Pulmonary Telerehabilitation for People With Chronic Obstructive Pulmonary Disease in Brazil: A Mixed-Methods Feasibility Study.

This study assessed the feasibility of pulmonary telerehabilitation‧s (PTR) acceptability, implementation, practicality, and adaptation for people with Chronic Obstructive Pulmonary Disease (COPD) in Brazil. It also explored associations with clinical and socioeconomic features of Brazilians with COPD. This mixed-method study included thirty-one participants with COPD (age 62±10 years; FEV1= 72±14% predicted). Most participants (74.2%) reported good PTR session acceptability on the System Usability Scale and scores of 4.6±0.3 and 4.5±0.6 on a 1-5 Likert-type scale of implementation and practicality, respectively. Participants suggested adaptations for better comfort on the exercise bike and varying exercise modalities. PTR acceptability was associated with participants' younger age (rs=-0.57, p<0.01) and higher education (rs=0.51, p<0.01). PTR is feasible for people with COPD in Brazil regarding acceptability, implementation, practicality, and adaptation. Younger age and higher educational level are associated with greater PTR acceptability.

Muscle strength and mobility of individuals with COVID-19 compared with non-COVID-19 in intensive care.

BACKGROUND: Critical illness may affect muscle strength and mobility. OBJECTIVES: To compare muscle strength, mobility, and in intensive care unit (ICU)-acquired weakness (ICUAW) prevalence among individuals with COVID-19 and other critical illnesses; to identify factors associated with muscle strength, mobility, and length of stay in COVID-19; and to determine the Perme Intensive Care Unit Mobility Score (PICUMS) cut-off point for ICUAW. METHODS: We included individuals aged ≥18 in ICU who require mechanical ventilation. We excluded those diagnosed with neuromusculoskeletal diseases or who did not understand the study procedures. The Medical Research Council - sum score (MRC-SS) and the PICUMS were applied before ICU and hospital discharge. Analysis of covariance, Quade´s test, and Fisher's exact test compared groups. Partial correlations were analized between the MRC-SS and PICUMS with clinical variables. Regression models identified the predictors of hospital length of stay. The ROC curve verified the PICUMS related to ICUAW. Significance was set as P<.05. RESULTS: 25 individuals were included in the COVID-19 group and 23 in the non-COVID-19 group. No between-groups difference was observed in MRC-SS and PICUMS at discharge from ICU or hospital. The MRC-SS and PICUMS at ICU discharge predicted the length of hospital stay in the COVID-19 group. The PICUMS cut-off related to ICUAW was 18. CONCLUSIONS: Muscle strength, mobility, and ICUAW are similar between COVID-19 and non-COVID-19. However, muscle strength and mobility at ICU discharge are associated with the length of stay during COVID-19. A PICUMS<18 at ICU discharge may indicate impaired physical functioning due to ICUAW.

Life-Space Mobility of Subjects With COPD on Long-Term Oxygen Therapy Delivered by Non-Portable Devices.

BACKGROUND: Mobility is human body movement in all its forms, including bed-to-chair transfer, walking, daily tasks, participating in work and social functions, exercising, and using public transport. The mobility of people living with COPD is affected negatively by the disease symptoms. However, limited data are available on the life-space mobility in people with COPD on long-term oxygen therapy (LTOT). This study aimed to explore the life-space mobility in subjects with COPD on LTOT and verify whether life-space mobility is associated with comorbidities and symptoms, activity in daily life, exercise capacity performance, and quality of life. METHODS: This cross-sectional study enrolled 61 subjects with COPD on LTOT (73.0 ± 8.8 y, FEV1 41.7 ± 16.0% predicted, on LTOT for 2.8 ± 3.3 y). Life-space mobility (Life-Space Assessment), LTOT usage time, comorbidities (Charlson comorbidity index), need for support from a caregiver, exercise capacity (6-min step test), dyspnea (modified Medical Research Council scale), activities of daily living (ADLs, Katz scale), and health-related quality of life (EuroQol 5-Dimension Questionnaire) were assessed. RESULTS: Mobility restriction was identified in 90% of participants. Life-space mobility was negatively associated with the number of comorbidities (rs = -0.31, P = .02), dyspnea symptom (rs = -0.60, P < .001), and positively associated with basic ADLs performance (rs = 0.59, P < .001) and exercise capacity (rs = 0.49, P < .001). Dyspnea and exercise capacity were independent predictors of vital space mobility. CONCLUSIONS: Subjects with COPD on LTOT had limited life-space mobility. Interventions to reduce dyspnea and improve exercise capacity should be prioritized to increase this population's domestic and community mobility.

Caregiver Burden Is Associated With the Physical Function of Individuals on Long-Term Oxygen Therapy.

BACKGROUND: The influence of physical function of individuals on long-term oxygen therapy (LTOT) on caregiver burden is underexplored. This study investigated the association of caregiver burden with physical function of individuals on LTOT and the association between caregiver's burden and quality of life. METHODS: This was a cross-sectional study. Informal caregivers were assessed for burden using the Caregiver Burden Inventory (CBI), the European Quality of Life 5 Dimension questionnaire index (EQ-5D index) and its Visual Analog Scale (EQ-VAS). Physical function of subjects on LTOT was assessed by dyspnea, activities of daily living (ADLs), and mobility. Univariate and multivariate linear regression models were explored. RESULTS: Fifty-four caregivers (54.7 ± 16.1 y, 74.1% female) were included. CBI total score was correlated with subject's dyspnea (r = 0.369, P = .006) and ADLs (r = 0.300, P = .03). In the multivariate regression models, subject's physical function limitation due to dyspnea explained 26.4% of the CBI total score variance (P = .005). In the CBI dimension analysis, the time-dependence caregiver burden was correlated with subject's dyspnea (r = 0.335, P = .01), ADLs (r = 0.436, P = .001), and mobility (r = -0.415, P = .002). CBI developmental and physical caregiver burden were correlated with dyspnea (r = 0.309, P = .02; r = 0.363, P = .007) and ADLs (r = 0.274, P = .045; r = 0.299, P = .03). Emotional caregiver burden was correlated with dyspnea (r = 0.333, P = .01). Higher CBI total score was correlated with worse quality of life on EQ-5D index (rs= -0.374, P = .005) and EQ-VAS (rs= -0.494, P = .001) in caregivers. CONCLUSIONS: Increased caregiver burden was associated with higher physical limitation due to dyspnea and dependence in ADLs of individuals on LTOT. The increased burden was associated with a worse caregiver's quality of life.

Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: A systematic review.

BACKGROUND: Falls are frequent in people with chronic obstructive pulmonary disease (COPD) and related to increased morbidity, mortality, and health care costs in older adults. This systematic review aims to synthesise the falls outcomes and to examine risk factors for falls in the COPD literature. METHODS: The protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42015017257). Searches were updated and operated in five electronic databases in December 2019 for studies reporting falls outcomes and risk factors in people with COPD. Meta-analyses were conducted on the prevalence of fallers and frequent fallers. Quality assessment appraised the risk of bias of included articles. RESULTS: Twenty-three studies met the eligibility criteria and were retained after the full-text review. In the meta-analyses, the pooled prevalence of COPD fallers was 30% (95%CI 19%-42%), and the pooled prevalence of frequent fallers (≥2 falls in the analysed period of occurrence) was 24% (95%CI 2%-56%). The falls incidence rate in stable COPD varied from 1.17 to 1.49 falls/person-year. Different study methodologies were identified. Age, female gender, falls history, the number of medications, comorbidities, coronary heart disease, use of supplemental oxygen, impaired balance performance and smoking history were risk factors for falls identified in stable COPD. CONCLUSION: Prevalence of fallers, frequent fallers, and falls incidence rate have been reported in the COPD literature using a varying methodology. People with stable COPD present with ageing and disease-related risk factors for falls. Further research using the recommended prospective recording is needed in COPD.

Individualized in-hospital exercise training program for people undergoing hematopoietic stem cell transplantation: a feasibility study.

PURPOSE: The purpose of this study is to evaluate the feasibility of an individualized exercise program for people undergoing hematopoietic stem cell transplantation. METHODS: This is a feasibility study of an individualized in-hospital exercise training program for people undergoing hematopoietic stem cell transplantation. Participants performed the exercise program based on daily clinical, hemodynamic and hematological assessment. The program was carried out on a daily basis for 20-40 min during their hospital admission. The primary outcome was feasibility (recruitment, adherence and attrition rates) of the exercise program. The secondary outcomes were functional capacity, peripheral muscle strength, and health-related quality of life evaluated on admission and prior to hospital discharge. The adverse events rate was recorded during the intervention. RESULTS: Twenty-six participants (58% female), aged 40 ± 15 (mean ± SD) years were included. The exercise program feasibility was demonstrated by 100% recruitment, 86% exercise adherence and 12% attrition rates with no adverse events recorded. Significant differences were observed in functional capacity (p = 0.03), upper and lower-limb muscle strength (p = 0.01) from admission to discharge (23 ± 7 d). CONCLUSIONS: An individualized exercise training program based on daily clinical parameters is feasible for hospitalized patients undergoing hematopoietic stem cell transplantation. This intervention warrants further investigation in a randomized controlled trial. Implications for rehabilitation The individualized in-hospital exercise training program guided by daily clinical, hemodynamic and hematologic parameters is feasible, safe and with good adherence in people undergoing hematopoietic stem cell transplantation. People undergoing hematopoietic stem cell transplantation may improve functional capacity and upper and lower limb muscle strength following in-hospital exercise training program. The individualized in-hospital exercise training program could tentatively be introduced as part of the rehabilitation process in people undergoing hematopoietic stem cell transplantation.

The Mini-Balance Evaluation System Test Can Predict Falls in Clinically Stable Outpatients With COPD: A 12-MO PROSPECTIVE COHORT STUDY.

PURPOSE: This study evaluated the accuracy of the Mini-Balance Evaluation System Test (Mini-BESTest) for predicting falls in patients with chronic obstructive pulmonary disease (COPD) and investigated whether postural balance is a risk factor for falls. METHODS: Postural balance was evaluated by the Mini-BESTest at baseline, and the incidence of falls over a 12-mo period was prospectively measured by a self-reported falls diary and confirmed by telephone calls. A discriminative power analysis was performed using receiver operating characteristic (ROC) curve and logistic regression analysis. RESULTS: Sixty-seven outpatients with COPD (mean age ± SD = 67 ± 9.3 yr) were included. Twenty-five patients (37.3%) experienced ≥1 fall, and 28.2% of the falls resulted in injuries. The Mini-BESTest predicted falls in patients with COPD at the 6- and 12-mo follow-ups with a cut-off score of 22.5 (area under the curve = 0.85 and 0.87) with good sensitivity and specificity (85.7% and 66.7%; 84% and 73.8%, respectively). Higher scores on the Mini-BESTest were associated with a lower risk of falls at 12 mo (OR = 0.50; 95% CI, 0.36-0.70; P < .001). CONCLUSIONS: Postural balance assessed by the Mini-BESTest is a good predictor of falls in patients with COPD. Our results imply that impaired balance contributes to the risk of falling and that balance training and fall prevention programs may be required for this population.

Balance and Falls in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Study.

Individuals with chronic obstructive pulmonary disease (COPD) have demonstrated balance impairment and a higher fall incidence. However, these have not been investigated in acute exacerbations of the disease (ECOPD). This study evaluates balance in patients during an ECOPD compared to stable COPD and healthy controls, and examines the fall incidence rate after hospitalisation due to ECOPD compared to individuals with stable COPD. Balance performance of 26 hospitalised patients with ECOPD was compared to 26 community-dwelling participants with stable COPD and 25 matched healthy controls. Balance was evaluated using computerised posturography and the Berg Balance Scale (BBS). Prospective falls were monitored by monthly calendars for 12 months in both COPD groups. Compared to controls, greater balance impairment was observed during ECOPD for most posturography variables across standing conditions (p ≤ 0.05). Both COPD groups had worse BBS scores (p ≤ 0.05) compared to controls. Increased dyspnoea and reduced quadriceps' strength were associated with impaired balance performance. A higher fall incidence (1.76 falls/person/year) was observed following hospitalisation in patients with ECOPD compared to stable COPD (0.53 falls/person/year) at 12 months. Patients with ECOPD demonstrate balance impairments which are associated with increased dyspnoea and reduced muscle strength. Balance impairment during ECOPD may contribute to a high incidence of falls following hospitalisation.

Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework.

QUESTION: What are the barriers and enablers of referral, uptake, attendance and completion of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD)? DESIGN: Systematic review of qualitative or quantitative studies reporting data relating to referral, uptake, attendance and/or completion in pulmonary rehabilitation. PARTICIPANTS: People aged >18years with a diagnosis of COPD and/or their healthcare professionals. DATA EXTRACTION AND ANALYSIS: Data were extracted regarding the nature of barriers and enablers of pulmonary rehabilitation referral and participation. Extracted data items were mapped to the Theoretical Domains Framework (TDF). RESULTS: A total of 6969 references were screened, with 48 studies included and 369 relevant items mapped to the TDF. The most frequently represented domain was 'Environment' (33/48 included studies, 37% of mapped items), which included items such as waiting time, burden of illness, travel, transport and health system resources. Other frequently represented domains were 'Knowledge' (18/48 studies, including items such as clinician knowledge of referral processes, patient understanding of rehabilitation content) and 'Beliefs about consequences' (15/48 studies, including items such as beliefs regarding role and safety of exercise, expectations of rehabilitation outcomes). Barriers to referral, uptake, attendance or completion represented 71% (n=183) of items mapped to the TDF. All domains of the TDF were represented; however, items were least frequently coded to the domains of 'Optimism' and 'Memory'. The methodological quality of included studies was fair (mean quality score 9/12, SD 2). CONCLUSION: Many factors - particularly those related to environment, knowledge, attitudes and behaviours - interact to influence referral, uptake, attendance and completion of pulmonary rehabilitation. Overcoming the challenges associated with the personal and/or healthcare system environment will be imperative to improving access and uptake of pulmonary rehabilitation. TRIAL REGISTRATION: PROSPERO CRD42015015976. [Cox NS, Oliveira CC, Lahham A, Holland AE (2017) Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy 63: 84-93].

Falls by individuals with chronic obstructive pulmonary disease: a preliminary 12-month prospective cohort study.

BACKGROUND AND OBJECTIVE: Despite evidence of an increased fall risk in people with chronic obstructive pulmonary disease (COPD), there is a paucity of prospective fall data in this population. This preliminary study aimed to prospectively examine the prevalence rate, incidence rate and associated risk factors for falls in a sample of community-dwelling people with COPD over 1 year. METHODS: Forty-one participants with stable COPD (mean ± SD) aged 71 ± 8 years with a forced expiratory volume in 1 s of 45.1 ± 16.2% predicted were included. At baseline, participants' demographic, physical function and fall-related measures were documented. Falls were monitored for 12 months following initial assessments. RESULTS: The prevalence of people having falls was 40% (95% CI: 24-56%); amongst these, 75% had frequent falls. The overall fall incidence rate was 1.17 falls/person-year. Risk factors associated with a higher fall incidence rate ratio (IRR) in COPD were: number of pack-years (IRR: 1.02; 95%CI: 1.00,1.04), comorbidities (IRR: 2.02; 95%CI: 1.42,3.06), number of medications (IRR: 1.15; 95%CI: 1.00,1.34), history of falls in the previous year (IRR: 1.89; 95%CI: 1.10,3.34), fear of falling (IRR: 1.08; 95% CI: 1.02,1.14) and higher score in a fall risk assessment questionnaire for older adults (IRR: 1.14; 95% CI: 1.05,1.25); P ≤ 0.05. When adjusted for age, only pack-years (P = 0.01), number of comorbidities (P < 0.001) and history of falls (P = 0.03) were related to an increased fall incidence. CONCLUSIONS: These preliminary findings demonstrated the fall prevalence and incidence rate in community-dwelling people with stable COPD and identified prospective risk factors for an increased fall incidence, which suggest potential mitigation strategies.

Reliability and concurrent validity of the Microsoft Xbox One Kinect for assessment of standing balance and postural control.

The Microsoft Kinect V2 for Windows, also known as the Xbox One Kinect, includes new and potentially far improved depth and image sensors which may increase its accuracy for assessing postural control and balance. The aim of this study was to assess the concurrent validity and reliability of kinematic data recorded using a marker-based three dimensional motion analysis (3DMA) system and the Kinect V2 during a variety of static and dynamic balance assessments. Thirty healthy adults performed two sessions, separated by one week, consisting of static standing balance tests under different visual (eyes open vs. closed) and supportive (single limb vs. double limb) conditions, and dynamic balance tests consisting of forward and lateral reach and an assessment of limits of stability. Marker coordinate and joint angle data were concurrently recorded using the Kinect V2 skeletal tracking algorithm and the 3DMA system. Task-specific outcome measures from each system on Day 1 and 2 were compared. Concurrent validity of trunk angle data during the dynamic tasks and anterior-posterior range and path length in the static balance tasks was excellent (Pearson's r>0.75). In contrast, concurrent validity for medial-lateral range and path length was poor to modest for all trials except single leg eyes closed balance. Within device test-retest reliability was variable; however, the results were generally comparable between devices. In conclusion, the Kinect V2 has the potential to be used as a reliable and valid tool for the assessment of some aspects of balance performance.

Fear of falling in people with chronic obstructive pulmonary disease.

BACKGROUND: Increased fear of falling (FOF) has been associated with impaired physical function, reduced physical activity and increased fall risk in older adults. Preliminary evidence suggests that individuals with chronic obstructive pulmonary disease (COPD) may have an increased FOF. This study aims to compare the level of FOF in people with COPD with healthy controls, and to determine the associations between FOF and measures of physical function, physical activity and fall risk in COPD. METHODS: FOF was assessed in 40 participants with COPD and 25 age- and gender-matched controls using the Falls Efficacy Scale-International (FES-I). Physical function was evaluated using quadriceps hand-held dynamometry, the Berg Balance Scale and the Six-minute Walk Test. Associations between FOF, physical activity and fall risk were evaluated using the Physical Activity Scale for the Elderly and the Falls Risk in Older People - Community Setting. Pearson's correlation coefficient and stepwise multivariate linear regression were used. RESULTS: Individuals with COPD (mean ± SD; age: 71 ± 8 years, FEV1: 45 ± 16 %pred) had higher FOF compared to controls (FES-I: 25.0 ± 7.9 vs 20.2 ± 5.2, p=0.01). Higher FOF was associated with lower quadriceps strength (p=0.02) and an impaired balance (p < 0.01); these explained 26% of the FOF variance. Reduced levels of physical activity (p=0.01) and a higher fall risk (p < 0.01) were associated with an increased FOF in COPD. CONCLUSION: People with COPD have a higher FOF compared to the healthy peers, which is related to lower quadriceps muscle strength, impaired balance, lower levels of physical activity and an increased fall risk.

The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial.

BACKGROUND: Positive expiratory pressure (PEP) is a technique used to enhance sputum clearance during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The impact of PEP therapy during acute exacerbations on clinically important outcomes is not clear. This study sought to determine the effect of PEP therapy on symptoms, quality of life and future exacerbations in patients with AECOPD. METHODS: 90 inpatients (58 men; mean age 68.6 years, FEV(1) 40.8% predicted) with AECOPD and sputum expectoration were randomised to receive usual care (including physical exercise)±PEP therapy. The Breathlessness, Cough and Sputum Scale (BCSS), St George's Respiratory Questionnaire (SGRQ) and BODE index (Body mass index, airflow Obstruction, Dyspnoea, Exercise tolerance) were measured at discharge, 8 weeks and 6 months following discharge, and analysed via linear mixed models. Exacerbations and hospitalisations were recorded using home diaries. RESULTS: There were no significant between-group differences over time for BCSS score [mean (SE) at discharge 5.2 (0.4) vs 5.0 (0.4) for PEP and control group, respectively; p=0.978] or SGRQ total score [41.6 (2.6) vs 40.8 (2.8) at 8 weeks, p=0.872]. Dyspnoea improved more rapidly in the PEP group over the first 8 weeks (p=0.006), however these benefits were not observed at 6 months. Exacerbations (p=0.986) and hospitalisations (p=0.359) did not differ between groups. CONCLUSIONS: We found no evidence that PEP therapy during AECOPD improves important short-term or long-term outcomes. There does not appear to be a routine role for PEP therapy in the management of such individuals.

Postural control and fear of falling assessment in people with chronic obstructive pulmonary disease: a systematic review of instruments, international classification of functioning, disability and health linkage, and measurement properties.

OBJECTIVES: To systematically review the instruments used to assess postural control and fear of falling in people with chronic obstructive pulmonary disease (COPD), and to synthesize and evaluate their breadth of content and measurement properties. DATA SOURCES: MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, PsycINFO, PEDro, and OTSeeker databases searched in September 2012. STUDY SELECTION: Two independent reviewers performed the selection of articles, the ICF linking process and quality assessment. Only quantitative studies were included, irrespective of language or publication date. DATA EXTRACTION: This systematic review comprised two phases. Phase 1 aimed to identify the commonly used instruments to assess postural control and fear of falling in the COPD literature. The breadth of content of each instrument was examined based on the International Classification of Functioning, Disability and Health (ICF). In phase 2, a measurement property search filter was adopted and used in four electronic databases to retrieve properties reported in the COPD population. The COSMIN checklist was used to assess the methodological quality of each measurement property reported. DATA SYNTHESIS: Seventeen out of 401 publications were eligible in phase 1. Seventeen instruments were identified including 15 for postural control and 2 for fear of falling assessment. The Berg Balance Scale, the Short Physical Performance Battery, and the Activities-specific Balance Confidence (ABC) scale were the most frequently used instruments to assess postural control and fear of falling respectively. The ICF categories covered varied considerably among instruments. The Balance Evaluation Systems test and ABC presented the greatest breadth of content. Measurement properties reported included criterion predictive validity (4 instruments), construct validity (11 instruments) and responsiveness (1 instrument), with inconsistent findings based on 'fair' and 'poor' quality studies. CONCLUSIONS: Different instruments with heterogeneous content have been used to assess postural control and fear of falling outcomes. Standardized assessment methods and best evidence on measurement properties is required in the COPD literature.

Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties.

BACKGROUND: The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. OBJECTIVES: To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. DATA SOURCES: A systematic review of articles using electronic databases MEDLINE (1950-2012), CINAHL (1982-2012), EMBASE (1980-2012), Cochrane Library (2012), Expanded Academic ASAP (1994-2012), Health Collection Informit (1995-2012) and PEDRO (1999-2012). Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter- or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist. RESULTS: Thirteen outcome measures were identified. Thirty-one studies evaluating measurement properties of the outcome measures in participants with NSCLC were included. Functional capacity was assessed using the six- and twelve-minute walk tests; incremental- and endurance-shuttle walk tests; and the stair-climbing test. Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness. Physical activity was measured using accelerometers and pedometers. Only the construct validity for accelerometers and pedometers was reported. Muscle strength was measured using hand-held dynamometry, hand-grip dynamometry, manual muscle test, one-repetition maximum and the chair-stand test, however only two studies reported reliability and measurement error and one study reported construct validity. CONCLUSION: Currently there is a gap in the literature regarding the measurement properties of commonly used outcome measures in NSCLC participants, particularly reliability, measurement error and responsiveness. Further research needs to be conducted to determine the most suitable outcome measures for use in trials involving NSCLC participants.

Haemodynamic effects of proportional assist ventilation during high-intensity exercise in patients with chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: Proportional assist ventilation (PAV) has been proposed as a more physiological modality of non-invasive ventilation, thereby reducing the potential for deleterious cardio-circulatory effects during exercise, in patients with COPD. We therefore evaluated whether PAV modulates the kinetic and 'steady-state' haemodynamic responses to exercise in patients with moderate-to-severe COPD. METHODS: Twenty patients underwent constant-load (75-80% peak work rate) cycle ergometer exercise testing to the limit of tolerance (T(lim)), while receiving PAV or breathing spontaneously. Stroke volume (SV), heart rate (HR) and cardiac output (CO) were monitored by impedance cardiography. RESULTS: Compared with unassisted breathing, PAV increased T(lim) in 8/20 patients (median improvement 113% (range 8 to 212) vs -20% (range -40 to -9)). PAV had no significant effects on 'steady-state' haemodynamic responses either in patients with or those without increased T(lim) (P > 0.05). However, at the onset of exercise, SV kinetics were slowed with PAV, in 13/15 patients with analysable data. HR dynamics remained unaltered or failed to accelerate sufficiently in nine of these patients, thereby slowing CO kinetics (T(1/2) 61 s (range 81-30) vs 89 s (range 100-47)). These deleterious effects were not, however, associated with PAV-induced changes in T(lim) (P > 0.05). CONCLUSIONS: PAV slowed the SV and CO kinetics at the onset of high-intensity exercise in selected patients with moderate-to-severe COPD. However, these adverse effects of PAV disappeared during the stable phase of exercise, and were not related to the ergogenic potential of PAV in this patient population.