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Validation of the dyspnea exertion scale of breathlessness in people with life-limiting illness

Sandberg, Jacob; Johnson, Miriam J.; Currow, David C.; Ekström, Magnus


Jacob Sandberg

David C. Currow

Magnus Ekström


Although chronic breathlessness is common in life-limiting illnesses, validated feasible instruments to measure functional impact of the symptom in this population are scarce. We aimed to validate the Dyspnea Exertion Scale (DES) compared with the modified Medical Research Council (mMRC) breathlessness scale for test-retest reliability, concurrent validity, and responsiveness in people with life-limiting illness.

A total of 188 participants, 66% males, with chronic breathlessness, mostly (70%) because of chronic pulmonary disease (chronic obstructive pulmonary disease) self-reported evening scores of mMRC, DES, Numerical Rating Scale (NRS), and Eastern Cooperative Oncology Group during nine days.

About 44% (n = 81) scored the highest score on mMRC indicating a ceiling effect not seen with DES. Both scales had moderate-to-good test-retest agreement (89% DES; 84% mMRC; P < 0.001 for both). Analyses for concurrent validity showed that higher DES and mMRC scores were correlated with higher NRS breathlessness intensity scores and Eastern Cooperative Oncology Group scores throughout the nine days. In longitudinal analyses, DES (r = 0.30; P < 0.001) was more responsive to change in NRS score during nine days than the mMRC (r = 0.16; P = 0.03).

Compared with mMRC, DES had comparable or better measurement properties in terms of test-retest reliability and concurrent validity and could be used as a discriminative tool in this population, but both scales are too insensitive to change to be used as an outcome in clinical trials.


Sandberg, J., Johnson, M. J., Currow, D. C., & Ekström, M. (2018). Validation of the dyspnea exertion scale of breathlessness in people with life-limiting illness. Journal of pain and symptom management, 56(3), 430-435.e2.

Journal Article Type Article
Acceptance Date May 2, 2018
Online Publication Date May 10, 2018
Publication Date Sep 1, 2018
Deposit Date Jul 19, 2018
Publicly Available Date May 11, 2019
Journal Journal of Pain and Symptom Management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 56
Issue 3
Pages 430-435.e2
Keywords Anesthesiology and Pain Medicine; General Nursing; Clinical Neurology
Public URL
Publisher URL


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