Date Published: April 30, 2019
Publisher: Public Library of Science
Author(s): Letícia F. Belo, Antenor Rodrigues, Ana Paula Vicentin, Thaís Paes, Larissa Araújo de Castro, Nidia A. Hernandes, Fabio Pitta, Barbara Schouten.
To provide a Portuguese version of the Multidimensional Dyspnea Profile (MDP), investigating its validity and reliability in Brazilian patients with COPD.
This was a cross-sectional study for translation and linguist validation of the Portuguese MDP version for patients with COPD. The process occurred according to the protocol of Mapi Research Trust, Lyon, France. Three scores of MDP were used for the analysis: the immediate unpleasantness of dyspnea (A1); the “immediate perception domain” (S) (sum of A1 plus the sensory descriptors) and the “emotional response domain” (A2) (sum of the emotional descriptors). The questionnaires COPD assessment Test (CAT), Hospital Anxiety and Depression scale (HADS) and Medical Research Council scale (MRC) were used as anchors to investigate MDP’s validity. Internal consistency was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficient (ICC) and concurrent validity was assessed with Spearman correlation coefficients.
Thirty patients with moderate-severe COPD were studied for MDP’s validation analysis (43% male, 63±8years, body mass index [BMI] 27±6Kg/m2, forced expiratory volume in the first second [FEV1] 48±15%predicted, six-minute walking test [6MWT] 464±84m and 84±16%predicted), whereas 10 patients were excluded from the test-retest reliability analysis due to missing data, resulting in a sample of 20 subjects for this purpose (50% male, 62±8years, BMI 27±6Kg/m2, FEV1 48±15%predicted, 6MWT 452±93m and 82±19%predicted). Both samples were similar regarding general characteristics (P>0,05 for all variables). MDP presented strong correlations, i.e., ICC intra-rater: A1: 0.77 (0.48–0.90), S: 0.78 (0.52–0.91), and A2: 0.85 (0.66–0.94), with high internal consistency (Cronbach’s α 0.86, 0.88 and 0.92 respectively); and ICC inter-rater: A1: 0.74 (0.46–0.89), S: 0.75 (0.48–0.89) and A2: 0.91 (0.78–0.96) with Cronbach’s α 0.85, 0.86 and 0.95 respectively.
The Portuguese version of the MDP is the first valid and reliable instrument to assess dyspnea multidimensionally in Portuguese-speaking patients with COPD.
Dyspnea is a major disabling symptom reported by patients with chronic obstructive pulmonary disease (COPD), described as a subjective experience, derived from interactions among multiple physiological, psychosocial, and environmental factors . Noteworthy, the majority of available instruments in Portuguese assesses dyspnea only in a one-dimensional approach [2,3]. Therefore, an instrument in Portuguese language which is able to assess and distinguish multiple aspects of dyspnea is necessary.
This was a cross-sectional study involving the translation and linguist validation of the MDP. The Portuguese version has been developed by three of the present researchers (LFB, LAC and NAH) in collaboration with Robert Banzett and Mapi Research Trust, Lyon, France (for information about permission to use the MDP, please access https://eprovide.mapi-trust.org), according to standard process of forward and backward translations, followed by cognitive interviews with five patients with previous diagnosis of chronic respiratory diseases (COPD, bronchiectasis and asthma) (S1 and S2 Appendix). The process was undertaken similarly to the French version , and it was not necessary to adapt or withdraw any item of the instrument.
Thirty patients with COPD were included in the validation analysis (43% male, 63±8years, body mass index [BMI] 27±6Kg/m2, forced expiratory volume in the first second [FEV1] 48±15%predicted, 6MWT 464±84m and 84±16%predicted). Ten patients were excluded from the reliability analysis due to the unavailability of data from the second and/or third MDP application upon these patients’ request to be dismissed from this assessment. This resulted in a sample of 20 subjects for this purpose (50% male, 62±8years, BMI 27±6Kg/m2, FEV1 48±15%predicted, 6MWT 452±93m and 82±19%predicted). Both samples were similar regarding general characteristics (P>0.05 for all). No patient reported exacerbation of symptoms and/or hospitalization during the focal period (data evaluated by a general questionnaire of anthropometric and exacerbation data).
Similarly to the French version , the moderate-to-strong correlations between the MDP Portuguese version and a priori established anchors (i.e., CAT, HADS and MRC) (Table 1) demonstrate that this version was valid to assess dyspnea in patients with COPD, strongly endorsing its use. Notably, concurrent validity was carried out against these three instruments since they are widely used in COPD and measure dimensions similar to the MDP’s composition.