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.

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.