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Comparing recalled versus experienced symptoms of breathlessness ratings: An ecological assessment study using mobile phone technology

Sandberg, Jacob; Sundh, Josefin; Anderberg, Peter; Currow, David C.; Johnson, Miriam; Lansing, Robert; Ekström, Magnus


Jacob Sandberg

Josefin Sundh

Peter Anderberg

David C. Currow

Robert Lansing

Magnus Ekström


Background and objective: Recall of breathlessness is important for clinical care but might differ from the experienced (momentary) symptoms. This study aimed to characterize the relationship between momentary breathlessness ratings and the recall of the experience. It is hypothesized that recall is influenced by the peak (worst) and end (most recent) ratings of momentary breathlessness (peak-end rule). Methods: This study used mobile ecological momentary assessment (mEMA) for assessing breathlessness in daily life through an application installed on participants' mobile phones. Breathlessness ratings (0–10 numerical rating scale) were recorded throughout the day and recalled each night and at the end of the week. Analyses were performed using regular and mixed linear regression. Results: Eighty-four people participated. Their mean age was 64.4 years, 60% were female and 98% had modified Medical Research Council (mMRC) ≥ 1. The mean number of momentary ratings of breathlessness provided was 7.7 ratings/participant/day. Recalled breathlessness was associated with the mean, peak and end values of the day. The mean was most closely associated with the daily recall. Associations were strong for weekly values: peak breathlessness (beta=0.95, r2= 0.57); mean (beta=0.91, r2= 0.53); and end (beta=0.67, r2= 0.48); p< 0.001 for all. Multivariate analysis showed that peak breathlessness had the strongest influence on the breathlessness recalled at the end of the week. Conclusion: Over 1 week, recalled breathlessness is most strongly influenced by the peak breathlessness; over 1 day, it is mean breathlessness that participants most readily recalled.


Sandberg, J., Sundh, J., Anderberg, P., Currow, D. C., Johnson, M., Lansing, R., & Ekström, M. (2022). Comparing recalled versus experienced symptoms of breathlessness ratings: An ecological assessment study using mobile phone technology. Respirology : official journal of the Asian Pacific Society of Respirology,

Journal Article Type Article
Acceptance Date May 31, 2022
Online Publication Date Jun 13, 2022
Publication Date 2022
Deposit Date Jun 14, 2022
Publicly Available Date Oct 27, 2022
Print ISSN 1323-7799
Electronic ISSN 1440-1843
Publisher Wiley
Peer Reviewed Peer Reviewed
Keywords Breathlessness; Dyspnoea symptoms; mEMA; Mobile ecological momentary assessment; Peak-end rule; Recall of symptoms
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Copyright Statement
© 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

This is an open access article under the terms of theCreative Commons AttributionLicense, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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