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Rocha BLC, Assis MG, Mendes LPDS, Velloso M. Glittre-ADL test without backpack: A qualitative study of perceptions of people with chronic obstructive pulmonary disease. Braz J Phys Ther 2023; 27:100564. [PMID: 38061168 PMCID: PMC10749238 DOI: 10.1016/j.bjpt.2023.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The Glittre Activities of Daily Living (Glittre-ADL) test without backpack was recently validated to assess the functional capacity of people with chronic obstructive pulmonary disease (COPD) OBJECTIVE: To understand the perceptions of people with COPD about the Glittre-ADL test with and without backpack and the possible similarities with their activities of daily living (ADLs). METHODS Participants performed 2 Glittre-ADL tests with a backpack (visit 1). On visit 2, participants randomly performed the Glittre-ADL test with and without backpack and completed a semi-structured interview with questions about the tests. Interviews were analyzed according to thematic analysis. RESULTS Twelve participants aged between 57 and 76 years with mild to severe COPD were included. Interviews were grouped into four thematic categories: (1) Glittre-ADL test with a backpack: does the backpack make the test worse, or does it not matter?; (2) test tasks and ADL: what is in common between them?; (3) "I enjoyed taking the test": the possibility of learning and new expectations; and (4) symptoms during the Glittre-ADL tests. CONCLUSION The following perceptions while performing the Glittre-ADL test with and without the backpack were observed: dyspnea and fatigue sensation, difficulty using the backpack while performing tasks such as squatting, and similarities to ADLs tasks despite different perspectives regarding the degree of ease and expectations on how to perform test tasks at home.
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Affiliation(s)
- Bianca Louise Carmona Rocha
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Marcella Guimarães Assis
- Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Liliane Patrícia de Souza Mendes
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Terapia Respiratória e do Sono Pesquisa & Ensino, Belo Horizonte, MG, Brazil
| | - Marcelo Velloso
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Gulart AA, Munari AB, Klein SR, Gavenda SG, Sagrillo LM, Mayer AF. Performance in the Glittre-ADL Test is Associated with the Pulmonary Function of Patients with Chronic Obstructive Pulmonary Disease. COPD 2021; 18:637-642. [PMID: 34865582 DOI: 10.1080/15412555.2021.2008339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between lung function and performance in some functional tests, as the six-minute walk test (6MWT) and Glittre-ADL test (TGlittre) are still discrepant in patients with chronic obstructive pulmonary disease (COPD). This study aimed to verify which test better correlates and is better explained by the pulmonary function, and which test better discriminates patients regarding the severity of the disease. Seventy-four patients with moderate to very severe COPD (54 men; 66 ± 9 years; FEV1: 37.2 ± 14.3%pred) were included. Spirometry, 6MWT and TGlittre were performed. The results showed weak to moderate correlation between pulmonary function variables and 6MWT (0.36 ≤ r ≤ 0.45) and TGlittre (-0.44 ≤ r ≤ -0.53). In patients with performance of ≤400 m in the 6MWT, a strong correlation was observed between TGlittre with FEV1 (%pred) (r = -0.82; p < .001). The pulmonary function variable that better predict the functional tests performance was FEV1 (R2 = 0.17). Both functional tests were able to discriminate patients with COPD GOLD 4 from the other classifications. When compared to GOLD 2 patients, GOLD 4 patients presented higher time spent on TGlittre (p < .001). When compared to GOLD 3 patients, GOLD 4 patients had higher TGlittre (p = .001). No statistical differences were found in the 6MWT between GOLD 3 and 4, as well as between GOLD 2 and 3. In conclusion, the pulmonary function presents stronger correlations and better explain the variability of TGlittre than of the 6MWT, especially in patients with greater functional impairment. The TGlittre seems to better discriminate patients with COPD regarding the severity of lung function.
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Affiliation(s)
- Aline Almeida Gulart
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Anelise Bauer Munari
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Suelen Roberta Klein
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Simone Graciosa Gavenda
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Luiza Minato Sagrillo
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Anamaria Fleig Mayer
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
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Luz CMD, Prim AC, Deitos J, Heck APF, Recchia TL, Mayer AF. Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery. Disabil Rehabil 2021; 44:4096-4103. [PMID: 33749472 DOI: 10.1080/09638288.2021.1897885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the reliability and convergent validity of the Upper Limb Functional Test (ULIFT) in women after breast cancer surgery. MATERIALS AND METHODS A cross-sectional study with 25 women (mean age 50 ± 7.3 years) with breast cancer submitted to a surgery intervention within a minimum period of three years. Intraclass correlation coefficients (ICCs) were calculated to assess the test-retest reliability. A Bland-Altman plot examined the agreement between the times to complete two tests. Validity was established by correlating the ULIFT and DASH total score. The receiver operating characteristic (ROC) curve was used to determine the cut-off point for ULIFT in order to discriminate patients with some level of upper limb dysfunction. RESULTS The ULIFT showed high reproducibility (ICC = 0.89; p < 0.001), learning effect of 7.21%, and a moderate correlation with the DASH total score (r = 0.536; R2 = 0.28; p = 0.006). The standard error of measurement was 6.9 s and the smallest real difference was 19.1 s. The ROC curve indicated a cut-off point of 109.2 s (sensitivity = 68.7%; specificity = 77.8%; area under ROC curve = 0.77). CONCLUSIONS The ULIFT could be a valid and reliable test to assess upper limb functionality in patients submitted to breast cancer surgery.Implications for rehabilitationThe ULIFT is a reliable and valid test to assess upper limb function in women after breast cancer surgery, considering specifically the lifting and range of motion construct of unilateral upper limb function.The ULIFT could help identify those most at risk of developing upper limb dysfunction after breast cancer surgery and could benefit the follow-up of a postoperative rehabilitation program.Two ULIFTs should be performed in order to achieve patient's best performance.
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Affiliation(s)
- Clarissa Medeiros da Luz
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Amably Cristiny Prim
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Julia Deitos
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Ailime Perito Feiber Heck
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Thaís Lunardi Recchia
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Anamaria Fleig Mayer
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
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Munari AB, Silva IJCS, Gulart AA, Venâncio RS, Klein SR, Zanotto J, Mayer AF. Reproducibility of the 6-Min Step Test in Subjects With COPD. Respir Care 2021; 66:292-299. [PMID: 32962994 PMCID: PMC9994210 DOI: 10.4187/respcare.08096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Test-retest reproducibility of the 6-min step test (6MST) is controversial in patients with COPD because the decision to perform a second test is influenced by interruptions, physiological overload, and the patient's exercise tolerance. The aim of this study was to analyze the reproducibility of performance on the 6MST (ie, number of steps climbed and interruptions) and physiological variables in subjects with COPD, with and without poor exercise tolerance, and with and without interruptions during the test. METHODS Subjects performed 2 6MST (6MST1, 6MST2) with a minimum of 30 min rest between tests. Physiological variables were assessed with a gas analyzer. Subjects who performed ≤ 78 steps in the 6MST1 and ≤ 86 steps in the test with the higher number of steps performed (6MSTBEST) were considered to have poor exercise tolerance. Subjects were also stratified according to those who interrupted the 6MSTBEST and those who did not interrupt the 6MSTBEST. RESULTS 40 subjects (31 men; FEV1 percent of predicted = 50.4 ± 13.5) participated in the study. The number of steps, interruptions, and physiological variables showed moderate to high reliability (intraclass correlation coefficient: 0.70-0.99, P < .001). Thirty-one (77.5%) subjects had a better performance during 6MST2 than 6MST1 (mean difference: 4.65 ± 5.59, P < .001). Although the number of times subjects were interrupted was similar between the 2 tests (P = .66), the duration of these interruptions was shorter during 6MST2 (mean difference: -0.12 ± 0.39 s, P = .040). The difference in the number of steps (6MST2 - 6MST1) did not differ between subjects who performed ≤78 steps (mean difference: 5.64 ± 5.32 steps; 10.3%; P < 0.001) and ≥ 79 steps (3.00 ± 5.82 steps; 6.13%; P = 0.08) on the 6MST1 (P = 0.15) and between subjects who performed ≤ 86 steps (5.39 ± 5.14 steps; 9.39%; P < 0.001) and ≥ 87 steps (2.92 ± 6.43 steps; 2.74%; P = 0.14) steps on the 6MSTBEST (P = 0.20). CONCLUSIONS Performance and physiological variables in the 6MST were reproducible, and a second test did not impose greater physiological overload. Two tests were essential for patients with poor exercise tolerance.
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Affiliation(s)
- Anelise Bauer Munari
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Isabela Julia Cristiana Santos Silva
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Aline Almeida Gulart
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Raysa Silva Venâncio
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Suelen Roberta Klein
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Júlia Zanotto
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Anamaria Fleig Mayer
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil.
- Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Mendes LPDS, Parreira VF, Spencer LM, Vieira DSR, Alison JA. Validity and Responsiveness of the Glittre-ADL Test without a Backpack in People with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:392-400. [PMID: 32594774 DOI: 10.1080/15412555.2020.1756236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Glittre-ADL test assesses the functional capacity for activities of daily living of people with chronic obstructive pulmonary disease (COPD). In the test, a weighted backpack is worn (2.5 kg for women and 5.0 kg for men). The differential in weight between men and women is not common in other tests of exercise capacity and may limit the comparison of the test between sexes. The primary aim of this study was to validate the Glittre-ADL test performed without the backpack in people with COPD. Forty participants with mild to severe COPD (mean ± SD age: 70 ± 6 years; FEV1: 48 ± 20%predicted) were recruited and performed two six-minute walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3). The Glittre-ADL test time was shorter without the backpack than with the backpack [mean difference -0.37 min (95%CI -0.59 to -0.15)] and heart rate (HR) and oxygen saturation (SpO2) were equivalents between tests [-1.31 beats/minute (-3.92 to 1.30) and -0.95% (-2.27 to 0.37), respectively]. The Glittre-ADL test without the backpack elicited similar HR and SpO2 responses as the test with the backpack, indicating equivalence of physiological demand. Thus, the Glittre-ADL test without the backpack was a valid, responsive, and appropriate test to assess functional capacity for activities of daily living.
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Affiliation(s)
- Liliane P de Souza Mendes
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Verônica Franco Parreira
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lissa M Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Jennifer Ailsey Alison
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Allied Health Professorial Unit, Sydney Local Health District, Sydney, New South Wales, Australia
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Physiological Responses and Dynamic Hyperinflation Induced by Unsupported Arm Activities Involved in Multiple-Task Activities of Daily Living Test in Patients With COPD. J Cardiopulm Rehabil Prev 2018; 38:E12-E15. [PMID: 29952808 DOI: 10.1097/hcr.0000000000000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to analyze the isolated role of unsupported arm activities and the physiological responses and dynamic hyperinflation (DH) induced by activities of daily living in patients with chronic obstructive pulmonary disease. Physiological responses and DH were compared using the Glittre activities of daily living test (TGlittre) and a modified protocol that emphasized unsupported arm activities and excluded squats and bending down to move objects on shelves (TGlittre-M). Data were also compared from the isolated shelf tasks of TGlittre (TSHELF) and TGlittre-M (TSHELF-M). METHODS This cross-sectional study included 30 patients with chronic obstructive pulmonary disease who performed the TGlittre, TGlittre-M, TSHELF and TSHELF-M. The physiological responses were evaluated during the 4 protocols and inspiratory capacity was measured before and immediately after the tests for evaluation of DH. RESULTS Patients had higher oxygen uptake, ventilatory demand, dyspnea, and DH in the TGlittre than in the TGlittre-M (mean differences: 123 ± 119 mL/min; 0.11 ± 0.10, 1 [-1 to 3], and - 0.14 ± 0.22, respectively; P < .05 for all). Oxygen uptake, ventilatory demand, and dyspnea were also higher in the TSHELF than in the TSHELF-M (mean differences: 408 ± 185 mL/min; 0.26 ± 0.17; 1 [-1 to 3], respectively; P < .05 for all). However, DH was similar for both tasks (P > .05). CONCLUSIONS In patients with chronic obstructive pulmonary disease, the physiological demands during unsupported arm activities were lower than during the task performed with squatting and bending down; however, the magnitude of DH did not differ between them. These results suggest that the isolated arm activities contribute less to the TGlittre's physiological requirement than the lower-limb and trunk activities.
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The effects of inspiratory muscle training based on the perceptions of patients with advanced lung disease: a qualitative study. Braz J Phys Ther 2017; 22:215-221. [PMID: 29258735 DOI: 10.1016/j.bjpt.2017.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advanced lung disease is a chronic non-neoplastic disease that compromises activities of daily living. Treatment includes pulmonary rehabilitation and inspiratory muscle training. Studies have shown the effectiveness of inspiratory muscle training in lung disease patients, but literature is scarce on the patients' perceptions about this topic. OBJECTIVE To explore the perceptions of patients with advanced lung disease about inspiratory muscle training. METHODS Qualitative study. Interviews were conducted using a semi-structured questionnaire regarding topics on the participation of patients in inspiratory muscle training and on daily activities performed before and after training. Interviews were transcribed and analyzed according to thematic content analysis. RESULTS Ten patients (eight women and 2 men, ranging in age from 27 to 89 years) with inspiratory muscle weakness (maximal inspiratory pressure=44±13.9cmH2O) were included. Five patients were diagnosed with Chronic Obstructive Pulmonary Disease, two with bronchiectasis and three with pulmonary fibrosis. All patients completed at least 80% of the total training sessions. The reports were grouped into four thematic categories: (1) impact of inspiratory muscle training on breathlessness (e.g., "I wasn't feeling as tired as I previously felt."); (2) change in daily activities (e.g., "I needed to go to the supermarket, I felt less tired doing it."); (3) improved mobility (e.g., "I could not stand for long periods […] walking, for example […] Now I stand more, I have more capability."); and (4) increased communication (e.g., "More power, right? Even in speaking […] When I could, I felt my voice coming out better."). CONCLUSION There were improvements in breathlessness, daily activities, mobility, and communication, which positively affected the psychological and social aspects of the patients.
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Paes T, Machado FVC, Cavalheri V, Pitta F, Hernandes NA. Multitask protocols to evaluate activities of daily living performance in people with COPD: a systematic review. Expert Rev Respir Med 2017; 11:581-590. [PMID: 28539067 DOI: 10.1080/17476348.2017.1335198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION People with chronic obstructive pulmonary disease (COPD) present symptoms such as dyspnea and fatigue, which hinder their performance in activities of daily living (ADL). A few multitask protocols have been developed to assess ADL performance in this population, although measurement properties of such protocols were not yet systematically reviewed. Areas covered: Studies were included if an assessment of the ability to perform ADL was conducted in people with COPD using a (objective) performance-based protocol. The search was conducted in the following databases: Pubmed, EMBASE, Cochrane Library, PEDro, CINAHL and LILACS. Furthermore, hand searches were conducted. Expert commentary: Up to this moment, only three protocols had measurement properties described: the Glittre ADL Test, the Monitored Functional Task Evaluation and the Londrina ADL Protocol were shown to be valid and reliable whereas only the Glittre ADL Test was shown to be responsive to change after pulmonary rehabilitation. These protocols can be used in laboratory settings and clinical practice to evaluate ADL performance in people with COPD, although there is need for more in-depth information on their validity, reliability and especially responsiveness due to the growing interest in the accurate assessment of ADL performance in this population.
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Affiliation(s)
- Thaís Paes
- a Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy , State University of Londrina (UEL) , Londrina , Brazil
| | - Felipe Vilaça Cavallari Machado
- a Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy , State University of Londrina (UEL) , Londrina , Brazil
| | - Vinícius Cavalheri
- b School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Australia
- c Institute for Respiratory Health , Sir Charles Gairdner Hospital , Perth , Australia
| | - Fabio Pitta
- a Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy , State University of Londrina (UEL) , Londrina , Brazil
| | - Nidia Aparecida Hernandes
- a Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy , State University of Londrina (UEL) , Londrina , Brazil
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