Evaluating and understanding performance testing in COPD patients.

PURPOSE There is increasing interest in the use of performance tests to assess physical function among patients with debilitating diseases. The purpose of this study was to describe the measurement properties of a performance test battery used in the Reconditioning Exercise and Chronic Obstructive Pulmonary Disease Trial and to explore how well-selected physiologic and psychosocial measures explained test performance. METHODS To assess test-retest reliability of the performance tests, older patients with chronic obstructive pulmonary disease (n = 30) completed, on two different occasions, a 6-minute walk for distance, a timed stair climb, and a timed elevated-arm task. In addition, stepwise regression analyses were conducted on a larger sample (n = 209) to examine how effective conceptually relevant physiologic and psychosocial variables were at explaining variation in task performance. RESULTS Results showed that all three performance tasks had good test-retest reliability (all coefficients > 0.80) and shared variance in expected directions with VO2peak, forced expiratory volume in 1 second (FEV1), and self-reported disability. Regression analyses suggest that VO2peak, FEV1, self-efficacy, and self-reported disability are important variables to consider in attempts to understand performance-related disability in patients with chronic obstructive pulmonary disease (COPD). CONCLUSIONS The physical performance test battery appears to be a reliable means of assessing physical functioning in older patients with COPD. Furthermore, findings support the important role that VO2peak plays in task performance and suggest that patients' perceptions should be given careful consideration when attempting to understand physical decline in clinical settings.

[1]  C. Wells,et al.  The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. , 1984, Chest.

[2]  Reproducibility of walking test results in chronic obstructive airways disease. , 1988 .

[3]  A. Woodcock,et al.  Two-, six-, and 12-minute walking tests in respiratory disease. , 1982, British medical journal.

[4]  B. Harrison,et al.  The use of the 12 minute walking test in assessing the effect of oral steroid therapy in patients with chronic airways obstruction. , 1982, British journal of diseases of the chest.

[5]  Life quality of patients with chronic obstructive pulmonary disease. , 1982, Archives of internal medicine.

[6]  G H Guyatt,et al.  Effect of encouragement on walking test performance. , 1984, Thorax.

[7]  P. Jones,et al.  Performance, ventilation, and oxygen consumption in three different types of exercise test in patients with chronic obstructive lung disease. , 1985, Thorax.

[8]  F. Martinez,et al.  Pulmonary rehabilitation that includes arm exercise reduces metabolic and ventilatory requirements for simple arm elevation. , 1993 .

[9]  R. Edwards,et al.  Exertion of stairclimbing in normal subjects and in patients with chronic obstructive bronchitis. , 1977, Thorax.

[10]  G H Guyatt,et al.  How should we measure function in patients with chronic heart and lung disease? , 1985, Journal of chronic diseases.

[11]  M. Artvinli,et al.  Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. , 1978, British medical journal.

[12]  R. Hainsworth,et al.  Assessment of respiratory function in patients with chronic obstructive airways disease. , 1979, Thorax.

[13]  R. Gardner.  Standardization of spirometry: a summary of recommendations from the American Thoracic Society. The 1987 update. , 1988, Annals of internal medicine.

[14]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[15]  R. Lowry,et al.  Pulmonary reflexes after human heart-lung transplantation. , 1991, Respiratory medicine.

[16]  B. Celli,et al.  Estimation of ventilatory reserve by stair climbing. A study in patients with chronic airflow obstruction. , 1993, Chest.

[17]  W. Ettinger,et al.  Assessing performance-related disability in patients with knee osteoarthritis. , 1995, Osteoarthritis and cartilage.

[18]  G. Guyatt,et al.  A measure of quality of life for clinical trials in chronic lung disease. , 1987, Thorax.

[19]  C. Hornung,et al.  Stair climbing as an indicator of pulmonary function. , 1987, Chest.

[20]  B. Steele,et al.  Timed walking tests of exercise capacity in chronic cardiopulmonary illness. , 1996, Journal of cardiopulmonary rehabilitation.

[21]  W. Applegate,et al.  A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). , 1997, JAMA.

[22]  L. Fried,et al.  Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk , 1997, Journal of the American Geriatrics Society.

[23]  A. Fishman.  Pulmonary rehabilitation research. , 1994, American journal of respiratory and critical care medicine.

[24]  S. P. Gupta,et al.  Twelve-minute walking test for assessing disability in chronic bronchitis. , 1976, British medical journal.

[25]  R Ceci,et al.  A category-ratio perceived exertion scale: relationship to blood and muscle lactates and heart rate. , 1983, Medicine and science in sports and exercise.