School of Life Sciences, Heriot-Watt University, Edinburgh, Scotland.
Sports Med. 2010 Dec 1;40(12):1055-74. doi: 10.2165/11536880-000000000-00000.
Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease. Deterioration of physical function is accelerated in patients with CKD to levels that significantly impact on clinically and patient-important outcomes such as morbidity, employment, quality of life and, ultimately, survival. However, meaningful interpretation of the existing physical function-related literature in adult patients with CKD is hindered, possibly due to inconsistent choice of methodology, assessment tools and reporting of data. The current comprehensive review of the literature aims to provide the theoretical rationale and framework for physical function assessment and to identify the prevailing approaches to (i) the characterization (classification and terminology), (ii) interpretation, and (iii) reporting of physical function assessment in people with CKD. Comprehensive assessment of physical function can provide important information about the presence of 'physiological impairment' at a body systems level (exercise tolerance under well controlled, laboratory-based procedures), 'functional limitations' (physical performance during tasks imitating usual daily, personal or occupational tasks) and 'functional disability' (via self-reported physical functioning in the context of a socio-cultural environment). The selection of physical function assessment tools should be guided by the primary purpose of the assessment (e.g. research or routine clinical monitoring), by the overall scientific 'soundness' of the chosen tool (e.g. validity, utility, reproducibility, responsiveness characteristics) and by operational factors (e.g. patient collaboration, cost, personnel expertise). Recommendations for tests, methods and protocols are therefore presented, for the assessment of cardiorespiratory and muscular fitness, physical performance and self-reported physical functioning. These recommendations are based on synthesis of available information as derived from controlled exercise training interventions in adult patients with CKD. Special considerations for physical function assessment and suggestions for future research are also addressed. Such an information synthesis might promote greater standardization of the physical function assessment of patients with CKD in routine clinical care or research settings. This would potentially lead to generation of adequate scientific decision-making criteria to help researchers and healthcare providers in selecting the most appropriate measures according to the physical function areas assessed, and to accurately and meaningfully characterize and compare patients' responses to therapeutic interventions.
慢性肾脏病（CKD）正在成为全球范围内一个严重的健康问题，也是心血管疾病最有力的已知危险因素之一。CKD 患者的身体功能恶化速度加快，达到了显著影响临床和患者重要结局（如发病率、就业、生活质量，最终是生存率）的水平。然而，由于方法学、评估工具和数据报告的选择不一致，可能会阻碍对现有与身体功能相关的成人 CKD 患者文献的有意义解读。本综述旨在为身体功能评估提供理论基础和框架，并确定当前用于（i）身体功能评估的特征（分类和术语）、（ii）解释和（iii）报告的主流方法。全面评估身体功能可以提供有关身体系统水平上“生理障碍”（在严格控制的实验室程序下的运动耐量）、“功能限制”（在模仿日常、个人或职业任务的身体表现）和“功能障碍”（通过自我报告的身体功能在社会文化环境中）的重要信息。身体功能评估工具的选择应根据评估的主要目的（例如研究或常规临床监测）、所选工具的整体科学“健全性”（例如有效性、实用性、可重复性、响应特征）和操作因素（例如患者合作、成本、人员专业知识）来指导。因此，提出了用于评估心肺和肌肉适应性、身体表现和自我报告的身体功能的测试、方法和方案的建议。这些建议是基于对 CKD 成年患者进行的受控运动训练干预的现有信息综合得出的。还讨论了身体功能评估的特殊考虑因素和未来研究的建议。这种信息综合可能会促进在常规临床护理或研究环境中对 CKD 患者的身体功能评估进行更大程度的标准化。这可能会导致生成足够的科学决策标准，以帮助研究人员和医疗保健提供者根据评估的身体功能区域选择最合适的措施，并准确且有意义地描述和比较患者对治疗干预的反应。
