Original Study
Problematic Activities of Daily Life are Weakly Associated With Clinical Characteristics in COPD

https://doi.org/10.1016/j.jamda.2011.01.002Get rights and content

Abstract

Background

Problematic activities of daily life (ADLs) can be the main reason to refer patients with chronic obstructive pulmonary disease (COPD) for pulmonary rehabilitation. To date, information on problematic ADLs and their clinical correlates in COPD remain scarce. This retrospective chart review aimed to identify the most prevalent self-reported problematic ADLs in COPD patients, determine performance and satisfaction scores of these problematic ADLs, and explore the association between 13 clinical determinants and 4 problematic ADL domains.

Methods

A total of 820 COPD patients entering pulmonary rehabilitation assessment were included in this retrospective study. Self-reported problematic ADLs were assessed using the Canadian Occupational Performance Measure, administered by occupational therapists in the form of a semistructured interview.

Results

COPD patients (59% male, age 63.6 ± 9.3 years, FEV1 (%pred): 46.4 ± 18.4) reported 2999 problematic ADLs. The most prevalent problematic ADLs were walking (68%), stair climbing (35%), and cycling (30%). Moreover, 30% of the patients reported “not able to do any of the scored problematic ADL” and 44% were “not satisfied at all with the performance of any of the scored problematic ADL.” Significant but weak associations were found between clinical determinants (eg, physical and psychosocial) and problematic ADLs.

Conclusions

The lack of a strong association between problematic ADLs and clinical determinants emphasizes the need for individualized assessment of these ADLs to allow tailored intervention.

Section snippets

Participants

Data were extracted from the records of 1102 clinically stable patients with the diagnosis of “COPD” who were evaluated at CIRO+, a center of excellence for chronic organ failure in Horn (the Netherlands), for rehabilitation eligibility between January 1, 2005, and April 1, 2009. Of these records, 820 met the following inclusion criteria: all necessary data present, a forced expiratory (FEV1)/forced vital capacity (FVC) ratio of 0.7 or less, and not representing a repeat admission for the same

Patients’ Characteristics

The current cohort consisted mostly of elderly male COPD patients, with generally a normal body composition, and a poor functional exercise performance. About one-third of the patients used a walking aid. As expected, patients in GOLD stage 4 had the worst mean 6-minute walking distance, also after correction for confounding variables, like height, body weight, age, and sex.25 Furthermore, mean SGRQtotal scores were significantly higher (= worse) among GOLD 4 patients (Table 1).

Problematic ADLs

A total of 820

Discussion

This is the most comprehensive evaluation of problematic ADLs in COPD patients to date, in which a staggering range of 2999 problematic ADLs were reported. Walking was the most prevalent problematic ADL independent of age, sex, or GOLD stage. Moreover, a huge proportion of patients were not satisfied at all with 1 or more problematic ADLs. Known clinical determinants of ADLs in COPD patients were only weakly associated with performance and satisfaction scores of problematic ADLs in the current

Acknowledgments

Paul Willems of Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism, and Suzanne Goossens, Mieke Kersten, Michelle van Mook and Malou Lammers of the Department of Occupational Therapy, Zuyd University, Heerlen, Netherlands, are gratefully acknowledged for their help with electronic data processing.

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    The CIRO+ Rehabilitation Network consists of CIRO+, Horn (NL), St. Laurentius Hospital, Roermond (NL), St. Jans gasthuis, Weert (NL), St Anna Hospital, Geldrop (NL), Elkerliek Hospital, Helmond (NL), Maxima Medical Centre, Veldhoven (NL), and Maastricht University Medical Centre, Maastricht (NL).

    The authors report no conflicts of interest.

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