Nijmegen Questionnaire (also: Nijmegen Hyperventilation Scale)

Abstract

The Nijmeegse Vragenlijst (NVL), also known as the Nijmeegse Hyperventilatieschaal, is a widely recognized self-report instrument designed to quantify functional breathing complaints. Developed in 1983, the NVL specifically assesses symptoms related to Dysfunctional Breathing (DA), a condition previously often referred to as Hyperventilation Syndrome. The scale consists of 16 items, focusing primarily on the subjective and psychological dimensions of respiration and the body’s respiratory response to stress. Each complaint is rated on a 5-point ordinal scale ranging from ‘never’ to ‘very often’.

Keywords

Nijmeegse Vragenlijst, NVL, Hyperventilatieschaal, Dysfunctional Breathing, Functional Breathing Complaints, Hyperventilation Syndrome, Respiratory Assessment, Psychosomatic, Stress Reaction, Self-report Questionnaire.

Authors

van Doorn P, Colla P, Folgering H (1983).

Purpose

The primary purpose of the NVL is to provide a standardized, quantifiable measure of the severity and frequency of symptoms associated with dysfunctional breathing patterns. It serves as a crucial screening tool in clinical settings to differentiate between organic respiratory issues and those complaints rooted in functional or psychological factors.

By focusing on the subjective experience of the patient, the scale helps clinicians understand the impact of respiratory irregularities on daily life and the patient’s perception of their condition, particularly how their breathing patterns react under conditions of stress or anxiety. It is used broadly across physiotherapy, pulmonology, and psychological assessment fields.

Construct

The NVL measures the psychological and somatic manifestations of Dysfunctional Breathing (DA). This construct is characterized by chronic or recurrent changes in breathing patterns (e.g., hyperventilation, sighing, breath holding) that lead to physical and psychological symptoms, often without a clear underlying organic disease. The scale captures the 16 most common complaints related to this syndrome.

The scale’s strength lies in capturing the subjective dimension—how often an individual experiences specific physical symptoms (such as dizziness, chest pain, or shortness of breath) that are linked to respiratory anomalies. The resulting scores reflect the degree to which an individual experiences these symptoms, which are frequently exacerbated by emotional or environmental stress.

Validity

Research has demonstrated favorable construct validity for the Nijmeegse Vragenlijst, confirming its ability to measure the intended construct of functional respiratory complaints distinct from purely organic respiratory diseases. Studies often correlate NVL scores with physiological measures (such as end-tidal CO2 levels during hyperventilation provocation tests) and other established measures of anxiety or somatic distress.

Furthermore, the NVL exhibits good discriminant validity, effectively distinguishing between patients diagnosed with Hyperventilation Syndrome (or DA) and healthy control groups or patients with other respiratory conditions like asthma. This robust validation supports its use in clinical differential diagnosis across various age groups, including children, adults, and the elderly.

Reliability

The NVL generally exhibits strong internal consistency, with Cronbach’s alpha values typically reported in the range of 0.80 to 0.90 across various patient populations, indicating high homogeneity among the 16 items in measuring the underlying construct of functional breathing issues.

Test-retest reliability has also been established, confirming the stability of the scale scores over short periods, provided the patient’s clinical status remains unchanged. This stability is critical for using the NVL to monitor treatment effectiveness over time, particularly in interventions targeting the circulatory and respiratory system.

Factor Analysis

Early factor analyses suggested that the NVL is largely unidimensional, supporting its use as a single, overall measure of functional breathing complaints. However, subsequent research using more sophisticated statistical methodologies often reveals a two-factor structure.

These two factors typically represent: 1) Somatic Symptoms (physical complaints like chest tightness, dizziness, and palpitations) and 2) Psychological Symptoms (feelings of anxiety, tension, or difficulty concentrating). While both factors contribute significantly to the total score, the total cumulative score remains the most commonly used metric in clinical and research practice.

Instrument

Test Type: Questionnaire (Self-report instrument)

Format: The scale consists of 16 items, each rated on a 5-point ordinal scale: 1 (Nooit/Never), 2 (Zelden/Rarely), 3 (Soms/Sometimes), 4 (Vaak/Often), 5 (Zeer Vaak/Very Often). The total score ranges from 16 to 80.

Language Available: Primarily Dutch (Nijmeegse Vragenlijst), but widely translated and validated in English, German, and other European languages.

Population Group: Clinical populations experiencing functional breathing complaints, as well as general populations for screening purposes. The scale specifically relates to disorders of the Circulation and Respiratory System.

Age Group: Children, Adults, and Elderly.

Population Details: Applicable across various clinical settings, including pulmonology, psychology, and physical therapy, where assessment of respiratory dysfunction is required, particularly focusing on the Thorax/abdomen/organs area.

Test Methodology: Pencil-and-paper or digital administration. Scoring involves summing the responses across all 16 items. A higher total score indicates a greater severity of functional breathing complaints and a higher likelihood of Dysfunctional Breathing.

Keywords

Psychometrics, Internal Consistency, Somatic Complaints, Psychological Symptoms, Respiratory Health, Clinical Screening, Hyperventilation, Self-assessment.

Authors

Author ORCID Identifier: Information not available in source content.

Affiliation Email addresses: Information not available in source content.

Correspondence Address: Information not available in source content.

Permissions & Fee and Test Year

The Nijmeegse Vragenlijst was first published in 1983 by van Doorn, Colla, and Folgering. It is generally considered a non-proprietary instrument in academic and clinical use, although specific versions or translations may be subject to licensing agreements depending on the distribution source.

The original PDF explanation form can be downloaded here: Toelichtingsformulier (PDF).

The original PDF measurement instrument can be downloaded here: Meetinstrument (PDF).

Reference’s

van Doorn P, Colla P, Folgering H. (1983). The Nijmegen Questionnaire as a screening instrument for the hyperventilation syndrome.

Additional references (2, 3, 4) cited in the source content typically detail the scale’s psychometric validation and clinical application in various populations.

Items of the Nijmeegse Vragenlijst (ook: Nijmeegse Hyperventilatieschaal)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source material provided does not include the text of the 16 specific items that constitute the Nijmeegse Vragenlijst. The scale assesses 16 most common complaints experienced by individuals with Dysfunctional Breathing.

These 16 items cover somatic and psychological symptoms, including (but not limited to, based on general scale knowledge):

• Shortness of breath
• Chest pain or tightness
• Dizziness or lightheadedness
• Tingling in fingers or toes
• Anxiety or tension
• Difficulty concentrating

All items are rated on the standard 5-point frequency scale.