M mrc scale

M mrc scale

1. mMRC Scale PHYSIOTHERAPY IN CARDIOPULMONARY CONDITIONS (BPT402) Submitted To:- Dr. Jamal Ali Moiz Submitted By:- Nahid BPT 4 th Year Roll No: 17BPT024 CPRS 1

2. Introduction The symptom of breathlessness is a common feature of both respiratory and cardiac problems and is subjective and difficult to quantify. To develop a measure of the effect of breathlessness on everyday a study on pneumoconiosis in Welsh coal miners was performed. This was then developed into the familiar Medical Research Council (MRC) breathlessness/ dyspnoea scale and was published in 1959. A respiratory questionnaire has also been developed by the MRC and is published along with guidance for interviewers, the latest version being published in 1986. 2

3. The mMRC breathlessness scale ranges from grade 0 to 4. It is very similar to the original version and is now widely used in studies. 3

4. Scoring and Interpretation The scale on the mMRC dyspnoea scale is very simple, consisting of just five items containing statements about the impact of breathlessness on the individual and leading to a grade from 0 to 4. It can be self-administered or in format of questions, delivered by a researcher or clinician. Either way it takes seconds to complete. It does not grade breathlessness itself but the functional impact of breathlessness and perceived limitations that result. 4

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7. Clinical Usage The use of the MRC breathlessness scale either on its own or in combination with other measures is widespread across the world in many scientific studies. The instrument allows stratification of populations to assess the effectiveness of interventions. An example is in pulmonary rehabilitation. Researchers such as Bestall et al. found that the scale was a simple and valid method which could be used to categorize patients with chronic obstructive pulmonary disease (COPD) in terms of their disability in the classification of the severity of disease. 7

8. Indiations Most recent use of the mMRC dyspnoea scale is in COPD patients, its performance in patients with idiopathic pulmonary fibrosis and sarcoidosis has also been documented. The original MRC breathlessness scale is currently recommended for use in the diagnosis of patients with COPD by government bodies such as NICE (National Institute for Health and Care Excellence in England) The modified version is a key feature of the GOLD 2011 (Global Initiative for Chronic Obstructive Airways Disease) recommendations on assessment. 8

9. Advantages Easy and efficient to calculate. Provides a baseline assessment of functional impairment attributable to dyspnea from respiratory disease. Correlates with healthcare-associated quality of life, morbidity, and possibly mortality for patients with respiratory diseases (particularly COPD). Has been used for almost two decades in multiple different heterogeneous patient populations. Correlates with other clinical and research dyspnea indices. Inter-rater reliability is very high. 9

10. mMRC dyspnoea scale to assess COPD disability, evaluate quality of life and provide tailored therapy has been supported across the world. Scores are variably associated with patients’ perceptions of respiratory symptom burden or disease severity ( Rennard 2002). Scores are associated with morbidity (hospitalization and adverse cardiovascular outcomes) and, in some studies, mortality. Used as a component of the BODE Index, which predicts adverse outcomes, including mortality and risk of hospitalization (Celli 2004). 10

11. In a study by Jones et al., the modified MRC ( mMRC ) dyspnoea scale showed a clear relationship with health status scores and even low mMRC scores were associated with health impairment 11

12. Disadvantages The mMRC Dyspnea Scale quantifies disability attributable to breathlessness, and is useful for characterizing baseline dyspnea in patients with respiratory diseases. Describes baseline dyspnea, but does not accurately quantify response to treatment of chronic obstructive pulmonary disease (COPD). Does not capture patient effort, such that dyspnea from pulmonary disease (and not behavioral responses to disability) are reflected in mMRC Dyspnea Scale scores. Does not consistently correlate with spirometric measurements (e.g. FEV₁) for patients with respiratory disease due to COPD. 12

13. Demonstrates at least moderate positive correlation with other dyspnea scores, including the baseline dyspnea index (BDI) and oxygen cost diagram (OCD) (Chhabra 2009). 13

14. References Nerys Williams, The MRC breathlessness scale, Occupational Medicine, Volume 67, Issue 6, August 2017, Pages 496–497, https://doi.org/10.1093/occmed/kqx086 Fletcher CM , Elmes PC , Fairbairn AS , Wood CH . The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J 1959;2:257–266. Rhee CK , Kim JW , Hwang YI et al. Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD. Int J Chron Obstruct Pulmon Dis 2015;10:1623–1631. 14