Relationship between patient functionality impairment and caregiver burden: is there a cut off point for the severe COPD patient?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients experience a progressive limitation of their functionality accompanying their clinical evolution. Concretely, severe COPD patients usually require the figure of a caregiver. Caregiver burden has yet to be explored in other similar chronic diseases. The objective is to propose a cutoff point in different functional impairment aspects, to predict the presence of caregiver burden. METHODS: Severe COPD patients were divided into two groups according to the caregiver burden, measured with the Zarit Burden Interview (ZBI). The patients were assessed with the London Chest Activity of Daily Living (LCADL) scale, the Functional Independence Measure (FIM), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). RESULTS: 70 COPD patients and their caregivers were included in this cross-sectional study. The ROC curve indicated a cutoff point of 19 in the LCADL scale (AUC = 0.722). Dependence in daily life activities had a cutoff point of 123 in the FIM (AUC = 0.776). Social participation in activities of daily living had a cutoff point of 37 in the WHODAS 2.0 (AUC = 0.739). CONCLUSION: Dyspnea related to functional status, dependence in daily life activities, and social participation in activities of daily living of severe COPD patients can predict caretaker burden.

[Prevalence and repercussions of the locomotor syndrome in patients with chronic obstructive pulmonary disease]. / Prevalencia y repercusión del síndrome locomotor en el perfil clínico de la enfermedad pulmonar obstructiva crónica.

BACKGROUND: Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer a progressive deterioration of functional status and a decrease in independence in activities of daily living. Locomotor Syndrome (SL) is the involvement of the musculoskeletal system due to the deterioration caused by age. AIM: In patients with COPD, to evaluate the prevalence in LS and assess its impact on functional status and quality of life. MATERIAL AND METHODS: Cross sectional assessment of 259 patients with COPD. LS was evaluated with the Geriatric Locomotive Function Scale (GFLS-25). Those with a score < 16 were classified as having LS. Functional status was evaluated with dynamometry, Five Times Sit-to-Stand test, and the Modified Baecke Physical Activity Questionnaire. Functional impairment was measured with the London Chest Activity of Daily Living, and the quality of life was evaluated with EuroQol-5D. RESULTS: LS was found in 139 patients (53%). Activity levels and muscle strength were lower in these patients. Also, they had a higher frequency of functional impairment and a lower quality of life perception. CONCLUSIONS: LS in patients with COPD impacts their functional status and quality of life.

Prevalencia y repercusión del síndrome locomotor en el perfil clínico de la enfermedad pulmonar obstructiva crónica / Prevalence and repercussions of the locomotor syndrome in patients with chronic obstructive pulmonary disease

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer a progressive deterioration of functional status and a decrease in independence in activities of daily living. Locomotor Syndrome (SL) is the involvement of the musculoskeletal system due to the deterioration caused by age. Aim: In patients with COPD, to evaluate the prevalence in LS and assess its impact on functional status and quality of life. Material and Methods: Cross sectional assessment of 259 patients with COPD. LS was evaluated with the Geriatric Locomotive Function Scale (GFLS-25). Those with a score < 16 were classified as having LS. Functional status was evaluated with dynamometry, Five Times Sit-to-Stand test, and the Modified Baecke Physical Activity Questionnaire. Functional impairment was measured with the London Chest Activity of Daily Living, and the quality of life was evaluated with EuroQol-5D. Results: LS was found in 139 patients (53%). Activity levels and muscle strength were lower in these patients. Also, they had a higher frequency of functional impairment and a lower quality of life perception. Conclusions: LS in patients with COPD impacts their functional status and quality of life.

Impact of Previous Physical Activity Levels on Symptomatology, Functionality, and Strength during an Acute Exacerbation in COPD Patients.

The main objective of this study is to determine the relationship between physical activity (PA) level prior to hospitalization and the pulmonary symptomatology, functionality, exercise capacity, and strength of acute exacerbated chronic obstructive pulmonary disease (COPD) patients. In this observational study, all data were taken during the patient's first day in hospital. Patients were divided into two groups (a PA group, and a physical inactivity (PI) group), according to the PA level evaluated by the Baecke questionnaire. Cough status was evaluated by the Leicester Cough Questionnaire (LCQ), and dyspnea was assessed using the modified Medical Research Council dyspnea scale (mMRC). Functionality was measured by the Functional Independence Measure (FIM) and the London Chest Activity of Daily Living scale (LCADL). Exercise capacity was evaluated by the two-minute step-in-place (2MSP) test, and strength assessed by dynamometry. A total of 151 patients were included in this observational study. Patients in the PI group obtained worse results compared to the PA group, and significant differences (p < 0.05) were found in all of the variables. Those COPD patients who regularly perform PA have less dyspnea and cough, as well as better functionality, exercise capacity and strength during an exacerbation, without relationship to the severity of the pathology.

Uso de test dual en ancianos institucionalizados con diferentes niveles de deterioro cognitivo. Estudio transversal / Dual tasks in institutionalized seniors with different levels of cognitive impairment. Cross-sectional study

Resumen Introducción. El envejecimiento se ha relacionado con una mayor prevalencia de deterioro cognitivo. Las personas mayores con pérdida de funciones cognitivas presentan elevadas tasas de caídas. El desarrollo de las actividades de la vida diaria engloba dos o más tareas, siendo necesarios componentes cognitivos y motores. Objetivo. Analizar el rendimiento en pruebas sencillas y duales de sujetos en entorno residencial con diferentes grados de deterioro cognitivo. Materiales y métodos. Se realizó un estudio observacional de corte transversal en ancianos institucionalizados >65 años (n=80). Se evaluó el deterioro cognitivo con el Mini-Mental State Examination y se solicitó a los participantes realizar una tarea simple y dual en las pruebas Six-Minute Walk Test (6MWT) y Timed Up and Go (TUG). Resultados. Se distribuyeron los participantes en tres grupos. Se encontraron diferencias significativas entre los grupos con deterioro cognitivo y el grupo sin deterioro cognitivo para las pruebas 6MWT (p<0.05) y TUG (p<0.05), tanto en la tarea simple como en la tarea dual. Un peor rendimiento se asoció con una menor capacidad cognitiva. Conclusión. La severidad del deterioro cognitivo se encuentra relacionada con el desempeño en las tareas duales.

Abstract Introduction: Aging is linked to a higher prevalence of cognitive impairment. Seniors presenting with loss of cognitive functions have high fall rates. The development of activities of daily living encompasses two or more tasks that require cognitive and motor components. Objective: To analyze the performance in simple and dual tasks of subjects living in a residential environment with different degrees of cognitive impairment. Materials and methods: An observational cross-sectional study was performed in a population of institutionalized elderly >65 years (n=80). Cognitive impairment was assessed using the Mini-Mental State Examination and participants were asked to perform simple and dual tasks using the Six-Minute Walk Test (6MWT) and Timed Up and Go (TUG). Results: The participants were divided into three groups. Significant differences were found between the groups with cognitive impairment and the group without cognitive impairment in the 6MWT (p<0.05) and TUG (p<0.05) tests, both in simple task and dual tasks. Poorer performance was associated with lower cognitive capacity. Conclusion: The severity of cognitive impairment is correlated to performance in dual tasks.