Multitask protocols to evaluate activities of daily living performance in people with COPD: a systematic review

Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

TOPIC IMPORTANCE

Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies.

REVIEW FINDINGS

This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life.

SUMMARY

There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.

Validity and reliability of the Glittre-ADL test in adults with asthma

INTRODUCTION

Adults with asthma may have limitations in their activities of daily living (ADL) and among the most used tests to assess ADL, performance-based instruments such as the Glittre-Activities of Daily Living (Glittre-ADL) test are available. However, metric properties of this instrument have not yet been investigated in this population.

OBJECTIVE

To verify the construct validity and reliability of the Glittre-ADL test in adults with asthma.

METHODS

Fifty-eight adults with asthma had their ADL objectively assessed by Glittre-ADL test, which was performed twice by the same rater. Lung function (spirometry), functional exercise capacity (6-minute walk test, 6MWT), and quality of life (St George's Respiratory Questionnaire, SGRQ) were also assessed.

RESULTS

Participants were 31% men; 43 ± 14 years; FEV1 74 ± 18% predicted. Performance in the Glittre-ADL test correlated with the 6MWT (r = -0.61; P < .0001) and had excellent intraclass correlation coefficient ICC_3,1 = 0.95. Standard error of measurement was 23%, and the minimal detectable change was 29 seconds. Furthermore, the learning effect was 11 seconds (5.03%).

CONCLUSION

The Glittre-ADL test is valid and reliable for assessing ADL in adults with asthma. However, considerable learning effect was observed and therefore the best of two measures can avoid underestimation.

Instruments to assess function or functionality in adults after a burn injury: A systematic review

INTRODUCTION

Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area.

OBJECTIVES

To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility.

METHODS

We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts.

RESULTS

Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility.

CONCLUSION

This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.

The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD

The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = -0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = -0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.

Baseline Characteristics of Subjects with Chronic Obstructive Pulmonary Disease Associated to the Improvement in Activities of Daily Living after Exercise Training

This study aimed to identify baseline variables predicting improvement in ADLs following an exercise training program in subjects with COPD. Sixty-seven patients with COPD underwent assessment of spirometry, modified Medical Research Council scale, COPD Assesment Test (CAT), Six Minute Walk Test (6MWT), London Chest Activity of Daily Living (LCADL) scale and Glittre-ADL test (TGlittre). After 24 sessions, they were reassessed for limitation in ADLs (LCADL and TGlittre). The main outcome was the achieving of minimal important difference (MID) of TGlittre, LCADL and both (ADLs). The cut-off points to discriminate the subjects who achieved the MID of TGlittre, LCADL and ADLs were established using the ROC curve. A cut-off point of 3.7 min in baseline TGlittre was able to discriminate subjects who achieved the MID of TGlittre (AUC = 0.77). Subjects with baseline TGlittre ≥3.7 min were 6.92 (95%CI 2.2-20.9) times more likely to achieve the MID of TGlittre post-exercise training. A cut-off point of 32% in LCADL was able to discriminate subjects who achieved the MID of LCADL (AUC = 0.81) and in ADLs (AUC = 0.78). Subjects with baseline LCADL ≥32% were 12.3 (95% CI 2.50 - 60.7) times more likely to achieve the MID of LCADL. In conclusion, the baseline variables that best predict the improvement of individuals after exercise training are TGlittre and LCADL, showing that subjects with significant functional impairment are more likely to clinically significantly improve their ADLs.

New Insights into Activities of Daily Living Performance in Chronic Obstructive Pulmonary Disease

Purpose

There have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD.

Methods

This cross-sectional study involved 84 participants aged 46–87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson’s correlation coefficient.

Results

The most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented.

Conclusion

Overall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation.

Activity repertoires and time use in people living with chronic obstructive pulmonary disease

BACKGROUND

Understanding the dynamics and aspects of how activity choices impact health and well-being in people living with chronic obstructive pulmonary disease (COPD) is important to inform rehabilitation.

AIM

To describe, firstly, how much time people living with COPD spend on work, daily living tasks, recreation and rest; secondly, how this population perceived competence, importance and enjoyment related to these activities; thirdly, if differences in such perceptions and time use were associated with the living situation and COPD severity.

MATERIAL AND METHODS

This cross-sectional study involved 76 participants (+45 years, COPD, living in ordinary homes), who completed the Occupational Questionnaire (OQ). Descriptive statistics and group comparisons were performed.

RESULTS

Most of the participants' time were spent on daily living activities and recreational activities. Participants spent approx. 80% of their recorded time in OQ on activities they valued, enjoyed and in which they felt competent. Participants living alone scored significantly lower on enjoyment in restful activities than those living in couples (p < 0.05). No statistically significant difference in perceived competence, importance or enjoyment was found in relation to COPD severity.

CONCLUSIONS AND SIGNIFICANCE

Findings underscore the importance of targeting overall daily activity repertoires including compositions of activity types, time use and perceived competence, importance and enjoyment.

Association between 6 min pegboard and ring test and arm performance in GOLD stage II-III patients

BACKGROUND

The 6 min pegboard and ring test (6PBRT) is a valid and reproducible test of unsupported arm exercise endurance. The aim of this study was to determine the associations between the 6PBRT, activities of daily living (ADL) and hemoglobin levels in chronic obstructive pulmonary disease (COPD).

METHODS

This study included 40 stable patients with COPD. All participants underwent the 6PBRT, peripheral venous blood sampling, arm ergometer test and the Glittre-ADL and ADL simulation tests for the ADLs performance.

RESULTS

An average 172.51 ± 25.94 rings were moved in 6 min. The number of rings in 6PBRT was significantly positively correlated with the number of cycles in ADL simulation test (r = 0.553, p < 0.001), peak oxygen consumption in arm ergometer (r = 0.381, p = 0.024) and serum hemoglobin level (r = 0.411, p = 0.011).

CONCLUSION

The number of rings moved in the 6PBRT is associated with ADL simulation test performance that reflects upper extremity ADLs. Therefore, the 6PBRT can be used for estimating limitation in upper extremity ADLs as a simple and quick evaluation in patients with GOLD stage II-III COPD.

Normative Values for Londrina ADL Protocol in Healthy Individuals in Age Group of 40-60 Years among Indian Population: A Cross-Sectional Study

Background

Due to increase in the life expectancy and changes related to aging, it is important to assess ADL (activities of daily living) in older adults. However, there is no standardized protocol available to assess ADLs. Considering the limitations of the available tools, a new protocol named Londrina ADL protocol was developed for which normative values are unavailable in different ethnic groups.

Objective

To develop the normative value and reference equation for the Londrina ADL protocol on the basis of anthropometric and demographic variables in healthy individuals in the age group of 40–60 years among the Indian population.

Methods

This cross-sectional study was conducted with 282 healthy individuals of both the genders between the age group of 40 and 60 and they were divided into 2 groups: 40–49 and 50–60. Each subject was made to perform the Londrina ADL protocol twice with a 30 min interval between the two protocols. The protocol is composed of 5 activities and the best out of the 2 performances were recorded.

Results

The mean time taken among 40–49 years by females is 3.50 ± 0.50 min and by males is 3.73 ± 0.43 min. The mean time taken among 50–60 years by females is 4.25 ± 0.20 min and by males is 4.36 ± 0.18 min. The reference equation to predict reference values for the Londrina ADL protocol was as follows: equation (1): Londrina ADL predicted = 1.205 + (0.054 × age (years)) + (0.001 × height (cm)); equation (2): Londrina ADL predicted = 1.374 + (0.054 × age (years)) + (−0.003 × BMI).

Conclusion

The reference equation for the time to complete the Londrina ADL protocol was based on age and BMI as independent variables and can be useful for predicting the performance of healthy individuals.

Comparison of Londrina activities of daily living protocol and Glittre ADL test on cardio-pulmonary response in patients with COPD: a cross-sectional study

Background

In COPD patients it is very important to assess the activities of daily living (ADL) due to an impairment of independence and quality of life. There is a lack of retrievable data regarding the cardio-pulmonary response to Londrina ADL protocol in patients with COPD. The aim of the present study was to assess the cardio-pulmonary response to Londrina ADL protocol in patients with COPD and to compare this with responses to the Glittre ADL test.

Methods

This cross-sectional study was done on 30 COPD subjects. Each subject was taken to perform the Londrina ADL protocol, Glittre ADL test, twice each, on subsequent days. The Londrina ADL protocol comprises 5 activities representing ADL, involving upper limbs, lower limbs, and trunk movements. The Glittre ADL test consists of completing a circuit while carrying a weighted backpack (2.5 kg for women, 5.0 kg for men). The better value of the two was taken into consideration. For the Londrina ADL protocol and Glittre ADL test the outcome of primary interest was time and for the six-minute walk test was the distance walked. The secondary outcomes for all tests were heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, saturation of oxygen in blood and dyspnea.

Results

The COPD subjects of age group 63.27±11.07 years took 5.94±0.36 min to complete trial 2 of the Londrina ADL protocol. Significant physiological increases in heart rate (p≤0.01), respiratory rate (p≤0.01), blood pressure (p≤0.01) and severity of dyspnea (p≤0.01) were observed, whereas saturation of oxygen in blood (p≤0.01) was reduced at the end of the Londrina ADL protocol and Glittre ADL test. There was a positive, non-significant correlation between the six-minute walk test distance and the Londrina ADL protocol time (r=0.236) (p=0.209). A positive, not significant correlation was observed between the Glittre ADL test (time) and the Londrina ADL protocol (time) (r=0.194) (p=0.304) and a negative but not significant correlation between the six-minute walk test (distance) and the Glittre ADL test (time) (r= -0.184) (p=0.330).

Conclusion

The Londrina ADL protocol can be used as an assessment tool for the evaluation of functional performance and activities of daily living in COPD along with other test protocols in pulmonary rehabilitation.

Association Between Everyday Technology Use, Activities of Daily Living and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Purpose

A decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL.

Methods

This cross-sectional study included (N=80) participants aged 46-87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis.

Results

The regression model explained 50.6% (R2=0.506) of the variation in HRQOL-physical. The following four variables were statistically significantly associated with HRQOL - physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R2=0.228) of HRQOL - mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL - mental (p=0.009).

Conclusion

Quality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD.