title: Breathlessness during daily activity: The psychometric properties of the London Chest Activity of Daily Living Scale in patients with advanced disease and refractory breathlessness.
abstract: BACKGROUND
  The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease.
  
  
  OBJECTIVE
  To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease.
  
  
  METHODS
  A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034). All patients completed the following questionnaires: the London Chest Activities of Daily Living Scale, Chronic Respiratory Questionnaire, the Palliative care Outcome Scale, Palliative care Outcome Scale-symptoms, the Hospital Anxiety and Depression Scale and breathlessness measured on a numerical rating scale. Data quality, scaling assumptions, acceptability, internal consistency and construct validity of the London Chest Activities of Daily Living Scale were determined using standard psychometric approaches.
  
  
  METHODS
  Breathless patients with advanced malignant and non-malignant disease.
  
  
  RESULTS
  A total of 88 patients were studied, primary diagnosis included; chronic obstructive pulmonary disease = 53, interstitial lung disease = 17, cancer = 18. Median (range) London Chest Activities of Daily Living Scale total score was 46.5 (14-67). No floor or ceiling effect was observed for the London Chest Activities of Daily Living Scale total score. Internal consistency was good, and Cronbach's alpha for the London Chest Activities of Daily Living Scale total score was 0.90. Construct validity was good with 13 out of 15 a priori hypotheses met.
  
  
  CONCLUSIONS
  Psychometric analyses suggest that the London Chest Activities of Daily Living Scale is acceptable, reliable and valid in patients with advanced disease and refractory breathlessness.
authors.affiliation: 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.|2 Physiotherapy, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Reilly
authors.affiliation: 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.|3 Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
authors.affiliation: 4 Department of Respiratory Medicine, King's College London, London, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Garrod
authors.affiliation: 5 Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK.|6 Centre of Human & Aerospace Physiological Sciences, King's College London, London, UK.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Jolley
authors.affiliation: 5 Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Moxham
authors.affiliation: 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008131:London; D017563:Lung Diseases, Interstitial / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology / Q000628:therapy*; D011594:Psychometrics; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Breathlessness; activities of daily living; breathlessness support service; cancer; chronic obstructive pulmonary disease; dyspnoea; palliative care; refractory breathlessness; therapies