Aline Almeida Gulart1, Anelise Bauer Munari2, Isabela Júlia Cristiana Santos Silva3, Hellen Fontão Alexandre4, Manuela Karloh5, Anamaria Fleig Mayer6. 1. 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. Electronic address: aline.gulart@hotmail.com. 2. 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. Electronic address: anelisebauer@gmail.com. 3. Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil. Electronic address: isabelajuliaa@gmail.com. 4. Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil. Electronic address: hellenalexandre@hotmail.com. 5. Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil. Electronic address: manukarloh@gmail.com. 6. 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; Programa de Pós Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil. Electronic address: anamaria.mayer@udesc.br.
Abstract
BACKGROUND: 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. AIMS: 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. METHODS: Fifty-three patients with COPD (FEV1: 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. RESULTS: The MID achievers presented lower FEV1, 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 (R2: 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. CONCLUSION: 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.
BACKGROUND: 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. AIMS: 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. METHODS: Fifty-three patients with COPD (FEV1: 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. RESULTS: The MID achievers presented lower FEV1, 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 (R2: 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. CONCLUSION: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.