Measurement properties of the incremental step test for people with chronic obstructive pulmonary disease: a cross-sectional study.

OBJECTIVES: The new incremental step test (IST) is a field test that was developed for people with chronic obstructive pulmonary disease (COPD), based on the characteristics of the incremental shuttle walk test (ISWT); however, its measurement properties still need to be determined. We aimed, first, to assess the construct validity (through the comparison with the ISWT), within-day reliability and measurement error of the IST in people with COPD; and, second, to identify whether the participants have a learning effect in the IST. DESIGN: Cross-sectional study, conducted according to COnsensus-based Standards for the selection of health status Measurement INstruments guidelines. SETTING: A family health unit in Portugal, April 2022 to June 2023. PARTICIPANTS AND ANALYSIS: 63 participants (67.5±10.5 years) attended two sessions to perform two IST and two ISWT, separately. Spearman's correlations were used to compare the best performances between the IST and the ISWT. Intraclass correlation coefficient (ICC2,1) was used for reliability, and the SE of measurement (SEM), minimal detectable change at 95% CI (MDC95) and Bland and Altman 95% limits of agreement (LoA) were used for measurement error. The learning effect was explored with the Wilcoxon signed-rank test. RESULTS: The IST was significant and strongly correlated with the ISWT (0.72<ρ<0.74, p<0.001), presented an ICC2,1 of 0.95 (95% CI 0.92 to 0.97), SEM=11.7 (18.9%), MDC95=32.4 (52.2%) and the LoA were -33.61 to 31.48 for the number of steps. No difference was observed between the number of steps of the two attempts of the IST (p>0.05). CONCLUSIONS: The IST can be suggested as a valid and reliable test to assess exercise capacity in people with COPD, with no learning effect when two IST are performed on the same day. The measurement error of the IST is considered indeterminate. TRIAL REGISTRATION NUMBER: NCT04715659.

[Impact of sleep hygiene on patients with obstructive sleep apnoea syndrome].

The purpose of this study was to evaluate the impact of a Sleep Hygiene brochure on a population of 36 patients recently diagnosed with Obstructive Sleep Apnoea Syndrome and beginning treatment. One expects that: 1) the information about Sleep Hygiene offered in the brochure would change some of the patients' habits toward sleep; and that, 2) this intervention in the form of a free informative brochure would have an echo in terms of a better subjective evaluation of sleep complaints. The sleep habits and the sleep complaints were evaluated in the pre-test. Those variables were re-evaluated in the post-test and at that time the patients filled in a scale of satisfaction with the information about Sleep Hygiene, in terms of its contribution to improving their sleep complaints. There were no significant differences in the level of compliance to Sleep Hygiene between the two periods, although the majority of the patients considered that Sleep Hygiene did improve their sleep difficulties. The low level of compliance may be due to the fact that patients already had reasonable Sleep Hygiene habits, and also to the fact that the scale was not sufficiently discriminative. In addition, the self-discipline that Sleep Hygiene involves may have collided with other demands such as the adaptation to treatment with CPAP (Continuous Positive Air Pressure). In a following study, it would be interesting to find if the levels of sleep hygiene compliance would change if they were implemented after the initial adaptation to CPAP, which would imply a longitudinal study. It would be helpful to keep reminding the patients of Sleep Hygiene importance, offering new and update brochures to the patients during consultations.