<p>Translation and Cultural Adaptation of PROactive Instruments for COPD in French and Influence of Weather and Pollution on Its Difficulty Score</p>

Abstract

Introduction:The recently developed daily and clinical visit PROactive physical activity in COPD (PPAC) instruments are hybrid tools to objectively quantify the level of physical activity and the difficulties experienced in everyday life. Our aim was to translate these instruments for the French-speaking chronic obstructive pulmonary disease (COPD) community worldwide and evaluate the influence of weather and pollution on difficulty score. Methods: The translation procedure was conducted following the guidelines for crosscultural adaptation process. The translated clinical visit (C-PPAC) was tested among COPD patients in France. A retest was conducted after an interval of at least 2 weeks. The C-PPAC difficulty score was then tested to see how sensitive it was to the influence of weather and outdoor pollution. Results: One hundred and seventeen COPD patients (age 65±9 years; FEV1: 51±20%) from 9 regions in France were included. The French version of C-PPAC was found comprehensible by the patients with an average score of 4.8/5 on a Likert-scale. It showed good internal consistency with Cronbach's α>0.90 and a good test retest reliability with an intraclass correlation coefficient of ≥0.80. The difficulty score was negatively correlated with duration of daylight (ρ=−0.266; p<0.01) and influenced by the intensity of rainfall (light vs. heavy rainfall: 68±16 vs. 76±14 respectively, p=0.045). The score was lower in patients receiving long term oxygen therapy (60 ±15 vs. 71±15, p<0.01), but not correlated with the pollution indices. Conclusion: The French versions of the questionnaires of the PPAC instruments are accepted and comprehensible to COPD patients. The difficulty score of C-PPAC is sensitive to duration of daylight and rainfall. Such weather factors must be taken into consideration when evaluating the physical activity behavior using these tools in COPD.

Data Reproducibility and Effectiveness of Bronchodilators for Improving Physical Activity in COPD Patients

“…PA is largely affected by weather. On rainy days, PA is significantly reduced in comparison to non-rainy days [70][71][72][73]. The time spent performing PA of ≥2.0 METs and ≥3.0 METs were 145.6 min and 21.3 min, respectively, on non-rainy days and 92.8 min and 11.1 min on rainy days [70].…”

“…When the temperature was >22.5 • C, the daily step count fell by −891 steps per 1 • C increase in temperature. Vaidya et al [73] reported that although there was a tendency for the questionnaire-evaluated PA to decrease with higher temperatures, the seasons did not have any influence on the PA score in French COPD patients. Balish et al [74] reported that daily step count increased 316 steps for each 10 • C rise in temperature in Canadian COPD patients.…”

“…After controlling for climatic and other variables, pollutant levels of >60-70 µg/m 3 influenced both the time outdoors and daily step count. On the other hand, Vaidya et al [73] reported that the questionnaire-evaluated PA was not correlated with the condition of main atmospheric pollutants (ATMO index: the level of particulate matter <10 µm in size, including PM10, ozone, nitrogen dioxide, and sulfur dioxide). The effects of air pollution on PA are still controversial.…”

“…Rainfall of 10 mm translated to a decrease of approximately 175 steps [74]. Furthermore, the questionnaire-evaluated difficulty scores of the proactive physical activity in COPD on heavy rainfall days were significantly higher in comparison to light to moderate rainfall days [73]. Therefore, the data of rainy days should be excluded from analyses to ensure the reproducibility of data obtained before and after intervention.…”

A machine learning approach to predict extreme inactivity in COPD patients using non-activity-related clinical data

“…At the same time, clinical interviews and patient questionnaires alone cannot accurately determine the patient’s true PA level [ 7 ]. To improve this situation, the PROactive consortium proposed that a combination of questionnaires and accelerometric measurements be used to assess the behavior of COPD patients [ 8 , 9 ]. Nevertheless, this approach does not eliminate the drawbacks of accelerometry, and therefore does not resolve the primary clinical concern, which is to accurately and objectively detect extreme inactivity (referred to hereafter as EI) in patients whose PA status initially presents as unclear or equivocal [ 10 , 11 ].…”