Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties

Author(s)

Leonardi, Naiara Tais ; Kawakami, Debora Mayumi Oliveira ; Hurst, John R. ; Cruz, Joana ; Mendes, Renata Gonsalves

• Document type: Journal article
• Source: EUROPEAN RESPIRATORY REVIEW; v. 32, n. 169, p. 17-pg., 2023-09-30.

Abstract

Introduction Hospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD.Methods A systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach.Results 13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties.Conclusion Measurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management. (AU)

• FAPESP's process: 15/12763-4 - Exacerbation of COPD and COPD overlap heart failure and noninvasive ventilatory support: impact on endothelial function and cardiac autonomic modulation and relationship among cardiovascular outcomes and clinical and functional aspects
• Grantee: Renata Gonçalves Mendes
• Support Opportunities: Regular Research Grants
• FAPESP's process: 21/03493-4 - Innovative assessment tool functional and guiding physical exercise prescription in patients with COPD exacerbated: investigation of clinical applicability and vascular and functional benefits
• Grantee: Naiara Tais Leonardi
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• FAPESP's process: 15/26501-1 - Study of limiting factors to physical exercise and adjunct effects to rehabilitation on cardiorespiratory disease: a multicentre approach
• Grantee: Audrey Borghi Silva
• Support Opportunities: Research Projects - Thematic Grants