Karoliny dos Santos

Can the Glittre ADL test differentiate the functional capacity of COPD patients from that of healthy subjects

BACKGROUND The Glittre ADL (TGlittre) test is a specifically designed to assess functional limitation in chronic obstructive pulmonary disease (COPD) patients. However, it is not known if it can differentiate the performance of these patients from healthy subjects. OBJECTIVES To investigate whether the Glittre ADL test is able to differentiate the functional capacity of COPD patients from that of healthy subjects and to compare the cardiorespiratory response between Glittre ADL and the six-minute walk test (6MWT). METHODS The study included 10 patients with COPD (GOLD 2 to 4) and 10 healthy subjects matched by age who performed the following: spirometry pre- and post-bronchodilator, a Glittre ADL test and two 6MWT on two consecutive days. RESULTS The performance of COPD (FEV1%pred= 38.1±11.8, age=64±10 years, BMI=23.7±5.2 kg/ m²) was worse than the control group on TGlittre (5.26±2.9 min, 3.3±0.3 min, p<0.05) and 6MWT (434.97±105.18 m vs. 593.25±87.36 m, p<0.05). TGlittre correlated with the physical activity domain of the London Chest Activity of Daily Living (LCADL) scale (r=0.67, p<0.05) and with 6MWT when the total sample was analyzed (r=-0.64, p<0.05). The COPD group had a statistically higher (p<0.05) increase in dyspnea (Borg scale) than the control group for both TGlittre and 6MWT, with a similar heart rate and peripheral oxygen saturation variation in both groups (p>0.05). CONCLUSIONS The performance of COPD patients is worse than that of healthy subjects on the Glittre ADL test, with a greater increase in dyspnea and similar heart rates.

Relação entre a limitação nas atividades de vida diária (AVD) e o índice BODE em pacientes com doença pulmonar obstrutiva crônica

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that reduces functional capacity, deteriorating the ability to perform activities of daily living (ADL). A close relationship between morbidity and mortality with functional limitation is observed in patients with COPD. OBJECTIVES: To determine if there is a relationship between ADL limitation and the BODE index, which is a predictor of mortality, in patients with moderate to severe COPD. METHODS: Thirty-nine patients with COPD GOLD 2 to 4 recruited by convenience, were submitted to the following tests: spirometry, body mass index (BMI), the London Chest Activity of Daily Living (LCADL) scale, six-minute walking test (6MWT), the Medical Research Council (MRC) scale and the BODE index was calculated. The total score and the percentage of the total score LCADL (LCADL%total) were compared between patients of the four quartiles of the BODE using the Analysis of Variance test. The Spearman correlation coefficient was used to investigate the association between scores of LCADL and BODE index. RESULTS: Patients had an average of FEV1%pred=37±12% and were on average 66±8 years-old. The LCADL%total correlated with the BODE index (r=0.65, p<0.05) as well as with the variables FEV1, dyspnea and walked distance in the 6MWT (r=-0.42, r=0.76 and r=-0.67, p<0.05, respectively). The comparison of the average scores of the LCADL%total between BODE quartiles 1, 2, 3 and 4, demonstrated that only the 4th quartile differed significantly from the others (p<0.05). CONCLUSIONS: ADL limitation has a strong association with the BODE index in patients with moderate to severe COPD and with three of the four variables that composes it.

Reproducibility of Ventilatory Parameters, Dynamic Hyperinflation, and Performance in the Glittre-ADL Test in COPD Patients

ABSTRACT Background: This study aimed to investigate the reproducibility of the ventilatory parameters and dynamic hyperinflation (DH) induced by the Glittre ADL-test (TGlittre) in chronic obstructive pulmonary disease (COPD) patients. Methods: Twenty-three patients with COPD underwent anthropometry, spirometry, TGlittre (TGlittre1 and TGlittre2) and pre- and post-test slow vital capacity. During the tests the ventilatory response was evaluated. Results: Regarding the TGlittre reproducibility, 87% of patients had a better performance in TGlittre2, and reduced on average 0.34 minute ± 0.62 (p = 0.01) from TGlittre1 time to TGlittre2, showing a learning effect of 6.34%. The difference average between tests was correlated with the time spent in TGlittre1 (r = −0.52; p < 0.05). The TGlittre time was statistically reproducible (intraclass correlation coefficient = 0.97; p < 0.001). Final ventilation parameters and their variations presented low-to-high reproducibility, except respiratory rate. The DH was similar (p > 0.05) in both tests, with low reproducibility in percentage, while in liters it was not reproducible. Conclusions: The TGlittre time and ventilatory parameters are reproducible, while DH is variable in COPD patients. A 6−7% learning effect was shown, and it is recommended to perform two tests.

Ventilatory demand and dynamic hyperinflation induced during ADL-based tests in Chronic Obstructive Pulmonary Disease patients

ABSTRACT Background Airflow limitation frequently leads to the interruption of activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Disease (COPD). These patients commonly show absence of ventilatory reserve, reduced inspiratory reserve volume, and dynamic hyperinflation (DH). Objective To investigate ventilatory response and DH induced by three ADL-based protocols in COPD patients and compare them to healthy subjects. Method Cross-sectional study. COPD group: 23 patients (65±6 years, FEV1 37.2±15.4%pred); control group: 14 healthy subjects (64±4 years) matched for age, sex, and body mass index. Both groups performed all three tests: Glittre-ADL test; an activity test that involved moving objects on a shelf (TSHELF); and a modified shelf protocol isolating activity with upper limbs (TSHELF-M). Ventilatory response and inspiratory capacity were evaluated. Results Baseline ventilatory variables were similar between groups (p>0.05). The ventilatory demand increased and the inspiratory capacity decreased significantly at the end of the tests in the COPD group. Ventilatory demand and DH were higher (p<0.05) in the TSHELF than in the TSHELF–M in the COPD group (p<0.05). There were no differences in DH between the three tests in the control group (p>0.05) and ventilatory demand increased at the end of the tests (p<0.05) but to a lower extent than the COPD group. Conclusion The TSHELF induces similar ventilatory responses to the Glittre-ADL test in COPD patients with higher ventilatory demand and DH. In contrast, the ventilatory response was attenuated in the TSHELF-M, suggesting that squatting and bending down during the Glittre-ADL test could trigger significant ventilatory overload.

Preliminary stages of cross-cultural adaptation of the Brazilian Portuguese version of McMaster Family Assessment Device

Objective To carry out the preliminary stages of the cross-cultural adaptation of the Family Assessment Device (FAD) to Brazilian Portuguese language and examine its reliability. Methods The translation and cross-cultural adaptation of the FAD were developed according to the methods internationally recommended. The resulting product was applied to 80 individuals who completed the questionnaire on two different occasions, seven days apart. Internal consistency was obtained through Cronbach’s alpha, and reliability was estimated by using the Bland and Altman method. Results The internal consistency obtained was very good (Cronbach’s alpha = 0.910). The mean differences of FAD dimensions found in the Bland and Altman test were the following: -0.21 (Problem Solving); -0.32 (Communication); -0.17 (Roles); 0.2 (Affective Responsiveness); -0.27 (Affective Involvement); -0.08 (Behavior Control); -0.02 (General Functioning). Conclusion The processes of translation and cross-cultural adaptation were successful. Assessment of the structural validity and external construct validity is recommended for the improvement of the Brazilian version.

Relationship between the functional status constructs and quality of life in COPD

Abstract Introduction : Functional status is an important component of health related quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD). However there is a lack of studies aiming to evaluate the association between QOL and the different methods for assessing patient´s limitation to perform ADL. Objectives : To investigate the association between QOL and functional status, measured by four different instruments: London Chest Activity of Daily Living scale (LCADL), six-minute walking test (6MWT), Glittre ADL-test (TGlittre) and assessment of physical activities in daily living (PADL). Methods : Twenty-three pa-tients with COPD, GOLD 2 to 4, were submitted to the following evaluations: spirometry, the Saint George Respiratory Questionnaire (SGRQ), LCADL, 6MWT, TGlittre and assessment of PADL. Pearson or Spearman correlation coefficients were used to verify the association between the variables. Results : It was observed correlation between all domains of the SGRQ and the 6MWT, between TGlittre and ‘leisure’ domain of LCADL; and between the domain ‘activity’ of the SGRQ with the total score of LCADL (r = 0.53), LCADL% (r =

Modified Medical Research Council Dyspnea Scale in GOLD Classification Better Reflects Physical Activities of Daily Living

BACKGROUND: In multidimensional Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the choice of the symptom assessment instrument (modified Medical Research Council dyspnea scale [mMRC] or COPD assessment test [CAT]) can lead to a different distribution of patients in each quadrant. Considering that physical activities of daily living (PADL) is an important functional outcome in COPD, the objective of this study was to determine which symptom assessment instrument is more strongly associated with and differentiates better the PADL of patients with COPD. METHODS: The study included 115 subjects with COPD (GOLD 2–4), who were submitted to spirometry, the mMRC, the CAT, and monitoring of PADL (triaxial accelerometer). Subjects were divided into 2 groups using the cutoffs proposed by the multidimensional GOLD classification: mMRC < 2 and ≥ 2 and CAT < 10 and ≥ 10. RESULTS: Both mMRC and CAT reflected the PADL of COPD subjects. Subjects with mMRC < 2 and CAT < 10 spent less time in physical activities < 1.5 metabolic equivalents of task (METs) (mean of the difference [95% CI] = −62.9 [−94.4 to −31.4], P < .001 vs −71.0 [−116 to −25.9], P = .002) and had a higher number of steps (3,076 [1,999–4,153], P < .001 vs 2,688 [1,042–4,333], P = .002) than subjects with mMRC > 2 and CAT > 10, respectively. Physical activities ≥ 3 METs differed only between mMRC < 2 and mMRC ≥ 2 (39.2 [18.8–59.6], P < .001). Furthermore, only the mMRC was able to predict the PADL alone (time active, r2 = 0.16; time sedentary, r2 = 0.12; time ≥ 3 METs, r2 = 0.12) and associated with lung function (number of steps, r2 = 0.35; walking time, r2 = 0.37; time < 1.5 METs, r2 = 0.25). CONCLUSIONS: The mMRC should be adopted as the classification criterion for symptom assessment in the GOLD ABCD system when focusing on PADL.

Limited utility of Kinesio Taping® in the physiotherapy treatment for patients with chronic obstructive pulmonary disease exacerbation

ABSTRACT Background: Kinesio Taping® has been used as a physiotherapy treatment in musculoskeletal disorders. However, few studies have evaluated its effectiveness in patients with chronic obstructive pulmonary disease (COPD). Objectives: To analyze the effects of Kinesio Taping® associated with conventional physiotherapy, on the maximal inspiratory and expiratory pressures (MIP and MEP), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), and pulse oxygen saturation (SpO2) of patients hospitalized for COPD exacerbation. Methods: Prospective, randomized, single-blinded study. Sixty-two participants who were randomized into two groups: 1) control (medication and standard physiotherapy treatment); and 2) Kinesio Taping® (standard treatment plus application of Kinesio Taping® on the respiratory muscles). The outcomes were assessed 24 hours after the treatment. Results: After the intervention, the Kinesio Taping® group showed a statistically significant increase in all outcomes assessed. However, when the mean differences between groups were analyzed, there were no statistically significant differences in MIP, MEP, FEV1, and PEF. Differences were found only in SpO2 that was improved in the Kinesio Taping® group. Conclusions: The application of Kinesio Taping® associated with physiotherapy improved SpO2 of non-hypoxemic patients with COPD exacerbation. Further studies should be conducted to evaluate the method in the long run and in another outcome.

Impulse oscillometry in the assessment of asthmatic children and adolescents: from a narrative to a systematic review

Diagnosis and management of asthma often relies mostly on symptoms because spirometry is not always reliable in some age groups, such as preschoolers. It is unclear whether impulse oscillometry (IOS) can supplement or replace spirometry. Available reports suggest that IOS has been applied with success in asthmatic children and adolescents to assess exacerbations, level of control, severity and response to treatment in the short and long term. Very few studies using adequate sample sizes and methods have been performed comparing the accuracy of IOS to spirometry for the diagnosis of asthma. Our systematic review found only four studies that met the eligibility criteria. However, no meta-analysis was possible with the available data. Consequently, this review helps to identify research gaps involving IOS, highlighting opportunities for future studies.

Glittre-ADL Multiple Tasks Induce Similar Dynamic Hyperinflation With Different Metabolic and Ventilatory Demands in Patients With COPD

Purpose: This cross-sectional study compared the physiological responses and dynamic hyperinflation (DH) of the Glittre-ADL test (TGlittre) and its specific tasks in patients with chronic obstructive pulmonary disease (COPD). Methods: Thirty patients with COPD performed the TGlittre. The individual tasks included stand up and sit down (TSS); climb up and down stairs (TSTAIRS); walk on a flat surface (TWALK); and move objects onto and off a shelf (TSHELF). While performing these tasks, the physiological responses were evaluated and inspiratory capacity measured before and immediately after the tests. Results: All physiological variables and inspiratory capacity were different at the end of the TGlittre and its tasks compared with baseline (P < .05). For most of the physiological variables, there were no significant differences between TSHELF and TWALK (P > .05), which were the tasks with the greatest physiological requirement, whereas the TSS represented the lowest metabolic, cardiovascular, and ventilatory demands among TGlittres tasks. DH did not differ significantly among TGlittres tasks. Conclusions: TWALK and TSHELF were the tasks that resulted in greater physiological overload, whereas TSS induced the lowest metabolic and ventilatory demands. Despite this, DH did not differ among the TGlittres tasks in patients with COPD.