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Test-retest reliability and agreement of remote home-based functional capacity self-administered assessments in community-dwelling, socially isolated older adults. Digit Health 2024; 10:20552076241254904. [PMID: 38778868 PMCID: PMC11110522 DOI: 10.1177/20552076241254904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives To determine the test-retest reliability and agreement of home-based functional capacity self-administered assessments in socially isolated older adults. Methods Fourteen community-dwelling older adults (eight females, 67.9 ± 7.7 years) volunteered for this study. Before testing, participants were screened online for eligibility and received instructional videos explaining test set-up and execution. Participants underwent the 30-second sit-to-standing test, gait speed tests at the usual pace, and timed-up-and-go tests administered 4 weeks apart. For the 30-second sit-to-standing protocol, participants were instructed to repeatedly sit and stand from a chair (with a height of ∼ 43 cm and without armrests) for 30 s, with the number of repetitions recorded. In the gait speed test protocol, participants were instructed to walk at their usual and comfortable pace, with the time taken recorded (seconds). In the timed-up-and-go, participants stood up from a chair, walked as fast as possible for 3 m, circled a marked point, and returned to the chair to sit down, completing the test, with the score recorded (seconds). A trained researcher conducted the scoring virtually via synchronous video. Results 30-second sit-to-standing, gait speed test, and timed-up-and-go showed excellent mean coefficient of variation values (2.0-4.9), small standard error of measurement (0.08-1.27), excellent intraclass coefficient (0.97-0.99), very strong correlations (0.97-0.99) and good agreement between the two days of testing. Conclusion Self-administered functional capacity tests performed by older adults at home were reliable with good agreement. Healthcare professionals and older adults should take advantage of simple remote self-administered assessments performed at home to evaluate older adults' health status.
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High-Intensity Small Muscle Mass Training in Patients With Heart Failure: Rationale and Design of a Randomized Controlled Trial. Phys Ther 2024; 104:pzad130. [PMID: 37758445 DOI: 10.1093/ptj/pzad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Small muscle mass training localized to the quadriceps femoris muscle group has been proposed as an intervention to reverse heart failure-related skeletal muscle impairments. Although this training paradigm has demonstrated efficacy in heart failure, it remains to be evaluated in a conventional clinical context. Hence, the aim of this proposed study is to determine the effects of integrating high-intensity small muscle mass training (HISMT) isolated to the knee extensor muscles within a standard heart failure rehabilitation program. METHODS This single-blind, randomized controlled trial will aim to recruit 70 participants with heart failure. Participants will be randomized to either (1) standard training: combination of upper and lower extremity cardiovascular and resistance-based exercises, or (2) HISMT plus modified standard training: bilateral knee extensor HISMT and a modified version of the standard training, so that the total volume of work will be similar to standard training alone. The training interventions will be undertaken twice weekly for 12 weeks in an outpatient clinical setting. Outcome measurements will be performed at baseline and after the 12-week intervention period. The primary outcome will be exercise capacity (6-Minute Walk Test), with secondary outcomes being physical performance measures, muscle strength, and health-related quality of life. Data will be analyzed using the intention-to-treat principle. IMPACT This study will address a gap in the literature regarding the efficacy of small muscle training under routine clinical conditions for individuals with heart failure. The findings will also provide insight into the effects of HISMT within a heart failure rehabilitation program, thus enabling the optimization of exercise prescription for this patient population.
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Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment. Disabil Rehabil 2023:1-11. [PMID: 38156771 DOI: 10.1080/09638288.2023.2297928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To assess the inter-reliability of the Short Physical Performance Battery (SPPB), the 1-min Sit to Stand test (1-MSTS), and the Chester Step Test (CST) via remote assessment in post-COVID-19 patients after hospitalization. METHODS Twenty-five post-COVID-19 patients randomly performed the functional tests via remote assessment using a software platform at home and via face-to-face assessment at the rehabilitation center 24-72 h apart. One day before the remote assessment, all participants had a 1-h guidance session regarding the platform use, safety instructions, and home equipment preparation. RESULTS Participants completed all tests for both assessment procedures without experience of adverse events. The mean age was 53 (SD = 10) years old, and the median days of hospitalization were 23 (IQR = 10-33). The inter-reliability was moderate for the total score in the SPPB: Cohen's kappa = 0.545 (95% CI: 0.234 to 0.838), excellent for the number of repetitions in the 1-MSTS: ICC = 0.977 (95% CI: 0.948 to 0.990) and good for the total number of steps in the CST: ICC = 0.871 (95% CI: 0.698 to 0.944). CONCLUSION Remote functional assessments for SPPB, 1-MSTS, and CST indicated moderate to excellent inter-reliability in post-COVID-19 patients after hospitalization.
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Measurement properties of performance-based measures to assess physical function in chronic kidney disease: recommendations from a COSMIN systematic review. Clin Kidney J 2023; 16:2108-2128. [PMID: 37915888 PMCID: PMC10616478 DOI: 10.1093/ckj/sfad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 11/03/2023] Open
Abstract
Background There is wide heterogeneity in physical function tests available for clinical and research use, hindering our ability to synthesize evidence. The aim of this review was to identify and evaluate physical function measures that could be recommended for standardized use in chronic kidney disease (CKD). Methods MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, Scopus and Web of Science were searched from inception to March 2022, identifying studies that evaluated a clinimetric property (validity, reliability, measurement error and/or responsiveness) of an objectively measured performance-based physical function outcomes using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) based recommendations. Studies with individuals of all ages and of any stage of CKD were included. Results In total, 50 studies with 21 315 participants were included. Clinimetric properties were reported for 22 different physical function tests. The short physical performance battery (SPPB), Timed-up-and-go (TUG) test and Sit-to-stand tests (STS-5 and STS-60) had favorable properties to support their use in CKD and should be integrated into routine use. However, the majority of studies were conducted in the hemodialysis population, and very few provided information regarding validity or reliability. Conclusion The SPPB demonstrated the highest quality of evidence for reliability, measurement error and construct validity amongst transplant, CKD and dialysis patients. This review is an important step towards standardizing a core outcome set of tools to measure physical function in research and clinical settings for the CKD population.
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Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial. Trials 2023; 24:532. [PMID: 37580800 PMCID: PMC10426202 DOI: 10.1186/s13063-023-07558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation. METHODS This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers. DISCUSSION This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated. TRIAL REGISTRATION ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.
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Psychometric properties of the Obstacles and Curb tests and their discriminative ability across functional levels in ambulatory children with spastic cerebral palsy. Int J Rehabil Res 2023; 46:178-186. [PMID: 37042182 PMCID: PMC10155681 DOI: 10.1097/mrr.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/13/2023]
Abstract
The Obstacles and Curb tests are timed walking assessments that have emerged from the Spinal Cord Injury Functional Ambulation Profile and have been modified for children; however, their psychometric properties have not been adequately investigated. The aim of this research was to examine the psychometric properties of the Obstacles and Curb tests for children with cerebral palsy (CP). This cross-sectional study included 68 children aged 6-12 years; there were 34 children with CP and 34 age- and sex-matched typically developing children. Validity was examined by correlation with the 10-m Walk Test (10-MWT), Modified Time Up and Go test (mTUG), and Pediatric Balance Scale (PBS). Differences in the Obstacle and Curb test scores were calculated between children with CP and typically developing children and within different Gross Motor Function Classification System (GMFCS) levels. Children with CP completed the tests twice within a 30-min interval in the same session. The tests showed significant strong to very strong correlations with the 10-MWT, mTUG, and PBS. The within-session reliability was excellent, typically developing children were significantly faster than children with CP with high sensitivity and specificity, and the time differed significantly within the GMFCS level. Thus, the Obstacles and Curb tests can be considered valid, reliable, and sensitive walking tests for ambulatory children with CP.
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Test-retest reliability of single-item assessments of immune fitness, mood, and quality of life. Heliyon 2023; 9:e15280. [PMID: 37089305 PMCID: PMC10113843 DOI: 10.1016/j.heliyon.2023.e15280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
The use of single-item assessments is increasingly important and popular, as these enable quick real-time assessments in clinical practice or research. In this study we investigated the test-retest reliability of single-item assessments of mood ("stress", "anxiety", "depression", "fatigue", "loneliness", "being active", "optimism", and "happiness"), quality of life, and immune fitness in N = 108 participants. The analysis revealed high test-retest correlations between the single-item assessments (r = 0.67 to 0.90), moderate to excellent intraclass correlations (r = 0.672 to 0.889), and the Bland-Altman analysis revealed agreement between all test-retest assessments, except for depression. Taken together, it can be concluded that the single-item assessments of mood, quality and immune fitness have a good test-retest reliability. This strengthens the rationale for using these single item assessments.
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Improving old tricks as new: Young adults learn from repeating everyday activities. PLoS One 2023; 18:e0285469. [PMID: 37167235 PMCID: PMC10174589 DOI: 10.1371/journal.pone.0285469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
The notion that young healthy adults can substantially improve in activities that are part of their daily routine is often overlooked because it is assumed that such activities have come to be fully mastered. We followed, in young healthy adults, the effects of repeated executions of the Timed-Up-and-Go (TUG) task, a clinical test that assesses the ability to execute motor activities relevant to daily function-rising from a seated position, walking, turning and returning to a seated position. The participants (N = 15) performed 18 consecutive trials of the TUG in one session, and were retested on the following day and a week later. The participants were video recorded and wore inertial measurement units. Task execution times improved robustly; performance was well fitted by a power function, with large gains at the beginning of the session and nearing plateau in later trials, as one would expect in the learning of a novel task. Moreover, these gains were well retained overnight and a week later, with further gains accruing in the subsequent test-sessions. Significant intra-session and inter-session changes occurred in step kinematics as well; some aspects underwent inter-sessions recalibrations, but other aspects showed delayed inter-session changes, suggesting post-practice memory consolidation processes. Even common everyday tasks can be improved upon by practice; a small number of consecutive task repetitions can trigger lasting gains in young healthy individuals performing highly practiced routine tasks. This new learning in highly familiar tasks proceeded in a time-course characteristic of the acquisition of novel 'how to' (procedural) knowledge.
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Healthy aging and chronic kidney disease. Kidney Res Clin Pract 2022; 41:644-656. [PMID: 36328991 PMCID: PMC9731776 DOI: 10.23876/j.krcp.22.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/18/2022] [Accepted: 07/03/2022] [Indexed: 07/30/2023] Open
Abstract
The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease (CKD) will increase significantly. With advances in medical treatment and public health, the human lifespan continues to outpace the health span in such a way that the last decade of life is generally spent in poor health. In 2015, the World Health Organization defined healthy aging as 'the process of developing and maintaining the functional ability that enables wellbeing in older age.' CKD is increasingly being recognized as a model of accelerated aging and is associated with physical performance decline, cognitive decline, falls and fractures, poor quality of life, loss of appetite, and inflammation. Frailty and dementia are the final pathways and key determinants of disability and mortality independent of underlying disease. CKD, dementia, and frailty share a triangular relationship with synergistic actions and have common risk factors wherein CKD accelerates frailty and dementia through mechanisms such as uremic toxicity, metabolic acidosis and derangements, anorexia and malnutrition, dialysis-related hemodynamic instability, and sleep disturbance. Frailty accelerates glomerular filtration decline as well as dialysis induction in CKD and more than doubles the mortality risk. Anorexia is one of the major causes of protein-energy malnutrition, which is also prevalent in the aging population and warrants screening. Healthcare systems across the world need to have a system in place for the prevention of CKD amongst high-risk older adults, focusing on screening for poor prognostic factors amongst patients with CKD such as frailty, poor appetite, and cognitive impairment and providing necessary person-centered interventions to reverse underlying factors that may contribute to poor outcomes.
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Intra- and Inter-Rater Reproducibility of the Face-to-Face and Tele-Assessment of Timed-up and Go and 5-Times Sit-to-Stand Tests in Patients with Chronic Obstructive Pulmonary Disease. COPD 2022; 19:125-132. [PMID: 35385377 DOI: 10.1080/15412555.2022.2038119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Timed-Up and Go (TUG) and 5-Times Sit-to-Stand (5STS) are frequently used in clinical practice for patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the intra- and inter-rater reproducibility of the TUG and 5STS as both face-to-face and tele-assessment tests in patients with COPD. Forty-four patients with diagnosed COPD were included. Evaluations were carried out face-to-face and tele-assessment (synchronized and asynchronized). Inter-reliability between face-to-face and tele-assessment was excellent for TUG (ICC = 0.977) and 5STS (ICC = 0.970). Inter-reliability between two tele-raters was also excellent for TUG (ICC = 0.995) with the SEM = 0.04, SEM95% = 0.08, and SDC95% = 0.10 s, and 5STS (ICC = 0.990) with the SEM = 0.06, SEM95% = 0.12, and SDC95% = 0.18 s. Intra-rater reliability of the tele-assessment (synchronized) was excellent for TUG (ICC = 0.976) and 5STS (ICC = 0.964). The SEM, SEM95%, and SDC95% values were computed as 0.08, 0.16, and 0.22 s for TUG, and 0.11, 0.22, and 0.31 s for 5STS, respectively. The TUG and 5STS tests are reproducible tele-assessment measures in patients with COPD with excellent intra- and inter-rater reproducibility. The authors recommend these tests as practical assessment tools in patients with COPD at home for tele-health interventions. The reported SEM, SEM95%, and SDC95% values can be used as a minimum change that needs to be observed to be confident that the observed change is real and not, potentially, a product of measurement error.
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Balance Function in Patients With COPD: A Systematic Review of Measurement Properties. Clin Nurs Res 2022; 31:1000-1013. [PMID: 35209730 DOI: 10.1177/10547738221078902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To conduct an overview, evaluation, and synthesis of measurement properties of instruments assessing balance of COPD patients. Electronic searches were performed in Web of Science, Scopus, Embase, PubMed, CINAHL, PsycINFO, WanFang, and China National Knowledge Infrastructure databases up to the end of April 2021. Two reviewers independently evaluated the methodological quality using the Consensus-based Standards for the Selection of Health Status Measurement Instrument checklist, and rated the overall quality level of evidence was graded based upon a modified Grades of Recommendation, Assessment, Development, and Evaluation approach. Finally, 12 instruments were included. The Berg Balance Scale and the Timed Up and Go test were the most frequently used tools to evaluate balance. None of 12 instruments provide any information regarding cross-cultural validation or criterion validation. High-quality studies exploring measurement properties with a focus on the criterion validity and cross-cultural validity of balance measurements in COPD patients are warranted.
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Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome. J Intensive Care Med 2022; 37:890-898. [PMID: 35072548 PMCID: PMC9160440 DOI: 10.1177/08850666221075568] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The purpose was to examine Dual Task (DT) performance in patients surviving
severe and critical COVID-19 compared to patients with chronic lung disease
(CLD). Secondarily, we aimed to determine the psychometric properties of the
Timed Up and Go (TUG) test in patients surviving COVID-19. Design Prospective, cross-sectional, observational study. Setting Academic medical center within United States. Patients Ninety-two patients including 36 survivors of critical COVID-19 that required
mechanical ventilation (critical-COVID), 20 patients recovering from
COVID-19 that required supplemental oxygen with hospitalization
(severe-COVID), and 36 patients with CLD serving as a control group. Measurements and Main Results Patients completed the TUG, DT-TUG, Short Physical Performance Battery
(SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A
subset of patients returned at 3-months and repeated testing to determine
the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3)
performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s;
P = .024) and Severe-COVID group (13.1 ± 5.1 s;
P = .025). Within-subject difference between TUG and
DT-TUG was also significantly worse in critical-COVID group (−21%) compared
to CLD (−10%; P = .012), even despite CLD patients having a
higher comorbid burden (P < .003) and older age
(P < .001). TUG and DT-TUG demonstrated strong to
excellent construct validity to the chair rise test, gait speed, and 6MWT
for both COVID-19 groups (r = −0.84to 0.73, P < .05).
One- and 3-months after hospital discharge there was a floor effect of 14%
(n = 5/36) and 5.2% (n = 1/19), respectively for patients in the
critical-COVID group. Ceiling effects were noted in four (11%)
critical-COVID, six (30%) severe-COVID patients for the TUG and DT-TUG at
1-month. Conclusion The ability to maintain mobility performance in the presence of a cognitive
DT is grossly impaired in patients surviving critical COVID-19. DT
performance may subserve the understanding of impairments related to
Post-intensive care syndrome (PICS) for survivors of critical illness.
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The association between time-of-day of habitual exercise training and changes in relevant cancer health outcomes among cancer survivors. PLoS One 2021; 16:e0258135. [PMID: 34637457 PMCID: PMC8509995 DOI: 10.1371/journal.pone.0258135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the relationship between time-of-day of exercise training and changes in relevant cancer health outcomes among cancer survivors. METHODS Retrospective analysis of data collected from 2016-2019 from a hospital-based exercise oncology program. Descriptive statistics were calculated for demographic, clinical, and exercise timing characteristics (e.g. AM, PM, or mix) among survivors with available data for exercise training time (n = 233). For the total sample and a breast cancer sub-analysis, univariate analysis of covariance, adjusted for age, was carried out by exercise training time, for change in the following outcomes collected during the program's assessment sessions: cardiorespiratory fitness and muscular endurance (human performance variables), physical function, anthropometrics, self-reported fatigue, and quality of life (QoL). Change in body mass index (BMI) and body weight was included in the breast cancer analysis. RESULTS Overall, 37.3% of survivors habitually engaged in AM exercise (e.g. ≥ 75% AM training), 34.3% in PM exercise, and 28.3% in a mix of AM and PM exercise training throughout the program. Median time in the program was 17 weeks. Significant improvements in most human performance and physical function variables were observed in the total sample regardless of exercise training time-of-day. Among breast cancer survivors, PM but not AM or mixed was associated with improvements in fitness, and lower-body muscular endurance and function. Mixed exercise timing was linked with greater increase in waist circumference (total sample: 3.02cm, 95%CI 1.55, 4.49; breast cancer: 3.57cm 95%CI 0.96, 6.18), body weight (breast cancer: 1.6kg, 95%CI 0.3, 2.8) and BMI (breast cancer: 0.6kg/m2, 95%CI 0.1, 1.0). AM and PM exercise, but not mixed, was associated with improvements in fatigue and QoL. CONCLUSION Time-of-day of exercise training may differentially impact changes in human performance and physical function variables. Mixed exercise training time may result in less favorable outcomes related of weight management variables among cancer survivors.
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Reference Values for 7 Different Protocols of Simple Functional Tests: A Multicenter Study. Arch Phys Med Rehabil 2021; 103:20-28.e5. [PMID: 34516997 DOI: 10.1016/j.apmr.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/23/2021] [Accepted: 08/09/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To establish reference values and equations (ages 20-80y) for 7 simple functional tests based on a multicenter study. DESIGN Cross-sectional data collection in 4 research centers across different regions of a continental dimension country. SETTING Healthy subjects from general community were assessed in different research laboratories. PARTICIPANTS Data collection of 296 volunteer subjects (N=296; 45% men; aged 50±18y, forced expiratory volume in the first second 95±13% pred, body mass index 26.9±4.5 kg/m2) aged 20-80 years; representing both sexes; with the ability to understand and perform all proposed assessments; and with no severe and/or unstable condition that could limit functional assessments occurred simultaneously in all centers. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All participants randomly performed the following 7 functional tests twice: (1) the 4-meter gait speed test at usual walking speed; (2) the 4-meter gait speed test at maximal walking speed; (3) the Sit-to-Stand test performed with 5 repetitions; (4) the Sit-to-Stand test performed in 30 seconds; (5) the Sit-to-Stand test performed in 1 minute; (6) the Timed Up and Go test at usual speed; and (7) the Timed Up and Go test at maximal speed. Spirometry, quality of life, depression, anxiety, physical activity, and comorbidities were also assessed to better characterize the sample. The best performance of each test was used to propose reference values for men and women and reference equations for all. RESULTS Participants similarly distributed by age groups from the 4 centers were included. All tests were correlated with age (0.34<r<0.53) and body mass index (0.24<r< 0.31; P<.05 for all). Reference values with limits of normality were provided by each 10-year age group and regression models identified reference equations for all tests. Reliability of the reference equations were confirmed in an independent sample. CONCLUSIONS Reference values and equations for 7 widely used simple functional tests were provided in this study and might help researchers and clinicians to identify and quantify functional impairments using easy-to-perform assessments.
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Standardized translated instruction versus spontaneously translated instruction: Test-retest and interrater reliability of a hand function test. J Hand Ther 2021; 33:553-561. [PMID: 32143983 DOI: 10.1016/j.jht.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/11/2019] [Accepted: 09/01/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional study. INTRODUCTION Adhering to test administration and standardized instructions is important for attainment of accurate and reliable results in performance-based tests. PURPOSE OF THE STUDY To determine test-retest and interrater reliability of standardized translated instruction (St-TI) and spontaneously translated instruction (Sp-TI) of a hand function test. METHODS Four raters and seventy-two subjects were divided into 2 groups: St-TI group, direct administration of the Hong Kong Chinese version of the Jebsen Hand Function Test to subjects by raters; and Sp-TI group, spontaneously translating the Jebsen-Taylor Hand Function Test from English into Chinese by raters. Test-retest and interrater reliability were calculated based on instruction time by the rater and performance time by the subject. RESULTS Test-retest and interrater reliability of instruction time by rater for St-TI has intraclass correlation coefficient of 0.35 to 0.70 and 0.24 to 0.55, respectively, whereas that for Sp-TI was -0.50 to 0.18 and -0.09 to 0.51, respectively. Test-retest and interrater reliability of performance time by subject for St-TI was 0.56 to 0.84 and 0.33 to 0.78, respectively, whereas that for Sp-TI was 0.54 to 0.87 and 0.35 to 0.77, respectively. Sp-TI had two test-retest minimal detectable change percent values that fell within the acceptable range (subtest 3 = 21.9% and subtest 6 = 25.7%). CONCLUSION Instruction time by rater for Jebsen-Taylor Hand Function Test subtests had generally poor to moderate test-retest and interrater reliability for both St-TI and Sp-TI. Performance time by subject generally had moderate to good reliability, except for St-TI with poor to good interrater reliability.
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Effects of Exercise-Based Interventions on Fall Risk and Balance in Patients With Chronic Obstructive Pulmonary Disease: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2021; 40:152-163. [PMID: 32355076 DOI: 10.1097/hcr.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by airflow limitation and is associated with decreased balance and increased fall risk. Since falls are related to increased mortality, interventions targeting balance and fall risk could reduce morbidity and mortality. The objective of this review was to systematically assess the effects of exercise-based interventions on fall risk and balance in patients with COPD. METHODS PubMed, Web of Science, EMBASE, and CINAHL were screened for randomized controlled trails and within-group studies evaluating effects of exercise-based interventions on fall risk or balance in patients with COPD. Data were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Fifteen studies were identified, 6 randomized controlled trails and 9 within-group studies. All interventions reported positive effects on balance outcomes. No studies reported fall risk. Taking current recommendations of balance outcome measures in patients with COPD into account, pulmonary rehabilitation combined with balance training had the highest effect size. Nine papers had concerns regarding bias, mostly due to the lack of blinding outcome assessors. CONCLUSIONS Exercise-based interventions have a positive effect on balance in patients with COPD. Pulmonary rehabilitation with balance training seems to have the most beneficial effect on balance. The effects on fall risk, as well as the long-term intervention effects remain unclear. A standardized balance assessment and research on long-term effects and fall risk are recommended.
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Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study. BMC Geriatr 2021; 21:411. [PMID: 34215211 PMCID: PMC8252257 DOI: 10.1186/s12877-021-02356-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is associated with multiple adverse outcomes in stage-5 chronic kidney disease (CKD-5) and upwards of one third of people receiving haemodialysis (HD) are frail. While many frailty screening methods are available in both uremic and non-uremic populations, their implementation in clinical settings is often challenged by time and resource constraints. In this study, we explored the diagnostic accuracy of time-efficient screening tools in people receiving HD. METHODS A convenience sample of 76 people receiving HD [mean age = 61.1 years (SD = 14), 53.9% male] from three Renal Units were recruited for this cross-sectional study. Frailty was diagnosed by means of the Fried phenotype. Physical performance-based screening tools encompassed handgrip strength, 15-ft gait speed, timed up and go (TUG), and five-repetition sit to stand (STS-5) tests. In addition, participants completed the SF-36 Health Survey, the short-form international physical activity questionnaire and the Tinetti falls efficacy scale (FES) as further frailty-related measures. Outcome measures included the area under the curve (AUC), sensitivity, specificity, positive (PPV) and negative predictive values (NPV). The diagnostic performance of screening tools in assessing fall-risk was also investigated. RESULTS Overall, 36.8% of participants were classified as frail. All the examined instruments could significantly discriminate frailty status in the study population. Gait speed [AUC = 0.89 (95%CI: 0.81-0.98), sensitivity = 75%, specificity = 93%] and TUG [AUC = 0.90 (95%CI: 0.80-0.99), sensitivity = 89%, specificity = 85%] exhibited the highest diagnostic accuracy. There was a significant difference in gait speed AUC (20%, p = 0.013) between participants aged 65 years or older (n = 36) and those under 65 years of age (n = 40), with better discriminating performance in the younger sub-group. The Tinetti FES was the only instrument showing good diagnostic accuracy (AUCs≥0.80) for both frailty (sensitivity = 82%, specificity = 79%) and fall-risk (sensitivity = 82%, specificity = 71%) screening. CONCLUSIONS This cross-sectional study revealed that time- and cost-efficient walking performance measures can accurately be used for frailty-screening purposes in people receiving HD. While self-selected gait speed had an excellent performance in people under 65 years of age, TUG may be a more suitable screening method for elderly patients (≥65 years). The Tinetti FES may be a clinically useful test when physical testing is not achievable.
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The relationship between height of vertical jumps, functionality and fall episodes in patients with chronic obstructive pulmonary disease: A case-control study. Exp Gerontol 2021; 152:111457. [PMID: 34157377 DOI: 10.1016/j.exger.2021.111457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/22/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to compare the height of jumps and functional parameters in patients with chronic obstructive pulmonary disease (COPD) to those in healthy people, in addition to assessing the relationship among variables in patients with COPD. Twenty patients with COPD (forced expiratory volume [FEV1] % of predicted: 39.98 ± 11.69%; age: 62.95 ± 8.06 years) and 16 healthy people (FEV1% of predicted: 97.44 ± 14.45%; age: 59.94 ± 6.43 years) were evaluated, and all participants performed the Squat Jump (SJ) and Counter Movement Jump (CMJ) tests to assess rapid force considering the jumping height. Functional capacity was assessed using the self-selected walking speed tests, walking speed in 10 m, walking test in 6 min, balance on one leg, sitting and standing, timed up and go, and a stair-climbing test. In addition, the questionnaires on recall of falls, Falls Efficacy Scale-International (concern with falling), International Physical Activity Questionnaires, and Saint George Respiratory Questionnaire were administered. The height of the jumps showed no difference between the groups, but the COPD group performed worse in most functional tests and was more afraid of falling. The number of falls was correlated with height in the SJ (r = -0.51) and CMJ (r = -0.62) jumps (p < 0.05), and with the performance in different functional tests. We suggest that interventions targeting rapid force may bring improvements in functional mobility and physical fitness as well as reducing fall episodes in patients with COPD.
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[Which physical tests for which objectives in pulmonary rehabilitation?]. Rev Mal Respir 2021; 38:646-663. [PMID: 33895033 DOI: 10.1016/j.rmr.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
Chronic respiratory disease is a major cause of morbidity and mortality worldwide and an important cause of disability including a reduction of exercise, functional and muscle capacity contributing to a decreased quality of life. In the context of pulmonary rehabilitation, a thorough patient-centered outcome assessment, including not only measures of lung function, but also exercise functional and muscle capacity, is imperative for a comprehensive disease management. Assessment of these impairments and dysfunctions with appropriate and change-sensitive procedures is thus necessary for personalizing the physical interventions and assessing the short- and long-term effectiveness of the intervention. The clinician currently has a wide variety of tests and measurements available to assess the physical and functional capacity of people with chronic respiratory disease. The aim of this review is to provide a pragmatic synthesis of the physical, functional and muscle capacity tests most commonly used in pulmonary rehabilitation. Ultimately, it should help the clinician to identify the relevant evaluations according to the objectives of the patients but also according to the available resources, the setting of pulmonary rehabilitation and the specific qualities of each test.
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Testes funcionais validados em indivíduos hospitalizados e não hospitalizados: revisão sistemática. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Realizar uma revisão sistemática sobre os testes funcionais validados em diferentes perfis de indivíduos hospitalizados e não hospitalizados e avaliar as evidências psicométricas para confiabilidade e validade. Métodos: Trata-se de uma revisão sistemática. Foram utilizadas as bases de dados EMBASE, MEDLINE, Lilacs e SciELO com as palavras-chave Functional Tests (Walk Test, Gait Speed Test, Chair Stand Test, Timed Up And Go, Step Test),Validation Studies as Topic e sinônimos. Foram incluídos estudos de validação de testes funcionais em indivíduos hospitalizados ou não hospitalizados que utilizaram os critérios de validade e/ou confiabilidade e relacionaram os testes a diferentes variáveis. Esses artigos poderiam ser observacionais longitudinais ou de corte transversal ou estudos de validação que utilizaram dados de ensaios clínicos. Foram excluídos os artigos que não apresentaram características importantes da amostra e a descrição do teste. Resultados: A pesquisa resultou em 36.150 artigos, e 89 foram incluídos. Os estudos foram organizados em tabelas com informações como autor, ano; critérios de validação; amostra; teste; variáveis associadas; resultados. A qualidade dos artigos foi avaliada por meio da Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Conclusão: Os testes funcionais são válidos e confiáveis para a avaliação de indivíduos hospitalizados e não hospitalizados, estando associados à força muscular, capacidade de caminhar, controle postural, atividades de vida diária, risco de quedas, hospitalização e mortalidade.
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Abstract
PURPOSE The aim of the study was to examine if the Timed Up and Go (TUG) Test would be a feasible, reproducible, and valid measure in patients post-coronary artery bypass grafting (CABG). DESIGN Cross-sectional study, controls and patients post-CABG, outpatient clinic. METHODS Participants performed the TUG Test and the 6-Minute Walking Distance (6MWD) Test. Reliability was measured within observer on two occasions. FINDINGS Patients and controls were similar in age. The patients had greater TUG mean (SD) of 14.4 seconds (4.9 seconds) and lower 6MWD of 358 m (76 m) compared with TUG of 8.2 seconds (2.7 seconds) and 6MWD of 487 m (56 m) in controls. In patients, intraclass correlation for the TUG was .98 (95% CI [.96, .98]) between the measurements. In patients, there was a high correlation between the TUG Test and the 6MWD Test, r = -.70, p < .001. CONCLUSION The TUG Test demonstrated to be a feasible, reproducible, and valid measure in patients post-CABG. CLINICAL RELEVANCE The TUG Test could serve as a screening tool for physical performance in clinics.
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Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review. Chron Respir Dis 2020; 17:1479973120952418. [PMID: 32840385 PMCID: PMC7450293 DOI: 10.1177/1479973120952418] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To identify exercise tests that are suitable for home-based or remote
administration in people with chronic lung disease. Methods: Rapid review of studies that reported home-based or remote administration of
an exercise test in people with chronic lung disease, and studies reporting
their clinimetric (measurement) properties. Results: 84 studies were included. Tests used at home were the 6-minute walk test
(6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go
(TUG, 4 studies) and step tests (two studies). Exercise tests administered
remotely were the 6MWT (two studies) and step test (one study). Compared to
centre-based testing the 6MWT distance was similar when performed outdoors
but shorter when performed at home (two studies). The STS, TUG and step
tests were feasible, reliable (intra-class correlation coefficients
>0.80), valid (concurrent and known groups validity) and moderately
responsive to pulmonary rehabilitation (medium effect sizes). These tests
elicited less desaturation than the 6MWT, and validated methods to prescribe
exercise were not reported. Discussion: The STS, step and TUG tests can be performed at home, but do not accurately
document desaturation with walking or allow exercise prescription. Patients
at risk of desaturation should be prioritised for centre-based exercise
testing when this is available.
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Association between patient-reported outcomes and exercise test outcomes in patients with COPD before and after pulmonary rehabilitation. Health Qual Life Outcomes 2020; 18:300. [PMID: 32891156 PMCID: PMC7487841 DOI: 10.1186/s12955-020-01505-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/22/2020] [Indexed: 01/04/2023] Open
Abstract
Background Over the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR). Methods Correlations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory- and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR. Results Overall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (ρ:-0.65; p<0.001). HRQoL related PROs showed weak correlations with exercise outcomes at baseline. Moderate correlations were found between St George’s Respiratory Questionnaire total score and 6MWD (r:-0.53; p<0.001) and maximal workload achieved during cardiopulmonary exercise testing (ρ:-0.48; p<0.001); and between Clinical COPD Questionnaire (CCQ) total score and 6MWD (r:-0.48; p<0.001) and maximal workload (ρ:-0.43; p<0.001). When significant, correlations between changes in exercise test outcomes and changes in PROs after PR were generally very weak or weak. The highest correlation was found between changes in CCQ total score and changes in 6MWD (ρ: − 0.36; p<0.001). Conclusions PROs and exercise test outcomes, although significantly correlated with each other, assess different disease features in patients with COPD. Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a PR program. Trial registration Netherlands Trial Register (NL3263/NTR3416). Registered 2 May 2012.
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Abstract
Balance problems and an increased rate and risk of falls are common in people
with chronic obstructive pulmonary disease (COPD). Although a balance assessment
is now recommended by clinical practice guidelines for pulmonary rehabilitation,
specific tests have yet to be suggested. The purpose of this review is to
provide an evidence-based synthesis of balance measurement in older adults and
in people with COPD, to guide practice in this area. An overview of best
practices for assessing balance and fall risk in older adults is provided along
with a practical synthesis of evidence to date on common balance measures used
in people with COPD such as the Timed Up and Go, Single Leg Stance, Berg
Balance, and Mini and Full Balance Evaluation Systems Tests. Finally, two
clinical scenarios are described to illustrate the process of evidence-based
clinical decision-making with respect to balance assessment in people with COPD.
Ultimately, the selection of balance test and its interpretation will depend on
the purpose of the assessment, available data on psychometric properties, the
patient’s individual characteristics, and the resources available to the
clinician.
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Incorporating Comprehensive Assessment Parameters to Better Characterize and Plan Rehabilitation for Persons with Chronic Obstructive Pulmonary Disease. J Am Med Dir Assoc 2020; 21:1986-1991.e3. [PMID: 32723539 DOI: 10.1016/j.jamda.2020.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The current management of chronic obstructive pulmonary disease (COPD) largely ignores its heterogeneous pulmonary and extrapulmonary manifestations in the individual patient. This study aimed to identify clusters of patients with COPD based on a thorough traits assessment. DESIGN An observational, prospective, single-center study. SETTING AND PARTICIPANTS Patients with COPD referred by chest physicians for a comprehensive pulmonary rehabilitation program to CIRO (Horn, the Netherlands) were eligible to participate. CIRO is a specialized pulmonary rehabilitation center in the southern part of the Netherlands for patients with complex underlying respiratory diseases. METHODS Clinically stable patients with COPD underwent a comprehensive assessment, including pulmonary traits (airflow limitation, static hyperinflation, gas transfer, respiratory pressures, and arterial blood gases), extrapulmonary functional traits, and health status (quadriceps muscle strength, physical functioning, body composition, comorbidities, symptoms perception, and social and emotional functioning). Clusters were generated using the SOM-Ward Cluster algorithm, a hybrid algorithm that applies the classical hierarchical method of Ward on top of the self-organizing map topology. RESULTS Based on the abovementioned attributes of 518 patients with mild to very severe COPD (44% women, age 64.1 ± 9.1 years, forced expiratory volume in the first second 48.6% ± 20.0% of predicted), 7 clusters were identified. Clusters had unique patterns differing in demographics, pulmonary, extrapulmonary functional, and behavioral traits and/or health status. CONCLUSION AND IMPLICATIONS The tremendous heterogeneity in pulmonary, extrapulmonary functional and behavioral traits, and health status in patients with COPD supports the need for an individual comprehensive assessment and a goal-directed personalized management strategy.
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Effects of Exercise Training Combined with Virtual Reality in Functionality and Health-Related Quality of Life of Patients on Hemodialysis. Games Health J 2020; 8:339-348. [PMID: 31539293 DOI: 10.1089/g4h.2018.0066] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The progression of chronic kidney disease can directly affect patient's health-related quality of life (HRQoL). Exercise training is a good option to reverse the impacts caused by the disease. To escape from the monotonous routine and stimulate further practice, the therapist should consider making physical activity more playful. Using videogames during exercise training is possible to rehabilitate the patient aiming for fun beyond the organic condition. The present study aimed to evaluate the effects of exercise training combined with Virtual Reality (VR) in functionality and HRQoL of patients on hemodialysis. Materials and Methods: A randomized controlled study in which control group (n = 20) maintained only hemodialysis without any physical effort or intervention from the researchers and intervention group (n = 20) who performed endurance and strength physical exercises in combination with VR during hemodialysis for 12 weeks. All eligible patients underwent a familiarization of games and were evaluated by an investigator-blind for functional capacity, quality of life, and depressive symptoms. Functional capacity tests included walking speed, timed up and go (TUG), and Duke Activity Status Index (DASI). To evaluate a HRQoL, Kidney Disease and Quality-of-Life Short-Form (KDQOL-SF™, v. 1.3) was used and to investigate depressive symptoms, the Center for Epidemiological Scale-Depression. Paired sample t-tests were conducted to determine differences within each group. Repeated-measures analysis of variance (group vs. time) was used to assess group differences in our major outcomes. The level of significance was 5%. Results: The exercise improved functional capacity (TUG: P = 0.002, DASI: P < 0.001) and HRQoL in physical and specific domains: physical functioning (P = 0.047), role physical (P = 0.021), as well as in physical composite summary (P < 0.001) and effects of kidney disease (P = 0.013). There was no influence on depressive symptoms (P = 0.154). Conclusion: Physical training combined with VR improved functional capacity and some quality-of-life domains of hemodialysis patients.
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Physical, Psychological, and Social Factors Associated with Exacerbation-Related Hospitalization in Patients with COPD. J Clin Med 2020; 9:jcm9030636. [PMID: 32120911 PMCID: PMC7141103 DOI: 10.3390/jcm9030636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background and objective: Exacerbation(s) of chronic obstructive pulmonary disease (eCOPD) entail important events describing an acute deterioration of respiratory symptoms. Changes in medication and/or hospitalization are needed to gain control over the event. However, an exacerbation leading to hospitalization is associated with a worse prognosis for the patient. The objective of this study is to explore factors that could predict the probability of an eCOPD-related hospitalization. Methods: Data from 128 patients with COPD included in a prospective, longitudinal study were used. At baseline, physical, emotional, and social status of the patients were assessed. Moreover, hospital admission during a one year follow-up was captured. Different models were made based on univariate analysis, literature, and practice. These models were combined to come to one final overall prediction model. Results: During follow-up, 31 (24.2%) participants were admitted for eCOPD. The overall model contained six significant variables: currently smoking (OR = 3.93), forced vital capacity (FVC; OR = 0.97), timed-up-and-go time (TUG-time) (OR = 14.16), knowledge (COPD knowledge questionnaire, percentage correctly answered questions (CIROPD%correct)) (<60% (OR = 1.00); 60%–75%: (OR = 0.30); >75%: (OR = 1.94), eCOPD history (OR = 9.98), and care dependency scale (CDS) total score (OR = 1.12). This model was well calibrated (goodness-of-fit test: p = 0.91) and correctly classified 79.7% of the patients. Conclusion: A combination of TUG-time, eCOPD-related admission(s) prior to baseline, currently smoking, FVC, CDS total score, and CIROPD%correct allows clinicians to predict the probability of an eCOPD-related hospitalization.
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Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial. Physiotherapy 2020; 107:58-65. [PMID: 32026836 DOI: 10.1016/j.physio.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 04/07/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN Randomised clinical trial. SETTING University-based, outpatient, physical therapy clinic. SUBJECTS Fifty individuals with COPD. INTERVENTIONS Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions: standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS Seventeen subjects completed the intervention in the LG {nine males, mean age 64 [standard deviation (SD) 8] years, mean forced expiratory volume in 1 second (FEV1) 48 (SD 17) %predicted} compared with 14 subjects in the WG [nine males, mean age 65 (SD 8) years, FEV1 51 (SD 15) %predicted]. Water-based exercise training had a positive effect on functional balance [TUG: mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; P=0.006], whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; P<0.001). CONCLUSION Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. CLINICAL TRIAL REGISTRATION NUMBER clinicalTrials.gov NCT01691131.
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Test-retest reliability and validity of the timed up and go test and 30-second sit to stand test in patients with pulmonary hypertension. Int J Cardiol 2020; 304:159-163. [PMID: 31980271 DOI: 10.1016/j.ijcard.2020.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/25/2019] [Accepted: 01/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timed up and go (TUG) and sit to stand (STS) tests that required less space and easier to be performed in respiratory and cardiac diseases for assessing functionality. Aim was to test the reliability of TUG and 30-second STS (30STS) tests and determine the validity of TUG and 30STS tests in patients with Pulmonary Hypertension (PH). METHODS Thirty-eight patients with diagnosed PH were included. We collected TUG, 30STS, quadriceps muscle strength, physical activity level, and 6MWT. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability and correlations with quadriceps muscle strength, physical activity level and 6MWT for validity of the TUG and 30STS tests. RESULTS The TUG and 30STS tests were associated with age, functional class, muscle strength, physical activity and functional exercise capacity in patients with PAH (p < 0.05). 6MWT was associated with age, functional class, muscle strength, physical activity and functional exercise capacity (p < 0.05). ICC (95%) for TUG test and 30STS were 0.96 (0.93-0.98) and 0.95 (0.90-0.97), respectively. CONCLUSIONS The TUG and 30STS tests were reliable and valid tests for measuring physical performance in PH. This study supports using the TUG and 30STS tests as practical assessment tools in patients with PH.
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Validity of balance and mobility screening tests for assessing fall risk in COPD. Chron Respir Dis 2020; 17:1479973120922538. [PMID: 32390529 PMCID: PMC7218331 DOI: 10.1177/1479973120922538] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
People with chronic obstructive pulmonary disease (COPD) have balance impairments and an increased risk of falls. The psychometric properties of short balance tests to inform fall risk assessment in COPD are unknown. Our objective was to determine the validity (concurrent, convergent, and known-groups) of short balance and mobility tests for fall risk screening. Participants with COPD aged ≥ 60 years attended a single assessment. Correlation coefficients described the relationships between the Brief Balance Evaluation Systems Test (Brief BESTest), Single-Leg Stance (SLS), Timed Up and Go (TUG), and Timed Up and Go Dual-Task (TUG-DT) tests, with the comprehensive Berg Balance Scale (BBS), chair-stand test, and measures of exercise tolerance, functional limitation, disability, and prognosis. Independent t-tests or Mann-Whitney U tests were used to examine differences between groups with respect to fall risk. Receiver operating characteristic curves examined the ability of the screening tests to identify individuals with previous falls. A total of 86 patients with COPD completed the study (72.9 ± 6.8 years; forced expiratory volume in 1 second: 47.3 ± 20.3% predicted). The Brief BESTest identified individuals who reported a previous fall (area under the curve (AUC) = 0.715, p = 0.001), and the SLS showed borderline acceptable accuracy in identifying individuals with a fall history (AUC = 0.684, p = 0.004). The strongest correlations were found for the Brief BESTest and SLS with the BBS (r = 0.80 and r = 0.72, respectively) and between the TUG and TUG-DT with the chair-stands test (r = 0.73 and r = 0.70, respectively). The Brief BESTest and SLS show the most promise as balance screening tools for fall risk assessment in older adults with COPD. These tests should be further evaluated prospectively.
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Test-Retest Reliability for Physical Function Measures in Patients with Chronic Kidney Disease. J Ren Care 2019; 46:25-34. [PMID: 31845535 DOI: 10.1111/jorc.12310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is important to determine relative and absolute reliability values in outcome measures that are used in clinical practice so as to discriminate between true changes following exercise interventions for patients with chronic kidney disease (CKD). OBJECTIVE The study aimed to assess test-retest reliability of the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 seconds (STS-60), timed up and go (TUAG), Duke's activity status index (DASI) and hospital anxiety and depression scale (HAD) in patients with CKD. STUDY DESIGN This study was a pragmatic non-randomised controlled trial. METHODS Forty people attended two study visits within a 16-day window involving the ISWT, STS-60, TUAG, DASI and HAD tests. Relative reliability was assessed using intraclass correlation coefficient (ICC) and absolute reliability using the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS Good test-retest reliability was found for the entire sample size across all outcome measures, with TUAG having the highest (ICC = 0.96) and HAD the lowest (ICC = 0.71). The MDC scores at 90% confidence interval (CI) were: 79.6 m for the ISWT, 2.9 seconds for the TUAG, 7.0 repetitions for the STS-60, 8.4 for the DASI, 3.8 for the anxiety HAD subscale and 4.4 for the depression HAD subscale. CONCLUSIONS This study demonstrated good test-retest reliability for all outcome measures across the CKD trajectory but caution needs to be taken when interpreting the findings for each CKD sub-group separately. The MDC scores at 90% CI can support therapists in determining a true improvement in CKD patients' physical or mental performance.
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A TUG Value Longer Than 11 s Predicts Fall Risk at 6-Month in Individuals with COPD. J Clin Med 2019; 8:E1752. [PMID: 31652506 PMCID: PMC6832491 DOI: 10.3390/jcm8101752] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
Risk of a fall is increased in individuals with chronic obstructive pulmonary disease (COPD), and is usually evaluated using the Berg Balance Scale (BBS), but this is difficult to perform in everyday clinical practice. We aimed to prospectively predict short-term fall recurrence in COPD patients using a predetermined cut-off value of the Timed Up and Go test (TUG). In stable COPD patients, we collected self-reported records of the number of falls in the previous year, and measured TUG and BBS scores for each individual. Records of fall recurrence were obtained prospectively at 6-months after the initial evaluation. Among the 50 patients recruited, 23 (46%) had at least one fall during the past year. The optimal diagnosis value for the TUG to detect a fall was 10.9 s with a sensitivity of 100% and a specificity of 97%. A cut-off of 11 s predicted fall recurrence with high sensitivity and specificity (93% and 74%, respectively). The TUG as well as the BBS score detected fallers, and a cut-off value of 11 s predicted fall recurrence. TUG could be easily incorporated into the scheduled functional evaluations of COPD patients, could predict the risk of a fall and when appropriate, could guide specific balance training exercises to prevent fall.
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Measuring and monitoring skeletal muscle function in COPD: current perspectives. Int J Chron Obstruct Pulmon Dis 2019; 14:1825-1838. [PMID: 31695351 PMCID: PMC6707440 DOI: 10.2147/copd.s178948] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Skeletal muscle dysfunction is an important systemic consequence of chronic obstructive pulmonary disease (COPD) that worsens the natural cause of the disease. Up to a third of all people with COPD express some form of impairment which encompasses reductions in strength and endurance, as well as an increased fatigability. Considering this complexity, no single test could be used to measure and monitor all aspects of the impaired skeletal muscle function within the COPD population, resulting in a wide range of available tests and measurement techniques. The aim of the current review is to highlight current and new perspectives relevant to skeletal muscle function measurements within the COPD population in order to provide guidance for researchers as well as for clinicians. First of all, standardized and clinically feasible measurement protocols, as well as normative values and predictive equations across the spectrum of impaired function in COPD, are needed before assessment of skeletal muscle function can become a reality in clinical praxis. This should minimally target the quadriceps muscle; however, depending on the objective of measurements, eg, to determine upper limb muscle function or walking capacity, other muscles could also be tested. Furthermore, even though muscle strength measurements are important, current evidence suggests that other aspects, such as the endurance and power capacity of the muscle, should also be considered. Moreover, although static (isometric) measurements have been favored, dynamic measurements of skeletal muscle function should not be neglected as they, in a larger extent than static measurements, are related to tasks of daily living. Lastly, the often modest relationships between functional tests and skeletal muscle function measurements indicate that they evaluate different constructs and thus cannot replace one another. Therefore, for accurate measurements of skeletal muscle function in people with COPD, specific and formal measurements should still be prioritized.
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Cognitive Function Is Associated With Mobility in Community Dwelling Older Adults With a History of Cardiovascular Disease. Cardiopulm Phys Ther J 2019. [DOI: 10.1097/cpt.0000000000000095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Interrater reliability of the standardized Timed Up and Go Test when used in hospitalized and community‐dwelling older individuals. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1769. [DOI: 10.1002/pri.1769] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/07/2018] [Accepted: 12/17/2018] [Indexed: 11/06/2022]
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Unravelling the mystery of the 'minimum important difference' using practical outcome measures in chronic respiratory disease. Chron Respir Dis 2019; 16:1479973118816491. [PMID: 30789024 PMCID: PMC6323555 DOI: 10.1177/1479973118816491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/18/2018] [Indexed: 01/09/2023] Open
Abstract
It is important for clinicians and researchers to understand the effects of treatments on their patients, both at an individual and group level. In clinical studies, treatment effects are often reported as a change in the outcome measure supported by a measure of variability; for example, the mean change with 95% confidence intervals and a probability ( p) value to indicate the level of statistical significance. However, a statistically significant change may not indicate a clinically meaningful or important change for clinicians or patients to interpret. The minimum clinically important difference (MCID) or minimally important difference (MID) has therefore been developed to add clinical relevance or patient experience to the reporting of an outcome measure. In this article, we consider the concept of the MID using the example of practical outcome measures in patients with CRD. We describe the various ways in which an MID can be calculated via anchor- and distribution-based methods, looking at practical examples and considering the importance of understanding how an MID was derived when seeking to apply it to a particular situation. The terms MID and MCID are challenging and often used interchangeably. However, we propose all MIDs are described as such, but they could be qualified by a suffix: MIDS (MID - Statistical), MID-C (MID - Clinical outcome), MID-P (MID - Patient determined). However, this type of classification would only work if accepted and adopted. In the meantime, we advise clinicians and researchers to use an MID where possible to aid their interpretation of functional outcome measures and effects of interventions, to add meaning above statistical significance alone.
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Evaluation of Limb Muscle Strength and Function in People With Chronic Obstructive Pulmonary Disease. Cardiopulm Phys Ther J 2019. [DOI: 10.1097/cpt.0000000000000090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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What Next in Refractory Breathlessness? Breathlessness? Research Questions for Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971403000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Introducing a Third Timed Up & Go Test Trial Improves Performances of Hospitalized and Community-Dwelling Older Individuals. J Geriatr Phys Ther 2018; 40:121-126. [PMID: 26881947 PMCID: PMC5473368 DOI: 10.1519/jpt.0000000000000080] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Originally, the Timed Up & Go (TUG) test was described as including a practice trial before a timed trial, but recent studies in individuals with hip fracture have reported that performance improved with a third trial and that high intertester reliability was achieved when the fastest of 3 timed trials was used. Thus, the fastest of 3 TUG trials is recommended when testing individuals with hip fracture. To our knowledge, no study has examined the number of trials needed to achieve performance stability on the TUG test (defined as no further improvement on subsequent trials) when performed by older individuals without hip fracture. The aim of the study, therefore, was to examine whether a third TUG trial is faster than either of 2 TUG trials conducted according to standardized TUG instructions and whether the fastest of 3 trials is the most appropriate measure to apply in hospitalized and community-dwelling older individuals. Methods: Eighty-two participants (50 from a geriatric hospital unit and 32 from an outpatient geriatric center; 52 women, 30 men) with a mean (SD) age of 83.6 (7.9) years were included in this cross-sectional study. All participants (except one from the hospital unit) performed 3 TUG trials, as fast as safely possible on the same day, and separated by up to 1-minute pauses. A rollator (4-wheeled rolling walker) was used as a standardized walking aid in the geriatric hospital unit, whereas participants used their normal walking aid (if any) in the outpatient geriatric center. Results and Discussion: The fastest trial was trial 3 for 47 (57%), trial 2 for 25 (31%), and trial 1 for 10 (12%). Repeated-measures analyses of variance with Bonferroni corrections showed that TUG times improved from trial 1 to trial 3 (P < .04). In addition, the fastest of the 3 timed trials was significantly (P < .001) faster than the other 2 trials. Conclusion: We suggest that the fastest of the 3 TUG trials is recorded instead of the second trial in both hospitalized and community-dwelling older individuals.
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Gait speed and survival of older surgical patient with cancer: Prediction after machine learning. J Geriatr Oncol 2018; 10:120-125. [PMID: 30017733 DOI: 10.1016/j.jgo.2018.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/07/2018] [Accepted: 06/27/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Gait speed in older patients with cancer is associated with mortality risk. One approach to assess gait speed is with the 'Timed Up and Go' (TUG) test. We utilized machine learning algorithms to automatically predict the results of the TUG tests and its association with survival, using patient-generated responses. METHODS A decision tree classifier was trained based on functional status data, obtained from preoperative geriatric assessment, and TUG test performance of older patients with cancer. The functional status data were used as input features to the decision tree, and the actual TUG data was used as ground truth labels. The decision tree was constructed to assign each patient to one of three categories: "TUG < 10 s", "TUG ≥ 10 s", and "uncertain." RESULTS In total, 1901 patients (49% women) with a mean age of 80 years were assessed. The most commonly performed operations were urologic, colorectal, and head and neck. The machine learning algorithm identified three features (cane/walker use, ability to walk outside, and ability to perform housework), in predicting TUG results with the decision tree classifier. The overall accuracy, specificity, and sensitivity of the prediction were 78%, 90%, and 66%, respectively. Furthermore, survival rates in each predicted TUG category differed by approximately 1% from the survival rates obtained by categorizing the patients based on their actual TUG results. CONCLUSIONS Machine learning algorithms can accurately predict the gait speed of older patients with cancer, based on their response to questions addressing other aspects of functional status.
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Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy. COPD 2018; 15:271-276. [PMID: 29799297 DOI: 10.1080/15412555.2018.1469608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has systemic consequences that lead to reduced physical activity in daily life (PADL). Little is known about PADL and its associations in individuals with COPD on home-based long-term oxygen therapy (LTOT). The objective of the study was to determine whether there is an association between severe physical inactivity and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on home-based LTOT using electric oxygen concentrators and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV1: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale - FSS), dyspnea (Medical Research Council - MRC scale), functional status (London Chest ADL scale [LCADL] and Timed Up and Go [TUG] test) and functional exercise capacity (Six-Minute Step test [6MST] and Sit-to-Stand test [STST]). PADL was markedly low (1444 ± 1203 steps/day) and associated with daily duration of LTOT (r = -0.50), fatigue (r = -0.36), LCADL (r = -0.41), 6MST (r = 0.48), and STST (r = 0.53) (p < .05 for all). Multiple linear regression revealed that daily duration of LTOT and STST explained 39% of the variability of PADL. Longer daily duration of LTOT, fatigue, worse functional status and exercise capacity were all associated with physical inactivity in individuals with COPD on LTOT, whereas daily duration of LTOT and the STST were determinants of reduced physical activity.
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Determinants of functional, peak and endurance exercise capacity in people with chronic obstructive pulmonary disease. Respir Med 2018; 138:81-87. [DOI: 10.1016/j.rmed.2018.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/22/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
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The Unsupported Upper Limb Exercise Test in People Without Disabilities: Assessing the Within-Day Test-Retest Reliability and the Effects of Age and Gender. Physiother Can 2018; 70:11-21. [PMID: 29434414 DOI: 10.3138/ptc.2016-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To estimate the within-day test-retest reliability and standard error of measurement (SEM) of the unsupported upper limb exercise test (UULEX) in adults without disabilities and to determine the effects of age and gender on performance of the UULEX. Method: A cross-sectional study was conducted with 100 adults without disabilities (44 men, mean age 44.2 [SD 26] y; 56 women, mean age 38.1 [SD 24.1] y). Participants performed three UULEX tests to establish within-day reliability, measured using an intra-class correlation coefficient (ICC) model 2 (two-way random effects) with a single rater (ICC[2,1]) and SEM. The effects of age and gender were examined using two-factor mixed-design analysis of variance (ANOVA) and one-way repeated-measures ANOVA. For analysis purposes, four sub-groups were created: younger adults, older adults, men, and women. Results: Excellent within-day reliability and a small SEM were found in the four sub-groups (younger adults: ICC[2,1]=0.88; 95% CI: 0.82, 0.92; SEM∼40 s; older adults: ICC[2,1]=0.82; 95% CI: 0.72, 0.90; SEM∼50 s; men: ICC[2,1]=0.93; 95% CI: 0.88, 0.96; SEM∼30 s; women: ICC[2,1]=0.85; 95% CI: 0.78, 0.91; SEM∼45 s). Younger adults took, on average, 308.24 seconds longer than older adults to perform the test; older adults performed significantly better on the third test (p<0.0001; η2=0.096). Gender effects were not found (p>0.05). Conclusion: The within-day test-retest reliability and SEM values of the UULEX may be used to define the magnitude of the error obtained with repeated measures. One UULEX test seems to be adequate for younger adults to achieve reliable results, whereas three tests seem to be needed for older adults.
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Efficacy of blood flow restriction exercise during dialysis for end stage kidney disease patients: protocol of a randomised controlled trial. BMC Nephrol 2017; 18:294. [PMID: 28893206 PMCID: PMC5594594 DOI: 10.1186/s12882-017-0713-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients. METHODS This is a randomised controlled trial design. A total of 75 participants will be recruited from haemodialysis clinics. Participants will be allocated to a blood flow restriction cycling group, traditional cycling group or usual care control group. Both exercising groups will complete 3 months of cycling exercise, performed intradialytically, three times per week. The blood flow restriction cycling group will complete two 10-min cycling bouts separated by a 20-min rest at a subjective effort of 15 on a 6 to 20 rating scale. This will be done with pressurised cuffs fitted proximally on the active limbs during exercise at 50% of a pre-determined limb occlusion pressure. The traditional cycling group will perform a continuous 20-min bout of exercise at a subjective effort of 12 on the same subjective effort scale. These workloads and volumes are equivalent and allow for comparison of a common blood flow restriction aerobic exercise prescription and a traditional aerobic exercise prescription. The primary outcome measures are lower limb strength, assessed by a three repetition maximum leg extension test, as well as objective measures of physical function: six-minute walk test, 30-s sit to stand, and timed up and go. Secondary outcome measures include thigh muscle cross sectional area, body composition, routine pathology, quality of life, and physical activity engagement. DISCUSSION This study will determine the efficacy of blood flow restriction exercise among dialysis patients for improving key physiological outcomes that impact independence and quality of life, with reduced burden on patients. This may have broader implications for other clinical populations with similarly declining muscle health and physical function, and those contraindicated to higher intensities of exercise. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Register: ACTRN12616000121460.
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Measurement Properties of Short Lower Extremity Functional Exercise Tests in People With Chronic Obstructive Pulmonary Disease: Systematic Review. Phys Ther 2017; 97:926-943. [PMID: 28605481 DOI: 10.1093/ptj/pzx063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND An increasing variety of short functional exercise tests are reported in people with chronic obstructive pulmonary disease (COPD). Systematic review of the psychometric properties of these exercise tests is indicated. PURPOSE The aim of this study was to determine the reliability, validity, and responsiveness of short (duration < 6 min) lower extremity functional exercise tests in people with COPD. DATA SOURCES Five databases were searched: MEDLINE, Embase, Scopus, AMED, and CINAHL. STUDY SELECTION Studies reporting psychometric properties of short functional exercise tests in people with COPD were included. DATA EXTRACTION Two reviewers independently extracted data and rated the quality of each measurement property using the COnsensus-based Standards for the Selection of Health Measurement INstrument (COSMIN). DATA SYNTHESIS Twenty-nine studies were identified reporting properties of 11 different tests. Four-meter gait speed [4MGS] and 5 repetition sit-to-stand [5STS] demonstrated high reliability (ICC = .95-.99; .97) with no learning effect (COSMIN study ratings = good--excellent). Their validity for use as a stratification tool anchored against an established prognostic indicator (area under receiver operator characteristics curve [AUC] = 0.72-0.87; 0.82) and responsiveness to change after pulmonary rehabilitation was greatest in more frail people with COPD. Studies of the Timed "Up and Go" [TUG] test support use of a practice test and show discriminative ability to detect falls history and low six-minute walk distance (AUC = 0.77; 0.82, COSMIN ratings = fair-excellent). LIMITATIONS Earlier studies were limited by small sample size. Limited data of lower study quality was identified for step tests and the Two-Minute Walk Test. CONCLUSIONS Selected short functional exercise tests can complement established exercise capacity measures, in stratification and measuring responsiveness to change especially in people with COPD and lower functional ability.
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Functional Tests in Chronic Obstructive Pulmonary Disease, Part 2: Measurement Properties. Ann Am Thorac Soc 2017; 14:785-794. [DOI: 10.1513/annalsats.201609-734as] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Activity Levels and Exercise Motivation in Patients With COPD and Their Resident Loved Ones. Chest 2017; 151:1028-1038. [DOI: 10.1016/j.chest.2016.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/02/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022] Open
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Validity, Reliability, and Ability to Identify Fall Status of the Berg Balance Scale, BESTest, Mini-BESTest, and Brief-BESTest in Patients With COPD. Phys Ther 2016; 96:1807-1815. [PMID: 27081201 DOI: 10.2522/ptj.20150391] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/31/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest are useful in the assessment of balance. Their psychometric properties, however, have not been tested in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE This study aimed to compare the validity, reliability, and ability to identify fall status of the BBS, BESTest, Mini-BESTest, and the Brief-BESTest in patients with COPD. DESIGN A cross-sectional study was conducted. METHODS Forty-six patients (24 men, 22 women; mean age=75.9 years, SD=7.1) were included. Participants were asked to report their falls during the previous 12 months and to fill in the Activity-specific Balance Confidence (ABC) Scale. The BBS and the BESTest were administered. Mini-BESTest and Brief-BESTest scores were computed based on the participants' BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC Scale. Interrater reliability (2 raters), intrarater reliability (48-72 hours), and minimal detectable changes (MDCs) were established. Receiver operating characteristics assessed the ability of each balance test to differentiate between participants with and without a history of falls. RESULTS Balance test scores were significantly correlated with each other (Spearman correlation rho=.73-.90) and with the ABC Scale (rho=.53-.75). Balance tests presented high interrater reliability (intraclass correlation coefficient [ICC]=.85-.97) and intrarater reliability (ICC=.52-.88) and acceptable MDCs (MDC=3.3-6.3 points). Although all balance tests were able to identify fall status (area under the curve=0.74-0.84), the BBS (sensitivity=73%, specificity=77%) and the Brief-BESTest (sensitivity=81%, specificity=73%) had the higher ability to identify fall status. LIMITATIONS Findings are generalizable mainly to older patients with moderate COPD. CONCLUSIONS The 4 balance tests are valid, reliable, and valuable in identifying fall status in patients with COPD. The Brief-BESTest presented slightly higher interrater reliability and ability to differentiate participants' fall status.
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What is the impact of impaired left ventricular ejection fraction in COPD after adjusting for confounders? Int J Cardiol 2016; 225:365-370. [PMID: 27760413 DOI: 10.1016/j.ijcard.2016.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND It remains unknown whether and to what extent impaired left ventricular ejection fraction (LVEF) affects physical and psychological status in COPD. We aimed to compare health outcome measures between COPD patients with and without impaired LVEF after adjusting for age, sex, BMI and FEV1. METHODS Impaired LVEF was defined as values <50%. 85 COPD patients with impaired LVEF and 85 COPD patients with normal LVEF were matched for sex, age, BMI and FEV1. Exercise capacity, quadriceps muscle function, functional mobility, inflammatory status, health status, care dependency, and mood disorders were cross-sectionally assessed. RESULTS Patients with impaired LVEF had shorter 6-minute walk distance (mean -59 (95% confidence interval: -94, -25)m), lower symptom-limited peak oxygen uptake (-131 (-268, 7)ml/min), weaker quadriceps muscles (-12 (-20, -3)Nm) and had more symptoms of anxiety (+2 (1, 3) points) and depression (+1 (0, 2) points) than those with normal LVEF (all P<0.05). Health status was not statistically different between groups (P>0.05). CONCLUSIONS Impaired LVEF has a clear impact on physical and psychological status in patients with COPD, even after adjusting for confounders. This reinforces the importance of assessing and treating cardiac problems in COPD.
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A simple and rapid test of physical performance inchronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11:1785-91. [PMID: 27536090 PMCID: PMC4976811 DOI: 10.2147/copd.s106151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Impaired physical performance is common in chronic obstructive pulmonary disease (COPD), but its assessment can be difficult in routine clinical practice. We compared the timed up and go (TUG) test and other easily applied assessments of physical performance with the 6-minute walk distance (6MWD). In a longitudinal study of comorbidities in COPD, submaximal physical performance was determined in 520 patients and 150 controls using the TUG test and 6MWD. Spirometry, body composition, handgrip strength, the COPD assessment test, St George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council dyspnoea scale were also determined. Patients and controls were similar in age, body mass index, and sex proportions. The TUG in the patients was greater than that in the control group, P=0.001, and was inversely related to 6MWD (r=−0.71, P<0.001) and forced expiratory volume in one second predicted (r=−0.19, P<0.01) and was directly related to the SGRQ activity (r=0.39, P<0.001), SGRQ total (r=0.37, P<0.001), and total COPD assessment test scores (r=0.37, P<0.001). The TUG identified the difference in physical performance between patients and controls. The TUG test and validated questionnaires provide a measure of physical performance, which is rapid and could be used in clinical practice.
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