Londrina Activities of Daily Living Protocol: validity, reliability, minimal detectable change, and standard error of measurement in adults with asthma.

INTRODUCTION: Asthma symptoms are dyspnea, chronic cough, wheezing, chest tightness, or chest discomfort, which can directly limit the activities of daily living (ADL), which is frequently reported by adults with asthma. Evaluating ADL with a reliable protocol with usual speed is necessary. OBJECTIVES: To investigate the validity, reliability, minimal detectable change (MDC), and standard error of measurement (SEM) of the Londrina ADL Protocol (LAP) for adults with asthma. METHODS: Adults with asthma were evaluated with the LAP test. Spearman's correlation coefficient was used to verify validity with the 6-minute walk test (6MWT), Glittre-ADL test, and London Chest Activity of Daily Living (LCADL). To test the reliability, the test was reapplied in at least 30 minutes; the Wilcoxon test and Intraclass Correlation Coefficient (ICC), SEM, MDC, and learning effect were performed. RESULTS: Fifty-three individuals were included (26% men, 43 ± 15 years, BMI 28 ± 8kg/m2, FEV1 70 ± 24%predicted). For convergent validity, the LAP test was correlated with the 6MWT, Glittre-ADL, and LCADL scale (r=-0.49, 0.71, and 0.30, respectively; p < 0.03). There was a difference in test-retest (p < 0.0001) and reliability analysis shows ICC3 of 0.94, SEM of 14.88 seconds (22%), and MDC of 41.23 seconds (15%). Furthermore, the individuals performed the second test with -23 ± 19 (7.9%) seconds. CONCLUSION: The LAP test is valid and reliable for assessing limitations during ADL in adults with asthma. Considerable learning effect was observed, therefore, the best of two measures may avoid underestimation.

Reliability and validity of the London Chest Activity of Daily Living scale for adults with asthma.

INTRODUCTION: Dyspnea during activities of daily living (ADL) is frequently reported by adults with asthma. However, instruments that specifically assess that in people with asthma have not yet been validated. OBJECTIVES: To investigate the validity and reliability, including standard error of measurement (SEM) and Minimum Detectable Change (MDC), of the London Chest Activity of Daily Living (LCADL) scale for adults with asthma. METHODS: Adults with asthma answered the LCADL scale which was performed twice by the same rater. Spirometry, 6-min walk test (6MWT), St George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea scale, Asthma Quality of Life questionnaire (AQLQ), Asthma Control Test (ACT), and Glittre-ADL test were assessed. For statistical analyses, Spearman correlation, Wilcoxon test, Intraclass Correlation Coefficient (ICC), Cronbach's alpha coefficient, SEM, MDC were performed. RESULTS: Seventy participants were included (30% men, 44 ± 15 years old, BMI 27[23-31]kg/m2, FEV1 80 ± 17%predicted). For convergent validity, the LCADL scale was moderately correlated with SGRQ, AQLQ, and Glittre-ADL (r = 0.57, -0.46, and 0.41 respectively; p < 0.0001). The LCADL scale correlated weakly with the mMRC scale, ACT, and spirometry measures (-0.23

Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma.

BACKGROUND: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.

Londrina ADL Protocol (LAP) Performance of Patients with Chronic Obstructive Pulmonary Disease in Different Gravity Classes / Desempenho no Londrina ADL Protocol (LAP) de Pacientes com Doença Pulmonar Obstrutiva Crônica em Diferentes Classes de Gravidade

Studies on the association between functionality and severity of chronic obstructive pulmonary disease (COPD) are conflicting. The GOLD ABCD system, as it includes variables ​​by influence such as activities of daily living (ADLs), would be discriminative to verify the magnitude of the disease influence on functionality. The aims of this study are to compare the performance in the ADLs of patients with COPD classified at different levels of severity according to the GOLD ABCD system, as well as to verify the association among these variables. Participants performed the Londrina ADL Protocol (LAP) to assess ADLs, as well as: lung function, functional exercise capacity and clinical history. LAP time was compared among the GOLD-A (n = 13), GOLD-B (n = 18) and GOLD-C + D (n = 14) groups by the Kruskal-Wallis test. χ2 test and V Cramer were used for analysis. The level of statistical significance adopted was P<0.05. For this study, 45 COPD patients completed the assessments (22 men; 65±8 years; FEV1: 51±15% predicted, 6MWT: 520±25m). Overall LAP runtime was 32[275-354] seconds (96[86-106]% predicted). When grouped together, the LAP time was 330[276-348]sec, 318[272-365]sec and 318[282-386]sec in the GOLD-A, B and C+D groups, respectively (P=0.78). There was no association between performance on the LAP and classification by the GOLD ABCD (P=0.24 and VCramer=0.27). It is possible to conclude that the performance in the ADLs of patients with COPD did not differ among the different levels of the GOLD ABCD. Other factors can interfere with performance in the LAP, due to the need for further studies. IAU)

Estudos sobre associação entre funcionalidade e gravidade da doença pulmonar obstrutiva crônica (DPOC), apresentam resultados conflitantes. O sistema GOLD ABCD, por incluir variáveis conhecidas por influenciar as atividades de vida diária (AVDs), seria discriminativo para verificar a magnitude da influência da doença sobre a funcionalidade. Os objetivos foram comparar o desempenho nas AVDs de pacientes com DPOC classificados em diferentes níveis de gravidade de acordo com o sistema GOLD ABCD, bem como verificar a associação entre estas variáveis. Os participantes realizaram o Londrina ADL Protocol (LAP) para avaliar as AVDs, assim como: função pulmonar, capacidade funcional de exercício e histórico clínico. O tempo do LAP foi comparado entre os grupos GOLD-A (n=13), GOLD-B (n=18) e GOLD-C+D (n=14) pelo teste de Kruskal-Wallis. Teste χ2 e V Cramer foram utilizados para analisar associações. O nível de significância estatística adotado foi P<0,05. Para esse estudo, 45 pacientes com DPOC completaram as avaliações (22 homens; 65±8 anos; VEF1: 51±15%predito, TC6min: 520±25m). O tempo de execução do LAP, no geral, foi de 321 [275-354]seg (96 [86-106]%predito). Quando agrupados, o tempo do LAP foi de 330 [276-348]seg, 318 [272-365]seg e 318 [282-386]seg nos grupos GOLD-A, B e C+D, respectivamente (P=0,78). Não houve associação entre o desempenho no LAP e a classificação pelo GOLD ABCD (P=0,24 e V Cramer=0,27). Portanto, concluiu-se que o desempenho nas AVDs de pacientes com DPOC não diferiu entre os diferentes níveis do GOLD ABCD. Outros fatores podem interferir no desempenho no LAP, apontando para a necessidade de novos estudos. (AU)