The Physiotherapy Assessment of Breathing Pattern Dysfunction

The Physiotherapy Assessment of Breathing Pattern Dysfunction Background Non-physiological disorders in breathing patterns are known as Breathing Pattern Disorder (BPD)2.

Its pathogenesis comprises a complex interplay between biomechanical/biochemical stimuli and psychopathological, cognitive factors3,4.

It is prevalent in up to 8% of the general population5, rising to 29% in those with asthma6 giving an overall prevalence of 10%7. The British Thoracic Society highlights the importance of screening for BPD in survivors of COVID-198.

BPD profoundly impacts on overall health and morbidity9,10 but its diagnosis is hampered by the lack of a universally accepted method of assessment2.

Without clear diagnosis, patients with BPD are prescribed expensive medications that may not be required, or be effective and may do harm11. In 2016 I developed an assessment tool called the Breathing Pattern Assessment Tool (BPAT)1; helping to evaluate BPD. The BPAT is clinically acceptable and widely used.

Further testing is need to determine its reliability and responsiveness to ensure that it is valid for use.

Well-designed assessment tools are required to target the right patients for physiotherapy and to evaluate treatment responses to in both clinical practice and trials12.

Aims To complete a systematic review to evaluate current methods for the assessment of BPD To investigate the validity, reliability and clinical utility of the BPAT in the characterisation and assessment of BPD and to investigate its responsiveness to a co-designed physiotherapy intervention To qualitatively evaluate the validity and acceptability, to patients and clinicians, of assessments and treatments for BPD Methods & Timelines Study 1: 0-12 months A systematic review of published evidence on tools used to assess BPD Study 2: 12-36 months An observational study of 100 patients referred to physiotherapy for BPD assessment.

Test-retest and inter-observer reliability of BPAT at rest will be assessed by calculating single-measure intra-class correlation coefficients (ICCs) of consistency. Validity of the BPAT and other assessments of BPD (NQ, SEBQ, D12, 6MWT) will be determined using Pearson's correlation. BPAT scores following exertion will also be evaluated.

The BPAT and other assessment tools will be prospectively measured before and after a co-designed physiotherapy intervention. Paired t-tests will compare pre- and post-measurements, and effect sizes calculated. Linear regression will be used to compare change in BPAT with change in other assessments.

Follow-up will occur at 3-months to determine if there are sustained improvements in the BPAT and other measurements.

Study 3: 32-43 months A qualitative study will investigate the acceptability of the assessment tools and treatments completed by patients and physiotherapy clinicians.

Analysis and stakeholder engagement 40-51 months Results will be analysed and submitted to peer reviewed scientific journals. Patients, clinicians and stakeholders will review the data and, where relevant, produce outputs together. Joint dissemination will occur through sharing with networks, PPI groups and presentations at conferences.

Anticipated impact and dissemination Increased knowledge on the clinical utility of a novel assessment tool (BPAT) for the assessment of BPD, and its feasibility for use in future clinical trials or for evaluation of treatment responses, as recommended by previous systematic reviews.