Reliability and validity of the Glittre-ADL test to assess the functional status of patients with interstitial lung disease.

The study objective was to investigated the reliability and validity of the ADL-Glittre test (TGlittre) to assess the functional status of patients with interstitial lung disease (ILD). Twenty-one individuals with ILD participated (age: 63 ± 11 years; DLCO: 51.0 ± 12.6%predicted), evaluated with body plethysmography, Saint George Respiratory Questionnaire, modified Medical Research Council dyspnea scale, six-minute walk test (6MWT) and monitoring of physical activity of daily living. Two TGlittre were performed, with an interval of 30 minutes between them. The TGlittre demonstrated high test-retest reliability, with an intraclass correlation coefficient of 0.90 (95%CI: 0.75-0.96; p < 0.001). Nineteen patients (90.5%) performed better on the second test (mean difference between TGlittre 1 and 2: -0.57 ± 0.96 minute; p = 0.001), with a learning effect of 11.6%. The time in TGlittre correlated with 6MWT (r = -0.70; p = 0.002) and with the total energy expenditure in physical activity of daily living (r = -0.52; p = 0.02). In %predicted, TGlittre and 6MWT also correlated (r = -0.50; p = 0.04). Correlations were observed between TGlittre and pulmonary function variables (r = -0.47 to -0.57; p = 0.01 to p = 0.04). There was no difference in the physiological response between TGlittre 1 and 2, and between TGlittre and 6MWT (p > 0.05). In conclusion, the TGlittre is reliable and valid for assessing functional status of patients with ILD.

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.

Baseline characteristics associated to improvement of patients with COPD in physical activity in daily life level after pulmonary rehabilitation.

BACKGROUND: Knowing the patients with chronic obstructive pulmonary disease (COPD) that increase the physical activity of daily living (PADL) after pulmonary rehabilitation (PR) is a challenge. AIMS: to compare baseline characteristics between patients who achieved and failed to achieve the minimal important difference (MID) of PADL post-PR; to verify which baseline variables better predict the change and identify a cut-off point to discriminate MID achievers. METHODS: Fifty-three patients with COPD (FEV1: 38.3; 95%CI 34.4-42.2%pred) were evaluated for spirometry, dyspnea, quality of life, functional capacity, mortality risk and PADL level. After 24 sessions of PR had their PADL level revaluated. RESULTS: The MID achievers presented lower FEV1, functional capacity, time walking, number of steps, active time, energy expenditure (EE) walking, time on PADL≥3 metabolic equivalent of task (METs) and higher time on PADL<1.5MET. Inactive patients and with severe physical inactivity presented a hazard ratio of 4.27 and 6.90 (95%CI: 1.31-13.9, p = 0.02; 95%CI: 1.99-23.9, p = 0.002; respectively) for achieving the MID. The variables of predictive model for the change in the PADL were EE walking and time on PADL<1.5MET (R2: 0.37; p = 0.002). The cut-off point of 6525 steps [sensitivity = 95%; specificity = 61%; AUC = 0.82 (95%CI: 0.71-0.93), p < 0.001] was able to discriminate patients who achieved and failed to achieve the MID. CONCLUSION: Patients with worse lung function, functional capacity and lower PADL level before PR are those that improve the PADL level. EE walking and time on PADL<1.5MET better predict this change. The cut-off point of 6525 steps can help to identify patients with higher chances of improving the PADL level.