The Physiotherapy Assessment of Breathing Pattern Disorder

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.

• Nijmegen Questionnaire [Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder]
• Dyspnoea 12 (D-12) Questionnaire [Time frame: 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) [Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder]
• Breath Hold [Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder]
• End Tidal C02 [Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder]
• Breathing Vigilance Questionnaire [Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder]
• Self evaluation of breathing questionnaire [Time frame: Baseline for all participants; and through study completion (up to 6 months) for participants with Breathing Pattern Disorder]