Thais Paes

Londrina Activities of Daily Living Protocol: Reproducibility, Validity, and Reference Values in Physically Independent Adults Age 50 Years and Older

BACKGROUND: It is important to assess activities of daily living (ADL) in older adults due to impairment of independence and quality of life. However, there is no objective and standardized protocol available to assess this outcome. Thus, the aim of this study was to verify the reproducibility and validity of a new protocol for ADL assessment applied in physically independent adults age ≥50 y, the Londrina ADL protocol, and to establish an equation to predict reference values of the Londrina ADL protocol. METHODS: Ninety-three physically independent adults age ≥50 y had their performance in ADL evaluated by registering the time spent to conclude the protocol. The protocol was performed twice. The 6-min walk test, which assesses functional exercise capacity, was used as a validation criterion. A multiple linear regression model was applied, including anthropometric and demographic variables that correlated with the protocol, to establish an equation to predict the protocols reference values. RESULTS: In general, the protocol was reproducible (intraclass correlation coefficient 0.91). The average difference between the first and second protocol was 5.3%. The new protocol was valid to assess ADL performance in the studied subjects, presenting a moderate correlation with the 6-min walk test (r = −0.53). The time spent to perform the protocol correlated significantly with age (r = 0.45) but neither with weight (r = −0.17) nor with height (r = −0.17). A model of stepwise multiple regression including sex and age showed that age was the only determinant factor to the Londrina ADL protocol, explaining 21% (P < .001) of its variability. The derived reference equation was: Londrina ADL protocolpred (s) = 135.618 + (3.102 × age [y]). CONCLUSIONS: The Londrina ADL protocol was reproducible and valid in physically independent adults age ≥50 y. A reference equation for the protocol was established including only age as an independent variable (r2 = 0.21), allowing a better interpretation of the protocols results in clinical practice.

GOLD B-C-D groups or GOLD II-III-IV grades: Which one better reflects the functionality of patients with chronic obstructive pulmonary disease?

The aim of this article is to investigate which global initiative for chronic obstructive lung disease (GOLD) classification (B-C-D or II-III-IV) better reflects the functionality of patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Ninety patients with COPD were classified according to the GOLD B-C-D and II-III-IV classifications. Functionality was assessed by different outcomes: 6-min walk test (6MWT), activities of daily living (ADL) (London Chest ADL Scale), and daily life activity/inactivity variables assessed by activity monitoring (SenseWear armband, Pittsburgh, Pennsylvania, USA). The 6MWT was the only outcome significantly associated with both the GOLD classifications. Good functionality as assessed by the 6MWT was observed in 80%, 69%, and 43.5% (GOLD B, C, and D, respectively) and 81%, 59%, and 29% (GOLD II, III, and IV, respectively) of the patients. Association (V Cramer’s) and correlation (Spearman) coefficients of 6MWT with GOLD B-C-D and II-III-IV were V = 0.30, r = −0.35, and V = 0.37, r = −0.25, respectively. Neither GOLD classification showed V or r ≥ 0.30 with any other functionality outcome. Both the GOLD B-C-D and II-III-IV classifications do not reflect well COPD patients’ functionality. Despite low association and correlation coefficients in general, both GOLD classifications were better associated with functional exercise capacity (6MWT) than with subjectively assessed ADL and objectively assessed outcomes of physical activity/inactivity.

Multitask protocols to evaluate activities of daily living performance in people with COPD: a systematic review

ABSTRACT Introduction: People with chronic obstructive pulmonary disease (COPD) present symptoms such as dyspnea and fatigue, which hinder their performance in activities of daily living (ADL). A few multitask protocols have been developed to assess ADL performance in this population, although measurement properties of such protocols were not yet systematically reviewed. Areas covered: Studies were included if an assessment of the ability to perform ADL was conducted in people with COPD using a (objective) performance-based protocol. The search was conducted in the following databases: Pubmed, EMBASE, Cochrane Library, PEDro, CINAHL and LILACS. Furthermore, hand searches were conducted. Expert commentary: Up to this moment, only three protocols had measurement properties described: the Glittre ADL Test, the Monitored Functional Task Evaluation and the Londrina ADL Protocol were shown to be valid and reliable whereas only the Glittre ADL Test was shown to be responsive to change after pulmonary rehabilitation. These protocols can be used in laboratory settings and clinical practice to evaluate ADL performance in people with COPD, although there is need for more in-depth information on their validity, reliability and especially responsiveness due to the growing interest in the accurate assessment of ADL performance in this population.

Validity of a cutoff point for the London Chest Activity Daily Living scale in patients with COPD

Background: The London Chest Activity Daily Living scale (LCADL) is an option to assess functional status in patients with chronic obstructive pulmonary disease (COPD). A cutoff point to discriminate worse prognosis in this scale was not yet described in the literature. Aims: To propose gender-based cutoff points for the LCADL which are capable to discriminate worse/better prognosis in patients with COPD. Methods: One hundred sixty-five patients with moderate-to-severe COPD (89 men) were evaluated regarding their functional status by the LCADL. Cutoff points were obtained from the best LCADL total score to discriminate patients with worse prognosis by the BODE index (body mass index; airflow obstruction [spirometry]; dyspnea [modified Medical Research Council scale]; and exercise capacity [six-minute walk test]). Results: Women had worse values than men for total score, domestic and leisure domains of the LCADL (P≤0.01 for all). The cutoff points found were 13 points for men (area under the curve [AUC] = 0.62; 95% confidence interval [CI] 0.50–0.74; sensitivity 0.97 and specificity 0.28) and 34 points for women (AUC = 0.77; CI 0.65–0.90; sensitivity 0.56 and specificity 0.88). Patients classified above the cutoff points presented worse prognosis than patients classified below it, as well as worse lung function, exercise capacity, dyspnea and disease severity (P≤0.002 for all). Conclusion: Men and women present significant differences in functional status classification made by the LCADL. The cutoff points of 13 for men and 34 for women were able to adequately discriminate patients concerning their prognosis assessed by the BODE index.

Do patients with COPD who live alone present better functional status than those who do not

Background: Dyspnea and fatigue are common symptoms in patients with chronic obstructive pulmonary disease (COPD) and often limit the performance of activities of daily living, also known as functional status. However, it is unknown whether patients with COPD who live alone present a better functional status than those who live with their relatives or carers. Objective: To compare the functional status of patients with COPD who live alone with those who do not. Methods: Twenty-eight patients with COPD were divided into two groups: patients who live alone (LA, n=14) and patients who live with their relatives or carers (LRC, n=14). Functional status was evaluated by two questionnaires: London Chest Activity of Daily Living scale (LCADL) and Pulmonary Functional Status and Dyspnea Questionnaire – modified version (PFSDQ-M). Results: No differences were observed in age, lung function, and functional exercise capacity between the groups ( P ≥0.05). Regarding functional status, there were no differences between the groups in any domain of the LCADL [Self-care ( P =0.68); Domestic ( P =0.46); Physical ( P =0.63); Leisure ( P =0.28)], as well as in total score (LA=27 [19-28] vs. LRC=30 [19-37] points; P =0.35). Additionally, no difference was observed in any domain of the PFSDQ-M either: dyspnea ( P =0.31), fatigue ( P =0.25) and symptoms ( P =0.58). Conclusion: Despite not having family support to perform their activities of daily living, patients with COPD who live alone do not present a better functional status than those who live with their relatives and carers, suggesting that physiological mechanisms may play a more important role in patients9 functional limitation than their housing situation.