Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.
Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.
Respir Med. 2019 May;151:142-147. doi: 10.1016/j.rmed.2019.04.006. Epub 2019 Apr 9.
Knowing the patients with chronic obstructive pulmonary disease (COPD) that increase the physical activity of daily living (PADL) after pulmonary rehabilitation (PR) is a challenge.
to compare baseline characteristics between patients who achieved and failed to achieve the minimal important difference (MID) of PADL post-PR; to verify which baseline variables better predict the change and identify a cut-off point to discriminate MID achievers.
Fifty-three patients with COPD (FEV: 38.3; 95%CI 34.4-42.2%pred) were evaluated for spirometry, dyspnea, quality of life, functional capacity, mortality risk and PADL level. After 24 sessions of PR had their PADL level revaluated.
The MID achievers presented lower FEV, functional capacity, time walking, number of steps, active time, energy expenditure (EE) walking, time on PADL≥3 metabolic equivalent of task (METs) and higher time on PADL<1.5MET. Inactive patients and with severe physical inactivity presented a hazard ratio of 4.27 and 6.90 (95%CI: 1.31-13.9, p = 0.02; 95%CI: 1.99-23.9, p = 0.002; respectively) for achieving the MID. The variables of predictive model for the change in the PADL were EE walking and time on PADL<1.5MET (R: 0.37; p = 0.002). The cut-off point of 6525 steps [sensitivity = 95%; specificity = 61%; AUC = 0.82 (95%CI: 0.71-0.93), p < 0.001] was able to discriminate patients who achieved and failed to achieve the MID.
Patients with worse lung function, functional capacity and lower PADL level before PR are those that improve the PADL level. EE walking and time on PADL<1.5MET better predict this change. The cut-off point of 6525 steps can help to identify patients with higher chances of improving the PADL level.
了解慢性阻塞性肺疾病（COPD）患者在肺康复（PR）后增加日常生活体力活动（PADL）是一项挑战。
比较 PR 后达到和未达到 PADL 最小有意义差异（MID）的患者的基线特征；验证哪些基线变量能更好地预测变化，并确定一个临界值来区分 MID 达标者。
对 53 例 COPD 患者（FEV：38.3；95%CI 34.4-42.2%pred）进行肺量计检查、呼吸困难、生活质量、功能能力、死亡率风险和 PADL 水平评估。24 个疗程 PR 后重新评估 PADL 水平。
MID 达标者的 FEV、功能能力、行走时间、步数、活动时间、行走时能量消耗（EE）、PADL 时间≥3 代谢当量（METs）和 PADL<1.5MET 的时间较高。不活动患者和严重体力不活动患者达到 MID 的危险比分别为 4.27 和 6.90（95%CI：1.31-13.9，p=0.02；95%CI：1.99-23.9，p=0.002）。预测 PADL 变化的模型变量为 EE 行走和 PADL<1.5MET 的时间（R：0.37；p=0.002）。6525 步的截断值[灵敏度为 95%；特异性为 61%；AUC 为 0.82（95%CI：0.71-0.93），p<0.001]能够区分达到和未达到 MID 的患者。
PR 前肺功能、功能能力和 PADL 水平较差的患者，其 PADL 水平有所提高。EE 行走和 PADL<1.5MET 的时间能更好地预测这种变化。6525 步的截断值有助于识别更有可能提高 PADL 水平的患者。
