Dyspnea is a subjective experience influenced by physiological, cognitive, behavioral, and sociocultural factors. While self-reported scales are commonly used to assess dyspnea severity, they are unsuitable for patients unable to communicate, such as those with cognitive impairment or sedation. The Respiratory Distress Observation Scale (RDOS), developed by Campbell in 2008, is a reliable and valid tool for evaluating dyspnea in non-communicative palliative care patients. The RDOS has been adapted into Chinese and Italian, but a Turkish version is lacking. This study aims to assess the reliability and validity of the Turkish version of the RDOS.
Any disorder affecting the components of the respiratory system directly impacts respiratory function, while impairments in other systems related to this system indirectly hinder respiratory function. This condition manifests in patients in various ways, including shortness of breath, air hunger, difficulty breathing, a sensation of suffocation, and chest tightness, influenced by physiological, cognitive, behavioral, and sociocultural factors. Under normal conditions, breathing is an unconscious physiological act that goes unnoticed. However, in the presence of the aforementioned disturbances, conscious awareness of the act of breathing emerges. According to the American Thoracic Society (ATS) report, dyspnea is defined as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations of varying intensity" and is acknowledged as a subjective sensation. Dyspnea does not result from a single pathophysiological mechanism but may develop due to dysfunctions in multiple systems. Therefore, both identifying the underlying pathophysiology of dyspnea and measuring its presence and severity, given its subjective nature, are of great importance. Dyspnea assessment has been conducted using psychophysical methods and clinical scales. Psychophysical tests measure the perception of respiratory changes in response to externally applied loads, whereas clinical scales aim to determine the magnitude of the work contributing to breathlessness in patients. In addition to identifying the cause of dyspnea and initiating appropriate treatment, accurately measuring dyspnea severity plays a crucial role in planning both medical treatment and pulmonary rehabilitation interventions. The assessment of dyspnea presence and severity is based on self-reported scales, which are considered partially objective. However, some patients-such as those with cognitive impairment, loss of consciousness, intubation, sedative medication use, or brain injury-are unable to provide self-reports. Monitoring dyspnea in patients unable to self-report has been reported as challenging. In clinical settings, healthcare professionals rely on respiratory rate and oxygen saturation levels to assess dyspnea severity and determine appropriate treatment strategies for such patients. In Turkey, scales used to assess the presence and severity of dyspnea are based on self-reporting and are therefore not suitable for patients unable to communicate their symptoms. In 2008, Dr. Campbell developed the Respiratory Distress Observation Scale (RDOS) and demonstrated its reliability and validity in patients receiving palliative care-such as those with cancer, chronic obstructive pulmonary disease (COPD), heart failure, and pneumonia-who are unable to self-report their dyspnea. The RDOS consists of eight indicators related to dyspnea and takes less than five minutes to administer. Originally developed in English, the RDOS has been translated into Chinese and Italian. However, a Turkish version of the scale is needed. This study aims to examine the reliability and validity of the Turkish version of the RDOS.
Study Type
OBSERVATIONAL
Enrollment
100
Istınye University, Istanbul,
Istanbul, Turkey (Türkiye)
Respiratory Distress Observation Scale (RDOS)
The RDOS was developed by Campbell to measure the presence and intensity of respiratory distress for patients who are unable to self-report dyspnea. The eight parameters assessed by the observer are assess heart rate, respiratory, restlessness, paradoxical breathing pattern, accessory muscle use, grunting at end-expiration, nasal flaring, and look of fear. Four parameters scored between 0 and 2 points; the other four parameters scored 0, or 2 points and progressed from most to least severity of distress. The intensity of respiratory distress is reflected by a total score ranging from 0 to 18. A high total score increases the risk of developing respiratory distress. RDOS score of 0 to 2 suggests no respiratory distress; a score of 3, mild distress; scores of 4 to 6, moderate distress; and 7 or greater, severe distress, with an adequate cutoff point for assigning clinical significance at a score of 3.
Time frame: Within the first assessment (Day 1) and repeated measures within 2 hours after baseline assessment
Heart Rate Assessment
Heart rate (beats per minute) will be extracted from patient records within 30 minutes before the RDOS (Respiratory Distress Observation Scale) assessment.
Time frame: Within 30 minutes prior to RDOS administration
Systolic Blood Pressure Assessment
Systolic blood pressure (mmHg) will be recorded from clinical documentation within 30 minutes before RDOS administration.
Time frame: Within 30 minutes prior to RDOS administration
Diastolic Blood Pressure Assessment
Diastolic blood pressure (mmHg) will be obtained from the patient's chart and used as a physiological indicator at the time of RDOS evaluatio
Time frame: Within 30 minutes prior to RDOS administration
Respiratory Rate Assessment
Respiratory rate (breaths per minute) will be noted from medical records as a clinical vital sign prior to RDOS assessment.
Time frame: Within 30 minutes prior to RDOS administration
Oxygen Saturation Assessment
Peripheral oxygen saturation (SpO₂, %) will be documented from the monitoring system or medical record shortly before RDOS scoring.
Time frame: Within 30 minutes prior to RDOS administration
Body Temperature Assessment
Body temperature (°C) will be recorded from the most recent measurement available before the RDOS is administered.
Time frame: Within 30 minutes prior to RDOS administration
Partial Pressure of Oxygen (PaO₂) Assessment
The most recent arterial partial pressure of oxygen (PaO₂, mmHg) will be obtained from medical records. The sample must be collected within 30 minutes prior to RDOS assessment.
Time frame: Within 30 minutes prior to RDOS administration
Partial Pressure of Carbon Dioxide (PaCO₂) Assessment
Arterial partial pressure of carbon dioxide (PaCO₂, mmHg) will be recorded from laboratory results. The value must be based on a sample taken no more than 30 minutes before RDOS administration.
Time frame: Within 30 minutes prior to RDOS administration
Arterial Oxygen Saturation (SaO₂) Assessment
SaO₂ (%) will be documented from arterial blood gas analysis and used as an objective indicator of blood oxygenation status.
Time frame: Within 30 minutes prior to RDOS administration
Blood pH Assessment
Arterial blood pH values will be extracted from the most recent arterial blood gas test, conducted within 30 minutes prior to RDOS application.
Time frame: Within 30 minutes prior to RDOS administration
Bicarbonate (HCO₃-) Assessment
The bicarbonate (HCO₃-, mmol/L) level will be obtained from arterial blood gas test results and analyzed as part of metabolic status assessment.
Time frame: Within 30 minutes prior to RDOS administration
Dyspnea Assessment
Verbal Dyspnea Scale (VDS):Conscious patients will self-rate their level of breathlessness on a 0-10 numeric rating scale, where 0 indicates no dyspnea and 10 indicates the most severe dyspnea.
Time frame: At baseline
ICU Stay Duration
Duration of stay in the intensive care unit (ICU) will be recorded in days from hospital records.
Time frame: At enrollment
Glasgow Coma Scale (GCS) Assessment
The Glasgow Coma Scale score will be recorded to assess the participant's level of consciousness. The Glasgow Coma Scale (GCS) will be used to determine the patient's level of consciousness. The Glasgow Coma Scale (GCS) assesses consciousness by evaluating three components: eye opening (4-1), verbal response (5-1), and motor response (6-1). Scores range from 3 (deep coma) to 15 (fully alert), with lower scores indicating more severe impairment. A score of 8 or below typically suggests the need for immediate intervention.
Time frame: At enrollment
Clock Drawing Test Assessment
Cognitive function will be assessed using the Clock Drawing Test, scored based on spatial and time-setting accuracy.
Time frame: At enrollment
Palliative Performance Scale (PPS) Score Assessment
The Palliative Performance Scale (PPS) is a validated clinical tool used to assess the functional status of patients receiving palliative care. It ranges from 0% (death) to 100% (fully active) in 10% increments, based on five parameters: ambulation, activity level and extent of disease, self-care ability, oral intake, and level of consciousness. A high PPS score (e.g., 80-100%) indicates that the patient is active, independent, and has minimal care needs, while a low PPS score (e.g., 10-30%) reflects a patient who is bedbound, has limited intake and consciousness, and requires full care. PPS is widely used to estimate survival time, guide care planning, and classify patients in clinical research. Lower scores are associated with reduced life expectancy and higher dependency.
Time frame: At enrollment
Type of Respiratory Support Assessment
The type of respiratory support (e.g., High-Flow Oxygen \[HFO\], Non-Invasive Mechanical Ventilation \[NIMV\], Invasive Mechanical Ventilation \[IMV\]) used at the time of RDOS assessment will be documented.
Time frame: At enrollment
Fraction of Inspired Oxygen (FiO₂) Assessment
FiO₂ (%) values will be documented from respiratory support devices to assess oxygen delivery.
Time frame: At baseline
PaO₂/FiO₂ Ratio Assessment
The ratio of arterial oxygen pressure (PaO₂) to inspired oxygen fraction (FiO₂) will be calculated to assess oxygenation efficiency.
Time frame: At baseline
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.