University Lille, University Artois, University Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France.
Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.
Int J Chron Obstruct Pulmon Dis. 2021 May 17;16:1381-1392. doi: 10.2147/COPD.S295885. eCollection 2021.
The prevalence of physical frailty and its clinical characteristics in advanced chronic obstructive pulmonary disease (COPD) is unknown, as well as the usefulness of functional capacity tests to screen for physical frailty. The aim of the study was to evaluate the proportion and clinical portrait of COPD patients with chronic respiratory failure exhibiting physical frailty at the time of referral to home-based pulmonary rehabilitation. We also evaluate the usefulness of the short physical performance battery (SPPB) and timed-up and go (TUG) as potential screening tools for physical frailty. Finally, we evaluated the specific contribution of gait speed to the frailty Fried total score.
This was a prospective observational study in which physical frailty was defined using Fried criteria (body mass loss, exhaustion, low physical activity, slower walking and weakness). Clinical portrait was documented from daily physical activity, exercise tolerance, functional capacity, anxiety and depressive symptoms, health-related quality of life, and fatigue scores. The ability of the SPPB and TUG to predict physical frailty was investigated using receiver operating characteristic curves. Contribution of each Fried criteria was evaluated with a principal component analysis (PCA).
Amongst the 44 included participants (FEV, 33 ± 13% of predicted), 19 were physically frail. Frail individuals had lower daily steps number, exercise tolerance and functional capacity, and higher fatigue, anxiety, and depressive symptom scores (p<0.05) compared to non-frail individuals. SPPB and TUG did not have an acceptable detection accuracy for screening physical frailty. PCA indicated that gait speed was the main contributor to the Fried total score of physical frailty.
Physical frailty affects a large proportion of COPD patients with chronic respiratory failure starting a home-based intervention and was associated with worse clinical status. Although the present results need to be confirmed by adequately powered studies, gait speed seems to have the potential to become a simple screening tool for physical frailty in this population.
在晚期慢性阻塞性肺疾病（COPD）中，身体虚弱的流行程度及其临床特征尚不清楚，功能能力测试在筛选身体虚弱方面的有用性也不清楚。本研究的目的是评估在开始家庭为基础的肺康复时患有慢性呼吸衰竭的 COPD 患者中身体虚弱的比例和临床特征。我们还评估了短体物理表现测试（SPPB）和计时起身行走测试（TUG）作为身体虚弱筛查工具的有用性。最后，我们评估了步速对 Fried 总评分的虚弱特征的具体贡献。
这是一项前瞻性观察性研究，其中使用 Fried 标准（体重减轻、疲劳、体力活动减少、步行速度较慢和虚弱）定义身体虚弱。临床特征从日常体力活动、运动耐量、功能能力、焦虑和抑郁症状、健康相关生活质量和疲劳评分中记录。使用接受者操作特征曲线研究 SPPB 和 TUG 预测身体虚弱的能力。使用主成分分析（PCA）评估每个 Fried 标准的贡献。
在纳入的 44 名参与者（FEV，预测值的 33±13%）中，有 19 名身体虚弱。与非虚弱个体相比，虚弱个体的日常步数、运动耐量和功能能力较低，疲劳、焦虑和抑郁症状评分较高（p<0.05）。SPPB 和 TUG 对身体虚弱的筛查没有可接受的检测准确性。PCA 表明，步速是身体虚弱 Fried 总评分的主要贡献者。
身体虚弱影响开始家庭干预的慢性呼吸衰竭的 COPD 患者的很大一部分，并且与更差的临床状况相关。尽管目前的结果需要通过充分的功率研究来证实，但步速似乎有可能成为该人群身体虚弱的简单筛查工具。
