A field test of functional status as performance of activities of daily living in COPD patients

Abstract

Patients with chronic obstructive pulmonary disease (COPD) frequently experience activity restrictions and discomfort during activities of daily living (ADL). Functional status refers to the capacity to perform ADL. Available tests only partly measure this domain. Our aim was therefore to establish an assessment tool for functional status in COPD, the Glittre ADL-test. This field test includes a standardised set of ADL-like activities: Walking stairs, carrying, lifting objects, bending down and rising from a seated position. The primary variable was time to complete the test (ADL-time). Validity was investigated in 57 COPD patients by correlating ADL-time to pulmonary function, 6-min walking distance (6MWD) and questionnaires addressing health-related quality of life. Responsiveness was investigated in another 40 patients comparing ADL-time before and after rehabilitation. Median ADL-time was 4.16 min (range 2.57-14.47). Spearman rho=0.93 for test-retest reliability. ADL-time correlated with forced expiratory volume in 1s (rho=-0.61), St. George's Respiratory Questionnaire activity subscore (rho=0.43), dyspnoea during ADL (rho=0.35) and hospitalisation rate (rho=0.35). Despite a close overall correlation with 6MWD (rho=-0.82), variability was substantial, particularly for the more disabled patients. ADL-time improved significantly after rehabilitation. Glittre ADL-test yields information complementary to 6MWD. It is a valid and reliable measure of functional status, useful for assessment of individual patients and rehabilitation programs.

Patients hospitalized for community-acquired pneumonia present reduced functional performance

“…The time spent by patients with COPD to perform the GT was 60% greater than that in a control group 21 , which is similar to the percentage (64%) difference found in our study when comparing the CAP and control groups. It is interesting to note that our patients with CAP had similar times for performing the GT compared with patients with COPD in this other study 16 (272.8 sec and 280.2 sec, respectively). Therefore, CAP patients demonstrate difficulties in performing simple and routine activities similar to activities of daily living (ADL).…”

“…Therefore, CAP patients demonstrate difficulties in performing simple and routine activities similar to activities of daily living (ADL). The poor performance of our younger patients (49±16 yrs) with better lung function (FEV 1 : 57.8±17.8% of predicted) could be attributed to the acute clinical condition of patients hospitalized with CAP as compared to stable COPD patients (61±8 yrs, FEV 1 : 48±15% of predicted) 16 .…”

“…On the first day, patients answered the Medical Research Council scale (MRC) 9 and Short-Form 36 questionnaire (SF-36) 10 , and their CRB-65 scores 11 were recorded. Subsequently, patients performed either a spirometry 12,13 or peripheral muscle strength (PMS) test, as well as either the 6-minute walk test (6MWT) 14,15 or the Glittre test (GT) 16 . On the second day, patients underwent the tests not performed on the previous day (spirometry or PMS and 6MWT or GT).…”

“…The GT was undertaken as previously described 16 . The test was conducted in a 10-meter-long hallway in the hospital.…”

“…The test was conducted in a 10-meter-long hallway in the hospital. Two tests were performed an hour apart on the same day to minimize the learning effect previously demonstrated in patients with COPD 16 . The test with shorter duration was used for the analysis.…”