ISGlobal, Barcelona, Spain
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
Thorax. 2021 Mar;76(3):228-238. doi: 10.1136/thoraxjnl-2020-214554. Epub 2021 Jan 21.
The Daily-PROactive and Clinical visit-PROactive Physical Activity (D-PPAC and C-PPAC) instruments in chronic obstructive pulmonary disease (COPD) combines questionnaire with activity monitor data to measure patients' experience of physical activity. Their amount, difficulty and total scores range from 0 (worst) to 100 (best) but require further psychometric evaluation.
To test reliability, validity and responsiveness, and to define minimal important difference (MID), of the D-PPAC and C-PPAC instruments, in a large population of patients with stable COPD from diverse severities, settings and countries.
We used data from seven randomised controlled trials to evaluate D-PPAC and C-PPAC internal consistency and construct validity by sex, age groups, COPD severity, country and language as well as responsiveness to interventions, ability to detect change and MID.
We included 1324 patients (mean (SD) age 66 (8) years, forced expiratory volume in 1 s 55 (17)% predicted). Scores covered almost the full range from 0 to 100, showed strong internal consistency after stratification and correlated as a priori hypothesised with dyspnoea, health-related quality of life and exercise capacity. Difficulty scores improved after pharmacological treatment and pulmonary rehabilitation, while amount scores improved after behavioural physical activity interventions. All scores were responsive to changes in self-reported physical activity experience (both worsening and improvement) and to the occurrence of COPD exacerbations during follow-up. The MID was estimated to 6 for amount and difficulty scores and 4 for total score.
The D-PPAC and C-PPAC instruments are reliable and valid across diverse COPD populations and responsive to pharmacological and non-pharmacological interventions and changes in clinically relevant variables.
慢性阻塞性肺疾病（COPD）的日常主动和临床就诊主动体力活动（D-PPAC 和 C-PPAC）工具将问卷与活动监测数据相结合，以衡量患者的体力活动体验。它们的数量、难度和总分范围从 0（最差）到 100（最佳），但需要进一步的心理测量评估。
在来自不同严重程度、环境和国家的大量稳定 COPD 患者中，测试 D-PPAC 和 C-PPAC 工具的可靠性、有效性和反应能力，并确定最小重要差异（MID）。
我们使用来自七个随机对照试验的数据，通过性别、年龄组、COPD 严重程度、国家和语言评估 D-PPAC 和 C-PPAC 的内部一致性和结构有效性，以及对干预的反应能力、检测变化的能力和 MID。
我们纳入了 1324 名患者（平均（SD）年龄 66（8）岁，1 秒用力呼气量占预计值的 55（17）%）。评分几乎涵盖了从 0 到 100 的整个范围，在分层后显示出很强的内部一致性，并与呼吸困难、健康相关的生活质量和运动能力如先验假设的那样相关。药物治疗和肺康复后，难度评分改善，而行为体力活动干预后，数量评分改善。所有评分均对自我报告的体力活动体验变化（恶化和改善）以及随访期间 COPD 加重的发生敏感。MID 估计为数量和难度评分的 6，总评分的 4。
D-PPAC 和 C-PPAC 工具在不同的 COPD 人群中具有可靠性和有效性，对药物和非药物干预以及与临床相关变量的变化均有反应。
