Stair-Climbing Capacity as a Marker of Improvement Following Pulmonary Rehabilitation

The one-minute sit-to-stand-test performance is associated with health-related quality of life in patients with pulmonary hypertension

INTRODUCTION

Patients with pulmonary hypertension (PH) have an impaired functional capacity and poor health-related quality of life (HRQoL). The one-minute sit-to-stand test (1-min STST) can be used for the assessment of functional capacity.

AIMS

Our aim was to evaluate the 1-min STST performance and its association with patient-reported HRQoL in patients with PH.

METHODS

We prospectively assessed functional capacity in 98 PH patients (mean age 66 ± 15 years, 55% female) using the 1-min STST. Patients had to stand up and sit down from a chair as many times as possible within one minute. Patients' HRQoL was evaluated with the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaire, which consists of the three subcategories symptoms, activities and quality of life (QoL).

RESULTS

We observed a significant correlation of the 1-min STST performance with all HRQoL subcategories assessed with the CAMPHOR questionnaire: A lower number of 1-min STST repetitions correlated with more symptoms (rs = -.398, p < .001), worse functioning (rs = -.551, p < .001) and a decreased QoL (rs = -.407, p < .001). Furthermore, in the multivariable linear regression analysis, adjusted for age, sex, body mass index (BMI) and mean pulmonary artery pressure (mPAP), lower 1-min STST performance was an independent predictor for worse symptoms (est. β = -0.112, p = .003), activities (est. β = -0.198, p < .001) and QoL (est. β = -0.130, p < .001) assessed with the CAMPHOR questionnaire.

CONCLUSION

Our results indicate that regardless of age, sex, BMI and mPAP the 1-min STST performance is associated with all CAMPHOR HRQoL subcategories in patients with PH. Therefore, the 1-min STST performance might be a new option to assess functional capacity correlated to HRQoL in patients with PH.

Reliability of stair-climbing speed in two cohorts of older adults

Background/Aims

The ability to climb stairs is an important prerequisite for activities of daily living and social participation in older adults, and is therefore an important part of rehabilitation. However, there is no consensus on how to measure stair-climbing ability. The aim of this study was to investigate the test–retest reliability of the measurement of stair-climbing speed (steps per second) as a parameter for functional ability in older adults.

Methods

A total of 57 participants who were in hospital and 56 participants who were community-dwelling and did not have any limitations in activities in daily living, all aged 60 years and over, ascended and descended a set of 13 stairs twice. The halfway point of the staircase was marked in order to split the time required for both the ascending and the descending actions. Additional measurements consisted of the Functional Reach Test, the Timed Up and Go Test, walking ability using the GAITRite walkway system and the isometric strength of four muscle groups of the lower extremities using a handheld dynamometer.

Results

Test–retest reliability of the first and second half of the stair-climbing for both ascending and descending showed excellent results for the group of hospitalised participants (intraclass correlation coefficient, [ICC] 0.87, 95% confidence interval [CI] 0.79–0.93 to 0.94, 95% CI 0.9 – 0.97 for comparison of first vs second half of stair climbing; ICC 0.9, 95% CI 0.83-0.94 to ICC 0.95, 95% CI 0.92–0.97 for comparing first vs second measurement)) and moderate to excellent results for the group of community-dwelling participants with no limitations (ICC 0.58, 95% CI 0.37–0.73 to ICC 0.76, 95% 95% CI 0.63-0.85 for comparison of first vs second half of stair climbing; ICC 0.82, 95% CI 0.71-0.89 to 0.92, 95% CI 0.87–0.95 for comparing first vs second measurement). As expected, hospitalised participants took significantly longer descending than ascending stairs (t(56)=6.98, P<0.001, d=0.93). A general and significant trend of increasing speed while descending could be observed in both groups (performing paired sample t-tests).

Conclusions

The results indicate that stair-climbing speed is not constant and that different patterns exist in older adults who have no limitations and in those who are hospitalised. The use of stair-climbing speed as an assessment tool should include both stair ascent and descent, because differences in these speeds seem to be indicators of stair-climbing ability.