Minimum Clinically Important Difference in 30-s Sit-to-Stand Test After Pulmonary Rehabilitation in Subjects With COPD

被引:60
作者
Zanini, Andrea [1 ]
Crisafulli, Ernesto [2 ]
D'Andria, Michele [3 ]
Gregorini, Cristina [3 ]
Cherubino, Francesca [4 ]
Zampogna, Elisabetta [4 ]
Azzola, Andrea [5 ]
Spanevello, Antonio [6 ]
Schiavone, Nicola [1 ]
Chetta, Alfredo [2 ]
机构
[1] Ente Osped Cantonale, Clin Rehabil, Pulm Rehabil, Novaggio, Switzerland
[2] Univ Parma, Resp Dis & Lung Funct Unit, Dept Med & Surg, Parma, Italy
[3] Osped Malcantonese, Div Gen Med, Castelrotto, Switzerland
[4] IRCCS, Div Pulm Rehabil, Ist Clin Sci Maugeri, Tradate, Italy
[5] Ente Osped Cantonale, Pulmonol Serv, Dept Internal Med, Lugano, Switzerland
[6] Univ Insubria, Dept Med & Surg, Resp Dis, Varese Como, Italy
关键词
COPD; sit-to-stand test; minimum clinically important difference; pulmonary rehabilitation; physical ability; diffusing lung capacity; REFERENCE VALUES; FUNCTIONAL PERFORMANCE; STRENGTH; DISEASE; RESISTANCE; STATEMENT; WEAKNESS;
D O I
10.4187/respcare.06694
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: The sit-to-stand (STS) test is a feasible tool for measuring peripheral muscle strength of the lower limbs. There is evidence of increasing use of STS tests in patients with COPD. We sought to evaluate in subjects with COPD the minimum clinically important difference in 30-s STS test after pulmonary rehabilitation. METHODS: Stable COPD subjects undergoing a 30-s STS test and a 6-min walk test (6MWT) before and after pulmonary rehabilitation were included. Responsiveness to pulmonary rehabilitation was determined by the change in 30-s STS test results (Delta 30-s STS) before and after pulmonary rehabilitation. The minimum clinically important difference was evaluated using an anchor-based method. RESULTS: 96 subjects with moderate-to-severe COPD were included. At baseline, 30-s STS test results were significantly related to distance covered in a 6MWT (6MWD) (r = 0.65, P < .001), FVC (r = 0.46, P <.001), P-aCO2 (r = -0.42, P < .001), FEV1 (r = 0.39, P <.001), and age (r = -0.31, P = .002). After pulmonary rehabilitation, a significant improvement in 30-s STS test results was observed (mean difference +2 repetitions, P < .001). The Delta 30-s STS was positively related to Delta 6MWD (r = 0.62, P < .001), transitional dyspnea index (r = 0.67, P <.001), and baseline residual volume (r = 0.27, P = .007). The receiver operating characteristic curves method identified a Delta 30-s STS cut-off of 2 repetitions as the best discriminating value (area under the curve: 0.892, P <.001) to identify the minimum clinically important difference for Delta 6MWD (30 m). In a multivariate logistic regression model, baseline 30-s STS (odds ratio 2.63; 95% CI 1.09-6.35, P = .031) and diffusing capacity of the lung for carbon monoxide (< 53% predicted) (odds ratio 2.49, 95% CI 1.04 -5.98, P = .041) predict the risk to have a Delta 30-s STS >= 2 repetitions. CONCLUSIONS: Our study indicates that in stable subjects with moderate-to-severe COPD, the 30-s STS test was a sensitive tool to assess the efficacy of pulmonary rehabilitation. A Delta 30-s STS of >= 2 repetitions represented the minimum clinically important difference, which may be predicted by the baseline ability in the 30-s STS test and lung function in terms of diffusing lung capacity.
引用
收藏
页码:1261 / 1269
页数:9
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