Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties

Naiara Tais Leonardi; Débora Mayumi Oliveira Kawakami; John R Hurst; Joana Cruz; Renata Gonçalves Mendes

doi:10.1183/16000617.0013-2023

Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties

Eur Respir Rev. 2023 Jul 12;32(169):230013. doi: 10.1183/16000617.0013-2023. Print 2023 Sep 30.

Authors

Naiara Tais Leonardi¹, Débora Mayumi Oliveira Kawakami¹, John R Hurst², Joana Cruz³, Renata Gonçalves Mendes⁴

Affiliations

¹ Department of Physical Therapy, Federal University of Sao Carlos, São Paulo, Brazil.
² UCL Respiratory, University College London, London, UK.
³ School of Health Sciences of the Polytechnic of Leiria, Leiria, Portugal.
⁴ Department of Physical Therapy, Federal University of Sao Carlos, São Paulo, Brazil renatamendes@ufscar.br.

Abstract

Introduction: Hospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD.

Methods: A systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach.

Results: 13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties.

Conclusion: Measurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management.

Publication types

Systematic Review
Review

MeSH terms

Consensus
Hand Strength*
Humans
Patients
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / therapy
Reproducibility of Results