Validity and Responsiveness of the Glittre-ADL Test without a Backpack in People with Chronic Obstructive Pulmonary Disease.

The Glittre-ADL test assesses the functional capacity for activities of daily living of people with chronic obstructive pulmonary disease (COPD). In the test, a weighted backpack is worn (2.5 kg for women and 5.0 kg for men). The differential in weight between men and women is not common in other tests of exercise capacity and may limit the comparison of the test between sexes. The primary aim of this study was to validate the Glittre-ADL test performed without the backpack in people with COPD. Forty participants with mild to severe COPD (mean ± SD age: 70 ± 6 years; FEV1: 48 ± 20%predicted) were recruited and performed two six-minute walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3). The Glittre-ADL test time was shorter without the backpack than with the backpack [mean difference -0.37 min (95%CI -0.59 to -0.15)] and heart rate (HR) and oxygen saturation (SpO2) were equivalents between tests [-1.31 beats/minute (-3.92 to 1.30) and -0.95% (-2.27 to 0.37), respectively]. The Glittre-ADL test without the backpack elicited similar HR and SpO2 responses as the test with the backpack, indicating equivalence of physiological demand. Thus, the Glittre-ADL test without the backpack was a valid, responsive, and appropriate test to assess functional capacity for activities of daily living.

Comparison of Psychophysiological Stress in Physiotherapy Students Undertaking Simulation and Hospital-Based Clinical Education.

INTRODUCTION: Simulation-based clinical education often aims to replicate varying aspects of real clinical practice. It is unknown whether learners' stress levels in simulation are comparable with those in clinical practice. The current study compared acute stress markers during simulation-based clinical education with that experienced in situ in a hospital-based environment. METHODS: Undergraduate physiotherapy students' (n = 33) acute stress responses [visual analog scales of stress and anxiety, continuous heart rate (HR), and saliva cortisol] were assessed during matched patient encounters in simulation-based laboratories using standardized patients and during hospital clinical placements with real patients. Group differences in stress variables were compared using repeated measures analysis of variance for 3 time points (before, during the patient encounter, and after) at 2 settings (simulation and hospital). RESULTS: Visual analog scale stress and anxiety as well as HR increased significantly from baseline levels before the encounter in both settings (all P < 0.05). Stress and anxiety were significantly higher in simulation [mean (SD), 45 (22) and 44 (25) mm; P = 0.003] compared with hospital [mean (SD), 31 (21) and 26 (20) mm; P = 0.002]. The mean (SD) HR during the simulation patient encounter was 90 (16) beats per minute and was not different compared with hospital [mean (SD), 87 (15) beats per minute; P = 0.89]. Changes in salivary cortisol before and after patient encounters were not statistically different between settings [mean (SD) simulation, 1.5 (2.4) nmol/L; hospital, 2.5 (2.9) nmol/L; P = 0.70]. CONCLUSIONS: Participants' experienced stress on clinical placements, irrespective of the clinical education setting (simulation vs. hospital). This study revealed that psychological stress and anxiety were greater during simulation compared with hospital settings; however, physiological stress responses (HR and cortisol) were comparable. These results indicate that psychological stress may be heightened in simulation, and health professional educators need to consider the impact of this on learners in simulation-based clinical education. New learners in their clinical education program may benefit from a less stressful simulation environment, before a gradual increase in stress demands as they approach clinical practice.

Prescription of walking exercise intensity from the 6-minute walk test in people with chronic obstructive pulmonary disease.

PURPOSE: The 6-minute walk test (6MWT) is widely used in clinical practice, particularly to assess functional exercise capacity and to prescribe walking training intensity in people with chronic obstructive pulmonary disease (COPD). However, the actual walking intensity prescribed from the 6MWT, in terms of percent peak oxygen uptake (%(Equation is included in full-text article.)O2peak) and percent (Equation is included in full-text article.)O2 reserve (%(Equation is included in full-text article.)O2R), has not been previously reported. This study aims to examine the exercise intensity when walking training is prescribed at 80% average 6MWT speed. METHODS: Patients with COPD (N = 45) were recruited. Peak (Equation is included in full-text article.)O2 from an incremental cycle test and 6MWT and (Equation is included in full-text article.)O2 from a 10-minute walking exercise (Walk-10) were measured by a portable metabolic system (Cosmed K4b; Cosmed, Rome, Italy). Walk-10 was done on the same oval course as the 6MWT. Participants were asked to walk at 80% average 6MWT speed for 10 minutes continuously. RESULTS: Four participants could not complete Walk-10 and 2 did not perform Walk-10 due to low 6MWT distance. The remaining 39 participants with mean (SD) forced expiratory volume in 1 minute of 58 (19)% predicted completed Walk-10. The mean intensity of Walk-10 was 69 (17)% (Equation is included in full-text article.)O2R or 77 (13)% (Equation is included in full-text article.)O2peak. Steady-state (Equation is included in full-text article.)O2 was achieved within the first 4 minutes of Walk-10. CONCLUSION: Walking exercise prescribed at 80% average 6MWT speed resulted in a high but tolerable exercise intensity that is likely to result in training benefits in most people with COPD.

How prepared are rural and remote health care practitioners to provide evidence-based management for people with chronic lung disease?

OBJECTIVE: To investigate the existing experience, training, confidence and knowledge of rural/remote health care practitioners in providing management for people with chronic obstructive pulmonary disease (COPD). DESIGN: Descriptive cross-sectional, observational survey design using a written anonymous questionnaire. This study formed part of a larger project evaluating the impact of breathe easy walk easy (BEWE), an interactive education and training program for rural and remote health care practitioners. SETTING: Rural (n = 1, New South Wales) and remote (n = 1, Northern Territory) Australian health care services. PARTICIPANTS: Health care practitioners who registered to attend the BEWE training program (n = 31). MAIN OUTCOME MEASURES: Participant attitudes, objective knowledge and self-rated experience, training and confidence related to providing components of management for people with COPD. RESULTS: Participants were from a variety of professional backgrounds (medical, nursing, allied health) but were predominantly nurses (n = 13) or physiotherapists (n = 9). Most participants reported that they had minimal or no experience or training in providing components of management for people with COPD. Confidence was also commonly rated by participants as low. Mean knowledge score (number of correct answers out of 19) was 8.5 (SD = 4.5). Questions relating to disease pathophysiology and diagnosis had higher correct response rates than those relating more specifically to pulmonary rehabilitation. CONCLUSION: The results of this study indicate that some rural and remote health care practitioners have low levels of experience, knowledge and confidence related to providing components of management for people with COPD and that education and training with an emphasis on pulmonary rehabilitation would be beneficial.

Evaluation of the SenseWear activity monitor during exercise in cystic fibrosis and in health.

OBJECTIVE: Determine the SenseWear Pro3 Armband (SWA) accuracy for estimating energy expenditure (EE) and step count during treadmill walking in cystic fibrosis (CF) compared to healthy adults. HYPOTHESIS: SWA estimation of EE would be less accurate for CF, than for healthy subjects, due to interference with the SWA skin sensors caused by the high salt concentration in the sweat of CF subjects. METHODS: 17 CF (mean age 26 yr; FEV1 54% predicted) and 17 age-matched control subjects walked slightly faster than their comfortable pace on a treadmill for 20 min, whilst simultaneously wearing the SWA and breathing through an open-circuit indirect calorimetry (IC) system. Subjects' steps were manually counted. RESULTS: Combined EE data from all subjects showed no significant difference in EE measured by IC (6.0+/-3.4 kcal min(-1)) compared to the SWA estimate (6.3+/-2.5 kcal min(-1)), however the SWA significantly overestimated EE at low exercise intensities and underestimated EE at high exercise intensities. Correlations between EE values, estimated by the SWA and measured by IC, were greater than 0.85 (p<0.001) for both the CF and control group. Standard multiple regression showed that diagnosis of CF independently predicted less than 0.1% of the difference between the IC measure of EE and the SWA estimate. The SWA recorded slightly but significantly fewer steps (113+/-12 steps min(-1)) than the manual count (119+/-9 steps min(-1)). CONCLUSION: Diagnosis of CF had no significant negative impact on the accuracy of the SWA estimate of EE. The SWA provided a reasonably accurate estimate of EE and step count during treadmill walking.