The following is a summary of “Dyspnea-induced Limitation (DYSLIM), a new self-administered concise questionnaire to evaluate dyspnea-related activity limitation in chronic respiratory diseases,” published in the June 2023 issue of Pulmonology by Perez, et al.

For a study, researchers sought to develop a self-administered questionnaire called DYSLIM (Dyspnea-induced Limitation), to assess the impact of chronic dyspnea on daily activities, as there are limited questionnaires available for routine dyspnea assessment.

The development process involved four steps. Firstly, relevant activities and related questions were selected through focus groups. Secondly, a clinical study was conducted to assess internal and concurrent validity in comparison to the modified Medical Research Council (mMRC), Baseline Dyspnea Index (BDI), and Saint George Respiratory Questionnaire (SGRQ). Thirdly, item reduction was performed to refine the questionnaire. Finally, responsiveness was evaluated. The questionnaire included 18 activities, ranging from eating to climbing stairs, with five modalities each: doing the task slowly, taking breaks, seeking assistance, changing habits, and activity avoidance. The modalities were graded on a scale from 5 (never) to 1 (very often). The validation study included 194 patients with various chronic respiratory conditions, such as COPD (FEV1 ≥ 50% pred: n = 40; FEV1 < 50% pred: n = 65), cystic fibrosis (n = 30), interstitial lung disease (n = 30), and pulmonary hypertension (n = 29). Responsiveness was assessed based on post-pulmonary rehabilitation data in 52 COPD patients.

The DYSLIM questionnaire showed high acceptability, and short-term reproducibility (7 days) was satisfactory, with Kappa values mostly above 0.7. Concurrent validity was also high, with significant correlations to mMRC (Spearman correlation coefficient, r = 0.71), BDI (r = – 0.75), and SGRQ (r = – 0.79). After item reduction, a shorter version of the questionnaire was selected, containing 8 activities (ranging from cleaning to climbing stairs) and 3 modalities (slowly, seeking help, changing habits), which showed comparable validity. The effect size of rehabilitation was good for both the full (0.57) and short (0.51) versions. Additionally, a significant correlation was found between changes in SGRQ and DYSLIM scores post-rehabilitation r = – 0.68 and r = – 0.60 for full and reduced questionnaires, further supporting the questionnaire’s responsiveness.

The DYSLIM questionnaire provided a promising tool for evaluating dyspnea-induced limitations in individuals with chronic respiratory diseases and could be effectively used in various clinical settings.


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