Validation of a three-factor measurement model of dyspnea in hospitalized adults with heart failure

doi:10.1016/j.hrtlng.2011.05.003

Heart & Lung

Volume 41, Issue 1, January–February 2012, Pages 44-56

https://doi.org/10.1016/j.hrtlng.2011.05.003 Get rights and content

Abstract

Objective

The purpose of this study was to validate a 3-factor measurement model of dyspnea sensory quality (WORK-EFFORT, TIGHTNESS, SMOTHERING-AIR HUNGER) originally derived in patients with exacerbated chronic obstructive pulmonary disease.

Methods

In this validation study, adult patients with heart failure were enrolled after hospital admission (median hospital day 1) and asked to rate the intensity of dyspnea sensory quality descriptors on the day of enrollment (study day 1; N = 119) and in a recall version for the day of admission (study day 0; n = 97).

Results

Confirmatory factor analysis demonstrated good model fit for both days. Cronbach’s α for each factor was greater than .87 for both study days.

Conclusion

This is the first study to validate a previously specified measurement model of dyspnea sensory quality in an independent sample. Results indicate that measurement of dyspnea sensory quality in exacerbated cardiopulmonary disease does not necessarily require disease-specific questionnaires.

Section snippets

Design and Setting

The study used a prospective, longitudinal correlational design. Participants were adults admitted for treatment of new-onset or decompensated HF to an urban academic medical center or a Department of Veterans Affairs medical center in the southwestern United States. The ethical review bodies of both institutions approved the study, and signed informed consent was obtained from all participants.

Eligibility

Participants were at least 18 years of age, able to speak and understand English, and of sufficient

Results

The median and modal hospital day on study day 1 was hospital day 1 (25th to 75th percentile: hospital day 1–2; range: hospital day 1–5). Cumulatively, 24% of the sample (n = 29) were enrolled on the day of admission, 72% (n = 86) by hospital day 1, 87% by hospital day 2 (n = 104), and 96% (n = 114) by hospital day 3. Only 5 participants (4%) were enrolled after hospital day 3 (4 on hospital day 4 and 1 on hospital day 5). All descriptors were endorsed by at least 60% of participants for day 0 (

Discussion

Overall, the same 3-factor/7-indicator measurement model fit the study day 1 and day 0 data and the COPD data satisfactorily and substantially better than any alternative model. All 3 factors had strong internal consistency reliability regardless of diagnosis or study day. To our knowledge, this is the first time that a specific measurement model of dyspnea sensory quality has been validated in an independent sample using CFA methods (which supports the internal validity of the 3-factor

Conclusions

This study demonstrates that intensity ratings for 3 sensory quality factors can be measured consistently and reproducibly with only a few descriptors both across diagnoses and across time points within a diagnosis. Although a single-item rating of intensity or distress has demonstrated responsiveness to clinical change in acute HF syndromes,31, 39, 40 using a single item assumes that differences in sensory quality are irrelevant to feeling better or worse. As far as we are aware, such an

Acknowledgments

The authors thank all the patients who participated or were willing to consider participating in the study, as well as the members of the inpatient cardiology services and the nursing staff of the participating hospitals. The authors thank Jessica Benton, RN, MSN, ACNP-C, Rebecca Mayo, PhD, RN, FNP-C, Eleanor Miranda, RN, MSN, FNP-C, Susie Stokely, RN, MSN, ACNP-C, Julia Silva, RN, BSN, and Vivian Yarmola, RN, MSN, for assistance. The authors thank Anne Mattarella of the UNM College of Nursing

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: Conflict of Interest: none

: Funded by a grant from the National Institute of Nursing Research (1 R15 NR008883). The opinions expressed in this article are solely those of the authors.

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Measurement of Symptoms and Quality of Life in Patients with Heart FailureValidation of a three-factor measurement model of dyspnea in hospitalized adults with heart failure

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Design and Setting

Eligibility

Results

Discussion

Conclusions

Acknowledgments

Respir Physiol

Respir Physiol

Respir Physiol

Chest

Chest

Respir Physiol

Heart Lung

J Pain Symptom Manage

Chest

Am Heart J

Am Heart J

Am Heart J

Respir Physiol

Respir Physiol

Respir Physiol

Respir Physiol

Biol Psychol

Respir Med

Respir Physiol Neurobiol

Respir Physiol Neurobiol

Respir Physiol Neurobiol

Respir Physiol Neurobiol

Respir Physiol Neurobiol

Respir Physiol Neurobiol

Respir Physiol Neurobiol

Chest

NeuroImage

Respir Med

The origin of the sensations of dyspnea?

Trans Am Clin Cimatol Assoc

The sensations of pulmonary dyspnea

Nurs Res

Grouping and multidimensional organization of respiratory sensations

Percept Psychophys

Distinguishable sensations of breathlessness induced in normal volunteers

Am Rev Respir Dis

Distinguishable types of dyspnea in patients with shortness of breath

Am Rev Respir Dis

The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease

Am Rev Respir Dis

Sensory origin of lobeline-induced sensations: a correlative study in man and cat

J Physiol

Descriptors of breathlessness in cardiorespiratory diseases

Am J Respir Crit Care Med

Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms

Am J Respir Crit Care Med

Language of dyspnea in assessment of patients with acute asthma treated with nebulized albuterol

Am J Respir Crit Care Med

Qualitative aspects of exertional dyspnea in patients with interstitial lung disease

J Appl Physiol

Measurement of Symptoms and Quality of Life in Patients with Heart Failure
Validation of a three-factor measurement model of dyspnea in hospitalized adults with heart failure