“Can do” versus “do do”: A Novel Concept to Better Understand Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease

Koolen, Noortje; Hees, Hieronymus W. van; Lummel, Rob C. van; Dekhuijzen, Richard; Djamin, Remco S.; Spruit, Martijn A.; Hul, Alex J van ’t

doi:10.3390/jcm8030340

Cited by 58 publications

(90 citation statements)

References 49 publications

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“…This implies that interventions may have to be individually tailored according to patients' impairments in PC or PA, or both. According to this new approach, Koolen et al [10] recently developed a PC-PA quadrant concept with PC ("can do") and PA ("do do") plotted against axes. This PC-PA quadrant concept identifies sub-groups of physical functioning and comparison of different clinical characteristics may provide an explanation for the discrepancies between PA and PC in individual COPD patients.…”

Section: Introductionmentioning

confidence: 99%

“Can do, don’t do” are not the lazy ones: a longitudinal study on physical functioning in patients with COPD

Sievi

Brack²,

Brutsche

et al. 2020

Respir Res

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Background and objective: Reduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of subgroups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics. Methods: In a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed. Results: Data from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) "can't do, don't do": most severe and symptomatic, several comorbidities II) "can do, don't do": severe but less symptomatic, several comorbidities III) "can't do, do do": few patients, severe and symptomatic, less comorbidities IV) "can do, do do": mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual subgroups. Conclusion: Our findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the "can do, don't do" quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC. Clinical trial registration: www.ClinicalTrials.gov, NCT01527773.

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Section: Introductionmentioning

confidence: 99%

“Can do, don’t do” are not the lazy ones: a longitudinal study on physical functioning in patients with COPD

Sievi

Brack²,

Brutsche

et al. 2020

Respir Res

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“…To date, use of primary care physiotherapy or PR is estimated to be very limited in The Netherlands (5.0 and 0.2%, respectively), while a larger proportion of the patients with COPD clearly qualify for this type of care [3]. So, improved referral rates are a necessity to lower the disease burden for patients and society.…”

Section: Discussionmentioning

confidence: 99%

“…It is hard to understand why GOLD D patients are entitled to a higher number of primary care physiotherapy sessions than GOLD B patients. Indeed, a secondary analysis of the data of Koolen et al [3] shows no differences in physical capacity and physical activity between GOLD B or D patients after stratification for patient profiles 2 to 5 (Fig. 2).…”

Section: Mild-to-moderate Disease Burdenmentioning

confidence: 93%

“…Moreover, the maximum number of sessions is solely based on the GOLD ABCD classification at the time of referral, and excludes GOLD 1 patients (Table 1). However, a subgroup of GOLD 1 patients can suffer from an impaired physical functioning [3], which justifies early referral to exercise-related care, such as physiotherapy [20]. Also respiratory symptom burden and exacerbation history (the two attributes required to classify patients into GOLD ABCD) have not been validated to identify the right candidates for the right type of exercise-based care in patients with COPD.…”

Section: Current Clinical Practicementioning

confidence: 99%

“…During this second screening visit physical activity is evaluated and the 6MWT is repeated [30]. Patients with a rather preserved physical capacity (> 70% predicted value [3]) and physical activity (> 5000 steps per day [3]) will receive healthy lifestyle advice, but no additional professional allied healthcare ( CCQ Clinical COPD Questionnaire, CAT COPD Assessment Test, % % predicted value, st/d steps per day. *During hospital admission patients with COPD should be offered exercise-based physiotherapy in addition to regular respiratory physiotherapy [58].…”

Section: Mild-to-moderate Disease Burdenmentioning

confidence: 99%

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Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

et al. 2020

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A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3-5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.

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Physical Functioning in Patients with a Recent Fracture: The “Can Do, Do Do” Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors

Schene,

Meijer,

Cheung

et al. 2023

Calcif Tissue Int

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Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the “can do, do do” framework. We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can’t do/can do) and PA by accelerometer (don’t do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) “can’t do, don’t do”; (2) “can do, don’t do”; (3) “can’t do, do do”; (4) “can do, do do”. Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% “can’t do, don’t do”; 3.0% “can do, don’t do”; 19.3% “can’t do, do do”; 69.5% “can do, do do”. For the “can’t do” group the OR for low PA was 9.76 (95% CI: 4.82–19.80). Both the “can’t do, don’t do” and “can’t do, do do” group differed significantly compared to the “can do, do do” group on several fall and fracture risk factors and had lower physical performance. The “can do, do do” framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% “can’t do, but “do do” while having a high prevalence of fall risk factors compared to persons that “can do, do do”, which may indicate this group is prone to fall.

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“Can do” versus “do do”: A Novel Concept to Better Understand Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease

Cited by 58 publications

References 49 publications

“Can do, don’t do” are not the lazy ones: a longitudinal study on physical functioning in patients with COPD

“Can do, don’t do” are not the lazy ones: a longitudinal study on physical functioning in patients with COPD

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

Physical Functioning in Patients with a Recent Fracture: The “Can Do, Do Do” Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors

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