RehabMeasures Instrument
  1. Rehabilitation Measures Database
  2. Baseline and Transition Dyspnea Index

Baseline and Transition Dyspnea Index

Last Updated

Purpose

The BDI-TDI measures changes in dyspnea severity from the baseline as established by the Baseline Dyspnea Index in 3 categories: functional impairment, magnitude of task, and magnitude of effort.

Link to Instrument

Acronym BDI-TDI

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Permission needed. User required to complete and sign a User Agreement. A fee may be incurred depending on context of use and study design.

Diagnosis/Conditions

  • Pulmonary Disorders

Populations

Pulmonary Diseases

Key Descriptions

  • Baseline Dyspnea Index:
    1) Used to find baseline dyspnea in 3 categories (functional impairment, magnitude of task, and magnitude of effort).
    2) Interviewer-administered rating.
    3) Scores range from 0 (severe) to 4 (unimpaired) for each domain.
    4) The sum of all domains yields the BDI focal score (0-12)
  • Transitional Dyspnea Index:
    1) Used to find change in dyspnea in 3 categories (functional impairment, magnitude of task, and magnitude of effort).
    2) Interviewer-administered rating.
    3) Scores range from ?3 (major deterioration) to +3 (major improvement) for each domain.
    4) The sum of all domains yields the TDI focal score (?9 to +9).
    5) A negative score indicates more severity in dyspnea whereas a positive score shows positive gains.
    6) In case of circumstances in which impairment is due to reasons other than dyspnea, that specific category does get scored and is not a contributor to the overall score

Number of Items

24

Equipment Required

  • Survey instrument and writing instrument.

Time to Administer

5-10 minutes

Depends on the interviewing process.

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Micaela Hornstein, SPT in 12/2013.

ICF Domain

Activity

Considerations

  • Good for measurement of specific components of dyspnea combined to provide a more detailed description than other tests.

  • Easy to use and relatively little time to conduct (Mahler, 1984).

  • Minimal evidence of reliability limits this tool.

  • Raters need to be experienced and have expertise in the area of dyspnea, along with familiarity of the ratings. This allows appropriate interview questioning.

  • Lacks standardized questions for raters (Eakin, 1995).

  • Interviewer bias: potential bias by the interviewer and/or patient.

  • Recall bias: Need BDI on hand.(Eakin, 1995; Glaab, 2010).

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Pulmonary Diseases

back to Populations

Minimal Detectable Change (MDC)

COPD: 

(Mahler and Witek et al., 2003a; n = 921; mean age = 65(8) years, retrospective analysis of data from a randomized, double-blind placebo-controlled clinical trial; all subjects dx with COPD (~ 8yrs))

  • MDC = 1 point

 

(Mahler and Witek et al., 2003b; n = 997; mean age = 64 years; multinational trial)

  • MDC = 1 point

Minimally Clinically Important Difference (MCID)

COPD:

(Mahler and Witek et al., 2003a)

  • MCID = 1 point 

 

(Mahler and Witek et al., 2003b)

  • MCID = 1 point

Interrater/Intrarater Reliability

COPD:

(Eakin, Sassi-Dambron, Ries et al., 1995; n = 143; mean age = 67.7 (8.6) years; 6 measures of dyspnea were reviewed)

  • Excellent interrater reliability (ICC = 0.83)

Construct Validity

COPD:

(Mahler et al., 1984)

  • Adequate construct validity with the 12 Minute Walk Test (r = 0.33)

Bibliography

Eakin, E. G., Sassi-Dambron, D. E., et al. (1995). "Reliability and validity of dyspnea measures in patients with obstructive lung disease." Int J Behav Med 2(2): 118-134.

Glaab, T., Vogelmeier, C., et al. (2010). "Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations." Respir Res 11(1): 79.

Mahler, D. A., Weinberg, D. H., et al. (1984). "The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes." Chest 85(6): 751-758.

Witek Jr, T. J. and Mahler, D. A. (2003). "Meaningful effect size and patterns of response of the transition dyspnea index." Journal of clinical epidemiology 56(3): 248-255.

Witek, T. J., Jr. and Mahler, D. A. (2003). "Minimal important difference of the transition dyspnoea index in a multinational clinical trial." Eur Respir J 21(2): 267-272.

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