Performance in the Glittre-ADL Test is Associated with the Pulmonary Function of Patients with Chronic Obstructive Pulmonary Disease.

The relationship between lung function and performance in some functional tests, as the six-minute walk test (6MWT) and Glittre-ADL test (TGlittre) are still discrepant in patients with chronic obstructive pulmonary disease (COPD). This study aimed to verify which test better correlates and is better explained by the pulmonary function, and which test better discriminates patients regarding the severity of the disease. Seventy-four patients with moderate to very severe COPD (54 men; 66 ± 9 years; FEV1: 37.2 ± 14.3%pred) were included. Spirometry, 6MWT and TGlittre were performed. The results showed weak to moderate correlation between pulmonary function variables and 6MWT (0.36 ≤ r ≤ 0.45) and TGlittre (-0.44 ≤ r ≤ -0.53). In patients with performance of ≤400 m in the 6MWT, a strong correlation was observed between TGlittre with FEV1 (%pred) (r = -0.82; p < .001). The pulmonary function variable that better predict the functional tests performance was FEV1 (R2 = 0.17). Both functional tests were able to discriminate patients with COPD GOLD 4 from the other classifications. When compared to GOLD 2 patients, GOLD 4 patients presented higher time spent on TGlittre (p < .001). When compared to GOLD 3 patients, GOLD 4 patients had higher TGlittre (p = .001). No statistical differences were found in the 6MWT between GOLD 3 and 4, as well as between GOLD 2 and 3. In conclusion, the pulmonary function presents stronger correlations and better explain the variability of TGlittre than of the 6MWT, especially in patients with greater functional impairment. The TGlittre seems to better discriminate patients with COPD regarding the severity of lung function.

Reliability and Learning Effect of the Glittre ADL-Test in Patients with Chronic Obstructive Pulmonary Disease.

The Glittre ADL-test (TGlittre) is a multiple-task test designed to assess functional limitation in patients with chronic obstructive pulmonary disease (COPD). Although few studies have investigated the TGlittre learning effect, the results are still conflicting. This study aimed to investigate the test-retest reliability and learning effect on TGlittre and to identify predicting factors of the learning effect in patients with COPD. Patients performed the TGlittre twice with a 30-minutes resting period between trials. TGlittre consists in measuring the time to complete five laps of a multiple ADL-like activities circuit: walking stairs, carrying a backpack, lifting objects, bending down and rising from a seated position. 124 patients with COPD were assessed [81 men; 66 ± 8 years, forced expiratory volume in one second (FEV1) 37.1 ± 15.0%pred; TGlittre 120 ± 60%pred; six-minute walking test 75.5 ± 17.4%pred]. The time spent in TGlittre presented excellent reliability (ICC = 0.96; 95%CI 0.92 - 0.98; p < 0.001; SEM 0.46 min; MDC 1.28 min) and decreased in the retest (5.24 ± 2.31 min to 4.85 ± 2.02 min; p < 0.001). Patients presented a learning effect of 6.11 ± 11.1% in TGlittre. A lower FEV1 (r2=0.10; p < 0.001) and a worse performance in the first TGlittre (r2=0.28; p < 0.001) are related to the improvement in performance of the second TGlittre. Although the TGlittre is reliable, patients improve their performance when performing the second test probably because they underestimate their functional capacity. These results should encourage professionals to assess TGlittre twice when using this test as an outcome measure.

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 Glittre-ADL Test Cut-Off Point to Discriminate Abnormal Functional Capacity in Patients with COPD.

The study objective was to determine a cut-off point for the Glittre activities of daily living (ADL)test (TGlittre) to discriminate patients with normal and abnormal functional capacity. Fifty-nine patients with moderate to very severe COPD (45 males; 65 ± 8.84 years; BMI: 26 ± 4.78 kg/m2; FEV1: 35.3 ± 13.4% pred) were evaluated for spirometry, TGlittre, 6-minute walk test (6 MWT), physical ADL, modified Medical Research Council scale (mMRC), BODE index, Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT). The receiver operating characteristic (ROC) curve was used to determine the cut-off point for TGlittre in order to discriminate patients with 6 MWT < 82% pred. The ROC curve indicated a cut-off point of 3.5 minutes for the TGlittre (sensitivity = 92%, specificity = 83%, and area under the ROC curve = 0.95 [95% CI: 0.89-0.99]). Patients with abnormal functional capacity had higher mMRC (median difference 1 point), CAT (mean difference: 4.5 points), SGRQ (mean difference: 12.1 points), and BODE (1.37 points) scores, longer time of physical activity <1.5 metabolic equivalent of task (mean difference: 47.9 minutes) and in sitting position (mean difference: 59.4 minutes) and smaller number of steps (mean difference: 1,549 minutes); p < 0.05 for all. In conclusion, the cut-off point of 3.5 minutes in the TGlittre is sensitive and specific to distinguish COPD patients with abnormal and normal functional capacity.

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.

Reproducibility of Ventilatory Parameters, Dynamic Hyperinflation, and Performance in the Glittre-ADL Test in COPD Patients.

BACKGROUND: This study aimed to investigate the reproducibility of the ventilatory parameters and dynamic hyperinflation (DH) induced by the Glittre ADL-test (TGlittre) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Twenty-three patients with COPD underwent anthropometry, spirometry, TGlittre (TGlittre1 and TGlittre2) and pre- and post-test slow vital capacity. During the tests the ventilatory response was evaluated. RESULTS: Regarding the TGlittre reproducibility, 87% of patients had a better performance in TGlittre2, and reduced on average 0.34 minute ± 0.62 (p = 0.01) from TGlittre1 time to TGlittre2, showing a learning effect of 6.34%. The difference average between tests was correlated with the time spent in TGlittre1 (r = -0.52; p < 0.05). The TGlittre time was statistically reproducible (intraclass correlation coefficient = 0.97; p < 0.001). Final ventilation parameters and their variations presented low-to-high reproducibility, except respiratory rate. The DH was similar (p > 0.05) in both tests, with low reproducibility in percentage, while in liters it was not reproducible. CONCLUSIONS: The TGlittre time and ventilatory parameters are reproducible, while DH is variable in COPD patients. A 6-7% learning effect was shown, and it is recommended to perform two tests.

Reliability and validity of the online application of London Chest Activity of Daily Living scale in assessing dyspnea-related functional impairment in individuals after hospitalization for COVID-19.

PURPOSE: To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19. METHODS: Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual's medical record. RESULTS: 104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73-0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach's α = 0.70-0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%). CONCLUSION: The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19.

The London Chest Activity of Daily Living Scale applied online is a method of evaluation of dyspnea-related ADL limitations that is valid and reliable after hospitalization for COVID-19 and can be used both in the telerehabilitation environment and in-person rehabilitation;The online form provides a more sustainable means of data storage, since no paper is needed, and saves time during in-person rehabilitation.

Comparison of the modified shuttle walk test in children with cystic fibrosis and healthy controls.

OBJECTIVE: To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. METHODS: A cross-sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann-Whitney and independent t-tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. RESULTS: Sixty-two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. CONCLUSIONS: There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG.

Functional Tests As Predictors Of Balance, Fear, And Risk Of Falling In Healthy Subjects.

OBJECTIVE: Verify which test, Glitttre-ADL test (TGlittre) or six-minute walk test (6MWT), better predicts balance, fear, and risk of falling in middle-aged and older adults. METHOD: Twenty-eight individuals (15 women) completed the study protocol, which included: anthropometric assessment, spirometry, Falls Efficacy Scale-International-Brazil (FES-I-Brazil), Activities-specific Balance Confidence Scale (ABC), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), TGlittre, and 6MWT. The Shapiro Wilk test investigated the distribution of the data. To verify if there was a correlation between the performance in TGlittre and 6MWT and the balance, fear, and risk of falling variables, the Pearson or Spearman correlation coefficient were used. Simple linear regression and stepwise multiple linear regression were conducted to identify which functional capacity test better predicts balance, fear, and risk of falling. RESULTS: Both TGlittre and 6MWT correlated (r = 0.44, p = .02 and r = -0.59, p = .003, respectively) and were able to predict the TUG (R2 = 0.17 and R2 = 0.26, p < .005, respectively). However, when analyzed in a multiple regression model, the 6MWT was better predictor of TUG (26%). Only TGlittre correlated (r = 0.39 and r = -0.38, p = .04) and was able to predict the FES-I-Brazil and BBS scores (17%), suggesting that TGlittre better reflects the worry about falls and balance in multiple ADL contexts. CONCLUSIONS: The 6MWT and the TGlittre are able to predict balance assessed by the TUG. However, the 6MWT has proved to be more effective in predicting TUG results.

Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery.

PURPOSE: To evaluate the reliability and convergent validity of the Upper Limb Functional Test (ULIFT) in women after breast cancer surgery. MATERIALS AND METHODS: A cross-sectional study with 25 women (mean age 50 ± 7.3 years) with breast cancer submitted to a surgery intervention within a minimum period of three years. Intraclass correlation coefficients (ICCs) were calculated to assess the test-retest reliability. A Bland-Altman plot examined the agreement between the times to complete two tests. Validity was established by correlating the ULIFT and DASH total score. The receiver operating characteristic (ROC) curve was used to determine the cut-off point for ULIFT in order to discriminate patients with some level of upper limb dysfunction. RESULTS: The ULIFT showed high reproducibility (ICC = 0.89; p < 0.001), learning effect of 7.21%, and a moderate correlation with the DASH total score (r = 0.536; R2 = 0.28; p = 0.006). The standard error of measurement was 6.9 s and the smallest real difference was 19.1 s. The ROC curve indicated a cut-off point of 109.2 s (sensitivity = 68.7%; specificity = 77.8%; area under ROC curve = 0.77). CONCLUSIONS: The ULIFT could be a valid and reliable test to assess upper limb functionality in patients submitted to breast cancer surgery.Implications for rehabilitationThe ULIFT is a reliable and valid test to assess upper limb function in women after breast cancer surgery, considering specifically the lifting and range of motion construct of unilateral upper limb function.The ULIFT could help identify those most at risk of developing upper limb dysfunction after breast cancer surgery and could benefit the follow-up of a postoperative rehabilitation program.Two ULIFTs should be performed in order to achieve patient's best performance.

Slow chest compression acutely reduces dynamic hyperinflation in people with chronic obstructive pulmonary disease: a randomized cross-over trial.

BACKGROUND: Strategies to minimize dynamic hyperinflation (DH) and dyspnea, such as slow chest compression (SCC), are relevant in people with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To analyze the acute effects of SCC after exercise on DH and dyspnea in people with COPD and to identify responders to the technique. METHODS: This is a cross-over study with 40 patients. Two six-minute step tests (6MSTs) were performed followed by a one-minute application of SCC (6MSTSCC) or rest (6MSTCONTROL), at random. End-expiratory lung volume (EELV) and dyspnea were assessed. A difference ≥76 ml in ΔEELV between SCC and control characterized the responders. RESULTS: The performance in 6MSTSCC and 6MSTCONTROL were similar. There was a greater reduction in EELV after 6MSTSCC compared to 6MSTCONTROL (124 ± 193 ml vs. 174 ± 183 ml; p = .049), while there was no difference in change in dyspnea between the SCC and control groups. Twenty-one participants were SCC responders and had higher functional residual capacity [FRC: 5.36 ± 1.09 vs. 4.58 ± 0.94; p = .02; cutoff point: 4.56; sensitivity = 76%; specificity = 53%; AUC = 0.71 (95%CI: 0.54 to 0.87); p = .02]. CONCLUSION: SCC applied immediately after exercise reduced DH, but did not reduce dyspnea in people with COPD. The technique is beneficial only for some patients and FRC can help to identify them.

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.

Performance difference on the six-minute walk test on tracks of 20 and 30 meters for patients with chronic obstructive pulmonary disease: validity and reliability.

BACKGROUND: Functional capacity assessment is important in patients with chronic obstructive pulmonary disease (COPD). It can be performed by the six-minute walk test (6MWT) on a 30-meter track. However, such space is not always available in clinical settings. OBJECTIVES: To compare the performance between the 6MWT on a 30- (6MWT30) and 20-meter (6MWT20) track; to evaluate the validity and reliability of the 6MWT30 and the 6MWT20; and to determine for which patients track length has the greatest impact on performance. METHODS: Patients with COPD randomly performed two 6MWT30 and two 6MWT20 on two different days and were also assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale. RESULTS: Thirty patients (23 men; mean ±â€¯standard deviation FEV1%pred: 45.6 ±â€¯12.1) participated in the study. They walked a greater distance on the 6MWT30 than on the 6MWT20 [mean difference: 22.1 m (95% CI: 12, 32 m)]. The longer the 6MWT30 distance, the greater the difference between the 2 tests (r = 0.51; p = 0.004). The 6MWT20 showed high reliability [ICC: 0.96 (95% CI: 0.77, 0.99)] and the results were associated with the distance walked on the 6MWT30 (r = 0.86), CAT (r = -0.53), and mMRC (r = -0.62). Patients who walked ≥430 m in the 6MWT30 presented a difference between the tests greater than those who walked <430 m (34.5 ±â€¯23.3 m vs. 12.6 ±â€¯24.1 m; respectively; p = 0.01). CONCLUSIONS: Performance was higher on the 6MWT30, with the difference increasing as performance improved. Therefore, the 6MWT20 is valid and reliable to evaluate functional capacity but should not be considered interchangeable with the 6MWT30, especially for the less disabled patients with COPD.

A performance comparison of the 20 and 30 meter six-minute walk tests among middle aged and older adults.

Objective: To compare the performance of the Six-Minute Walk Test on 20-meter (6MWT20) and 30-meter (6MWT30) tracks and to test the validity and reliability of the 6MWT20 in middle-aged and older adults.Method: The subjects underwent lung function assessment and performed the 6MWT30 and 6MWT20. Student´s t-tests or Wilcoxon tests were used to compare the variables. The Pearson or Spearman correlation coefficients were used to evaluate the validity of the 6MWT20 and the reliability of the 6MWT20. The 6MWT30 was tested by the two-way mixed model of the Intraclass Correlation Coefficient (ICC 3,1).Results: Twenty-five subjects (age: 60 ± 10 years) walked, on average, 11.0 ± 21.9 m more in the 6MWT30 than in the 6MWT20 (p < .05). The walking distance, the number of steps, the energy expenditure and the movement intensity between the 6MWT20 and 6MWT30 was correlated (r = 0.95; r = 0.81; r = 0.91; r = 0.67; respectively, p < .001). The walking distances showed high reliability and were similar between test and re-test in the 6MWT30 (544 ± 72.1 vs. 551 ± 70.5; p < .05; ICC = 0.97) and in the 6MWT20 (533 ± 73.1 vs. 532 ± 59.1; p < .05; ICC = 0.87).Conclusion: The 6MWT20 performance is lower than the 6MWT30 However, this difference is not clinically relevant. Additionally, the 6MWT20 is a valid and reproducible test to assess the functional capacity of middle-aged and older adults.

Reproducibility of the 6-Min Step Test in Subjects With COPD.

BACKGROUND: Test-retest reproducibility of the 6-min step test (6MST) is controversial in patients with COPD because the decision to perform a second test is influenced by interruptions, physiological overload, and the patient's exercise tolerance. The aim of this study was to analyze the reproducibility of performance on the 6MST (ie, number of steps climbed and interruptions) and physiological variables in subjects with COPD, with and without poor exercise tolerance, and with and without interruptions during the test. METHODS: Subjects performed 2 6MST (6MST1, 6MST2) with a minimum of 30 min rest between tests. Physiological variables were assessed with a gas analyzer. Subjects who performed ≤ 78 steps in the 6MST1 and ≤ 86 steps in the test with the higher number of steps performed (6MSTBEST) were considered to have poor exercise tolerance. Subjects were also stratified according to those who interrupted the 6MSTBEST and those who did not interrupt the 6MSTBEST. RESULTS: 40 subjects (31 men; FEV1 percent of predicted = 50.4 ± 13.5) participated in the study. The number of steps, interruptions, and physiological variables showed moderate to high reliability (intraclass correlation coefficient: 0.70-0.99, P < .001). Thirty-one (77.5%) subjects had a better performance during 6MST2 than 6MST1 (mean difference: 4.65 ± 5.59, P < .001). Although the number of times subjects were interrupted was similar between the 2 tests (P = .66), the duration of these interruptions was shorter during 6MST2 (mean difference: -0.12 ± 0.39 s, P = .040). The difference in the number of steps (6MST2 - 6MST1) did not differ between subjects who performed ≤78 steps (mean difference: 5.64 ± 5.32 steps; 10.3%; P < 0.001) and ≥ 79 steps (3.00 ± 5.82 steps; 6.13%; P = 0.08) on the 6MST1 (P = 0.15) and between subjects who performed ≤ 86 steps (5.39 ± 5.14 steps; 9.39%; P < 0.001) and ≥ 87 steps (2.92 ± 6.43 steps; 2.74%; P = 0.14) steps on the 6MSTBEST (P = 0.20). CONCLUSIONS: Performance and physiological variables in the 6MST were reproducible, and a second test did not impose greater physiological overload. Two tests were essential for patients with poor exercise tolerance.

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.

Reliability of the five-repetition sit-to-stand test in patients with chronic obstructive pulmonary disease on domiciliary oxygen therapy.

Objectives: To evaluate the reliability and learning effect of the five-repetition sit-to-stand test (5STSt) in severe and very severe chronic obstructive pulmonary disease (COPD) patients on domiciliary oxygen therapy compare the results with those of COPD patients not on such therapy. Methods: Twenty-eight COPD patients were included in the domiciliary oxygen therapy group (DOTG) and 17 in the control group (CG). The participants of the groups were paired by age, sex, body mass index, and lung function. The groups performed two 5STSt (5STSt1 and 5STSt2). Results: In total, 96% of the patients in the DOTG performed better on the second 5STSt (5STSt2) (17.1 ± 4.63s), with an average reduction of 3.87 ± 3.50 s (p < 0.001) and a learning effect of 18.4%. In the CG, 82.3% of patients had better performance on the 5STSt2 (15.06 ± 3.45 s), with an average reduction of 1.38 ± 2.51 s (p = 0.035) and a learning effect of 8.39%. The 5STSt had an ICC of 0.79 (95%CI: 0.02-0.93; p < 0.001) in the DOTG and of 0.89 (95%CI: 0.65-0.96; p < 0.001) in the CG. Conclusion: The 5STSt is reliable in patients with severe and very severe COPD on domiciliary oxygen therapy, with learning effect of nearly 18% in the DOTG. Thus, performing two tests is recommended to achieve the patient´s best performance in this population.

Minimal important difference for London Chest Activity of Daily Living scale in patients with chronic obstructive pulmonary disease.

OBJECTIVES: To determine the minimal important difference (MID) for the London Chest Activity of Daily Living scale (LCADL) in patients with chronic obstructive pulmonary disease (COPD), focusing on the percentage of the total score (LCADL%total), using an anchor-based method in addition to distribution-based methods. DESIGN: Non-controlled before-and-after study. SETTING: Two outpatient centres. PARTICIPANTS: Seventy-seven patients with COPD (GOLD II-IV, 47 males, forced expiratory volume in 1second mean 37 (SD 14) % predicted). INTERVENTIONS: Aerobic training and localised training for upper and lower limbs was conducted for 24 sessions, three times per week. MAIN OUTCOME MEASURES: The main outcome was LCADL score pre- and post-exercise training. The MID was established using distribution and anchor-based methods. The modified Saint George Respiratory Questionnaire was the anchor for the analysis of sensitivity and specificity of the MID. RESULTS: The established MIDs ranged from -2.1 to -5.9 points for LCADLtotal and from -2 to -6 points for LCADL%total. The receiver operating characteristic curve indicated a cut-off point of -3 points for LCADLtotal (sensitivity 51%, specificity 82%; P=0.01) and -4 points for LCADL%total (sensitivity 56%, specificity 82%; P=0.04). CONCLUSIONS: The present findings suggest -3 points and -4 points as the MIDs for LCADLtotal and LCADL%total, respectively. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT03251781.

The minimal important difference for Glittre-ADL test in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine Glittre-ADL test minimal important difference in patients with chronic obstructive pulmonary disease. METHODS: This is quasi-experimental study. Sixty patients with moderate to very severe chronic obstructive pulmonary disease (age 64.1, SD=9.09 years; forced expiratory volume in the first second 37.9, SD=13.0% predicted participated in a pulmonary rehabilitation program based on physical training, conducted over 24 sessions supervised, three times a week, including aerobic training in treadmill and resistance training for upper limbs and lower limbs. The main outcomes were the Glittre-ADL test and six-minute walk test, before and after 24 sessions of pulmonary rehabilitation. The minimal important difference was established using the distribution and anchor-based methods. RESULTS: Patients improved their functional capacity after the pulmonary rehabilitation. The effect sizes of Glittre-ADL test and six-minute walk test improvement were similar (0.45 vs 0.44, respectively). The established minimal important differences ranged from -0.38 to -1.05. The reduction of 0.38min (23s) corresponded to a sensitivity of 64% and a specificity of 69% with an area under the curve of 0.66 (95%CI 0.51-0.81; p=0.04). Subjects who achieved the minimal important difference of -0.38min for the Glittre-ADL test had a superior improvement of approximately 42m in the six-minute walk test when compared to patients who did not. CONCLUSIONS: The present findings suggest -0.38min as the minimal important difference in the time spent in the Glittre-ADL test after 24 sessions of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. TRIAL REGISTRATION: NCT03251781 (https://clinicaltrials.gov/ct2/show/NCT03251781).

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.