Initial development of the seven-dimension dysfunctional breathing dimensional model (DyB DiM 7) : A scoping review

Dysfunctional breathing is a clinical concept that may occur in isolation or in association with chronic health conditions, leading in both cases to significant health alterations. Categorical approaches to dysfunctional breathing present several limitations, and a dimensional approach has been widely recommended. However, existing dimensional models of dysfunctional breathing are mainly based on narrative studies, and several relevant dimensions may be missing. This study aimed to develop a descriptive, dimension-based model of dysfunctional breathing by identifying measurable components of this condition. We conducted a scoping review of white and grey literature, searching 11 databases from inception to October 2024. We performed open, axial and selective coding of measurable components of dysfunctional breathing identified in the selected articles. These elements were drawn from definitions, existing models, and clinical tools used to assess dysfunctional breathing, including clinical concepts, pathophysiological features, diagnostic criteria, clinical signs and symptoms. In the 338 papers selected, we identified 24 sub-dimensions grouped into seven overarching dimensions that characterize dysfunctional breathing: ventilation, physiology, biomechanics, acoustics, perceptions, psychology, and social factors. These dimensions seem to be influenced by specific states and tasks, the presence or absence of pathology, and fluid characteristics. The seven-dimension Dysfunctional Breathing Dimensional Model (DyB DiM 7) offers a descriptive and measurement framework for clinicians and researchers investigating dysfunctional breathing through a dimensional lens. Further structural and cultural validation of this model is required.