Measurement of Functional Ability in Patients with Coronary Artery Disease

Abstract

The purpose of this study was to examine measures of functional ability in a group (n=60) of cardiac patients undergoing treadmill exercise tests. Functional ability was defined as the degree to which the individual is able to perform physical activity in the absence of symptoms. Instruments used were the Modified Harvard Alumni Scale (MHAS), the Symptom Scale (SS) comprised of the following subscales: angina (AS), shortness of breath (SOBS), and fatigue (FS); the overall Health Rating Index (OHRI); and the Goldman Specific Activity Scale (SAS). Concurrent validity was supported by the fact that the instruments were correlated with metabolic equivalents achieved on the treadmill. Correlations were: MHAS (r=.34, P<.01), SS (r= -.67, p<.01), AS (r= -.54, p<.01), SOBS (r= -.41, p<.05), FS (r= -.56, P<.001) and the OHRI (r=.45, p<.001). Reliability was determined using Cronbachs, alpha and were: SS= .92, AS=.87, SOBS=.86, FS=.85 and OHRI=.88. Findings support the need for testing and evaluation of instruments measuring functional ability in diverse cardiovascular populations.

Measurement of breathlessness in clinical trials in patients with chronic heart failure: the need for a standardized approach: a systematic review

“…Most are multi‐dimensional, measuring different aspects of the experience of breathlessness as well as severity. Some of the multi‐dimensional measurements assess breathlessness from any aetiology, while others are designed as disease‐specific tools ( Table ) 5–22. Fewer tools are uni‐dimensional, measuring severity of breathlessness only.…”

Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures

“…of language versions Yes Internal consistency Reproducibility Criterion validity Construct validity 2 Herlitz J., 1988 [ 100 ] Cardiac follow-up questionnaire a - to assess rehospitalization, bypass surgery, smoking habits, working situation, symptoms of chest pain and dyspnea, and medication 5 years after reporting chest pain ? Swedish No 3 Keresztes P, 1993 [ 30 ] Symptoms scale a SS “to assess level of angina, shortness of breath, fatigue, and the extent to which the symptoms interfere with overall functional ability” 4 Angina Shortness of breath Fatigue English (USA) No Internal consistency Construct validity 4 Artinian NT, 1993 [ 31 ] Symptoms Inventory a - “to measure cardiac surgery-specific recovery” 20 English (UK) No Internal consistency 5 Plach SK, 2001 [ 32 ] Cardiac Symptom Scale ac CSS “to measure the frequency of physical symptoms that may occur following a cardiac procedure such as angioplasty or heart surgery” 8 English (UK) No Internal consistency Content validity Construct validity 6 …”

“…Almost 40 years of research have documented substantial limitations in the CCS classification system [26,27]: the data collectively suggest a need for more consistent, systematic, and accurate means to quantify the frequency and burden of angina from the patient's perspective. In this sense, 12 symptoms [28][29][30][31][32][33][34][35][36][37][38][39] and 3 functional status instruments [40][41][42] have been developed, but only 5 symptoms and 2 functional status scales have been used in the last 10 years. This is probably the consequence of some of them having been established as "gold standards" and used consistently due to the accumulated evidence of well-established validity, reproducibility, prognostic importance, and sensitivity to clinical change [25].…”