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Clinical Research on Dyspnea
Author Bios
What is Dyspnea?
What Provokes Dyspnea?
The Nature of Dyspnea
Language of Dyspnea
Clinical Application
Research Application
Variability in Sensations
Challenges in Study
Mechanical Loads and Sense of Effort
Chemoreceptors
Mechanoreceptors
Neuro-Mechanical Dissociation
Phase of Respiration and Dyspnea
Physiology of Dyspnea
Respiratory System
Cardiovascular System
Measuring Dyspnea
Scaling Issues
Qualitative Aspects
Reliability and Validity Overview
Reliability and Validity
Sensitivity and Specificity
Scales
Sensation vs. Perception vs. Symptom
Treating Dyspnea
Why Measure?
Currently selected section: Cluster Analysis
Statistical vs. Clinical Significance
Standard Error of Measurement
Measuring Fatigue
Measuring Depression
Measuring Anxiety and Hyperventilation
Measuring Quality of Life
Conclusion

 

Chapter 23: Dyspnea: More on Scaling: Cluster Analysis
        

Most scales are designed to provide a single number that provides a measure of performance (e.g. general mental ability), a sample of behavior (e.g. cooperation), or a description of feelings, attitudes, beliefs, values, opinions, or symptoms (e.g. self-esteem). For a brief review of the four ways to construct scales (Thurstone scales, Likert scales, Guttman scaling, and Semantic differential) see: http://faculty.ncwc.edu/toconnor/308/308lect05.htm.

A scale can have any number of dimensions. The Baseline Dyspnea Index (BDI) and the dyspnea component of the Chronic Respiratory Questionnaire (CRQ) are "multidimensional" instruments that emphasize the kinds of activities that give rise to dyspnea in patients as well as the effort required to complete various activities (Mahler, Guyatt, and Jones, 1998). The BDI, for example, includes three dimensions of experience: magnitude of task, magnitude of effort, and functional impairment. On the other hand, neither the BDI nor the CRQ were designed to provide specific information about the multiple sensations that make up dyspnea.

Our understanding of respiratory symptoms has been advanced as much by the use of multidimensional scales as by the use of multidimensional scaling. Factor analysis, cluster analysis, and multidimensional scaling are analytic techniques used to simplify data to underlying structures or dimensions. The results of these statistical approaches have allowed us to favor some attributes of dyspnea -- such as "effort" and "chest tightness" -- over others. They have also allowed for a firmer basis of theory construction in interpreting the physiological mechanisms underlying various aspects of breathing discomfort.

In cluster and multidimensional scaling algorithms, individuals represent their subjective world by rating the relative similarity (or dissimilarity) between pairs of stimulus objects.

Question 27.1

Similarity ratings are obtained on a scale most closely resembling:

Selection A Thurstone scales
Selection B Likert scales
Selection CGuttman scaling
Selection DSemantic differential

Cluster analysis produces a hierarchical tree (a dendogram) showing each object at the top and the linkages among all stimuli in a nested arrangement defined by perceived similarity. A cluster analysis of ratings of perceived similarity for six animals obtained in 100 healthy adults is shown here.

Figure 27.1: Hierarchical Clustering Solution for Dissimilarity Judgments (n=100) Obtained between Pairs of Animals.
Cluster analysis of ratings of perceived similarity for six animals obtained in 100 healthy adults is shown here. Animals paired are Sheep-Cow, Cat-Dog, Chicken-Canary.
Reprinted by permission of Chest. http://www.chestjournal.org

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