome in managed care services, pulmonary critical pathways, and patient disability, the measurement of functional status in clinical practice assumes greater relevance. Functional status instruments in this review will refer to questionnaires measuring the day-to-day activities of patients. Questionnaires reviewed will include those that provide measures of general health status with activity-specific items, as well as questionnaires specifically designed to evaluate patients with pulmonary disease. The psychometric strengths, reliability and validity, and clinical utility of the instruments will be presented.

Focus on psychometrics. Scaling stimuli with magnitude estimation.

Magnitude estimation has been shown to be a useful model for scaling physical and social stimuli. This scaling method holds promise for researchers who are interested in scaling the individual's perceptions of physiological states such as breathlessness as well as social phenomena such as intrusiveness or difficulty in performing a task. The purpose of this article is to provide information about magnitude estimation as a scaling method in general and about the use of magnitude estimation to scale the individual's subjective responses to stimuli.