Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease

Division of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE, UK.
Thorax (Impact Factor: 8.29). 08/1999; 54(7):581-6. DOI: 10.1136/thx.54.7.581
Source: PubMed


Methods of classifying chronic obstructive pulmonary disease (COPD) depend largely upon spirometric measurements but disability is only weakly related to measurements of lung function. With the increased use of pulmonary rehabilitation, a need has been identified for a simple and standardised method of categorising disability in COPD. This study examined the validity of the Medical Research Council (MRC) dyspnoea scale for this purpose.
One hundred patients with COPD were recruited from an outpatient pulmonary rehabilitation programme. Assessments included the MRC dyspnoea scale, spirometric tests, blood gas tensions, a shuttle walking test, and Borg scores for perceived breathlessness before and after exercise. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ). The Nottingham Extended Activities of Daily Living (EADL) score and Hospital Anxiety and Depression (HAD) score were also measured.
Of the patients studied, 32 were classified as having MRC grade 3 dyspnoea, 34 MRC grade 4 dyspnoea, and 34 MRC grade 5 dyspnoea. Patients with MRC grades 1 and 2 dyspnoea were not included in the study. There was a significant association between MRC grade and shuttle distance, SGRQ and CRQ scores, mood state and EADL. Forced expiratory volume in one second (FEV1) was not associated with MRC grade. Multiple logistic regression showed that the determinants of disability appeared to vary with the level of disability. Between MRC grades 3 and 4 the significant covariates were exercise performance, SGRQ and depression score, whilst between grades 4 and 5 exercise performance and age were the major determinants.
The MRC dyspnoea scale is a simple and valid method of categorising patients with COPD in terms of their disability that could be used to complement FEV1 in the classification of COPD severity.

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Available from: Janine Bestall, Feb 15, 2014
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    • "Validation Construct validity was assessed using the COSMIN hypothesis testing approach, which refers to the extent to which instrument scores relate to other measures in theoretically consistent ways (Mokkink, Terwee, Knol, et al., 2010; Terwee et al., 2007). To assess construct validity of scores from the Dutch version of the FPI, hypotheses about relationships with the CCQ (van der Molen et al., 2003), the self-administered CRQ-SAS (Williams et al., 2001), and the MRC Dyspnea Scale (Bestall et al., 1999) were formulated. Pearson correlations were estimated . "
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    • "Clinically 1. Presence of erythema nodosum (EN); 2. Arthritis; 3. Presence of dyspnea. Degree of dyspnea was evaluated according to the English Medical Research Council (MRC) Dyspnea Scale [13] "

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    • "Exertional dyspnea being a common symptom across the pulmonary hypertension population provides a method to assess disease severity and progress. Dyspnea may be measures subjectively by using instruments such as the Borg Dyspnea Scale and Medical Research Council Dyspnea Scale (Bestall et al., 1999; Borg, 1970). "
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