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Are within-person Numerical Rating Scale (NRS) ratings of breathlessness ‘on average’ valid in advanced disease for patients and for patients’ informal carers?

Overview of attention for article published in BMJ Open Respiratory Research, October 2017
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5 tweeters

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2 Dimensions

Readers on

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12 Mendeley
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Title
Are within-person Numerical Rating Scale (NRS) ratings of breathlessness ‘on average’ valid in advanced disease for patients and for patients’ informal carers?
Published in
BMJ Open Respiratory Research, October 2017
DOI 10.1136/bmjresp-2017-000235
Pubmed ID
Authors

Joshua Wade, Silvia Mendonca, Sara Booth, Gail Ewing, A Carole Gardener, Morag Farquhar

Abstract

The Numerical Rating Scale (NRS) is frequently used to assess patient-reported breathlessness in both a research and clinical context. A subgroup of patients report average breathlessness as worse than their worst breathlessness in the last 24 hours (paradoxical average). The Peak/End rule describes how the most extreme and current breathlessness influence reported average. This study seeks to highlight the existence of a subpopulation who give 'paradoxical averages using the NRS, to characterise this group and to investigate the explanatory relevance of the 'Peak/End' rule. Data were collected within mixed method face-to-face interviews for three studies: the Living with Breathlessness Study and the two subprotocols of the Breathlessness Intervention Service phase III randomised controlled trial. Key variables from the three datasets were pooled (n=561), and cases where participants reported a paradoxical average (n=45) were identified. These were compared with non-cases and interview transcripts interrogated. NRS ratings of average breathlessness were assessed for fit to Peak/End rule. Patients in the paradoxical average group had higher Chronic Respiratory Questionnaire physical domain scores on average p=0.042). Peak/End rule analysis showed high positive correlation (Spearman's rho=0.756, p<0.001). The NRS requires further standardisation with reporting of question order and construction of scale used to enable informed interpretation. The application of the Peak/End rule demonstrates fallibility of NRS-Average as a construct as it is affected by current breathlessness. Measurement of breathlessness is important for both clinical management and research, but standardisation and transparency are required for meaningful results.

Twitter Demographics

The data shown below were collected from the profiles of 5 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 12 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 12 100%

Demographic breakdown

Readers by professional status Count As %
Unspecified 4 33%
Researcher 2 17%
Other 2 17%
Student > Doctoral Student 1 8%
Student > Master 1 8%
Other 2 17%
Readers by discipline Count As %
Medicine and Dentistry 5 42%
Unspecified 3 25%
Nursing and Health Professions 1 8%
Psychology 1 8%
Arts and Humanities 1 8%
Other 1 8%

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 April 2019.
All research outputs
#7,077,471
of 13,785,324 outputs
Outputs from BMJ Open Respiratory Research
#150
of 239 outputs
Outputs of similar age
#107,743
of 275,452 outputs
Outputs of similar age from BMJ Open Respiratory Research
#10
of 15 outputs
Altmetric has tracked 13,785,324 research outputs across all sources so far. This one is in the 48th percentile – i.e., 48% of other outputs scored the same or lower than it.
So far Altmetric has tracked 239 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 12.5. This one is in the 35th percentile – i.e., 35% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 275,452 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 60% of its contemporaries.
We're also able to compare this research output to 15 others from the same source and published within six weeks on either side of this one. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.