Association between patient-reported outcomes and exercise test outcomes in patients with COPD before and after pulmonary rehabilitation

Abstract

Background: Over the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR). Methods: Correlations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory-and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR. Results: Overall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (ρ:-0.65; p<0.001). HRQoL related PROs showed weak correlations with exercise outcomes at baseline. Moderate correlations were found between St George's Respiratory Questionnaire total score and 6MWD (r:-0.53; p<0.001) and maximal workload achieved during cardiopulmonary exercise testing (ρ:-0.48; p<0.001); and between Clinical COPD Questionnaire (CCQ) total score and 6MWD (r:-0.48; p<0.001) and maximal workload (ρ:-0.43; p<0.001). When significant, correlations between changes in exercise test outcomes and changes in PROs after PR were generally very weak or weak. The highest correlation was found between changes in CCQ total score and changes in 6MWD (ρ: − 0.36; p<0.001).

Provision of pulmonary rehabilitation in Latin America 18 months after the COVID-19 pandemic: A survey of the Latin American Thoracic Association

“… 6 This symptom, and dyspnoea, are two of the main outcomes of interest to the patient (PROMs) 26 and should be used to complement the results of other evaluations used in PR programmes, such as exercise tests. 27 However, and clarifying that it was not an objective of this paper to measure the use of spirometry in other chronic lung diseases, its use is scarce, especially considering that spirometry is a diagnostic test in COPD and asthma, its inclusion is imperative, within the initial evaluation protocols.…”

Enhance Access to Pulmonary Rehabilitation with a Structured and Personalized Home-Based Program—reabilitAR: Protocol for Real-World Setting

“…Traditionally, the assessment of the patients in the hospital-based programs is only based on two domains (body functions and structures, and activities) with laboratory-based tests and exercise test outcomes, that need to be performed in a standardized environment. However, their assessments are not always representative of patients’ functional capacity and true ability to fulfill their social roles in the real-life situations [ 37 , 54 ]. The home-based approach is, in fact, an important opportunity to add a direct observation and intervention of daily life activities in patients’ real environment supported by functional measurements.…”

Effects of a Home-Based Pulmonary Rehabilitation Program in Patients with Chronic Obstructive Pulmonary Disease in GOLD B Group: A Pilot Study

“…Despite the importance of improvements in exercise capacity, according to Meys and colleagues, improvement in exercise test outcomes obtained after PR do not necessarily result in alterations in PROMs in patients with COPD [ 48 ]. In fact, functional measurements to assess functional capacity are more recommended, which may better reflect the individual PROM improvements and thus provide a more detailed assessment of the effectiveness of PR programs [ 48 ]. This recommendation is especially important in the home setting because it gives an opportunity for direct and thorough analysis of patients’ true ability to fulfill their social roles in real-life situations [ 49 , 50 ].…”