2000 OPEN FORUM Abstracts
The Modified Borg Dyspnea Scale: Like pulling numbers from a hat?
Terry S. LeGrand, PhD, RRT, Shana Giles, David C. Shelledy, PhD, RRT, University of Texas Health Science Center, San Antonio, TX
Background: The Borg scale is often used during asthma, pulmonary or cardiac education programs to quantify patients' progress in learning disease management. The Borg scale, designed in 1962, rates perceived exertion during exercise. It was modified in 1982 to measure perceived intensity of dyspnea using a 12-point scale. Conflicting results have been reported in studies designed to correlate the modified Borg scale with indices of pulmonary and physical function. For example, there was no significant difference between Borg scores before and after a pulmonary rehabilitation program in which there were significant increases in metabolic and physical function parameters. Method: To determine if the modified Borg scale is a valid tool to quantify outcomes associated with disease management education programs, Borg dyspnea scores were collected on asthmatics (n=43) who presented to the emergency department during acute asthma exacerbation. Subsequently, scores corresponding to the Borg scale were assigned in a blinded fashion to these subjects by randomly selecting cards from a box. Means were compared using a paired t-test.
Results: There was no significant difference between mean dyspnea scores reported by asthmatics and randomly assigned scores (4.21 ± 2.7 vs 4.74 ± 2.9, p = 0.38). Conclusion: While the modified Borg scale may be a useful determinant of a patient's subjective level of distress during a given episode of dyspnea, its use as a measure of the effectiveness of disease management education is questionable. Respiratory therapists who routinely use the Borg scale should be aware of its limitations, and that it may, in fact, be no more significant than "pulling numbers from a hat." In this study, the unreliability of Borg scores coupled with fimitations shown in other studies demonstrates the importance of utilizing objective measures of progress, such as exercise tolerance, pulmonary function and standardized measures of health related quality of life, to determine the effectiveness of education in disease management programs.