Dyspnea-12-Arabic: Testing of an instrument to measure breathlessness in Arabic patients with chronic obstructive pulmonary disease Ekhlas Al-Gamal, BSc, MSc, PhD, RN a, * , Janelle Yorke, PhD, MRes, Post Grad Dip (Cardiothoracic Nursing), PGCE, RN b , Mohammed K.E.A. Al-Shwaiyat, BSc, MSc, PhD c a Faculty of Nursing, The University of Jordan, P.O. Box 11942, Amman, Jordan b School of Nursing, Midwifery and Social Work, University of Manchester, Room 5.320 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK c Al-Balqa’ Applied University, Amman, Jordan article info Article history: Received 16 October 2013 Received in revised form 3 February 2014 Accepted 4 February 2014 Available online 7 March 2014 Keywords: Arabic translation COPD Dyspnea Breathlessness Jordan Instrument-development Patients abstract Objective: The aim of this study was to develop the Dyspnoea-12-Arabic (D-12-A) questionnaire and test its reliability and validity for the assessment of breathlessness in Arabic speaking patients with chronic obstructive pulmonary disease (COPD) in Jordan. Background: Breathlessness is a complex multidimensional symptom which incorporates physiology and psychology. Methods: The D-12-A, Hospital Anxiety and Depression Scale (HADS), and Quality of Life Index pulmo- nary version (QLI-P) were completed by 67 Jordanian patients with COPD. Cronbach alpha was used to assess internal consistency, and Pearson productemoment correlation calculated for construct validity. Results: The D-12-A and its sub-components (‘physical’ and ‘affective’) demonstrated excellent internal reliability (Cronbach alpha range from 0.88 to 0.91). D-12-A scores correlated significantly with other relevant outcome measures and demonstrated good construct validity. Conclusions: The D-12-A should provide clinicians and researchers with a useful tool for the assessment of breathlessness in Arabic speaking patients with COPD. Ó 2014 Elsevier Inc. All rights reserved. Introduction Breathlessness is a cardinal symptom in chronic obstructive pulmonary disease (COPD). Patients generally endure long- standing chronic breathlessness with acute episodes or periods of increased breathlessness severity. 1 There is now a literature which demonstrates that the burden of breathlessness in COPD is com- parable to patients with cancer and congestive heart failure. 2,3 The severity of COPD is defined by the degree of lung function impair- ment measured by spirometry testing, but it is the degree of breathlessness that drives clinical management. There is often a poor match between the level of breathlessness reported by a patient and the result of lung function tests. 4 This implies that a person’s perception of the severity of their breathlessness is influenced not only by the level of disease but also by a complex interplay of emotions, previous experiences, and social and envi- ronmental circumstances. 5 Breathlessness is a complex multidimensional symptom which incorporates physiology and psychology. 6 Most patients report accompanying distress or anxiety with breathlessness and there is evidence that symptom related distress can be more dominant than symptom severity. 7,8 Recent international consensus statements on the management of breathlessness in patients with advanced lung or heart disease strongly emphasize the importance of assessing the overall burden associated with the symptom. 5,9 A plethora of questionnaires for the measurement of patients’ reports of breathlessness exist and the majority instruments have been developed and validated in COPD. 2,10 Most of these ques- tionnaires focus either on patient’s accounts of their perceived breathlessness intensity or severity, 11 on how far the breathlessness limits their activities 12 or within health-related quality of life questionnaires (HRQL). 13,14 These instruments do not reflect the emotional sequelae of breathlessness or require the administration No conflict of interest has been declared by the authors. * Corresponding author. E-mail address: e.algamal@ju.edu.jo (E. Al-Gamal). Contents lists available at ScienceDirect Heart & Lung journal homepage: www.heartandlung.org 0147-9563/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2014.02.003 Heart & Lung 43 (2014) 244e248