Bisca Gianna Waldrich, Proença Mahara, Salomão Alexandre, Hernandes Nidia A, Pitta Fabio
Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Londrina, PR, Brazil (Mss Bisca, Proença, and Salomão and Drs Hernandes and Pitta); and Research Centre in Health Sciences, North Parana University, Londrina, Paraná, Brazil (Dr Hernandes).
J Cardiopulm Rehabil Prev. 2014 May-Jun;34(3):213-6. doi: 10.1097/HCR.0000000000000047.
Dyspnea and fatigue frequently impair the ability to perform activities of daily living (ADL) in patients with chronic obstructive pulmonary disease. Questionnaires and scales have been used to assess limitations in ADL. The London Chest Activity of Daily Living (LCADL) scale is responsive to intervention to a higher extent when compared with other tools. However, the minimal detectable change (MDC) for this scale remains unknown. The aim of this study was to determine the MDC for functional status improvement measured by the LCADL scale in patients with chronic obstructive pulmonary disease.
Forty patients (20 men, 66 ± 7 years, forced expired volume in 1 second 44 ± 16% predicted) participated in a 3-month high-intensity exercise training program. Before and after the protocol, participants complete the LCADL scale and the Saint George Respiratory Questionnaire. To calculate the MDC, we used the standard error of measurement and the effect size (distribution-based estimates).
There was improvement in the LCADL self-care, domestic and leisure domains, and total score after the training program, with a strong trend for improvement in the physical activity domain. The MDC estimated for the LCADL were 0.89, 2.60, 0.44, 0.58, and 3.88 points for self-care, domestic, physical, and leisure domains, and total score, respectively. Correlations between changes in LCADL and in the Saint George Respiratory Questionnaire were weak (r < 0.4 for all).
This study provided the MDC for the domains and total score of the LCADL. A change of 4 points in the total score of the LCADL can be interpreted as a meaningful change.
呼吸困难和疲劳常常损害慢性阻塞性肺疾病患者进行日常生活活动（ADL）的能力。问卷和量表已被用于评估ADL受限情况。与其他工具相比，伦敦胸部日常生活活动（LCADL）量表对干预的反应程度更高。然而，该量表的最小可检测变化（MDC）仍不清楚。本研究的目的是确定通过LCADL量表测量的慢性阻塞性肺疾病患者功能状态改善的MDC。
40名患者（20名男性，66±7岁，一秒用力呼气量为预测值的44±16%）参加了为期3个月的高强度运动训练项目。在方案前后，参与者完成LCADL量表和圣乔治呼吸问卷。为了计算MDC，我们使用了测量标准误差和效应量（基于分布的估计值）。
训练项目后，LCADL的自我护理、家庭和休闲领域以及总分均有改善，身体活动领域有明显的改善趋势。LCADL自我护理、家庭、身体、休闲领域和总分的MDC估计分别为0.89、2.60、0.44、0.58和3.88分。LCADL变化与圣乔治呼吸问卷变化之间的相关性较弱（所有r<0.4）。
本研究提供了LCADL各领域和总分的MDC。LCADL总分变化4分可解释为有意义的变化。
