An Evaluation of Physiotherapy Assessment; A Mixed Methods Study to Evaluate the Physiotherapy Assessment of Breathing Pattern Disorder
Overview
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 150
- Locations
- 1
- Primary Endpoint
- Breathing Pattern Assessment Tool BPAT
Overview
Brief Summary
This study aims to evaluate a clinical tool called the Breathing Pattern Assessment Tool (BPAT), which is used by physiotherapists to assess breathing pattern disorder (BPD). BPD is a condition where breathing is inefficient or out of sync with the body's needs, leading to symptoms such as breathlessness.
The study will investigate whether the BPAT is a reliable and accurate way to identify and assess BPD, and whether it can be used to monitor changes over time, particularly following physiotherapy treatment. It will also compare BPAT scores with other commonly used questionnaires that measure breathlessness and breathing symptoms.
Participants will include patients with BPD, patients with asthma, and healthy individuals. Patients with BPD will attend physiotherapy sessions as part of their usual care, during which their breathing will be assessed using the BPAT at different time points, including before and after treatment. Healthy participants will attend a single assessment visit, and asthma participants' data will be collected from routine clinical care.
The study will also explore whether BPAT scores change following treatment and whether these changes reflect improvements reported by patients and clinicians.
In addition, a small number of patients and physiotherapists will be invited to take part in interviews to share their experiences of the assessment process and treatment. This will help understand whether the BPAT is acceptable and useful in clinical practice.
Overall, this study aims to improve how breathing pattern disorder is assessed and monitored, which may help guide better treatment for patients in the future.
Detailed Description
This study will evaluate the measurement properties and clinical usefulness of the Breathing Pattern Assessment Tool (BPAT), a physiotherapist-completed assessment used to identify breathing pattern disorder (BPD). BPD is a condition in which breathing is inefficient or inappropriate for the body's needs and is associated with symptoms such as breathlessness.
The study aims to determine whether the BPAT is a reliable and valid method for identifying and assessing BPD, and whether it can be used to monitor changes over time, particularly following physiotherapy treatment. BPAT scores will be compared with established questionnaires that measure breathing symptoms and breathlessness. The study will also assess whether changes in BPAT scores reflect changes reported by patients and clinicians.
Participants will include patients with BPD (n=100), patients with asthma (n=25), and healthy controls (n=25). Patients with BPD will be recruited from physiotherapy outpatient services and will receive physiotherapy as part of usual care. Healthy controls will attend a single assessment visit, and asthma control data will be obtained from routine clinical assessments.
At the initial assessment, two physiotherapists will independently complete BPAT scores for each participant. Patients with BPD will attend a follow-up assessment within approximately 4 weeks, where a repeat BPAT assessment will be completed. Those diagnosed with BPD will then undergo a course of physiotherapy treatment as part of usual care, typically consisting of four sessions. BPAT and other outcome measures will be repeated at the end of treatment (up to 6 months). Patients and clinicians will also provide ratings of change in symptoms following treatment.
The study will evaluate the reliability of the BPAT between clinicians and across time, its validity through comparison with other commonly used outcome measures, and its responsiveness to change following treatment.
In addition, a subgroup of patients and physiotherapists will take part in qualitative interviews to explore their experiences of the BPAT and its use in clinical practice. These interviews will help assess the acceptability and practicality of the tool.
This mixed-methods study aims to improve the assessment and monitoring of breathing pattern disorder and to support more consistent and effective clinical care.
Study Design
- Study Type
- Observational
- Observational Model
- Case Control
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •(Breathing Pattern Disorder group)
- •Adults aged above 18 years
- •Outpatient referrals for 'unexplained breathlessness' or possible breathing pattern disorder
- •Primary BPD (no other significant respiratory or cardiology diagnosis)
- •Secondary BPD (patients with a diagnosis of asthma)
- •Able to complete up to four sessions of outpatient physiotherapy intervention
Exclusion Criteria
- •Patients with a respiratory diagnosis including COPD, ILD, Bronchiectasis and Cystic Fibrosis or structural heart disease
- •Pregnancy
- •Unable to give informed consent
- •Anyone currently participating in pulmonary/cardiac rehabilitation
- •Anyone receiving specialist ENT speech and language therapy for Upper airway symptoms
Arms & Interventions
Breathing Pattern Disorder
Patients referred to physiotherapy with a Breathing Pattern Disorder
Intervention: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool (Diagnostic Test)
Healthy Control
Patients with no respiratory symptoms or disorders
Intervention: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool (Diagnostic Test)
Asthma
Patients diagnosed with asthma but no concerns for breathing pattern disorder
Intervention: Assessment of Breathing Pattern- Breathing Pattern Assessment Tool (Diagnostic Test)
Outcomes
Primary Outcomes
Breathing Pattern Assessment Tool BPAT
Time Frame: Baseline for all participants; 4 weeks and through study completion (up to 6 months) for participants with Breathing Pattern Disorder
A Clinician completed tool to look at components of breathing pattern assessment. The BPAT is a tabulated means of collating data obtained at respiratory physiotherapy assessment (appendix 1). Assessment components include (i) evaluation of chest/abdominal wall movement, noise of (ii) inspiratory and (iii) expiratory flow, (iv) channel of inspiration and expiration, (v) signs of air hunger (yawning, sighing and deeper breaths), (vi) RR and (vii) rhythm. Each component is given a score from 0 to 2, based on features consistent with expected normal (0) versus that present in severe DB (2), giving a total score of between 0 and 14. The BPAT is completed with a patient positioned, as per the standard assessment of resting breathing pattern (i.e. sat comfortably in a supported seat for at least 5 min) and takes approximately 1 min to collate. Each item is scored and summed for a total score, with higher scores indicating greater deviation from normal breathing patterns
Secondary Outcomes
- Nijmegen Questionnaire(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
- Dyspnoea 12(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
- EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L)(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
- Breath Hold(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
- End Tidal C02(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
- Breathing Vigilance Questionnaire(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
- Self evaluation of breathing questionnaire(Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder)
Investigators
Lizzie Grillo
Advanced Physiotherapist
Royal Brompton & Harefield NHS Foundation Trust