Measurement properties of physiotherapy assessment tools for breathing pattern disorder in adults with breathlessness: a systematic review using COSMIN methodology

Background Breathing pattern disorder (BrPD) is increasingly recognised as a contributor to breathlessness. Physiotherapists commonly use symptom-based questionnaires and observations during clinical evaluation. However, the measurement properties of these instruments remain unclear. Objectives: This systematic review aimed to evaluate the measurement properties of physiotherapy assessment measures, including reliability, validity and responsiveness. Methods Embase, PubMed, MEDLINE, and PEDro were searched from database inception to July 2023 and updated in December 2025, including reference lists. Studies evaluating the measurement properties of patient-reported outcome measures (PROMs), clinician-reported outcome measures (ClinROMs), or performance-based outcome measures were included. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Results Eighteen studies met the inclusion criteria, evaluating three instruments: the Nijmegen Questionnaire (NQ), the Self-Evaluation of Breathing Questionnaire (SEBQ), and the Breathing Pattern Assessment Tool (BPAT). Evidence for the NQ was the most extensive but showed substantial heterogeneity. The BPAT demonstrated moderate-certainty evidence for inter-rater reliability in specialist clinical settings, although evidence for other measurement properties was limited. Evidence supporting the SEBQ in symptomatic populations was limited. Conclusion The NQ and BPAT may support assessment when interpreted within their limitations but should not be used as standalone diagnostic tools. A multimodal approach combining symptom-based questionnaires with structured clinical observation is recommended. Further high-quality studies are needed to establish robust, standardised outcome measures for BrPD.