Expert Review of Respiratory Medicine Downloaded from informahealthcare.com by Nyu Medical Center on 07/31/15 For personal use only.
Original Research
Assessment of pulmonary rehabilitation efficacy in chronic obstructive pulmonary disease patients using the chronic obstructive pulmonary disease assessment test Expert Rev. Respir. Med. 9(4), 487–492 (2015)
Ipek Candemir*, Dicle Kaymaz, Pinar Ergun, Nese Demir, Nurcan Egesel and Fatma Sengul Ataturk Chest Diseases and Surgery Education and Research Hospital, Pulmonary Rehabilitation and Home Care Center, Ankara, Turkey *Author for correspondence: [email protected]
Aim: We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment test (CAT) and improvements after pulmonary rehabilitation (PR) and PR efficiency in COPD patients. Methods & results: Forty COPD patients completed PR. After PR, mean change in CAT score was found to be 13 (p < 0.001), Medical Research Council (MRC), St George’s Respiratory Questionnaire (SRGQ) and London Chest Activity Daily Living (LCADL) scores decreased, while Endurance Shuttle Walking Test (ESWT) time and Incremental Shuttle Walking Test (ISWT) distance increased significantly. Baseline CAT scores correlated with MRC, SRGQtotal, %FVC, ISWT, ESWT, LCADL. Change in CAT was significantly correlated with changes in MRC, SGRQtotal, LCADL-leisure scores, and ESWT. Conclusion: CAT score shows moderate degree correlation with some measures of outcome of PR and response to PR efficacy. KEYWORDS: chronic obstructive pulmonary disease . chronic obstructive pulmonary disease assessment test .
exercise capacity
.
pulmonary rehabilitation
.
quality of life
An important component of a pulmonary rehabilitation (PR) program is the assessment of specific outcomes that helps in determining the individual patient response and the overall effectiveness. Therefore, outcome assessment should be incorporated into every comprehensive PR program. The exercise capacity, dyspnea and quality of life have all been identified as the three most important outcome variables. Nevertheless, several other outcomes, such as daily living activity, have been utilized to evaluate the efficacy of PR [1]. However, daily clinical practice requires a more simple and practical method. Therefore, the chronic obstructive pulmonary disease (COPD) assessment test (CAT) has recently
informahealthcare.com
10.1586/17476348.2015.1067608
been introduced as a simple and patientcompleted form to determine health-related quality of life and symptom burden in patients with COPD that positively responds to PR [2]. In this study, we sought to determine whether CAT correlates well with the improvements in exercise capacity, pulmonary function, sensation of dyspnea, daily living activity and health-related quality of life after a PR program and to identify multidisciplinary PR efficacy using CAT. Method
Forty stable COPD patients who were referred to Atatu¨rk Chest Diseases and Chest Surgery Training and Research Hospital, Pulmonary
2015 Informa UK Ltd
ISSN 1747-6348
487
Original Research
Candemir, Kaymaz, Ergun, Demir, Egesel & Sengul
Expert Review of Respiratory Medicine Downloaded from informahealthcare.com by Nyu Medical Center on 07/31/15 For personal use only.
Table 1. Response to pulmonary rehabilitation. Recorded parameters
Before PR
After PR
p-value
MRC
3.4 ± 0.8
2.6 ± 0.6
< 0.001
ISWT (meter)
227 ± 124
300 ± 115
< 0.001
ESWT (min.)
7.6 ± 6
10.4 ± 8
0.039
BMI
26 ± 6
27 ± 5
0.179
FFMI
20 ± 2
20 ± 2
0.601
%FVC
60.7 ± 14.5
61.4 ± 15.3
0.245
%FEV1
39.6 ± 16.7
40.2 ± 16.7
0.093
FEV1/FVC
51 ± 13.7
50 ± 12.6
0.108
CAT
25.4 ± 7
13 ± 5
< 0.001
SGRQ – symptom
75 ± 11
42 ± 15
< 0.001
SGRQ – activity
75 ± 19
43 ± 9
< 0.001
SGRQ – impact
63 ± 19
22 ± 11
< 0.001
SGRQ – total
68 ± 16
32 ± 8
< 0.001
LCADL – self-care
10 ± 4
7±3
< 0.001
LCADL – domestic
4±7
3±5
0.152
LCADL – physical activity
5±1
4±1
< 0.001
LCADL – leisure
8±2
5±1
< 0.001
LCADL – Total
25 ± 9
19 ± 7
< 0.001
BMI: Body mass index; CAT: COPD assessment test; ESWT: Endurance Shuttle Walking Test; FFMI: Fat free mass index; ISWT: Incremental Shuttle Walking Test; LCADL: London Chest Activity Daily Living; MRC: Medical Research Council; SRGQ: St George’s Respiratory Questionnaire.
Rehabilitation and Home Care Center, between November 2012 and May 2013 were enrolled in this prospective study. Prior to the program, a respiratory physician assessed all patients in order to ensure that the diagnosis was correct, and there were no contraindications for enrollment into the PR. At baseline, spirometry was performed pre- and postbronchodilator 15–30 min after the administration of salbutamol 400 mcg via a spacer tool using spirometer; lung functions were expressed as the percentages of the reference values. The criterion for confirmation of diagnosis of COPD was a postbronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of
Original Research
Assessment of pulmonary rehabilitation efficacy in chronic obstructive pulmonary disease patients using the chronic obstructive pulmonary disease assessment test Expert Rev. Respir. Med. 9(4), 487–492 (2015)
Ipek Candemir*, Dicle Kaymaz, Pinar Ergun, Nese Demir, Nurcan Egesel and Fatma Sengul Ataturk Chest Diseases and Surgery Education and Research Hospital, Pulmonary Rehabilitation and Home Care Center, Ankara, Turkey *Author for correspondence: [email protected]
Aim: We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment test (CAT) and improvements after pulmonary rehabilitation (PR) and PR efficiency in COPD patients. Methods & results: Forty COPD patients completed PR. After PR, mean change in CAT score was found to be 13 (p < 0.001), Medical Research Council (MRC), St George’s Respiratory Questionnaire (SRGQ) and London Chest Activity Daily Living (LCADL) scores decreased, while Endurance Shuttle Walking Test (ESWT) time and Incremental Shuttle Walking Test (ISWT) distance increased significantly. Baseline CAT scores correlated with MRC, SRGQtotal, %FVC, ISWT, ESWT, LCADL. Change in CAT was significantly correlated with changes in MRC, SGRQtotal, LCADL-leisure scores, and ESWT. Conclusion: CAT score shows moderate degree correlation with some measures of outcome of PR and response to PR efficacy. KEYWORDS: chronic obstructive pulmonary disease . chronic obstructive pulmonary disease assessment test .
exercise capacity
.
pulmonary rehabilitation
.
quality of life
An important component of a pulmonary rehabilitation (PR) program is the assessment of specific outcomes that helps in determining the individual patient response and the overall effectiveness. Therefore, outcome assessment should be incorporated into every comprehensive PR program. The exercise capacity, dyspnea and quality of life have all been identified as the three most important outcome variables. Nevertheless, several other outcomes, such as daily living activity, have been utilized to evaluate the efficacy of PR [1]. However, daily clinical practice requires a more simple and practical method. Therefore, the chronic obstructive pulmonary disease (COPD) assessment test (CAT) has recently
informahealthcare.com
10.1586/17476348.2015.1067608
been introduced as a simple and patientcompleted form to determine health-related quality of life and symptom burden in patients with COPD that positively responds to PR [2]. In this study, we sought to determine whether CAT correlates well with the improvements in exercise capacity, pulmonary function, sensation of dyspnea, daily living activity and health-related quality of life after a PR program and to identify multidisciplinary PR efficacy using CAT. Method
Forty stable COPD patients who were referred to Atatu¨rk Chest Diseases and Chest Surgery Training and Research Hospital, Pulmonary
2015 Informa UK Ltd
ISSN 1747-6348
487
Original Research
Candemir, Kaymaz, Ergun, Demir, Egesel & Sengul
Expert Review of Respiratory Medicine Downloaded from informahealthcare.com by Nyu Medical Center on 07/31/15 For personal use only.
Table 1. Response to pulmonary rehabilitation. Recorded parameters
Before PR
After PR
p-value
MRC
3.4 ± 0.8
2.6 ± 0.6
< 0.001
ISWT (meter)
227 ± 124
300 ± 115
< 0.001
ESWT (min.)
7.6 ± 6
10.4 ± 8
0.039
BMI
26 ± 6
27 ± 5
0.179
FFMI
20 ± 2
20 ± 2
0.601
%FVC
60.7 ± 14.5
61.4 ± 15.3
0.245
%FEV1
39.6 ± 16.7
40.2 ± 16.7
0.093
FEV1/FVC
51 ± 13.7
50 ± 12.6
0.108
CAT
25.4 ± 7
13 ± 5
< 0.001
SGRQ – symptom
75 ± 11
42 ± 15
< 0.001
SGRQ – activity
75 ± 19
43 ± 9
< 0.001
SGRQ – impact
63 ± 19
22 ± 11
< 0.001
SGRQ – total
68 ± 16
32 ± 8
< 0.001
LCADL – self-care
10 ± 4
7±3
< 0.001
LCADL – domestic
4±7
3±5
0.152
LCADL – physical activity
5±1
4±1
< 0.001
LCADL – leisure
8±2
5±1
< 0.001
LCADL – Total
25 ± 9
19 ± 7
< 0.001
BMI: Body mass index; CAT: COPD assessment test; ESWT: Endurance Shuttle Walking Test; FFMI: Fat free mass index; ISWT: Incremental Shuttle Walking Test; LCADL: London Chest Activity Daily Living; MRC: Medical Research Council; SRGQ: St George’s Respiratory Questionnaire.
Rehabilitation and Home Care Center, between November 2012 and May 2013 were enrolled in this prospective study. Prior to the program, a respiratory physician assessed all patients in order to ensure that the diagnosis was correct, and there were no contraindications for enrollment into the PR. At baseline, spirometry was performed pre- and postbronchodilator 15–30 min after the administration of salbutamol 400 mcg via a spacer tool using spirometer; lung functions were expressed as the percentages of the reference values. The criterion for confirmation of diagnosis of COPD was a postbronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of
![[Usefulness of the Chronic Obstructive Pulmonary Disease Assessment Test in chronic obstructive pulmonary disease with severe airflow limitation].](/assets/img/hold.png)
