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Development of emPHasis-10 questionnaire

EmPHasis-10 was designed to help clinicians assess and improve management of PH by measuring the impact that PH has on a person’s life and how this changes over time.

The tool has now been translated into over 20 languages across the globe.

Wendy Gin-Sing, PH Professionals group member and Clinical Nurse Specialist in the Pulmonary Hypertension Service at the Hammersmith Hospital, said:

“The questionnaire is easy to use and the simple scoring using a scale of 0-5 means that with one glance you can assess a patient’s current quality of life. Also, because it is a disease specific quality of life questionnaire, it can identify subtle changes in exercise capacity and energy levels that other
measurements may miss.
Exercise tests and cardiac catheters can give us data about how well the body is functioning but EmPHasis-10 allows us to measure quality of life, which is often the most important factor for our patients as well as the team looking after them.”

Administering and scoring emPHasis-10

emPHasis-10 consists of 10 items which address breathlessness, fatigue, control and confidence. The questionnaire is short and easy for clinicians to administer in a clinic setting. It is also easy for patients to complete.

It does not require complex analysis or interpretation. Each item is scored on a semantic differential six-point scale (0-5), with contrasting adjectives at each end. A total emPHasis-10 score is derived using simple aggregation of the 10 items. emPHasis-10 scores range from 0 to 50, higher scores indicate worse quality of life.

Using emPHasis-10

The emPHasis-10 can be used for clinical or non-funded research purposes without permission and cost, as long as the integrity of the test is respected. All copyright information must be maintained.

For commercial use permission should be sought from the PHA UK. It may be appropriate that such use involves a donation to the charity.

If you have any questions about using emPHasis-10 please contact Shaun Clayton at shaun@phauk.org or call 01709 761450.

Latest study

A new study published in 2020, led by researchers in Sheffield, aimed to understand whether a lower emPHasis-10 score correlated with improved results in clinical tests, such as the six-minute walk test, incremental shuttle walk test, readings taken at right heart catheterisation and World Health Organisation (WHO) functional class.

The findings confirmed the correlations and the results have just been published in acclaimed peer-reviewed medical journal the European Respiratory Journal (ERJ) – raising awareness of the emPHasis-10 questionnaire amongst the international medical community.

Dr Robert Lewis, Specialty Registrar in Respiratory Medicine, led the study and wrote the published paper. He said: “The ERJ is one of the most prestigious respiratory journals in the world and publishes high quality research that may lead to a change in practice. By having this work published in a journal that has such a reputation and an international readership, it means that our findings are likely to be seen by PH physicians around the world and will hopefully encourage others to place more importance on quality of life scores.”

Dr Lewis had expected the results of the study to show there would be correlations with measures that tell you how well you are doing – such as WHO functional class and exercise – but the research also shows that emPHasis-10 is effective as an independent marker of life expectancy for people with pulmonary arterial hypertension.  

He added: “We were really fortunate that we were able to get data from almost all the UK specialist centres for the study, and it was a collaborative effort. Colleagues from other centres had to put work in to extract the data from their clinical databases and the paper wouldn’t have been possible without their help.”