Functional Status and Quality of Life in Chronic Obstructive Pulmonary Disease
Section snippets
Definitions and concepts of functional status and health-related quality of life
“Functional status” is a term often used to refer to the level of involvement in activities and is often synonymous with the performance of ADLs. Functional status has also been used to describe other elements of function, such as physiologic (spirometry), exercise (walk tests), psychologic, or social function. For our discussion, functional status will be used to refer to participation in ADLs.1 QOL has been defined as “a holistic, self-determined evaluation of satisfaction with issues
Methods of functional status assessment in chronic obstructive pulmonary disease
Functional status, or activity limitation, in COPD is most commonly assessed in clinical research with self-report questionnaires or by monitoring activity with devices such as pedometers or triaxial accelerometers.
The Pulmonary Functional Status Scale (PFSS)11 and the long and short version of the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ)12 are 2 COPD-specific functional status questionnaires. The functional activities domain of the PFSS includes subscores for self-care,
Methods of health-related quality of life measurement in chronic obstructive pulmonary disease
HRQOL can be measured using standardized and validated questionnaires that address common issues experienced by patients. Most HRQOL questionnaires are multidimensional, often covering symptom, physical, psychologic, and social domains. The ideal instrument should be both discriminative—able to separate individuals with differing degrees of impairment—and evaluative—able to detect small changes following therapy or over time. HRQOL assessment provides an estimate of the global effect of a
Case study
The following case is included to underscore the value of assessing respiratory symptoms (e.g., dyspnea), functional status, and HRQOL in the workup of COPD. Additionally, it will serve to highlight how these important health variables may show change after a strong therapeutic intervention, pulmonary rehabilitation.
A 65-year-old man was referred to outpatient pulmonary rehabilitation because of persistent exertional dyspnea despite optimized pharmacologic therapy. He had a history of asthma in
Summary
Symptoms and functional status limitations are major contributors to HRQOL in COPD. Assessment in these areas using standardized questionnaires in clinical trials is useful in determining the overall effectiveness of a particular intervention. The usefulness of questionnaires in the clinical setting remains to be determined and their routine use is often impractical. However, the one-on-one clinical evaluation should (and often does) informally incorporate elements of symptom evaluation,
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