The minimal important difference for Glittre-ADL test in patients with chronic obstructive pulmonary disease

ObjectiveTo determine Glittre-ADL test minimal important difference in patients with chronic obstructive pulmonary disease.MethodsThis is quasi-experimental study. Sixty patients with moderate to very severe chronic obstructive pulmonary disease (age 64.1, SD = 9.09 years; forced expiratory volume in the first second 37.9, SD = 13.0% predicted participated in a pulmonary rehabilitation program based on physical training, conducted over 24 sessions supervised, three times a week, including aerobic training in treadmill and resistance training for upper limbs and lower limbs. The main outcomes were the Glittre-ADL test and six-minute walk test, before and after 24 sessions of pulmonary rehabilitation. The minimal important difference was established using the distribution and anchor-based methods.ResultsPatients improved their functional capacity after the pulmonary rehabilitation. The effect sizes of Glittre-ADL test and six-minute walk test improvement were similar (0.45 vs 0.44, respectively). The established minimal important differences ranged from −0.38 to −1.05. The reduction of 0.38 min (23 s) corresponded to a sensitivity of 64% and a specificity of 69% with an area under the curve of 0.66 (95%CI 0.51–0.81; p = 0.04). Subjects who achieved the minimal important difference of −0.38 min for the Glittre-ADL test had a superior improvement of approximately 42 m in the six-minute walk test when compared to patients who did not.ConclusionsThe present findings suggest −0.38 min as the minimal important difference in the time spent in the Glittre-ADL test after 24 sessions of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.Trial registration: NCT03251781 (https://clinicaltrials.gov/ct2/show/NCT03251781)     

Activity monitoring for assessment of physical activities in daily life in patients with chronic obstructive pulmonary disease

OBJECTIVE: To investigate the degree of agreement between different methods of assessing physical activities in daily life in patients with chronic obstructive pulmonary disease (COPD): video recordings (criterion standard), the DynaPort Activity Monitor (DAM), and patient self-report. DESIGN: Study A: outcomes from video recordings were compared with DAM outcomes and with patient estimation of time spent on each activity after a 1-hour protocol including walking, cycling, standing, sitting, and lying. Study B: DAM outcomes and patient self-report were compared during 1 day in real life. SETTING: Outpatient clinic in a university hospital. PARTICIPANTS: Study A: 10 patients with COPD (mean age, 62+/-6 y; forced expiratory volume in the first second [FEV1]=40%+/-16% of predicted). Study B: 13 patients with COPD (mean age, 61+/-8 y; FEV1=33%+/-10% of predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time spent on different activities and movement intensity during walking and cycling. RESULTS: Study A: time estimated by the patients in the sitting position was significantly lower than the time showed by the video recordings and the DAM (both P<.001). For the other variables, there were no statistically significant differences (all P>.05). However, Bland and Altman plots and intraclass correlation coefficients showed large disagreement between video recordings and patients' estimations, in contrast to the high degree of agreement between video recordings and DAM. Changes in walking speed correlated highly to changes in DAM movement intensity (r=.81, P<.01). Study B: patients significantly overestimated walking time (22+/-47 min, P=.04) and underestimated standing time (-45+/-71 min, P=.04). CONCLUSIONS: The DAM showed high accuracy in objectively assessing time spent on different activities and changes in walking speed in patients with COPD. Patients' estimations of time spent on physical activities in daily life disagreed with objective assessment.     

稳定期慢性阻塞性肺疾病患者运动时低氧血症的发生及相关因素

目的：探讨运动时低氧血症与静息时常规肺功能和血气分析指标、运动后呼吸生理改变及最大运动能力的关系。方法：３０ 例稳定期中重度慢性阻塞性肺疾病（ＣＯＰＤ）患者,运动前进行肺功能检查和血气分析。应用自行车功率仪进行递增负荷运动试验,运动过程通过呼吸感应性体表描记仪监测胸腹呼吸运动之和与潮气量之比（ＴＣＤ／ＶＴ） 。结果：３０ 例受试者中１４ 例运动时出现低氧血症,其常规肺功能指标和最大运动能力指标均显著低于其余１６例。极量运动时血氧饱和度（ＳａＯ２ｍｉｎ） 与静息时ＰａＣＯ２ 和ＲＶ／ＴＬＣ 显著负相关,与ＦＥＶ１ ％ ｐｒｅｄ 、ＦＶＣ％ ｐｒｅｄ、ＭＶＶ％ ｐｒｅｄ 和ＰａＯ２ 等均有一定的相关性;极量运动时ＳａＯ２ 下降幅度与静息时ＰａＣＯ２ 、ＰａＯ２ 和ＲＶ 显著相关;ＳａＯ２ｍｉｎ与ＴＣＤ／ＶＴ 的变化负相关;ΔＳａＯ２ 与ＶＥｍａｘ 相关;ＳａＯ２ｍｉｎ 和ΔＳａＯ２ 与最大运动能力指标无明显的相关性。结论：ＣＯＰＤ患者运动时可出现低氧血症,肺充气过度和通气功能损害是引起运动时低氧血症的主要因素,运动时诱发的胸腹矛盾呼吸和运动时通气不足对低氧血症的发生有一定的影响;运动时低氧血症与最大运动能力无明显的相关性。     

康复治疗对慢性阻塞性肺疾病患者肺功能影响的临床调查

目的观察康复治疗对慢性阻塞性肺疾病(COPD)患者肺功能的影响。方法将2003年1月~2004年1月在深圳第四人民医院就诊的30例COPD患者随机分为训练组和对照组,各15例,训练组除基本治疗外,每天需进行多项康复治疗。对照组进行常规对症治疗及一般的肢体活动,治疗前及治疗后24周分别检查两组肺功能,并进行评估。结果治疗前两组肺功能评分无统计学意义(P>0.05)。治疗组治疗后肺功能较治疗前及对照组治疗后明显改善(P<0.05)。结论康复治疗能明显改善COPD患者的肺功能。     

Daily utility and satisfaction with rollators among persons with chronic obstructive pulmonary disease

Hill K, Goldstein R, Gartner EJ, Brooks D. Daily utility and satisfaction with rollators among persons with chronic obstructive pulmonary disease.

Objective

To characterize the daily utility and satisfaction with rollators in patients with chronic obstructive pulmonary disease (COPD).

Design

Cross-sectional observational study.

Setting

Community.

Participants

COPD patients describing dyspnea during activities of living, who had been provided with a rollator by a health care professional within the preceding 5-year period.

Interventions

Not applicable.

Main Outcome Measures

Three questionnaires were administered in random order. The St. George's Respiratory Questionnaire was used to measure health-related quality of life, version 2.0 of the Quebec User Evaluation of Satisfaction with Assistive Technology was used to assess satisfaction with the rollator, and a structured questionnaire was used to obtain information regarding daily utility of the device and barriers to its use. Demographic data were obtained through patient interview. Anthropometric data, measurements of resting lung function, and 6-minute walk distance were extracted from the medical records.

Results

Twenty-seven (10 men) patients (forced expiratory volume in 1 second, 35.1%±22.3% predicted) completed the study. Sixteen (59%) patients reported daily rollator use. All patients used the rollator to assist with ambulation outdoors, but 16 (59%) patients stated that they did not use the rollator for any activity in their home. Although satisfaction with the rollator was high, women were less satisfied with the weight of the device than men (P=.008). Thirteen (48%) patients reported being embarrassed while using the device.

Conclusions

COPD patients provided with a rollator for use during daily life were most satisfied with its effectiveness and least satisfied with its weight. Daily use was generally high with over half the patients using the rollator on a daily basis. Rollators were more often used outdoors than indoors.     

Psychometric Validation of the Manual Ability Measure-36 (MAM-36) in Patients With Neurologic and Musculoskeletal Disorders

Chen CC, Bode RK. Psychometric validation of the Manual Ability Measure-36 (MAM-36) in patients with neurologic and musculoskeletal disorders.

Objectives

To evaluate the psychometric properties of the Manual Ability Measure-36 (MAM-36), a new hand function outcome measure, and to examine differences in manual abilities and item parameters in patients with neurologic and musculoskeletal conditions.

Design

Convenience sample from 2 time periods, cross-sectional.

Setting

Outpatient rehabilitation units and private hand clinics.

Participants

Patients (N=337; mean age, 50.3±14.9y) with a variety of neurologic and musculoskeletal (orthopedic) diagnoses. Most of these individuals were community dwelling, and all had residual functional limitations in the hand(s).

Interventions

Not applicable.

Main Outcome Measures

Rasch analysis was performed on MAM-36 data to evaluate both scale structure and psychometric properties, which include rating distribution, step measures, item fit, separation, and dimensionality. A t test was performed to examine the differences in manual abilities in patients with the 2 conditions. Uniform differential item functioning (DIF) between neurologic and musculoskeletal groups was examined. (DIF occurs when subgroup members within the sample with the same level of the underlying trait being measured respond differently to an individual item.) Manual ability estimates were recalibrated with step and common item anchoring; they were compared with those derived from the original analysis.

Results

The 36 items measured a single construct with no misfitting items. The scale was used as intended. The items can reliably separate the participants into 5 ability strata. Neurologic patients had a significantly lower mean manual ability than musculoskeletal patients. Fourteen items exhibited DIF. However, DIF had no effect on either scale quality or calibration of manual ability. We decided that a single rating scale is appropriate for both groups.

Conclusions

This study showed that the MAM-36 has more than adequate psychometric properties and can be used as a generic outcome measure for patients with a wide variety of clinical diagnoses.     

社区慢性阻塞性肺疾病患者的自我保健意识调查及分析

目的了解社区慢性阻塞件肺疾病患者的自我保健意识,分析影响因素。方法抽查5个社区中确诊为慢性阻塞性肺疾病患者532例。设计问卷,以直接访谈法及邮寄法对患者进行调查。结果不同文化层次、不同经济收入、不同家庭支持程度的患者,在戒烟、参加锻炼、对氧疗知识了解、对疾病预防知识了解等方面比较有统计学意义。不同年龄组患者自我保健意识（除参加锻炼外）比较无统计学意义。结论慢性阻塞性肺疾病患者自我保健意识普遍缺乏,尤其是文化程度低、经济收入低、家庭支持差的患者,需对不同层次人群普及健康知识。     

慢性阻塞性肺疾病的内涵界定与康复护理方法的研究

文章重点就慢性阻塞性肺疾病（ＣＯＰＤ）的内涵界定中ＣＯＰＤ概念命名的发生及内涵演变;美国胸科学会对慢性阻塞性肺疾病（ＣＯＰＤ）的命名及内涵界定及康复护理方法中的面罩压力支持通气对提高慢性阻塞性肺疾病问题进行详尽的论述和深入的讨论。     

The relation between subjective and objective measures of everyday life activities in persons with multiple sclerosis

OBJECTIVES: To investigate the relation between subjective and objective performance-based measures of functional status in persons with multiple sclerosis (MS), and to compare their performance with healthy controls. DESIGN: A between-groups design, using a correlational approach to examine the relation between objective and subjective measures of functional capacity. SETTING: Outpatient rehabilitation research institution. PARTICIPANTS: Seventy-four subjects with clinically definite MS and 35 healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Executive Function Performance Test (EFPT), Functional Assessment of Multiple Sclerosis (FAMS), and Functional Behavior Profile (FBP). RESULTS: MS participants reported more difficulties performing functional tasks than did the healthy controls. MS participants also performed significantly worse on the EFPT than healthy controls. However, all correlations between subjective and objective functional measures were nonsignificant. After controlling for depressive symptomatology, EFPT performance was significantly associated with FBP scores, but not FAMS scores. CONCLUSIONS: The lack of association between objective performance-based measures and subjective self-report measures of functional activities is a challenge to outcomes measurement and has implications for assessment of functional performance. Results are discussed in terms of the different dimensions that these tools are measuring and their respective strengths and limitations.     

运动疗法加音乐疗法对COPD患者生活质量影响的研究

目的 评价运动加音乐疗法对改善慢性阻塞性肺疾病(COPD)患者生活质量的效果.方法 对40例中度和重度慢性阻塞性肺疾病患者进行6个月的运动康复训练和音乐治疗,在治疗前、后分别进行6 min步行试验(6MWT)测量和生活质量评价,然后进行统计学分析.结果 与训练前比较,患者训练后6 min行走距离较训练前明显延长(P=0.000);同时生活质量各方面(日常生活能力、社会活动能力和抑郁焦虑症状)都有明显改善(P=0.000).结论 对COPD患者实施长期、个体化的运动和音乐治疗可有效改善其生活质量.     

Management of patients with end-stage chronic obstructive pulmonary disease

Patients with end-stage chronic obstructive pulmonary disease (COPD) have poor quality of life, with limited activity, breathlessness, dependence on others, and recurrent needs for medical evaluation and treatment. Such patients demonstrate significant and progressive impairments in physical, mental, and social functioning. Because the rate of decline is variable, however, it is difficult to predict prognosis of survival. Currently available treatments only partially relieve symptoms, and patients become increasingly more disabled. This article reviews quality of life issues, proposed prognostic indicators, and pharmacologic and nonpharmacologic treatments in advanced COPD. Palliative measures to address breathlessness and unmet needs among patients with end-stage COPD are discussed.     

吸入糖皮质激素治疗慢性阻塞性肺疾病的研究

目的探讨中等剂量二丙酸氯地米松短疗程吸入治疗慢性阻塞性肺疾病稳定期患者的疗效。方法按照随机、对照、单盲的设计,将44例稳定期慢性阻塞性肺疾病患者分2组,观察组给予二丙酸氯地米松(800μg/d)与对照组给予安慰剂吸入治疗6周,观察治疗前后测定肺功能第1秒用力呼气量、用力肺活量,并记录临床症状评分及生活质量评分。结果观察组21例,临床症状改善,治疗前症状评分为(5.1±0.5)分,治疗后为(4.6±0.4)分(P<0.05);第1秒用力呼气量治疗前为(1.79±0.02)L,治疗后为(2.16±0.03)L(P<0.01);用力肺活量治疗前为(2.20±0.02)L,治疗后为(2.50±0.03)L(P<0.05),呼吸功能提高显著。对照组19例,治疗前后各项指标均无显著性差异(P>0.05)。结论短期二丙酸氯地米松吸入治疗稳定期慢性阻塞性肺疾病患者可缓解临床症状,提高肺功能和生活质量。     

综合康复护理模式对慢性阻塞性肺疾病患者康复效果的影响

目的探讨综合康复护理模式对慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者康复效果的影响。方法选取2017年1~10月该院收治COPD患者100例作为研究对象。随机分为对照组和干预组,各50例。对照组采取传统护理方法,干预组在此基础上采用综合康复护理模式。比较两组患者出院后3个月的肺功能情况及生活质量。结果干预组患者肺功能情况及生活质量优于对照组,差异均有统计学意义(均P<0.05)。结论采用综合康复护理模式可以改善COPD患者的肺功能,提高生活质量,值得进一步推广应用。     

舒适护理对慢性阻塞性肺疾病患者的疗效分析

目的探讨舒适护理对慢性阻塞性肺疾病患者的临床效果。方法以我院40例慢性阻塞性肺疾病为试验组,给予舒适护理;以同期收治的40例慢性阻塞性肺疾病为对照组,给予常规基础及生活护理,比较两组护理效果。结果试验组在给予舒适护理后,心理异常率明显低于对照组;生活自理率、满意率及治疗依从率均明显高于对照组,两组间差异均具有统计学意义(P<0.05)。结论舒适护理可改善慢性阻塞性肺疾病患者生活质量,改善不良心理状态,提高满意度及治疗依从性,明显提高整体护理质量。     

肺康复锻炼对稳定期COPD患者生活质量的影响

目的探讨肺功能康复锻炼对COPD患者的临床作用。方法26例中~重度COPD病人经过20周肺康复锻炼后,分别观察呼吸困难程度和6 min行走距离(6MWD),用圣乔治呼吸问卷(SGRQ)评定生活质量(总积分和分项积分)。结果10周及20周康复锻炼后,COPD患者6MWD及SGRQ积分(总积分及各项积分)均有改善,第20周呼吸困难指数有明显改善,且20周后6MWD、SGRQ总积分较第10周差异有显著意义。结论肺功能康复锻炼对COPD患者有积极作用,20周的康复锻炼比10周产生更好的临床疗效。     

Transitional care for patients with chronic obstructive pulmonary disease

ObjectivesTo observe the effects of transitional care on the quality of life of chronic obstructive pulmonary disease (COPD) patients.MethodsA total of 114 COPD patients were recruited from the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China and divided equally into an intervention group and control group. Following discharge, patients from the intervention group recieved three-months intervention in addition to regular nursing care, while control group patients received regular nursing care only. Patients' quality of life was measured using the St. George's respiratory questionnaire (SGRQ), the 12-item General Health Questionnaire (GHQ-12) and body mass index (BMI).ResultsThe symptoms section score, the activity section score, the impacts section score, the total score and the rate of mental disorders were significantly changed after the intervention while there was no statistical difference in BMI between groups.ConclusionsTransitional care can improve health-related quality of life in COPD patients who have recently suffered an exacerbation.     

Predictors of extubation failure in patients with chronic obstructive pulmonary disease

Few studies have focused on extubation outcome in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation (MV). We conducted a study using prospectively collected data in a cohort of patients with COPD requiring invasive MV to identify variables associated with extubation failure. Use of noninvasive or invasive MV within 48 hours after extubation was defined as extubation failure. A total of 148 patients with COPD were studied. Extubation failure occurred in 35% of studied patients. Using multiple regression analysis, independent predictors of extubation failure were physiologic abnormalities measured by Simplified Acute Physiology Score II above 35 on intensive care unit (ICU) admission (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.65-9.12), home noninvasive MV (OR, 12.99; 95% CI, 2.86-58.89), and sterile endotracheal aspirations on the day of extubation were predictors of success (OR, 0.23; 95% CI, 0.10-0.52). Despite high rate of extubation failure, survival to ICU discharge was 91% of the studied population. Extubation failure in patients with COPD remains high despite a successful spontaneous breathing on T piece. Simplified Acute Physiology Score II at ICU admission, home noninvasive MV, and isolated pathogens on quantitative cultures of tracheobronchial secretions within 72 hours preceding extubation were predictors of extubation failure in the study population.     

老年慢性阻塞性肺疾病患者生存质量及其影响因素分析

目的　探讨老年慢性阻塞性肺疾病 (COPD)患者生存质量及其影响因素的关系。方法　用生活质量问卷表对 5 0 0例 6 0岁以上老年COPD患者进行调查 ,并用多元逐步回归方法对老年COPD患者生存质量的影响因素进行分析。结果　身体健康状态和日常生活能力是影响老年COPD患者生存质量的主、客观评价共有的第 1、2位因素 ,COPD是老年人身体患病率仅次于心血管疾病而位居第二位的老年慢性疾病。结论　加强老年COPD患者的健康教育和医疗保健 ,积极预防和治疗高血压、冠心病、骨关节疾病等老年常见病对提高老年COPD患者生存质量有显著作用。     

Reliability and Responsiveness of the Activities of Daily Living Computerized Adaptive Testing System in Patients With Stroke

Objective

To examine the intrarater reliability, interrater reliability, and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system (ADL CAT) in patients with stroke.

Design

One repeated-measures design (at an interval of 7d) was used to examine the intrarater reliability and interrater reliability of the ADL CAT. For the responsiveness study, participants were assessed with the ADL CAT at admission to the rehabilitation ward and at discharge from the hospital.

Setting

Eight rehabilitation units.

Participants

Three different (nonoverlapping) groups of patients (N=157) were recruited. Fifty-five and 42 outpatients with chronic stroke participated in the intrarater and interrater reliability studies, respectively; 60 inpatients who had recently had a stroke participated in the responsiveness study.

Interventions

Not applicable.

Main Outcome Measure

ADL CAT.

Results

The intraclass correlation coefficient values were .94 and .80 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The classical test theory–based minimal detectable change values were 6.5 and 9.5 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The Kazis' effect size and standardized response mean of the ADL CAT were moderate (.62–.73).

Conclusions

The ADL CAT has good intrarater reliability and interrater reliability in outpatients with chronic stroke, and sufficient responsiveness in inpatients with stroke undergoing inpatient rehabilitation. Further investigations on the responsiveness of the ADL CAT in outpatients are needed to obtain more evidence on the utility of the ADL CAT.     

Analyzing change in recovery patterns in the year after acute hospitalization

Prvu Bettger JA, Coster WJ, Latham NK, Keysor JJ. Analyzing change in recovery patterns in the year after acute hospitalization.

Objective

To examine trajectories of recovery and change in patterns of personal care and instrumental functional activity performance to determine whether different assessment interval designs within a 12-month period yield different estimates of improvement and decline after acute hospitalization and inpatient rehabilitation.

Design

Secondary analysis of a 12-month prospective cohort study.

Setting

Transition to the community.

Participants

Adults (N=419) admitted to acute care and receiving inpatient rehabilitation for a neurologic, lower-extremity musculoskeletal, or medically complex condition.

Interventions

Not applicable.

Main Outcome Measures

Improvement, no change, and decline as measured by the personal care and instrumental scale of the Activity Measure for Post-Acute Care.

Results

Assessment at the end of a single 12-month follow-up assessment interval showed that over 60% of the participants improved. In contrast, analysis of 2 fixed-length 6-month assessment intervals revealed an almost 40% decrease in the proportion who improved from 6 to 12 months. Fewer participants continued to improve in the time periods further from the acute hospitalization and the proportion of subjects who declined increased from 21.4% to 31.2% to 38.0% over the 3 consecutive assessment intervals (baseline to 1mo, 1−6mo, 6−12mo). Only 58 (19.7%) participants continued on the same path of recovery from baseline to 12 months (9.8% improved over all 3 consecutive time periods, 3.1% made no change, 6.8% declined).

Conclusions

Examination of change over shorter compared with longer assessment intervals revealed considerable variability in the trajectories of recovery. Research is needed to determine the appropriate frequency and timing for measuring and monitoring function and recovery after an acute hospitalization.