Heart, Lung and Circulation

Validation of a Verbal Rating Scale for Breathlessness Amongst Patients Referred for Cardiac Stress Tests


      Acute shortness of breath (SOB) is a common symptom and a potentially significant marker of cardiorespiratory disease. The subjective and unmeasurable nature of breathlessness can make its clinical evaluation difficult. This study aimed to investigate the convergent validity of a verbal 0–10 rating scale for SOB.


      This prospective observational study used a convenience sample of patients presenting for cardiac stress tests. Objective and subjective breathlessness parameters were collected before, during and after stress test exercise. Objective measures included respiratory rate (RR), oxygen saturation (SaO2), heart rate (HR), systolic blood pressure (SBP) and the subjective breathlessness parameter was verbal dyspnea scores (VDS) for present dyspnea obtained using the SOB rating scale question, “On a scale from 0–10, how bad is your SOB, with zero being no SOB and ten the worst SOB you could ever imagine?”


      Within subjects, VDS correlated significantly with RR (mean r = 0.95, CI: 0.93–0.97), HR (mean r = 0.90, CI: 0.86–0.93) and SBP (mean r = 0.95, CI: 0.93–0.97); p < 0.05. Between subjects, correlations were significant at all time points for RR only (r = 0.45–0.65, p < 0.05), indicating high individual variability in dyspnea perception..


      A verbal numerical rating scale is a valid measure of breathlessness and may provide useful insight into a prognostically significant symptom.


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        • Kunitoh H.
        • Watanable K.
        • Sajima Y.
        Dyspnea in acute bronchial asthma in an emergency room.
        Ann Allergy. 1994; 72: 250-254
        • Kendrick K.R.
        • Baxi S.C.
        • Smith R.M.
        Usefulness of the modified 0–10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma.
        J Emerg Nurs. 2000; 26: 216-222
      1. Anonymous. Pain-rating scales help caregivers and patients speak common language. Patient Care Manage 2001;17:4.

      2. American Thoracic Society. Dyspnea mechanisms, assessment, and management: a consensus statement. Am J Respir Crit Care Med 1999;159:321–40.

        • Janson C.
        • Herala M.
        Dyspnea in acute asthma: relationship with other clinical and physiological variables.
        Ann Allergy. 1993; 70: 400-404
        • Gift A.G.
        • Narsavage G.
        Validation of the numerical rating scale of a measure of dyspnea.
        Am J Crit Care. 1998; 7: 200-204
        • Moy M.L.
        • Lantin M.L.
        • Harver A.
        • Schwartzstein R.M.
        Language of dyspnea in assessment of patients with acute asthma treated with nebulized albuterol.
        Am J Respir Crit Care Med. 1998; 158: 749-753
        • Cavallazzi T.G.L.
        • Cavallazzi R.S.
        • Cavalcante T.M.C.
        Evaluation of the use of the modified scale of Borg in the asthmatic crisis.
        Acta Paulista de Enfermagem. 2005; 18: 39-45
        • MacDonald S.
        • Yates J.
        • Lance R.
        • Giganti N.
        • Chepurko D.
        Are you asking the right admission questions when assessing dyspnea?.
        Heart Lung. 2005; 34: 260-269
        • van der Molen B.
        Dyspnoea: a study of measurement instruments for the assessment of dyspnoea and their application for patients with advanced cancer.
        J Adv Nurs. 1995; 22: 948-956
        • Lee J.S.
        Pain measurement: understanding existing tools and their application in the emergency department.
        Emerg Med. 2001; 13: 279-287
        • Williamson A.
        • Hoggart B.
        Pain: a review of three commonly used pain rating scales.
        J Clin Nurs. 2005; 17: 798-804
        • Berthier F.
        • Potel G.
        • Leconte P.
        Comparative study of methods of measuring acute pain intensity in an ED.
        Am J Emerg Med. 1998; 16: 132-136
        • Bijur P.E.
        • Latimer C.T.
        • Gallagher E.J.
        Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.
        Acad Emerg Med. 2003; 10: 390-392
        • Holdgate A.
        • Asha S.
        • Craig J.
        • Thompson J.
        Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain.
        Emerg Med. 2003; 15: 441-446
        • Todd K.H.
        Pain assessment instruments for use in the emergency department.
        Emerg Med Clin North Am. 2005; 23: 285-295
        • el-Manshawi A.
        • Killian K.J.
        • Summers E.
        • Jones L.
        Breathlessness during exercise with and without resistive loading.
        J Appl Physiol. 1986; 61: 896-905
        • Leblanc P.
        • Bowie D.M.
        • Summers E.
        Breathlessness and exercise in patients with cardiorespiratory disease.
        Am Rev Respir Dis. 1986; 133: 21-25
        • Mahler D.A.
        • Faryniarz K.
        • Lentine T.
        • Ward J.
        • Olmstead E.M.
        • O’Connor G.T.
        Measurement of breathlessness during exercise in asthmatics. Predictor variables, reliability, and responsiveness.
        Am Rev Respir Dis. 1991; 144: 39-44
        • Grant S.A.
        • Aitchison T.
        • Henderson E.
        • Christie J.
        • Zare S.
        • McMurray J.
        A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise.
        Chest. 1999; 116: 1208-1217
        • Burdon J.G.W.
        • Juniper E.F.
        • Killina K.J.
        • Hargreave F.R.
        • Campbell E.J.M.
        The perception of breathlessness in asthma.
        Am Rev Respir Dis. 1982; 126: 825-828
        • Gift A.G.
        Validation of a vertical visual analogue scale as a measure of clinical dyspnoea.
        Rehabil Nurs. 1989; 14: 323-325
        • Muza S.R.
        • Silverman M.T.
        • Gilmore G.C.
        • Hellerstein H.K.
        • Kelsen S.G.
        Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease.
        Am Rev Respir Dis. 1990; 141: 909-913
        • Wilson R.C.
        • Jones P.W.
        Long-term reproducibility of Borg scale estimates of breathlessness during exercise.
        Clin Sci. 1991; 80: 309-312
        • Wilson R.C.
        • Jones P.W.
        Differentiation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise.
        Clin Sci. 1991; 80: 65-70
        • Bernstein M.L.
        • Despars J.A.
        • Singh N.P.
        • Avalos K.
        • Stansbury D.W.
        • Light R.W.
        Reanalysis of the 12-minute walk in patients with chronic obstructive pulmonary disease.
        Chest. 1994; 105: 163-167
        • Mador M.J.
        • Kufel T.J.
        Reproducibility of visual analog scale measurements of dyspnea in patients with chronic obstructive pulmonary disease.
        Am Rev Respir Dis. 1992; 146: 82-87
        • Franco M.J.
        • Olmstead E.M.
        • Tosteson A.N.
        • Lentine T.
        • Ward J.
        • Mahler D.A.
        Comparison of dyspnea ratings during submaximal constant work exercise with incremental testing.
        Med Sci Sports Exerc. 1998; 30: 479-482
        • Gupta D.
        • Aggarwal A.N.
        • Subalaxmi M.V.
        • Jindal S.K.
        Assessing severity of asthma: spirometric correlates with visual analogue scale.
        Indian J Chest Dis Allied Sci. 2000; 42: 95-100
        • Wilson R.C.
        • Jones P.W.
        A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnea during exercise.
        Clin Sci. 1988; 76: 277-282
        • Gracely R.
        Dyspnea and pain: similarities and contrasts between two very unpleasant sensations.
        Am Pain Soc Bull. 2001; : 11
        • Heinzer M.M.V.
        • Bish C.
        • Detwiler R.
        Acute dyspnea as perceived by patients with chronic obstructive pulmonary disease.
        Clin Nurs Res. 2003; 12: 85-101
        • Bergeron S.
        • Ommen S.R.
        • Bailey K.R.
        • Oh J.K.
        • McCully R.B.
        • Pellikka P.A.
        Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea.
        J Am Coll Cardiol. 2004; 43: 2242-2246
        • Abidov A.
        • Rozanski A.
        • Hachamovitch R.
        • Hayes S.W.
        • Aboul-Enein F.
        • Cohen I.
        • Friedman J.D.
        • Germano G.
        • Berman D.S.
        Prognostic significance of dyspnea in patients referred for cardiac stress testing.
        N Engl J Med. 2005; 353: 1889-1898
        • Jensen M.P.
        • Turner J.A.
        • Romano J.M.
        What is the maximum number of levels needed in pain intensity measurement?.
        Pain. 1994; 58: 387-392
        • Brevik E.K.
        • Bjornsson G.A.
        • Skovlund E.
        A comparison of pain rating scales by sampling from clinical trial data.
        Clin J Pain. 2001; 16: 22-28