Functional status measurement in COPD: a review of available methods and their feasibility in primary care

Functional capacity using sit-to-stand tests in people with chronic obstructive pulmonary disease and its relationship with disease severity-a cross-sectional study with matched controls

BACKGROUND

Functional capacity impairment is a crucial consequence of chronic obstructive pulmonary disease (COPD). Although it can be identified with simple tests, such as the sit-to-stand tests, its prevalence, relation with disease severity, and the characteristics of people presenting this impairment remain unknown.

OBJECTIVE

To explore the functional capacity of people with COPD.

METHODS

A cross-sectional study with people with COPD and age-/sex-matched healthy controls was conducted. Functional capacity was assessed with the 5-repetitions (5-STS) and the 1-minute (1-minSTS) sit-to-stand tests. People with COPD were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications. Comparisons between people with COPD and healthy controls, and among GOLD groups were established. Associations between symptoms, muscle strength, quality of life, and measures of functional capacity were explored.

RESULTS

302 people with COPD [79% male; mean (SD) 68 (10) years old] and 304 healthy controls [75% male; 66 (9) years old] were included. 23% of people with COPD presented impairment in the 5-STS and 33% in the 1-minSTS. People with COPD from all GOLD classifications presented significantly lower functional capacity than healthy controls (5-STS: COPD median [1st quartile; 3rd quartile] 8.4 [6.7; 10.6] versus healthy 7.4 [6.2; 9.3] s; 1-minSTS: COPD 27 [21; 35] vs healthy 35 [29; 43] reps). Correlations with symptoms, muscle strength, and quality of life were mostly weak (5-STS: rs [-0.34; 0.33]; 1-minSTS: rs [-0.47; 0.40]).

CONCLUSION

People with COPD have decreased functional capacity independently of their GOLD classifications. The prevalence of functional impairment is 23-33%. Because impaired functional capacity is a treatable trait not accurately reflected by other outcomes, comprehensive assessment and management is needed.

Primary care patients with mild or stable chronic obstructive pulmonary disease need more support in disease management: a secondary analysis of a cluster randomized controlled trial

OBJECTIVE

Patient education based on the patient's individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients' subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education.

DESIGN

A secondary analysis of a cluster randomized controlled trial.

SETTING

22 PHCCs in Stockholm, Sweden.

SUBJECTS

Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 293).

OUTCOME MEASURES

Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18 months, spirometry results, and self-reported, descriptive patient data.

RESULTS

GPs' improved skills in COPD did not affect patients' self-management skills over time. In general, patients' information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93-5.23], p < .01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05-4.86], p = .038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD.

CONCLUSION

Patients' information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient's current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education.

TRIAL REGISTRATION

Clinicaltrials.gov, 10 August 2014, Identifier NCT02213809.

Glittre-ADL test without backpack: A qualitative study of perceptions of people with chronic obstructive pulmonary disease

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.

One-minute sit-to-stand test as a quick functional test for people with COPD in general practice

Assessing changes in functional exercise capacity is highly relevant in the treatment of people with Chronic Obstructive Pulmonary Disease (COPD), as lung function is often static. In Denmark, most people with COPD are followed in general practice where traditional functional tests, like six-minute walk test, require too much time and space. Therefore, there is an urgent need for a quick functional exercise capacity test that can be performed in a limited setting, such as general practice. This study aimed to identify a quick test to measure functional exercise capacity in people with COPD and identify which factors could affect the implementation of such a test in general practice. A mixed method feasibility study composed of a literature review and qualitative interviews was used. Quick functional tests for people with COPD were identified and evaluated through the COSMIN methodology. For the interviews, 64 general practices were included, and 50 staff members and 14 general practitioners (GPs) participated in the interviews. Responses were categorized and thematically analyzed. The 1 min sit-to-stand-test (1 M STST) was found suitable for a general practice setting. The COSMIN methodology rated it "sufficient" in reliability (ICC 0.90-0.99), measurement error (MID 2.5-3), construct validity and responsiveness (AUC 0.72), and found a moderate to strong correlation in criterion validity (r = 0.4-0.75). Several GPs wished for a quick functional test and emphasized evidence, information, and limitations as essential when deciding on implementation. Other factors identified included time, other tests, and economy. 1 M STST is a valid test to assess functional exercise capacity in people with COPD. The test is quick and can easily be performed in a standard consultation, and several GPs wished for such a test.

Swetha, Prasanth G., Sakthi Sangeetha V., V. Gangadharan. Correlation between six-minute walk test and sit-to-stand test in COPD patients

Introduction and Aim: Six Minute Walk Test (6MWT) and spirometry are commonly used tests to assess the functional status of the Chronic Obstructive Pulmonary Diseases (COPD) patients. However, many other simpler tests like Sit to Stand Test (STST) are also available. This study is done to assess the utility of STST in comparison to 6MWT to evaluate the functional status of COPD patients in our hospital.   Materials and Methods: This study is a prospective and an observational study conducted on 50 COPD patients. Each patient underwent spirometry and subjected to 6MWT and STST. Quadriceps femoris muscle powers are measured for every patient before start of study. During the test, dyspnoea grade, Pulse rate, respiratory rate, saturation and blood pressure were measured.   Results: In this study group mean age was 60.38±11.09 years, mean FEV1 55.24% ±16.18% and then 6MWT and STST were correlating with each other. On comparing parameters hemodynamic parameters before and after performing 6MWT and STST for 30 seconds. There is significant correlation between 6MWT and STST using Pearson’s correlation. However, there is a negative correlation between FEV1 and both 6MWT and  STST.   Conclusion: Sit to stand test is less time consuming, repeatable and easy to perform. STST can also determine the functional status of COPD patient similar to Spirometry and Six-minute walk test. Hence, STST can be an alternative test for Spirometry and 6MWT in COPD patients in a limited resource facility.

Monthly Follow-Ups of Functional Status in People with COPD: A Longitudinal Study

Functional status is an important and meaningful outcome in people with chronic obstructive pulmonary disease (COPD), although its measurement is not embedded in routine clinical assessments. This study described the functional status of people with COPD using the 1-min sit-to-stand test (1minSTS) over a 6-month period and the examined sociodemographic and clinical characteristics associated with this outcome. Data from a prospective study including people with COPD were analyzed. Functional status was assessed monthly with the 1minSTS over 6 months. Linear-mixed effect models assessed the 1minSTS number of repetitions mean change. One-hundred and eight participants (82.4% men; 66.9 ± 9.5 years) were included. A significantly lower number of repetitions in the 1minSTS over the 6-month period was associated with being female (estimate: −4.69, 95%CI: −8.20; −1.18), being older (estimate: −0.56, 95%CI: −0.77; −0.34), having higher BMI (estimate: −0.55, 95%CI: −0.81; −0.28) and having higher activity-related dyspnea (estimate: −2.04, 95%CI: −3.25; −0.83). Half of the participants showed improvements above three repetitions in the 1minSTS over the 6-month period, independently of their baseline impairment (1minSTS < 70% predicted: 52.5%; ≥70% predicted: 54.4%). To conclude, monthly follow-up assessments were associated with clinically relevant benefits in the functional status of people with COPD. Age, body composition, and activity-related dyspnea were the main predictors of functional status over time. Further research is needed to corroborate our findings and to support the beneficial effects of regular COPD monitoring.

Modified Medical Research Council and COPD Assessment Test Cutoff Points

BACKGROUND

The modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) are assessment instruments associated with level of physical activity of daily living (PADL) in patients with COPD. This study aimed to identify mMRC and CAT cutoff points to discriminate sedentary behavior and PADL level of subjects with COPD and verify whether these cutoff points differentiate pulmonary function, health-related quality of life (HRQOL), functional status, and mortality index in subjects with COPD.

METHODS

Subjects (N = 131, FEV₁: 36.7 ± 16.1% predicted) were assessed for lung function, mMRC, CAT, HRQOL, functional status, and mortality index. PADL was monitored using a triaxial accelerometer, and subjects were classified as sedentary/nonsedentary (cutoff point of 8.5 h/d in PADL < 1.5 metabolic equivalent of task [MET]), physically active/inactive (cutoff point of 80 min/d in PADL ≥ 3 METs), and with/without severe physical inactivity (cutoff point of 4,580 steps/d), according to variables provided by accelerometer.

RESULTS

ROC curve indicated mMRC cutoff point of ≥ 2 (P < .05) for physical inactivity (sensitivity = 66%, specificity = 56%, AUC = 0.62), severe physical inactivity (sensitivity = 81%, specificity = 66%, AUC = 0.76), and sedentary behavior (sensitivity = 61%, specificity = 70%, AUC = 0.65). The identified CAT cutoff points were ≥ 16 and ≥ 20, considering severe physical inactivity (sensitivity = 76%, specificity = 54%, AUC = 0.69, P < .001) and sedentary behavior (sensitivity = 51%, specificity = 90%, AUC = 0.71, P = .001), respectively. Subjects who had mMRC ≥ 2 and CAT ≥ 16 or ≥ 20 presented worse pulmonary function, HRQOL, functional status, and mortality index compared with those who scored mMRC < 2 and CAT <16 or < 20.

CONCLUSIONS

mMRC cutoff point of ≥ 2 is recommended to discriminate PADL level and sedentary behavior, whereas CAT cutoff points of ≥ 16 and ≥ 20 discriminated severe physical inactivity and sedentary behavior, respectively. These cutoff points differentiated subjects with COPD regarding all the outcomes assessed in this study.

Body composition parameters and functional status test in predicting future acute exacerbation risk among hospitalized patients with chronic obstructive pulmonary disease

BACKGROUND & AIMS

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Nutritional and functional status derangement is a commonly seen in COPD patients, and this is associated with a higher disease severity and mortality. To assess body composition analysis - measured by segmental multi-frequency bioelectrical impedance analysis (BIA)- and functional status and investigate their relationship with the COPD acute exacerbation risk.

METHODS

Eighty COPD patients admitted to hospital for COPD acute exacerbation were prospectively followed-up for one year after discharge, focusing on a new incidence of COPD acute exacerbation. Following discharge, participants' body composition was assessed with the use of segmental multi-frequency BIA, whereas physical function by performing 5-repetitions and 30 s sit-to-stand (STS) tests. Unadjusted and multivariate logistic regression analyses were performed to evaluate the ability of the various measures to predict incidence of future COPD acute exacerbation in one-year period.

RESULTS

Seventy-six out of 80 participants completed the study and were analyzed. Fifty-one [24 male (47.1%)] out of 76 participants (67.1%), mean aged of 69.3 ± 8.9 years, developed at least one new COPD acute exacerbation during the one year follow-up. The probability of COPD acute exacerbation in one year was significantly related to BMI (OR = 0.75, 95% CI; 0.61-0.91, p = 0.004) and Fat Free Mass (OR = 0.88, 95% CI; 0.79-0.97, p = 0.012) after adjustment for sex, age and smoking index (pack × years). Both 5-repetitions and 30 s STS tests had a good predictive ability for the incidence of COPD acute exacerbation in one year (AUC = 0.80, 95% CI; 0.65-0.95, p = 0.009 and AUC = 0.83, 95% CI; 0.70-0.96, p = 0.004, respectively).

CONCLUSION

In an observational study among patients admitted with COPD acute exacerbation, body composition analysis parameters and functional status are related to acute exacerbation risk incidence.

Actigraphy informs distinct patient-centered outcomes in Pre-COPD

BACKGROUND

Actigraphy can provide useful patient-centered outcomes for quantification of physical activity in the "real-world" setting.

METHODS

To characterize the relationship of actigraphy outputs with "in-laboratory" measures of cardiopulmonary function and respiratory symptoms in pre-COPD, we obtained actigraphy data for 8 h/day for 5 consecutive days a week before in-laboratory administration of respiratory questionnaires, PFT, and CPET to a subgroup of subjects participating in the larger study of the health effects of exposure to secondhand tobacco smoke who had air trapping but no spirometric obstruction (pre-COPD). Using machine learning approaches, we identified the most relevant actigraphy predictors and examined their associations with symptoms, lung function, and exercise outcomes.

RESULTS

Sixty-one subjects (age = 66±7 years; BMI = 24±3 kg/m²; FEV₁/FVC = 0.75 ± 0.05; FEV₁ = 103 ± 17 %predicted) completed the nested study. In the hierarchical cluster analysis, the activity, distance, and energy domains of actigraphy, including moderate to vigorous physical activity, were closely correlated with each other, but were only loosely associated with spirometric and peak exercise measures of oxygen consumption, ventilation, oxygen-pulse, and anaerobic threshold (VO_2AT), and were divergent from symptom measures. Conversely, the sedentary domain clustered with respiratory symptoms, air trapping, airflow indices, and ventilatory efficiency. In Regression modeling, sedentary domain was inversely associated with baseline lung volumes and tidal breathing at peak exercise, while the activity domains were associated with VO_2AT. Respiratory symptoms and PFT data were not associated with actigraphy outcomes.

DISCUSSION

Outpatient actigraphy can provide information for "real-world" patient-centered outcomes that are not captured by standardized respiratory questionnaires, lung function, or exercise testing. Actigraphy activity and sedentary domains inform of distinct outcomes.

Targeting exertional breathlessness to improve physical activity: the role of primary care

Primary care physicians (PCPs) play a crucial role in the diagnosis and management of chronic obstructive pulmonary disease (COPD). By working together with patients to target exertional breathlessness and increase physical activity, PCPs have an important role to play, early in the disease course, in improving patient outcomes in both the short and long term. In this article, we consider how physical activity affects disease progression from the PCP perspective. We discuss the role of pharmacological therapy, the importance of an holistic approach and the role of PCPs in assessing and promoting physical activity. The complexity and heterogeneity of COPD make it a challenging disease to treat. Patients' avoidance of activity, and subsequent decline in capacity to perform it, further impacts the management of the disease. Improving patient tolerance of physical activity, increasing participation in daily activities and helping patients to remain active are clear goals of COPD management. These may require an holistic approach to management, including pulmonary rehabilitation and psychological programmes in parallel with bronchodilation therapy, in order to address both physiological and behavioural factors. PCPs have an important role to optimise therapy, set goals and communicate the importance of maintaining physical activity to their patients. In addition, optimal treatment that addresses activity-related breathlessness can help prevent the downward spiral of inactivity and get patients moving again, to improve their overall health and long-term prognosis.

The Glittre Activities of Daily Living Test in patients with acromegaly: Associations with hand function and health-related quality of life

BACKGROUND

Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T).

OBJECTIVES

To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life.

METHODS

The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test.

RESULTS

Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (rs=-0.487, p= 0.002; rs=-0.369, p= 0.026; rs= 0.538, p= 0.0007, respectively).

CONCLUSIONS

Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.

Concurrence of 1- and 3-Min Sit-to-Stand Tests with the 6-Min Walk Test in Idiopathic Pulmonary Fibrosis

BACKGROUND

In idiopathic pulmonary fibrosis (IPF), some physiological parameters measured during a 6-min walk test (6-MWT) impart reliable prognostic information. Sit-to-stand tests (STSTs) are field exercise tests that are easier to implement than the 6-MWT in daily practice.

OBJECTIVES

The aims of the study were to test the reproducibility and compare 2 STSTs (the 1-min STST [1-STST] and the semi-paced 3-min chair rise test [3-CRT]) in IPF, and to determine if selected physiological parameters (speed of displacement and changes in pulse oxygen saturation [SpO2]) are interchangeable between the STSTs and the 6-MWT.

METHODS

Thirty-three patients with stable IPF were studied in 3 French expert centers. To test reproducibility, intra-class correlations (ICCs) of parameters measured during tests performed 7-14 days apart were calculated. To test interchangeability, the agreement and correlation of physiological responses measured during STSTs and during 6-MWT were studied.

RESULTS

Vertical displacements and changes in SpO2 during both STSTs were reproducible, with ICCs ranging from 0.78 [0.63-0.87] to 0.95 [0.92-0.97]. Vertical displacements during 1-STST and 3-CRT were correlated with 6-MWT distance (correlation coefficients (r) of 0.72 and 0.77, respectively; p < 0.001). Similarly, correlations were found between changes in SpO2 measured during the 2 STSTs and the 6-MWT, with coefficients ranging from 0.73 to 0.91 (p < 0.001). Distance walked and SpO2 during 6-MWT were well estimated from vertical displacement and SpO2 during the 2 STSTs, respectively.

CONCLUSION

The correlations found between the 2 STSTs and the 6-MWT suggest that STSTs may be of interest to assess displacement and exercise-induced changes in SpO2 in IPF patients.

Sit-to-stand tests in patients hospitalised for chronic obstructive pulmonary disease exacerbation: association with pulmonary function tests and risk of future exacerbations

Background/Aims

The sit-to-stand test is a quick and cost-effective measure of exercise tolerance and lower body strength. The literature focuses on its use in stable patients with chronic obstructive pulmonary disease. This study in patients hospitalised for chronic obstructive pulmonary disease exacerbation aimed to investigate possible associations of the sit-to-stand test with pulmonary function and risk of future acute exacerbations.

Methods

This study was conducted on a sample of 22 patients with chronic obstructive pulmonary disease. Participants' clinical details were recorded before they undertook spirometry, 30-second and five-repetition sit-to-stand tests. Participants were assessed via a structured telephone interview for the occurrence of acute exacerbation events in the 12 months following discharge.

Results

Patients were classified based on the presence or absence of acute exacerbations of chronic obstructive pulmonary disease over 12 months. A negative correlation was observed between five-repetition sit-to-stand test performance time and number of repetitions during the 30-second sit-to-stand test; longer sit-to-stand times and fewer repetitions were observed in patients who experienced exacerbations during follow up. The 30-second sit-to-stand test repetitions correlated positively with forced expiratory volume in 1 second (FEV1). Five-repetition sit-to-stand test performance correlated negatively with FEV1, FEV1% predicted, forced vital capacity and FEV1/forced vital capacity ratio. From the various exercise parameters, five-repetition sit-to-stand test performance time demonstrated a moderate ability to predict exacerbations.

Conclusions

This study is the first to focus on the use of the sit-to-stand tests in inpatients with acute exacerbation of chronic obstructive pulmonary disease. There was a significant correlation between the 30-second sit-to-stand test and five-repetition sit-to-stand test results. Both tests were associated with pulmonary function indices and risk of future chronic obstructive pulmonary disease exacerbations.

Patient outcomes following GPs' educations about COPD: a cluster randomized controlled trial

This study aimed to compare patient outcomes following case method learning and traditional lectures as methods for continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) in Sweden. In a pragmatic cluster randomized controlled trial, COPD patients (n = 425; case method group n = 209, traditional lectures group n = 216) from 24 primary health care centers replied to questionnaires prior to and 18 months after a 2 × 2-h CME was given to GPs (n = 255). We measured changes in the scores of the Clinical COPD Questionnaire (CCQ), symptoms, needs for disease information, exacerbations, smoking, and use of pulmonary rehabilitation. The changes over time were similar for both CME methods. Patients who had used pulmonary rehabilitation increased from 13.2 to 17.8% (P = 0.04), and prevalence of smoking decreased from 28.9 to 25.1% (P = 0.003). In conclusion, neither of the used CME methods was superior than the other regarding patient outcomes. CME's primary value may lay in improving GPs' adherence to guidelines, which should lead to long-term positive changes in patient health.

The Correlation of Sit-to-Stand Tests with COPD Assessment Test and GOLD Staging Classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD classification tool has been used to assess the symptom burden and exacerbation risk of patients with chronic obstructive pulmonary disease (COPD). An area requiring further exploration is the relationship between the GOLD classification's basic components and the measurements acquired by Sit-to-Stand tests (STST). We aimed to study the relationship between STST and the component of the GOLD classification tool. This study was conducted on a sample of 42 COPD subjects with patient history, COPD assessment test (CAT) and spirometry. 5STST performance time and the number 30s-STST repetitions showed differences of statistical significance in COPD subjects considered to be more symptomatic and in subjects with high risk of future exacerbations. Both STSTs correlated significantly with forced expiratory volume in one second % predicted (FEV1%), CAT, number of acute exacerbations in the past year and number of hospitalized exacerbations in the past year. STST performance correlates significantly with items of the CAT questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy. Using multivariate analysis, age, FEV1% and CAT score manifested the strongest negative association with STST performance. 5STST performance time and the number 30s-STST repetitions in COPD patients correlates with the level of symptoms and the risk of future exacerbations that define groups A-D based on GOLD 2018 classification tool (at the time of data acquisition). The correlation of STST performance with CAT score involves specific items of the questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy.

REPRODUCIBILITY OF PHYSIOLOGICAL VARIABLES OF THE SIX-MINUTE WALK TEST IN HEALTHY STUDENTS

OBJECTIVE

To verify the reproducibility of the six-minute walk test (6MWT) performance and its physiological variables in healthy students.

METHODS

This is as prospective cross-sectional study. The sample consisted of healthy students aged 6-12 years old from public and private schools in the region of Florianópolis City, Santa Catarina State, (Southern Brazil). The medical state was considered according to the health records and scores on the International Study of Asthma and Allergies in Childhood (ISAAC) and the spirometric values of forced expiratory volume in the first second and forced vital capacity above 80% of what was predicted. Two 6MWTs were conducted with a 30-minute interval between them, following the recommendations from the American Thoracic Society. Physiologic variables were recorded using the portable telemetric gas analyzer K4b2 (Cosmed®, Italy). For analysis, the dyspnea index, the perception of effort and performance variables identified in both 6MWT were considered. Data distribution was verified with the Shapiro-Wilk test and statistical analysis included paired t-test or Wilcoxon test, and intraclass correlation coefficient (ICC). The significance level adopted was 5%.

RESULTS

A total of 22 students with a mean age of 10.2±1.5 years participated in the study. The covered distance and the variation of oxygen consumption reproducibility between the two 6MWTs presented ICC=0.76 and ICC=0.86, respectively. There was also similar behavior of the physiological variables when comparing the two tests (p=0.001), especially the minute volume (MV), the oxygen consumption (VO2), and the carbon dioxide production (VCO2).

CONCLUSIONS

The 6MWT showed reproducible values, both in performance and physiological parameters, in the healthy students analyzed.

The London Chest Activity of Daily Living scale cut-off point to discriminate functional status in patients with chronic obstructive pulmonary disease

OBJECTIVE

To determine the cut-off point for the London Chest Activity of Daily Living scale in order to better discriminate functional status. Secondarily, to determine which of the scores (total or %total) is better associated with clinical outcomes of a pulmonary rehabilitation program.

METHODS

Sixty-one patients with chronic obstructive pulmonary disease performed the following tests: spirometry; Chronic Obstructive Pulmonary Disease Assessment Test; Saint George's Respiratory Questionnaire; modified Medical Research Council, the body-mass index, airflow obstruction, dyspnea, and exercise capacity index; six-minute walk test; physical activity in daily life assessment and London Chest Activity of Daily Living scale. Thirty-eight patients were evaluated pre- and post-pulmonary rehabilitation . The cut-off point was determined using the receiver operating characteristic curve with six-minute walk test (cut-off point: 82%pred), modified Medical Research Council (cut-off point: 2), level of physical (in)activity (cut-off point: 80min per day in physical activity ≥3 metabolic equivalent of task) and presence/absence of severe physical inactivity (cut-off point: 4580 steps per day) as anchors.

RESULTS

A cut-off point found for all anchors was 28%: modified Medical Research Council [sensitivity=83%; specificity=72%; area under the curve=0.80]; level of physical (in)activity [sensitivity=65%; specificity=59%; area under the curve=0.67] and classification of severe physical inactivity [sensitivity=70%; specificity=62%; area under the curve=0.70]. The patients who scored ≤28% in %total score of London Chest Activity of Daily Living had lower modified Medical Research Council , Chronic Obstructive Pulmonary Disease Assessment Test, Saint George's Respiratory Questionnaire, body-mass index, airflow obstruction, dyspnea and exercise capacity index and sitting time than who scored >28%, and higher forced expiratory volume in the first second, time in physical activity ≥3 metabolic equivalent of task, steps per day and six-minute walk distance. The %total score of London Chest Activity of Daily Living correlated better with clinical outcomes than the total score.

CONCLUSIONS

The cut-off point of 28% is sensitive and specific to distinguish the functional status in patients with chronic obstructive pulmonary disease. The %total score of the London Chest Activity of Daily Living reflects better outcomes of chronic obstructive pulmonary disease when compared to total score.

The Glittre ADL-Test Differentiates COPD Patients with and without Self-Reported Functional Limitation

The Glittre ADL-test is based on important and common activities of daily living (ADLs), and it is an useful test to objectively distinguish patients with and without self-reported functional limitations. This study aims to analyze if difficulty to perform ADLs, as self-reported by patients with COPD, would reflect a worse Glittre ADL-test performance. In the first visit, patients were evaluated for clinical and nutritional status, spirometry, maximal cardiopulmonary exercise test on a treadmill. One week later, the patients performed two Glittre ADL-tests. Maximal voluntary ventilation (MVV) and the VE_Glittre/MVV, VO_2Glittre/VO_2peak, and HR_Glittre/HR_peak ratios were calculated to analyze the ventilatory, metabolic, and cardiac reserves. The London Chest Activity of Daily Living (LCADL) scale was only answered after the two Glittre ADL-test were performed. Patients were splited into two subgroups based on the anchor question of the LCADL: those with and those without self-reported ADL limitation. Sixty-two COPD patients were included (65.3 ± 8.6 years, FEV₁ 62 ± 22%pred). Those with ADL limitation (39 patients) completed the Glittre ADL-test with a significantly longer time (p = 0.002), as well as higher VE_Glittre/MVV (p = 0.005) and lower oxygen pulse (p = 0.021) than those without ADL limitation. The time spent to perform the Glittre ADL-test was significantly associated with total LCADL score (ρ = 0.327, p < 0.05). A cutoff of 253 s was able to distinguish those patients without and with ADL limitation. COPD patients who self-reported ADL limitation according to the LCADL scale took a longer time to perform the Glittre ADL-test with higher VE_Glittre/MVV and lower oxygen pulse than those without ADL limitation.

Physiological response to the Glittre-ADL test in elderly COPD patients

Abstract Introduction: The Glittre-ADL (TGlittre) test was developed to assess functional capacity in a group of activities of daily living, but little is known about the physiological responses expected during its implementation. Objective: To evaluate the physiological responses induced by TGlittre in COPD patients and compare them with those induced by the 6-minute walk test (6MWT). Method: This is a cross-sectional study involving 15 elderly patients with COPD (70±6 years and predicted FEV1 of 47±16%). The TGlittre and 6MWT were performed on two different days, evaluating heart rate, peripheral oxygen saturation and perceived exertion in the 1st, 4th and 6th minutes of the 6MWT and at the start, after each lap and the end of TGlittre. After the normality test (Shapiro-Wilk), the Wilcoxon test was applied to compare the functional tests, and Spearman’s correlation coefficient to assess the association between variables. Results: At the end of TGlittre, heart rate was faster than in the 6MWT (106.7±21.9 vs 96.4±16.2bpm, p = 0.02). The other physiological variables were similar at the end of both tests. Heart rate at the end of TGlittre correlated with the final heart rate in the 6MWT (r = 0.69; p = 0.002). Conclusion: TGlittre induced a faster heart rate than in the 6MWT, with increased metabolic demand, but with similar ventilatory responses.

The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error

OBJECTIVE

To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD.

METHODS

We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error.

RESULTS

The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, -2.24 to 1.96 and -2.65 to 2.69.

CONCLUSIONS

In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.

COPD patients need more information about self-management: a cross-sectional study in Swedish primary care

Objective: In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings.Design: A cross-sectional study.Setting: Twenty-four PHCCs in Stockholm, Sweden.Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 542).Main outcome measures: The Lung Information Needs Questionnaire (LINQ) was used to assess perceived information needs. Spirometry results and descriptive, self-reported data on patient factors such as exacerbation history, treatment, smoking, weight/height, comorbidities, health care contacts, education and symptoms were collected.Results: Overall, the greatest reported needs were for information about self-management and diet. GOLD 2 patients (68%) expressed greater needs for information than GOLD 3 patients (32%). We found significant associations between high information needs and patient-related factors such as 'No assigned GP' (OR = 4.32 [95% CI 2.65-7.05]) and 'No contact with COPD nurse in the past 12 months' (OR = 1.83 [95% CI 1.19-2.81]).Conclusion: COPD patients felt they knew too little about self-management of their disease. Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. These associations were strongest in patients with moderate COPD.Key points: As patients with COPD often have multimorbidity, identifying patients' needs for information about COPD is essential to providing individualized patient education and care. In this study of 542 patients from 24 Swedish primary care centers, we found that:Patients with COPD, particularly those with moderate airflow limitation (i.e. GOLD 2) felt they needed more information about COPD than currently provided by health care professionals in primary care.Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. GPs' part in COPD patient education should not be overlooked, as individualized COPD care relies on GPs' expertise in managing patients with multimorbidity.

Telomere length in COPD: Relationships with physical activity, exercise capacity, and acute exacerbations

RATIONALE

Shorter leukocyte telomere length (LTL) is associated with reduced health-related quality of life and increased risk for acute exacerbations (AEs) and mortality in chronic obstructive pulmonary disease (COPD). Increased physical activity and exercise capacity are associated with reduced risk for AEs and death. However, the relationships between LTL and physical activity, exercise capacity, and AEs in COPD are unknown.

METHODS

Data from 3 COPD cohorts were examined: Cohort 1 (n = 112, physical activity intervention trial), Cohorts 2 and 3 (n = 182 and 294, respectively, separate observational studies). Subjects completed a 6-minute walk test (6MWT) and provided blood for LTL assessment using real-time PCR. Physical activity was measured as average daily step count using an accelerometer or pedometer. Number of self-reported AEs was available for 1) the year prior to enrollment (Cohorts 1 and 3) and 2) prospectively after enrollment (all cohorts). Multivariate models examined associations between LTL and average daily step count, 6MWT distance, and AEs.

RESULTS

A significant association between longer LTL and increased 6MWT distance was observed in the three combined cohorts (β = 3x10-5, p = 0.045). No association between LTL and average daily step count was observed. Shorter LTL was associated with an increased number of AEs in the year prior to enrollment (Cohorts 1 and 3 combined, β = -1.93, p = 0.04) and with prospective AEs (Cohort 3, β = -1.3388, p = 0.0003).

CONCLUSIONS

Among COPD patients, increased LTL is associated with higher exercise capacity, but not physical activity. Shorter LTL was associated with AEs in a subgroup of cohorts.

Minimal clinically important difference of 3-minute chair rise test and the DIRECT questionnaire after pulmonary rehabilitation in COPD patients

BACKGROUND

The 3-minute chair rise test (3-minute CRT) and the Disability Related to COPD Tool (DIRECT) are two reproducible and valid short tests that can assess the benefit of pulmonary rehabilitation (PR) in terms of functional capacity and dyspnea in everyday activities.

METHODS

We determined the minimal clinically important difference (MCID) of the DIRECT questionnaire and 3-minute CRT using distribution methods and anchor encroaches with a panel of eight standard tests in a cohort of 116 COPD patients who completed a PR program in real-life settings.

RESULTS

The estimated MCID for the 3-minute CRT and DIRECT scores was five repetitions and two units, respectively, using separate and combined independent anchors. The all-patient (body mass index-obstruction-dyspnea-exercise [BODE] scores 0-7), BODE 0-2 (n=42), and BODE 3-4 (n=50) groups showed improvements greater than the MCID in most tests and questionnaires used. In contrast, the BODE 5-7 group (n=24) showed improvements greater than MCID in only the 3-minute CRT, 6-minute walk test, endurance exercise test, and DIRECT questionnaire.

DISCUSSION AND CONCLUSION

This study demonstrates that the short and simple DIRECT questionnaire and 3-minute CRT are responsive to capture the beneficial effects of a PR program in COPD patients, including those with severe disease.

TRIAL REGISTRATION NUMBER

NCT03286660.

PSYCHOMETRIC PROPERTIES OF FUNCTIONAL CAPACITY TESTS IN CHILDREN AND ADOLESCENTS: SYSTEMATIC REVIEW

OBJECTIVES

To identify studies that evaluated psychometric properties of functional capacity tests in children and adolescents, and to verify which of these have satisfactory properties of measurement.

DATA SOURCES

Searches on MEDical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scientific Electronic Library Online (SciELO) databases without limiting period or language. Two investigators independently selected articles based on the following inclusion criteria: children and/or adolescent population (healthy or with cardiorespiratory diseases); and assessment of psychometric properties of functional capacity tests. Studies with (I) adult samples, (II) sample with neurological diseases, and (III) on reference values or prediction equations only were excluded.

DATA SYNTHESIS

From the total of 677 articles identified, 11 were selected. These evaluated the psychometric properties of the following tests: 6-minute walk test (6MWT) (n=7); 6MWT and the 3-minute step test (3MST) (n=1); and Incremental Shuttle Walk Test (ISWT) (n=3). Reproducibility and reliability were good for 6MWT and ISWT, and moderate for 3MST. The ISWT showed high validity measures for both healthy children and children with chronic respiratory disease. The validity of 6MWT varied across studies, and should be analyzed according to the health conditions of test takers. The validity of 3MST is unclear, and further studies in pediatric population are required.

CONCLUSIONS

Most studies investigated 6MWT measurement properties. Validity of 6MWT varied according to different pediatric populations. The use of 6MWT, ISWT and 3MST tests to measure clinically important changes in children and adolescents with cardiorespiratory diseases is still unclear.

Clinically relevant differences in COPD health status: systematic review and triangulation

The minimal clinically important difference (MCID) quantifies when measured differences can be considered clinically relevant. This study aims to review and triangulate MCIDs of chronic obstructive pulmonary disease (COPD) health status tools.A systematic search in PubMed, EMBASE and Cochrane Library was conducted (Prospero #CRD42015023221). Study details, patient characteristics, MCID methodology and estimates were assessed and extracted by two authors. A triangulated mean was obtained for each tool's MCID, with two-thirds weighting for anchor-based and one-third for distribution-based results. This was then multiplied by a weighted factor based upon the study size and quality rating.Overall, 785 records were reviewed of which 21 studies were included for analysis. MCIDs of 12 tools were presented. General quality and risk of bias were average to good. Triangulated MCIDs for the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and St. George's Respiratory Questionnaire (SGRQ) were -2.54, -0.43 and -7.43 for improvement. Too few and/or too diverse studies were present to triangulate MCIDs of other tools.Evidence for the MCID of the CAT and CCQ was strong and triangulation was valid. Currently used MCIDs in clinical practice for the SGRQ (4) and Chronic Respiratory Questionnaire (0.5) did not match the reviewed content, for which the MCIDs were much higher. Using too low MCIDs may lead to an overestimation of the interpretation of treatment effects. MCIDs for deterioration were scarce, which highlights the need for more research.

Replacement of the 6-Min Walk Test With Glittre ADL Test and Scores From the PFSDQ-M and HAP Questionnaires in the BODE Index

PURPOSE

Chronic obstructive pulmonary disease reduces functional capacity, which is strongly correlated with the morbidity and mortality of patients. The BODE index considers the multifactorial nature of the disease, including the functional capacity measured by the 6-min walk test (6MWT), and this index predicts the mortality in patients with chronic obstructive pulmonary disease. Our aim was to assess whether association exists between the original BODE index and the modified BODE index by replacing the 6MWT with the scores from the Pulmonary Functional Status and Dyspnea Questionnaire-Modified version (PFSDQ-M), Human Activity Profile (HAP) questionnaire, and the results of the Glittre ADL Test (TGlittre).

METHODS

Twenty-eight subjects diagnosed with chronic obstructive pulmonary disease underwent the 6MWT and TGlittre and responded to the PFSDQ-M and HAP questionnaires. Four BODE index scores were obtained: 1 calculated by using the original method (ie, using the 6MWT) and 3 others calculated by using the results obtained from the TGlittre, PFSDQ-M, and HAP (the modified BODE index scores).

RESULTS

High levels of association were observed between the original BODE index and the BODE TGlittre (R = 0.824, P ≤ .0001), BODE PFSDQ-M (R = 0.803, P ≤ .0001), and BODE HAP (R = 0.500, P ≤ .0001).

CONCLUSION

The BODE TGlittre, and BODE PFSDQ-M may be used as alternatives to the 6MWT when physical space is not available to perform the 6MWT or when the condition of a patient does not allow performance of the 6MWT.

The Glittre-ADL test reflects functional performance measured by physical activities of daily living in patients with chronic obstructive pulmonary disease

BACKGROUND

The Glittre-ADL test (TGlittre) is a valid and reliable test for the evaluation of functional capacity and involves multiple physical activities of daily living (PADL), which are known to be troublesome to patients with Chronic Obstructive Pulmonary Disease (COPD). However, it is still unknown if this test is also able to reflect the functional performance of patients with COPD.

OBJECTIVE

To investigate whether the TGlittre reflects the functional performance of COPD patients and whether the necessary time to complete the TGlittre and the PADL varies according to disease severity.

METHOD

Thirty-eight patients with COPD (age 65, SD=7 years; forced expiratory volume in the first second 41.3, SD=15.2% predicted) underwent anthropometric and lung function assessments and were submitted to the TGlittre and PADL measurement.

RESULTS

TGlittre performance correlated significantly (p<0.05) with PADL variables, such as time sitting (r=0.50), walking (r=-0.46), number of steps taken (r=-0.53), walking movement intensity (r=-0.66), walking energy expenditure (r=-0.50), and total energy expenditure (r=-0.33). TGlittre performance was not significantly different in patients among the Global Initiative for COPD (GOLD) spirometric stages, but walking and sitting time were significantly lower and greater, respectively, in severe and very severe patients compared to those with moderate disease (p<0.05).

CONCLUSION

The performance on the TGlittre correlates with walking and sitting time and other real life PADL measurements. The severity of the disease is associated with the differences in the level of physical activity in daily life more than in functional capacity.

The Dutch-Flemish PROMIS Physical Function item bank exhibited strong psychometric properties in patients with chronic pain

OBJECTIVE

The objective of this study was to assess the psychometric properties of the Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function item bank in Dutch patients with chronic pain.

STUDY DESIGN AND SETTING

A bank of 121 items was administered to 1,247 Dutch patients with chronic pain. Unidimensionality was assessed by fitting a one-factor confirmatory factor analysis and evaluating resulting fit statistics. Items were calibrated with the graded response model and its fit was evaluated. Cross-cultural validity was assessed by testing items for differential item functioning (DIF) based on language (Dutch vs. English). Construct validity was evaluated by calculation correlations between scores on the Dutch-Flemish PROMIS Physical Function measure and scores on generic and disease-specific measures.

RESULTS

Results supported the Dutch-Flemish PROMIS Physical Function item bank's unidimensionality (Comparative Fit Index = 0.976, Tucker Lewis Index = 0.976) and model fit. Item thresholds targeted a wide range of physical function construct (threshold-parameters range: -4.2 to 5.6). Cross-cultural validity was good as four items only showed DIF for language and their impact on item scores was minimal. Physical Function scores were strongly associated with scores on all other measures (all correlations ≤ -0.60 as expected).

CONCLUSION

The Dutch-Flemish PROMIS Physical Function item bank exhibited good psychometric properties. Development of a computer adaptive test based on the large bank is warranted.

Consistency of medical record reporting of a set of indicators for proactive palliative care in patients with chronic obstructive pulmonary disease

To identify patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD) who have a poor prognosis and might benefit from proactive palliative care, a set of indicators had been developed from the literature. A patient is considered eligible for proactive palliative care when meeting ≥2 criteria of the proposed set of 11 indicators. In order to develop a doctor-friendly and patient-convenient tool, our primary objective was to examine whether these indicators are documented consistently in the medical records. Besides, percentage of patients with a poor prognosis and prognostic value were explored. We conducted a retrospective medical record review of 33 patients. Five indicators; non-invasive ventilation (NIV), comorbidity, body mass index (BMI), previous admissions for acute exacerbation COPD and age were always documented. Three indicators; hypoxaemia and/or hypercapnia, professional home care and actual forced expiratory volume1% (FEV1%) were documented in more than half of the records, whereas the clinical COPD questionnaire (CCQ), medical research council dyspnoea (MRC dyspnoea) and the surprise question were never registered. Besides, 78.8% of the patients met ≥2 criteria and there was a significant association between meeting ≥2 criteria and mortality within 1 year (one-sided Fisher's exact test, p = 0.04). The set of indicators for proactive palliative care in patients with COPD appeared to be user-friendly and feasible.

Does the COPD assessment test reflect functional status in patients with COPD?

The aim of this study was to investigate whether the chronic obstructive pulmonary disease (COPD) assessment test (CAT) reflects the functional status of patients with COPD. Forty-seven patients underwent anthropometric assessment, spirometry, the 6-minute walk test (6MWT), the Glittre-activity of daily living (ADL) test (TGlittre), the London Chest ADL (LCADL) scale, and the CAT. The total score of the CAT correlated with 6MWT distance, TGlittre time spent, and LCADL_%total ( r = -0.56, 0.52, and 0.78, respectively; p < 0.05 for all). There was significant difference in 6MWT distance (490 ± 85.4 m vs. 387 ± 56.8 m), TGlittre time spent (3.67 ± 1.07 min vs. 5.03 ± 1.32 min), and LCADL_%total (24.2 ± 3.02% vs. 44.4 ± 13.3%) between the low and high impacts of COPD on health status (respectively, p < 0.05 for all) as well as in the LCADL_%total between medium and high impact of COPD on health status (31.3 ± 7.35% vs. 44.4 ± 13.3%; p = 0.001). In conclusion, the CAT reflects the functional status of patients with COPD.

Functional Status Assessment of Patients With COPD: A Systematic Review of Performance-Based Measures and Patient-Reported Measures

Presently, there is no recommendation on how to assess functional status of chronic obstructive pulmonary disease (COPD) patients. This study aimed to summarize and systematically evaluate these measures.Studies on measures of COPD patients' functional status published before the end of January 2015 were included using a search filters in PubMed and Web of Science, screening reference lists of all included studies, and cross-checking against some relevant reviews. After title, abstract, and main text screening, the remaining was appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist. All measures from these studies were rated according to best-evidence synthesis and the best-rated measures were selected.A total of 6447 records were found and 102 studies were reviewed, suggesting 44 performance-based measures and 14 patient-reported measures. The majority of the studies focused on internal consistency, reliability, and hypothesis testing, but only 21% of them employed good or excellent methodology. Their common weaknesses include lack of checks for unidimensionality, inadequate sample sizes, no prior hypotheses, and improper methods. On average, patient-reported measures perform better than performance-based measures. The best-rated patient-reported measures are functional performance inventory (FPI), functional performance inventory short form (FPI-SF), living with COPD questionnaire (LCOPD), COPD activity rating scale (CARS), University of Cincinnati dyspnea questionnaire (UCDQ), shortness of breath with daily activities (SOBDA), and short-form pulmonary functional status scale (PFSS-11), and the best-rated performance-based measures are exercise testing: 6-minute walk test (6MWT), endurance treadmill test, and usual 4-meter gait speed (usual 4MGS).Further research is needed to evaluate the reliability and validity of performance-based measures since present studies failed to provide convincing evidence. FPI, FPI-SF, LCOPD, CARS, UCDQ, SOBDA, PFSS-11, 6MWT, endurance treadmill test, and usual 4MGS performed well and are preferable to assess functional status of COPD patients.

Sit-to-stand test and 6-min walking test correlation in patients with chronic obstructive pulmonary disease

BACKGROUND:

The 6-min walking test (6MWT) is one of the most commonly used tests to assess exercise capacity during chronic obstructive pulmonary disease (COPD). However, it is a relatively time-consuming test. Many authors assessed the usefulness of simpler methods, as the sit-to-stand test (STST), to estimate exercise capacity.

PURPOSE:

To demonstrate the feasibility of STST, in comparison to 6MWT, for the evaluation of functional status in Tunisian COPD patients and evaluate its correlation to the severity of the disease.

METHODS:

We studied patients with COPD (Global Initiative for Chronic Obstructive Lung Disease A-D). All patients had plethysmography and manual quadriceps femoris muscle strength evaluation. Each patient completed a 6MWT and a STST. During the tests, dyspnea severity (Borg scale), heart rate, pulsed oxygen saturation, and blood pressure were measured.

RESULTS:

In 49 patients with stable COPD (mean age 67.06 ± 8.4 years, mean forced expiratory volume in the first second 46.25% ± 19.64%), 6MWT and STST were correlated with each other (r = 0.47, P = 0.001). During 6MWT and STST, the rise in heart rate, systolic blood pressure, and severity of dyspnea were statistically significant compared to baseline (P < 0.05). However, cardiorespiratory stress was lower after STST than after 6MWT (P < 0.05). A statistically significant positive correlation was noted between the 6MWT distance and forced vital capacity (r = 0.357, P < 0.05). The 6MWT was negatively correlated with dyspnea severity at baseline (r = −0.289, P < 0.05) and with BODE index (r = −0.672, P < 0.01). STST was correlated only with age (r = 0.377, P < 0.01). No correlation was found between both tests and quadriceps femoris strength.

CONCLUSION:

As like as 6MWT, STST can determine functional status during COPD. In addition, it is less time consuming and produces less hemodynamical stress compared to 6MWT. STST can be used as an alternative for 6MWT in patients with COPD.

Functional Status Assessment of COPD Based on Ability to Perform Daily Living Activities: A Systematic Review of Paper and Pencil Instruments

Context:

Activity of daily living (ADL) is an important predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Increasing ADL is important in patients with COPD and assessment of ADL is one of the best ways to evaluate the status of COPD patients.

Objectives:

The objective of this systematic review was to provide an overview of the psychometric properties of paper and pencil instruments measuring ADL in patients with COPD.

Data Sources:

English papers published from 1980 to 2014 regarding ADL in patients with COPD were searched in Web of Science, MEDLINE, Google Scholar, Cochrane, PubMed, ProQuest, and CINAHL databases using the following keywords: “COPD”, “ADL”, “activities of daily living”, “daily activities”, “instrument”, “questionnaire”, “paper-and-pencil instruments”, and “measure”. Following the Internet search, manual search was also done to find article references.

Study Selection:

A total of 186 articles were found. Of those, 31 met the inclusion criteria. Full texts of articles meeting the inclusion criteria were studied. Consensus-based standards for the selection of health measurement instruments”(COSMIN) were used to assess the quality of the studies.

Data Extraction:

Data extraction form based on research aims developed by researchers and psychometric experts, with 17 questions was used.

Results:

In these articles, 14 pen and paper instruments were identified for examining ADL in patients with COPD; of which, 4 dealt directly with ADL while 9 assessed other criteria i.e. dyspnea as ADL indicator. The majority of instruments only dealt with two main dimensions of ADL: Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and did not consider Advanced Activities of Daily Living (AADL), which is influenced by cultural and motivational factors.

Conclusion:

Despite several ADL instruments identified, complete psychometric processes have only been done in a few of them. Selection of the appropriate instrument should focus on the aim of the study and the target construct.

Repeatability of usual and fast walking speeds in patients with chronic obstructive pulmonary disease

RATIONALE

Evaluation of the role of walking speeds in chronic obstructive pulmonary disease (COPD) should be preceded by an assessment of its repeatability. This study aimed to establish the repeatability of the usual (susual) and fast (sfast) walking speeds among patients with stable COPD and determine the accuracy of manual measurement.

METHODS

Participants demonstrated their susual and sfast over 10 m with speed calculated using a stopwatch; the accuracy was confirmed with optical sensors. The walks were repeated after a 5-minute rest; the session was repeated on 2 subsequent days. The coefficient of repeatability (CR) was calculated for both speeds, and their stability over days was determined.

RESULTS

A total of 29 participants (forced expiratory volume in 1 second (FEV1) = 43 ± 25% predicted; FEV1/forced vital capacity (FVC) = 41 ± 13%; susual = 60.3 ± 11 m·min; sfast = 74.3 ± 11.5 m·min) completed the study. The CRs for the susual and sfast were 7.5 (95% CI: 5.0-10.0) and 7.1 (95% CI: 4.8-9.4) m·min, respectively. There was a small increase in the susual (5%; P < .001) on the second trial of every day and between successive days (5%; P < .001); the sfast was not different between trials (P = .09) and increased only between day 1 and day 2 (4%; P < .0001). There was no difference between the stopwatch and the sensor determined susual (-0.5 [95% CI: -1.1 to 0.1] m·min; P = .12). The small difference (-2.1 [95% CI: -2.7 to -1.5] m·min; P = .0001) between the methods for sfast was within the CR of the sfast.

CONCLUSIONS

In patients with moderate to severe COPD, repeated measures of the susual and sfast using a stopwatch support the use of these tests for simple, quick assessments of disability.

Physical function decline and degradation of postural sway dynamics in asymptomatic sedentary postmenopausal women

BACKGROUND

Postural control is an important aspect of physical functioning.

OBJECTIVE

To determine whether postural sway complexity could discriminate asymptomatic sedentary postmenopausal women with normal or subnormal physical function from those with lower physical function.

DESIGN

Cross-sectional study.

SETTING

Department of Geriatrics, University Hospital of Montpellier.

PARTICIPANTS

126 community-dwelling women aged 55 to 76 recruited though public meetings aimed at promoting physical activity in postmenopausal women.

MEASUREMENTS

Women were asked to stand still on a force platform, either with eyes open (EO) or eyes closed (EC). Physical function was estimated using the Six-Minute Walking Distance (6MWD) test, expressed as a percentage of the predicted 6MWD (%-pred 6MWD) based on age, gender, body height, and weight. In addition to traditional stabilometric measures, dynamical measures (percentage of determinism of recurrence quantification analysis [DETRQA], sample entropy [SampEn] and complexity index of multiscale entropy [CIMSE]) were used to quantify the complexity of center of pressure (COP) time series (DETRQA: predictability, SampEn: regularity, CIMSE: multiscale regularity).

RESULTS

None of the traditional stabilometric measures differentiated women with lower (%-pred 6MWD ≤ 85.5%) from those with subnormal or normal (%-pred 6MWD > 85.5%) physical function. Conversely, women with lower physical function showed lower SampEn values in the AP direction in both EO and EC conditions, as well as lower SampEn and higher DETRQA values in the ML direction in EC condition. No significant difference in the CIMSE values was found between the two groups.

CONCLUSION

Lower physical function was found to be associated with lower postural sway complexity (higher regularity and predictability) in asymptomatic sedentary postmenopausal women, especially in the absence of vision. Future work is needed to determine whether a decrease in postural sway complexity could predict future decline in physical function in these women.

Sertraline hydrochloride treatment for patients with stable chronic obstructive pulmonary disease complicated with depression: a randomized controlled trial

BACKGROUND

There is a lack of randomized controlled trials to assess the effects of pharmacological treatments in patients with stable chronic obstructive pulmonary disease (COPD) complicated with moderate or severe depression.

AIMS

To assess the efficacy of sertraline hydrochloride on improving the quality of life of patients with stable COPD complicated with depression.

METHODS

This randomized controlled trial, conducted from May to November 2013 in the Huai'an Second Hospital, Huai'an, China, enrolled 120 patients with stable COPD who had moderate or severe depression. Patients were randomly assigned to control and interventional groups (n = 60 in each group). In addition to the treatment for COPD, interventional group also received sertraline hydrochloride tablets 50 mg/day for 6 weeks, while the control group received placebo. The primary end point included COPD assessment test (CAT) scores and the secondary endpoint included 6-min walk distance and 17-item Hamilton Depression Rating Scale (HAMD-17) scores. Parameters of spirometry and adverse events were also observed.

RESULTS

There was no significant difference in improvements in the parameters of spirometry tests before and after the treatment with sertraline hydrochloride tablets between the placebo and interventional groups (P > 0.05). Patients in the sertraline hydrochloride group showed more changes in the HAMD-17 scores and CAT scores after treatment (P < 0.05) and travelled longer distances in the 6-min walk test than in the placebo group (P < 0.05).

CONCLUSION

Antidepressant treatment can improve the quality of life and exercise capacity of patients with depression, and it can also improve depression scores, but not lung function.

A simple semipaced 3-minute chair rise test for routine exercise tolerance testing in COPD

The functional work capacity of chronic obstructive pulmonary disease (COPD) patients is usually assessed with walk tests such as the 6-minute walk test (6MWT) or the shuttle test. Because these exercise modalities require a controlled environment which limits their use by pulmonologists and severely restricts their use among general practitioners, different modalities of a short (1 minute or less) sit-to-stand test were recently proposed. In this study, we evaluated a new modality of a semipaced 3-minute chair rise test (3CRT) in 40 patients with COPD, and compared the reproducibility of physiological responses and symptoms during the 3CRT and their interchangeability with the 6MWT. The results demonstrate that physiological variables, heart rate, pulse oxygen saturation, work done, and symptoms (Borg dyspnea and fatigue scores), during the 3CRT were highly reproducible, and that the physiological responses and symptoms obtained during the 3CRT and the 6MWT were interchangeable for most patients. Moreover, these preliminary data suggest that patients able to perform more than 50 rises during 3 minutes had no significant disability. The simplicity and ease of execution of the 3CRT will facilitate the assessment of exercise symptoms and disability in COPD patients during routine consultations with pulmonologists and general practitioners, and will thus contribute to the improved management of COPD patients.

Active video gaming in patients with renal transplant: a pilot study

Background

Patients with renal transplant are at higher risk of mortality from cardiovascular disease (CVD) compared with the general population. Physical activity has been shown to reduce the risk of CVD mortality in these patients. Unfortunately, barriers such as the harsh Canadian climate prevent patients from engaging in and harvesting the health benefits of physical activity. This pilot study explored active video gaming (AVG) as a way for patients with renal transplant to obtain physical activity and examined its effect on their functional status and quality of life (QOL).

Main text

We recruited nine patients for an 8-week prospective pilot study. All patients received a Microsoft Xbox 360™ video gaming console, a Microsoft Kinect™ sensor, and the video game Your Shape Fitness Evolved 2012. Assessment of each participant before and after the intervention included blood pressure measures, a 6-minute walk test, and the Godin Leisure Time Questionnaire (GLTQ). We analyzed all nine patients at the end of the 8-week study period, and found no changes in blood pressure or GLTQ scores. However, there was a significant increase in the 6-minute walk distance (P = 0.022), which represented a consistent increase for most patients (correlation = 0.977). In addition, participants over the age of 45 years (n = 4) were more likely to use the AVG system (P = 0.042).

Conclusion

AVG has the potential to improve the functional status in patients with renal transplant. Further research is required to corroborate the full health benefits of AVG in this patient population.

Patient-reported outcomes in primary care patients with COPD: psychometric properties and usefulness of the Clinical COPD Questionnaire (CCQ). A cross-sectional study

Background:

Chronic obstructive pulmonary disease (COPD) is a common disease with considerable consequences for patients’ daily lives. The Clinical COPD Questionnaire (CCQ) was designed to measure these consequences in daily practice. Although the CCQ is widely used, its original structure has never been tested.

Aims:

This study examines the psychometric properties of the CCQ with regard to its latent structure in a sample of primary care patients with COPD.

Methods:

Two cross-sectional studies were conducted; in study 1 (N=243) exploratory analyses, including exploratory factor analysis (EFA) and Mokken scale analysis, were performed to explore the latent structure of the CCQ. In study 2 (N=244), confirmatory factor analysis (CFA) was conducted to evaluate the model fit of the structure found in study 1.

Results:

Both EFA and Mokken scale analysis revealed a structure of two dimensions (‘general impact’ α=0.91 and ‘cough’ α=0.84). This structure, however, was not confirmed in study 2, nor was the original structure. However, subsequently removing items that violated the assumption of a normal response distribution did result in an excellent model fit with two dimensions measuring ‘dyspnoea’ and ‘cough’ (CFA: comparative fit index (CFI) 0.98; normed fit index (NFI) 0.97; root mean squared error of approximation (RMSEA) 0.08 (0.04)).

Conclusions:

In primary care, factor analyses on the CCQ revealed a two-component structure measuring ‘general impact’, and ‘cough’. A shortened and more specific version of the CCQ could be regarded as a useful instrument to screen for exacerbations by measuring dyspnoea, coughing and producing phlegm.

Development of the Assessment of Burden of COPD tool: an integrated tool to measure the burden of COPD

In deciding on the treatment plan for patients with chronic obstructive pulmonary disease (COPD), the burden of COPD as experienced by patients should be the core focus. It is therefore important for daily practice to develop a tool that can both assess the burden of COPD and facilitate communication with patients in clinical practice. This paper describes the development of an integrated tool to assess the burden of COPD in daily practice. A definition of the burden of COPD was formulated by a Dutch expert team. Interviews showed that patients and health-care providers agreed on this definition. We found no existing instruments that fully measured burden of disease according to this definition. However, the Clinical COPD Questionnaire meets most requirements, and was therefore used and adapted. The adapted questionnaire is called the Assessment of Burden of COPD (ABC) scale. In addition, the ABC tool was developed, of which the ABC scale is the core part. The ABC tool is a computer program with an algorithm that visualises outcomes and provides treatment advice. The next step in the development of the tool is to test the validity and effectiveness of both the ABC scale and tool in daily practice.

Association between peripheral muscle strength, exercise performance, and physical activity in daily life in patients with Chronic Obstructive Pulmonary Disease

BACKGROUND

Resistance training of peripheral muscles has been recommended in order to increase muscle strength in patients with Chronic Obstructive Pulmonary Disease (COPD). However, whether peripheral muscle strength is associated with exercise performance (EP) and physical activity in daily life (PADL) in these patients needs to be investigated. The aim of this study is to evaluate whether strength of the quadriceps muscle (QS) is associated with EP and daily PADL in patients with COPD.

METHODS

We studied patients with COPD (GOLD A-D) and measured maximal isometric strength of the left QS. PADL was measured for 7 days with a SenseWear-Pro® accelerometer. EP was quantified by the 6-minute walk distance (6MWD), the number of stands in the Sit-to-Stand Test (STST), and the handgrip-strength. Univariate and multivariate analyses were used to examine possible associations between QS, PADL and EP.

RESULTS

In 27 patients with COPD with a mean (SD) FEV1 of 37.6 (17.6)% predicted, QS was associated with 6MWD, STST, and handgrip-strength but not with PADL. Multiple linear regression analyses showed that QS was independently associated with the 6MWD (β = 0.42, 95% CI 0.09 to 0.84, p = 0.019), STST (β = 0.50, 95% CI 0.11 to 0.86, p = 0.014) and with handgrip-strength (β = 0.45, 95% CI 0.05 to 0.84, p = 0.038).

CONCLUSIONS

Peripheral muscle strength may be associated with exercise performance but not with physical activity in daily life. This may be due to the fact that EP tests evaluate patients' true abilities while PADL accelerometers may not.

Health status measured by the Clinical COPD Questionnaire (CCQ) improves following post-acute pulmonary rehabilitation in patients with advanced COPD: a prospective observational study

Aims:

To evaluate outcomes of the Clinical Chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ) in patients with advanced COPD admitted for a post-acute pulmonary rehabilitation (PR) programme and to relate (change in) health status to lung function, degree of dyspnoea and (change in) functional capacity.

Methods:

This is a prospective observational study in patients with advanced COPD admitted for a post-acute PR programme in a skilled nursing facility. Health status (CCQ) and functional capacity were measured before and after rehabilitation.

Results:

Health status measured by the CCQ was severely impaired and showed significant and clinically relevant improvement during the post-acute PR programme. Moderate to strong correlations were found between CCQ scores and functional capacity on admission and at discharge. Moderate correlations were found between improvement in CCQ scores and improvement in functional capacity. No correlation was found between CCQ scores and lung function (forced expiratory volume in 1 s % predicted).

Conclusions:

Health status measured by the CCQ improves following a post-acute PR programme in patients with advanced COPD and correlates with improvement in functional capacity. These results suggest that the CCQ is sensitive to change in response to PR in this specific group of patients.

PROLONG: a cluster controlled trial to examine identification of patients with COPD with poor prognosis and implementation of proactive palliative care

BACKGROUND

Proactive palliative care is not yet common practice for patients with COPD. Important barriers are the identification of patients with a poor prognosis and the organization of proactive palliative care dedicated to the COPD patient. Recently a set of indicators has been developed to identify those patients with COPD hospitalized for an acute exacerbation who are at risk for post-discharge mortality. Only after identification of these patients with poor prognosis a multi disciplinary approach to proactive palliative care with support of a specialized palliative care team can be initiated.

METHODS/DESIGN

The PROLONG study is a prospective cluster controlled trial in which 6 hospitals will participate. Three hospitals are selected for the intervention condition based on the presence of a specialized palliative care team. The study population consists of patients with COPD and their main informal caregivers. Patients will be included during hospitalization for an acute exacerbation. All patients in the study receive standard care (usual care). Besides, patients in the intervention condition who meet two or more criteria of the set of indicators for proactive palliative care will have additionally regular consultations with a specialized palliative care team. The objectives of the PROLONG study are: 1) to assess the discriminating power of the proposed set of indicators (indicator study) and 2) to assess the effects of proactive palliative care for qualifying patients with COPD on the wellbeing of these patients and their informal caregivers (intervention study). The primary outcome measure of the indicator study is time to death for any cause. The primary outcome measure of the intervention study is the change in quality of life measured by the St George Respiratory Questionnaire (SGRQ) three months after inclusion.

DISCUSSION

The PROLONG study may lead to better understanding of the conditions to start and the effectiveness of proactive palliative care for patients with COPD. Innovative aspects of the PROLONG study are the use of a set of indicators for proactive palliative care, the active involvement of a specialized palliative care team and the use of a patient-tailored proactive palliative care plan.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): NTR4037.

Chronic obstructive pulmonary disease (COPD): evaluation from clinical, immunological and bacterial pathogenesis perspectives

Chronic obstructive pulmonary disease (COPD), a disease manifested by significantly impaired airflow, afflicts ∼14.2 million cases in the United States alone with an estimated 63 million people world-wide. Although there are a number of causes, the predominant cause is excessive tobacco smoke. In fact, in China, there have been estimates of 315,000,000 people that smoke. Other less frequent causes are associated with indirect cigarette smoke, air pollutants, biomass fuels, and genetic mutations. COPD is often associated with heart disease, lung cancer, osteoporosis and conditions can worsen in patients with sudden falls. COPD also affects both innate and adaptive immune processes. Cigarette smoke increases the expression of matrix metalloproteases and proinflammatory chemokines and increases lung titers of natural killer cells and neutrophils. Yet, neutrophil reactive oxygen species (ROS) mediated by the phagocytic respiratory burst and phagocytosis is impaired by nicotine. In contrast to innate immunity in COPD, dendritic cells represent leukocytes recruited to the lung that link the innate immune responses to adaptive immune responses by activating naïve T cells through antigen presentation. The autoimmune process that is also a significant part of inflammation associated with COPD. Moreover, coupled with restricted FEV1 values, are the prevalence of patients with single or multiple infections by bacteria, viruses and fungi. Finally, we focus on one of the more problematic infectious agents, the Gram-negative opportunistic pathogenic bacterium, Pseudomonas aeruginosa. Specifically, we delve into the development of highly problematic biofilm infections that are highly refractory to conventional antibiotic therapies in COPD. We offer a non-conventional, biocidal treatment that may be effective for COPD airway infections as well as with combinations of current antibiotic regimens for more effective treatment outcomes and relief for patients with COPD.