Felisberto Rosimeire Marcos, de Barros Cassia Fabiane, Nucci Kelly Cristina Albanezi, de Albuquerque Andre Luis Pereira, Paulin Elaine, de Brito Christina May Moran, Yamaguti Wellington Pereira
Hospital Sírio-Libanês, São Paulo, SP, Brazil.
Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
Int J Chron Obstruct Pulmon Dis. 2018 May 22;13:1663-1673. doi: 10.2147/COPD.S161463. eCollection 2018.
The 6-minute pegboard and ring test (6-PBRT) is a useful test for assessing the functional capacity of upper limbs in patients with stable COPD. Although 6-PBRT has been validated in stable patients, the possibility of a high floor effect could compromise the validity of the test in the hospital setting. The aim of this study was to verify the convergent validity of 6-PBRT in hospitalized patients with acute exacerbation of COPD (AECOPD).
A cross-sectional study was conducted in a tertiary hospital. Patients who were hospitalized due to AECOPD and healthy elderly participants, voluntarily recruited from the community, were considered for inclusion. All participants underwent a 6-PBRT. Isokinetic evaluation to measure the strength and endurance of elbow flexors and extensors, handgrip strength (HGS), spirometry testing, the modified Pulmonary Functional Status Dyspnea Questionnaire (PFSDQ-M), the COPD assessment test (CAT), and symptoms of dyspnea and fatigue were all measured as comparisons for convergent validity. Good convergent validity was considered if >75% of these hypotheses could be confirmed (correlation coefficient>0.50).
A total of 17 patients with AECOPD (70.9±5.1 years and forced expiratory volume in 1 second [FEV] of 41.8%±17.9% of predicted) and 11 healthy elderly subjects were included. The HGS showed a significant strong correlation with 6-PBRT performance (=0.70; =0.002). The performance in 6-PBRT presented a significant moderate correlation with elbow flexor torque peak (=0.52; =0.03) and elbow extensor torque peak (=0.61; =0.01). The total muscular work of the 15 isokinetic contractions of the elbow flexor and extensor muscles showed a significant moderate correlation with the performance in 6-PBRT (=0.59; =0.01 and =0.57; =0.02, respectively). Concerning the endurance of elbow flexors and extensors, there was a significant moderate correlation with 6-PBRT performance (=-0.50; =0.04 and =-0.51; =0.03, respectively). In relation to the upper-extremity physical activities of daily living (ADLs) assessed by means of PFSDQ-M, there was a significant moderate correlation of 6-PBRT with three domains: influence of dyspnea on ADLs (=-0.66; <0.001), influence of fatigue on ADLs (=-0.60; =0.01), and change in ADLs in relation to the period before the disease onset (=-0.51; =0.03). The CAT was also correlated with 6-PBRT (=-0.51; =0.03). Finally, the performance in 6-PBRT showed a significant moderate correlation with the increase in dyspnea (=-0.63; =0.01) and a strong correlation with the increase in fatigue of upper limbs (=-0.76; <0.001) in patients with AECOPD. Convergent validity was considered adequate, since 81% from 16 predefined hypotheses were confirmed. There was no correlation between 6-PBRT and patients' height. The performance in 6-PBRT was worse in patients with AECOPD compared to healthy elderly individuals (248.7±63.0 vs 361.6±49.9 number of moved rings; <0.001).
The 6-PBRT is valid for the evaluation of functional capacity of upper limbs in hospitalized patients with AECOPD.
6分钟钉板套环试验（6-PBRT）是评估稳定期慢性阻塞性肺疾病（COPD）患者上肢功能能力的一项有用测试。尽管6-PBRT已在稳定期患者中得到验证，但高地板效应的可能性可能会损害该测试在医院环境中的有效性。本研究的目的是验证6-PBRT在住院的慢性阻塞性肺疾病急性加重期（AECOPD）患者中的收敛效度。
在一家三级医院进行了一项横断面研究。纳入因AECOPD住院的患者以及从社区自愿招募的健康老年参与者。所有参与者均接受6-PBRT。测量肘屈肌和伸肌的力量和耐力的等速评估、握力（HGS）、肺功能测试、改良的肺功能状态呼吸困难问卷（PFSDQ-M）、慢性阻塞性肺疾病评估测试（CAT）以及呼吸困难和疲劳症状均作为收敛效度的比较指标。如果这些假设中有超过75%可以得到证实（相关系数>0.50），则认为具有良好的收敛效度。
共纳入17例AECOPD患者（年龄70.9±5.1岁，第1秒用力呼气容积[FEV]为预测值的41.8%±17.9%）和11名健康老年受试者。HGS与6-PBRT表现呈显著强相关（=0.70；=0.002）。6-PBRT表现与肘屈肌扭矩峰值（=0.52；=0.03）和肘伸肌扭矩峰值（=0.61；=0.01）呈显著中度相关。肘屈肌和伸肌15次等速收缩的总肌肉功与6-PBRT表现呈显著中度相关（分别为=0.59；=0.01和=0.57；=0.02）。关于肘屈肌和伸肌的耐力，与6-PBRT表现呈显著中度相关（分别为=-0.50；=0.04和=-0.51；=0.03）。在通过PFSDQ-M评估的上肢日常生活活动（ADL）方面，6-PBRT与三个领域呈显著中度相关：呼吸困难对ADL的影响（=-0.66；<0.001）、疲劳对ADL的影响（=-0.60；=0.01）以及与疾病发作前相比ADL的变化（=-0.51；=0.03）。CAT也与6-PBRT相关（=-0.51；=0.03）。最后，6-PBRT表现与AECOPD患者呼吸困难的增加呈显著中度相关（=-0.63；=0.01），与上肢疲劳的增加呈强相关（=-0.76；<0.001）。由于16个预定义假设中有81%得到证实，因此认为收敛效度足够。6-PBRT与患者身高之间无相关性。与健康老年个体相比，AECOPD患者的6-PBRT表现更差（移动环数分别为248.7±63.0和361.6±49.9；<0.001）。
6-PBRT对于评估住院AECOPD患者的上肢功能能力是有效的。
