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Phenotypic Characteristics of Patients With Chronic Obstructive Pulmonary Disease After Stratification for the Short Physical Performance Battery Summary Score

      Abstract

      Objective

      To assess the phenotypic characteristics of patients with chronic obstructive pulmonary disease (COPD) after stratification for Short Physical Performance Battery (SPPB) summary scores and to determine phenotypic characteristics of the SPPB summary score at the start of pulmonary rehabilitation (PR).

      Design

      Retrospective, cross-sectional.

      Setting

      Baseline assessment for PR program.

      Participants

      Patients with COPD (n=900; age 65±8y, 52% male, forced expiratory volume in the first second of expiration, 43% [interquartile range, 31%-62%] predicted).

      Interventions

      Not applicable.

      Main Outcome Measures

      Patients were stratified according to their SPPB summary scores into low-performance (LP), moderate-performance (MP), or high-performance (HP) groups. Furthermore, lung function, arterial blood gases, body composition, physical capacity, lower limb muscle strength and endurance, and symptoms of anxiety and depression were assessed.

      Results

      Generally, physical capacity and muscle function were lower and scores for symptoms of anxiety and depression were higher in LP patients than MP and HP patients (all values, P<.01). However, 25% of HP patients with COPD scored high on symptoms of anxiety and/or depression (≥10 points), and HP patients still had on average an impaired physical capacity (median, 6-minute walk test [6MWT] distance of 69% predicted). Furthermore, age and 6MWT distance (m) were the only independent predictors in a multivariate regression model, explaining 29% of the variance in SPPB summary score.

      Conclusions

      In COPD, LP patients have the worst physical and emotional functioning. However, HP patients can still exhibit physical and emotional impairments. Because the explained variance in SPPB summary score is low, SPPB should not be considered as a test to discriminate between patients with COPD with a low or preserved physical capacity and emotional status.

      Keywords

      List of abbreviations:

      CAT (COPD Assessment Test), COPD (chronic obstructive pulmonary disease), CWRT (constant work rate test), FFM (fat-free mass), 5STS (5-repetition sit-to-stand), 4MGS (4-m gait speed), GOLD (Global Initiative for Chronic Obstructive Lung Disease), HP (high-performance), LP (low-performance), mMRC (modified Medical Research Council), MP (moderate-performance), PR (pulmonary rehabilitation), 6MWT (6-minute walk test), SPPB (Short Physical Performance Battery), Wmax (maximal workload)
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      References

        • Lopez-Campos J.L.
        • Soler-Cataluna J.J.
        • Miravitlles M.
        Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2019 report: future challenges.
        Arch Bronconeumol. 2020; 56: 65-67
        • Wouters E.F.
        Chronic obstructive pulmonary disease. 5: systemic effects of COPD.
        Thorax. 2002; 57: 1067-1070
        • Chatila W.M.
        • Thomashow B.M.
        • Minai O.A.
        • Criner G.J.
        • Make B.J.
        Comorbidities in chronic obstructive pulmonary disease.
        Proc Am Thorac Soc. 2008; 5: 549-555
        • Vanfleteren L.
        • Spruit M.A.
        • Wouters E.F.M.
        • Franssen F.M.E.
        Management of chronic obstructive pulmonary disease beyond the lungs.
        Lancet Respir Med. 2016; 4: 911-924
        • Ozge A.
        • Atis S.
        • Sevim S.
        Subclinical peripheral neuropathy associated with chronic obstructive pulmonary disease.
        Electromyogr Clin Neurophysiol. 2001; 41: 185-191
        • Beauchamp M.K.
        • Hill K.
        • Goldstein R.S.
        • Janaudis-Ferreira T.
        • Brooks D.
        Impairments in balance discriminate fallers from non-fallers in COPD.
        Respir Med. 2009; 103: 1885-1891
        • Katz P.P.
        • Gregorich S.
        • Eisner M.
        • et al.
        Disability in valued life activities among individuals with COPD and other respiratory conditions.
        J Cardiopulm Rehabil Prev. 2010; 30: 126-136
        • Bernabeu-Mora R.
        • Medina-Mirapeix F.
        • Llamazares-Herran E.
        • Garcia-Guillamon G.
        • Gimenez-Gimenez L.M.
        • Sanchez-Nieto J.M.
        The Short Physical Performance Battery is a discriminative tool for identifying patients with COPD at risk of disability.
        Int J Chron Obstruct Pulmon Dis. 2015; 10: 2619-2626
        • Crisan A.F.
        • Oancea C.
        • Timar B.
        • Fira-Mladinescu O.
        • Tudorache V.
        Balance impairment in patients with COPD.
        PLoS One. 2015; 10e0120573
        • Eisner M.D.
        • Iribarren C.
        • Blanc P.D.
        • et al.
        Development of disability in chronic obstructive pulmonary disease: beyond lung function.
        Thorax. 2011; 66: 108-114
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • Salive M.E.
        • Wallace R.B.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Studenski S.
        • Perera S.
        • Wallace D.
        • et al.
        Physical performance measures in the clinical setting.
        J Am Geriatr Soc. 2003; 51: 314-322
      1. European Medicines Agency. Reflection paper on physical frailty: instruments for baseline characterisation of older populations in clinical trials. EMA/CHMP/778709/2015. 2018. Available at: https://www.ema.europa.eu/en/physical-frailty-instruments-baseline-characterisation-older-populations-clinical-trials. Accessed November 15, 2019.

        • Volpato S.
        • Cavalieri M.
        • Sioulis F.
        • et al.
        Predictive value of the Short Physical Performance Battery following hospitalization in older patients.
        J Gerontol A Biol Sci Med Sci. 2011; 66: 89-96
        • Patel M.S.
        • Mohan D.
        • Andersson Y.M.
        • et al.
        Phenotypic characteristics associated with reduced short physical performance battery score in COPD.
        Chest. 2014; 145: 1016-1024
        • Mohan D.
        • Benson V.S.
        • Allinder M.
        • et al.
        Short Physical Performance Battery: what does each sub-test measure in patients with chronic obstructive pulmonary disease?.
        Chronic Obstr Pulm Dis. 2020; 7: 13-25
        • Miravitlles M.
        • Murio C.
        • Tirado-Conde G.
        • et al.
        Geographic differences in clinical characteristics and management of COPD: the EPOCA study.
        Int J Chron Obstruct Pulmon Dis. 2008; 3: 803-814
        • Cleutjens F.
        • Spruit M.A.
        • Ponds R.
        • et al.
        Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease.
        Chron Respir Dis. 2018; 15: 91-102
        • Lenze E.J.
        • Schulz R.
        • Martire L.M.
        • et al.
        The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study.
        J Am Geriatr Soc. 2005; 53: 569-575
        • Stuck A.E.
        • Walthert J.M.
        • Nikolaus T.
        • Bula C.J.
        • Hohmann C.
        • Beck J.C.
        Risk factors for functional status decline in community-living elderly people: a systematic literature review.
        Soc Sci Med. 1999; 48: 445-469
        • Spruit M.A.
        • Vanderhoven-Augustin I.
        • Janssen P.P.
        • Wouters E.F.
        Integration of pulmonary rehabilitation in COPD.
        Lancet. 2008; 371: 12-13
        • Bestall J.C.
        • Paul E.A.
        • Garrod R.
        • Garnham R.
        • Jones P.W.
        • Wedzicha J.A.
        Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease.
        Thorax. 1999; 54: 581-586
        • Jones P.W.
        • Harding G.
        • Berry P.
        • Wiklund I.
        • Chen W.H.
        • Kline Leidy N.
        Development and first validation of the COPD Assessment Test.
        Eur Respir J. 2009; 34: 648-654
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Jones P.W.
        • Tabberer M.
        • Chen W.H.
        Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT) scores.
        BMC Pulm Med. 2011; 11: 42
        • Smid D.E.
        • Franssen F.M.E.
        • Gonik M.
        • et al.
        Redefining cut-points for high symptom burden of the global initiative for chronic obstructive lung disease classification in 18,577 patients with chronic obstructive pulmonary disease.
        J Am Med Dir Assoc. 2017; 18: 1097
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-94
        • Global Initiative for Chronic Obstructive Lung Disease
        Pocket guide to COPD diagnosis, management, and prevention: a guide for health care professionals, 2017 report.
        (Available at:)
        • Quanjer P.H.
        • Tammeling G.J.
        • Cotes J.E.
        • Pedersen O.F.
        • Peslin R.
        • Yernault J.C.
        Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official statement of the European Respiratory Society.
        Eur Respir J Suppl. 1993; 16: 5-40
        • Coin A.
        • Sergi G.
        • Minicuci N.
        • et al.
        Fat-free mass and fat mass reference values by dual-energy x-ray absorptiometry (DEXA) in a 20-80 year-old Italian population.
        Clin Nutr. 2008; 27: 87-94
        • Internation Diabetes Federation
        The IDF consensus worldwide definition of the metabolic syndrome.
        International Diabetes Federation (IDF). 2006; (Available at: https://www.idf.org/component/attachments/attachments.html?id=705&task=download. Accessed November 04, 2019): 11
        • Holland A.E.
        • Spruit M.A.
        • Troosters T.
        • et al.
        An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.
        Eur Respir J. 2014; 44: 1428-1446
        • Hernandes N.A.
        • Wouters E.F.
        • Meijer K.
        • Annegarn J.
        • Pitta F.
        • Spruit M.A.
        Reproducibility of 6-minute walking test in patients with COPD.
        Eur Respir J. 2011; 38: 261-267
        • Troosters T.
        • Gosselink R.
        • Decramer M.
        Six minute walking distance in healthy elderly subjects.
        Eur Respir J. 1999; 14: 270-274
        • Spruit M.A.
        • Polkey M.I.
        • Celli B.
        • et al.
        Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease.
        J Am Med Dir Assoc. 2012; 13: 291-297
        • Radtke T.
        • Crook S.
        • Kaltsakas G.
        • et al.
        ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases.
        Eur Respir Rev. 2019; 28: 180101
        • Jones N.L.
        • Makrides L.
        • Hitchcock C.
        • Chypchar T.
        • McCartney N.
        Normal standards for an incremental progressive cycle ergometer test.
        Am Rev Respir Dis. 1985; 131: 700-708
        • van 't Hul A.
        • Gosselink R.
        • Kwakkel G.
        Constant-load cycle endurance performance: test-retest reliability and validity in patients with COPD.
        J Cardiopulm Rehabil. 2003; 23: 143-150
        • Borges O.
        Isometric and isokinetic knee extension and flexion torque in men and women aged 20–70.
        Scand J Rehab Med. 1989; 21: 45-53
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
        • Bernabeu-Mora R.
        • Gimenez-Gimenez L.M.
        • Montilla-Herrador J.
        • Garcia-Guillamon G.
        • Garcia-Vidal J.A.
        • Medina-Mirapeix F.
        Determinants of each domain of the Short Physical Performance Battery in COPD.
        Int J Chron Obstruct Pulmon Dis. 2017; 12: 2539-2544
        • Larsson P.
        • Borge C.R.
        • Nygren-Bonnier M.
        • Lerdal A.
        • Edvardsen A.
        An evaluation of the Short Physical Performance Battery following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.
        BMC Res Notes. 2018; 11: 348
        • Ozalevli S.
        • Ozden A.
        • Itil O.
        • Akkoclu A.
        Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease.
        Respir Med. 2007; 101: 286-293
        • Eisner M.D.
        • Iribarren C.
        • Yelin E.H.
        • et al.
        Pulmonary function and the risk of functional limitation in chronic obstructive pulmonary disease.
        Am J Epidemiol. 2008; 167: 1090-1101
        • McIntosh E.I.
        • Smale K.B.
        • Vallis L.A.
        Predicting fat-free mass index and sarcopenia: a pilot study in community-dwelling older adults.
        Age (Dordr). 2013; 35: 2423-2434
        • Mainenti M.R.
        • Rodrigues Ede C.
        • Oliveira J.F.
        • Ferreira Ade S.
        • Dias C.M.
        • Silva A.L.
        Adiposity and postural balance control: correlations between bioelectrical impedance and stabilometric signals in elderly Brazilian women.
        Clinics (Sao Paulo). 2011; 66: 1513-1518
        • Janssen I.
        • Heymsfield S.B.
        • Ross R.
        Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability.
        J Am Geriatr Soc. 2002; 50: 889-896
        • World Health Organization
        International classification of functioning, disability, and health.
        World Health Organization, Geneva, Switzerland2002
        • van de Ven-Stevens L.A.
        • Graff M.J.
        • Peters M.A.
        • van der Linde H.
        • Geurts A.C.
        Construct validity of the canadian occupational performance measure in participants with tendon injury and Dupuytren disease.
        Phys Ther. 2015; 95: 750-757
        • Mathiowetz V.
        • Weber K.
        • Volland G.
        • Kashman N.
        Reliability and validity of grip and pinch strength evaluations.
        J Hand Surg Am. 1984; 9: 222-226
        • Curtis M.
        • Kon S.
        • Canavan J.
        • et al.
        The minimum important difference of the hospital anxiety and depression scale in COPD.
        Eur Respir J. 2014; 44: 4829
        • Maurer J.
        • Rebbapragada V.
        • Borson S.
        • et al.
        Anxiety and depression in COPD: current understanding, unanswered questions, and research needs.
        Chest. 2008; 134: 43S-56S
        • Rubenstein L.Z.
        • Josephson K.R.
        Falls and their prevention in elderly people: what does the evidence show?.
        Med Clin North Am. 2006; 90: 807-824
        • Anderson E.
        • Shivakumar G.
        Effects of exercise and physical activity on anxiety.
        Front Psychiatry. 2013; 4: 27