"Relevancia de las pruebas de la batería denominada ""Short Physical Performance Battery"" en la identificación de discapacidades en pacientes con EPOC"

Resumo

THESIS ABSTRACT OBJECTIVES 1. To evaluate the interobserver reliability of the Short Physical Performance Battery (SPPB), its 3 components, and hand dynamometry when measuring isometric muscle strength by pulmonary physicians and physical therapists, in people with chronic obstructive pulmonary disease (COPD).? 2. To determine the clinical validity of the SPPB for identifying mobility limitations in this patients. 3. To assess whether any component of the SPPB might be equivalent to the full test battery in terms of clinical validity and value for identifying limitations in mobility. 4. To identify whether both the 4 meters gait speed (4MGS) and 5 sit-to-stand (5STS) tests could be used as diagnostic markers of a poor 6 minutes walking test (6MWT) performance (<350) in patients with COPD. 5. To analyze the relevance of both tests, 4MGS and 5STS, as clinical determinants of a poor 6MWT performance, after adjustment for other clinical determinants. METHODS A cross-sectional study was devised. Patients with stable COPD were prospectively recruited from an outpatient pulmonary service at Meseguer Hospital in Murcia. During a 1-year period, a consecutive sample of 137 patients was identifed from patient health examinations. A pulmonary physician assessed the eligibility criteria for recruitment. A total of 30 of them participated in the reliability study and completed the SPPB, its components and other measures of muscular function and exercise tolerance. Each patient was assessed by a pulmonology physician and a physical therapist in 2 separate sessions. Each rater was blinded to the other&apos;s results.?Then, all patients performed the 6MWT and were surveyed for self- reported mobility limitations and other covariates and clinical determinants of poor exercise tolerance. The validity of SPPB was analyzed by developing receiver operating characteristic curves to determinate the sensitivity and specificity for identifying patients with mobility limitations; by examining group differences in SPPB scores across categories of mobility activities; and by correlating SPPB scores to strength tests. Patients completed the 4MGS and 5STS tests, with quantitative (in seconds) and qualitative ordinal data collected. The following potential covariates and clinical determinants of poor 6MWT were collated: age, quadriceps muscle-strength, health status, dyspnea, depression, and airflow limitation. Area under the ROC curve data was used to assess accuracy as clinical markers, with logistic regression used to explore relevance as clinical determinants of a poor 6MWT performance. CONCLUSIONS 1. Interobserver reliability was good for quadriceps and handgrip dynamometry and for the SPPB summary score and its chair stand and gait speed subscales. Both pulmonary physicians and physical therapists can obtain and exchange the scores. Because the reliability of the balance subscale was questionable, it is better to use the SPPB summary score.? 2. This study provided evidence for the validity of the SPPB summary score and the five-repetition sit-to-stand test for assessing mobility in patients with COPD. 3. Our results showed that these tests had equivalent potential as screening tools for identifying patients with mobility limitations. 4. The present study shows that 5STS scores can be used as a robust clinical determinant of a poor 6MWT, specially when measured using ordinal data. The 4MGS test score is also a good marker when measured using continuous data. Covariate effects on accuracy were only relevant for the 4MGS test, when measured using ordinal data. 5. 5STS test score, unlike 4MGS, is a strong clinical determinant of a poor exercise tolerance in patients with COPD.