A Multidimensional Computer Adaptive Test Approach to Dyspnea Assessment

Norweg A, Ni P, Garshick E, O'Connor G, Wilke K, Jette AM. A multidimensional computer adaptive test approach to dyspnea assessment.ObjectivesTo develop and test a prototype dyspnea computer adaptive test (CAT).DesignProspective study.SettingTwo outpatient medical facilities.ParticipantsA convenience sample of adults (N=292) with chronic obstructive pulmonary disease (COPD).InterventionsNot applicable.Main Outcome MeasureWe developed a modified and expanded item bank and CAT for the Dyspnea Management Questionnaire (DMQ), an outcome measure consisting of 4 dyspnea dimensions: dyspnea intensity, dyspnea anxiety, activity avoidance, and activity self-efficacy.ResultsFactor analyses supported a 4-dimensional model underlying the 71 DMQ items. The DMQ item bank achieved acceptable Rasch model fit statistics, good measurement breadth with minimal floor and ceiling effects, and evidence of high internal consistency reliability (α=.92–.98). With the use of CAT simulation analyses, the DMQ-CAT showed high measurement accuracy compared with the total item pool (r=.83–.97, P<.0001) and evidence of good to excellent concurrent validity (r=–.61 to –.80, P<.0001). All DMQ-CAT domains showed evidence for known-groups validity (P≤.001).ConclusionsThe DMQ-CAT reliably and validly captured 4 distinct dyspnea domains. Multidimensional dyspnea assessment in COPD is needed to better measure the effectiveness of pharmacologic, pulmonary rehabilitation, and psychosocial interventions in not only alleviating the somatic sensation of dyspnea but also reducing dysfunctional emotions, cognitions, and behaviors associated with dyspnea, especially for anxious patients.