Modified Medical Research Council Scale
Objective[edit | edit source]
Shortness of breath is a widely experienced symptom and an important indicator for the prognosis of numerous respiratory conditions. Several scales exist for assessing the severity of breathlessness; the modified Medical Research Council dyspnoea scale ("mMRC") evaluates how breathlessness impacts daily activities and is endorsed in respiratory guidelines and as a fundamental measure in clinical trials. Its straightforwardness enables easy adoption across different clinical environments.[1]
Intended Population[edit | edit source]
The mMRC Scale is applicable for measuring breathlessness across a spectrum of conditions including COPD, bronchial asthma, restrictive lung diseases, pulmonary fibrosis, occupational lung diseases, and diverse heart conditions such as heart failure.
Method of Use[edit | edit source]
The mMRC scale is a self-assessment tool used to measure the level of impairment caused by breathlessness during daily activities, rated on a scale from 0 to 4.[2]
0, no breathlessness except on strenuous exercise; 1, shortness of breath when hurrying on the level or walking up a slight hill; 2, walks slower than people of same age on the level because of breathlessness or has to stop to catch breath when walking at their own pace on the level; 3, stops for breath after walking ∼100 m or after few minutes on the level ground; and 4, too breathless to leave the house, or breathless when dressing or undressing.[3]
| Grade | Description of Breathlessness |
|---|---|
| Grade 0 | I only get breathless with strenuous exercise |
| Grade 1 | I get short of breath when hurrying on level ground or walking up a slight hill |
| Grade 2 | On level ground, I walk slower than people of the same age because of breathlessness, or I have to stop for breath when walking at my own pace on the level |
| Grade 3 | I stop for breath after walking about 100 yards or after a few minutes on level ground |
| Grade 4 | I am too breathless to leave the house or I am breathless when dressing |
Evidence[edit | edit source]
- The modified Medical Research Council dyspnoea scale is a good indicator of health-related quality of life in patients with chronic obstructive pulmonary disease[4]
- Modified Medical Research Council Dyspnea Scale in GOLD Classification Better Reflects Physical Activities of Daily Living[5]
- Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease[6]
- Evaluation of three scales of dyspnea in chronic obstructive pulmonary disease[7]
- Differences in physical activity according to mMRC grade in patients with COPD[8]
- Correlation of the modified Medical Research Council dyspnea scale with airway structure assessed by three-dimensional CT in patients with chronic obstructive pulmonary disease[9]
Reliability and Validity[edit | edit source]
Past research has demonstrated the sound validity and reliability of the mMRC Dyspnea Scale. Currently, this scale enjoys extensive utilization in China.[10]
A study done by Jacob et al[11]. aimed to assess the test-retest reliability, concurrent validity, and responsiveness of DES when compared to mMRC in measuring long-standing breathlessness among individuals diagnosed with life-limiting illnesses. In this study he concluded that in comparison to mMRC, DES exhibited similar or superior measurement properties concerning test-retest reliability and concurrent validity. It could serve as a discriminative tool within this population, but both scales lack the sensitivity to detect changes, making them unsuitable as outcomes in clinical trials.
A study done in 2022 evaluated the content validity of the mMRC among individuals presenting with various respiratory or cardiac conditions, as well as among healthy volunteers. This research discovered significant variability among participants' assessments of the mMRC descriptors, especially for grades 0, 2, and 3. This study also suggests that the mMRC might not effectively distinguish differences or changes in dyspnoea severity and highlights the crucial need for content validation, even for well-established Patient-Reported Outcomes (PROs) such as the mMRC.[12]
Responsiveness[edit | edit source]
The mMRC dyspnoea scale proves to be a compact and pragmatic instrument for evaluating the Health-Related Quality of Life (HRQoL) among COPD patients in routine clinical settings.[4]
A study done by Sandberg et al.[11] aimed to assess the test-retest reliability, concurrent validity, and responsiveness of Dyspnoea Exertion Scale (DES) when compared to mMRC in measuring long-standing breathlessness among individuals diagnosed with life-limiting illnesses. In this study he concluded that in comparison to mMRC, DES exhibited similar or superior measurement properties concerning test-retest reliability and concurrent validity. It could serve as a discriminative tool within this population, but both scales lack the sensitivity to detect changes, making them unsuitable as outcomes in clinical trials.
References[edit | edit source]
- ↑ Sunjaya A, Poulos L, Reddel H, Jenkins C. Qualitative validation of the modified Medical Research Council (mMRC) dyspnoea scale as a patient-reported measure of breathlessness severity. Respiratory Medicine. 2022 Nov 1;203:106984.
- ↑ Rajala K, Lehto JT, Sutinen E, Kautiainen H, Myllärniemi M, Saarto T. mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis. ERJ open research. 2017 Oct 1;3(4).
- ↑ 3.0 3.1 Williams N. The MRC breathlessness scale. Occupational medicine. 2017 Aug 1;67(6):496-7.
- ↑ 4.0 4.1 Hsu KY, Lin JR, Lin MS, Chen W, Chen YJ, Yan YH. The modified Medical Research Council dyspnoea scale is a good indicator of health-related quality of life in patients with chronic obstructive pulmonary disease. Singapore Med J. 2013 Jun 1;54(6):321-7.
- ↑ Munari AB, Gulart AA, Dos Santos K, Venâncio RS, Karloh M, Mayer AF. Modified medical research council dyspnea scale in GOLD classification better reflects physical activities of daily living. Respiratory care. 2018 Jan 1;63(1):77-85.
- ↑ Perez T, Burgel PR, Paillasseur JL, Caillaud D, Deslée G, Chanez P, Roche N. Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2015 Aug 18:1663-72.
- ↑ Chhabra SK, Gupta AK, Khuma MZ. Evaluation of three scales of dyspnea in chronic obstructive pulmonary disease. Annals of thoracic medicine. 2009 Jul;4(3):128.
- ↑ Hayata A, Minakata Y, Matsunaga K, Nakanishi M, Yamamoto N. Differences in physical activity according to mMRC grade in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2016 Sep 13:2203-8.
- ↑ Yasui, H., Inui, N., Karayama, M., Mori, K., Hozumi, H., Suzuki, Y., Furuhashi, K., Enomoto, N., Fujisawa, T., Nakamura, Y. and Watanabe, H., 2019. Correlation of the modified Medical Research Council dyspnea scale with airway structure assessed by three-dimensional CT in patients with chronic obstructive pulmonary disease. Respiratory Medicine, 146, pp.76-80.
- ↑ Chen H, Li Y, Wang W, Zhang H, Nie N, Ou J, Li L. Reliability and validity of the multidimensional dyspnea profile in hospitalized Chinese patients with respiratory diseases. SAGE Open Medicine. 2021 Sep;9:2050312120965336.
- ↑ 11.0 11.1 Sandberg J, Johnson MJ, Currow DC, Ekström M. Validation of the dyspnea exertion scale of breathlessness in people with life-limiting illness. Journal of Pain and Symptom Management. 2018 Sep 1;56(3):430-5.
- ↑ Sunjaya A, Poulos L, Reddel H, Jenkins C. Qualitative validation of the modified Medical Research Council (mMRC) dyspnoea scale as a patient-reported measure of breathlessness severity. Respiratory Medicine. 2022 Nov 1;203:106984.
