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

Abstract

IntroductionHospitalised 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.MethodsA 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.Results13 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.ConclusionMeasurement 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.

Development of a performance-based toolkit of the treatable traits of functioning in hospitalised patients with exacerbation of COPD: a survey-based study protocol

“…[ 20 ], with categories taken from International Classification of Functioning, Disability and Health (ICF) definitions [ 14 ] and L eonardi et al . [ 22 ]. ECOPD: exacerbation of COPD.…”

“…A third part will ask participants to rate the degree of relevance of the treatable traits to be assessed in hospitalised patients with ECOPD, using ICF codes and definitions. Treatable traits were chosen according to the functioning categories of the ICF framework ( figure 1 ) and a systematic review carried out previously by L eonardi et al [ 22 ]. Participants will be asked to rate each treatable trait on a scale from 0 to 10, when 0 is “not relevant at all” and 10 is “extremely relevant” ( supplementary material box S1 ).…”

“…The interview will be prepared in Portuguese using closed questions and will be saved in the REDCap electronic data capture tools hosted at EBSERH, Brazil. The interview will elicit data on: characterisation measures; history of previous exacerbations; dyspnoea, using the modified Medical [20], with categories taken from International Classification of Functioning, Disability and Health (ICF) definitions [14] and LEONARDI et al [22]. ECOPD: exacerbation of COPD.…”

“…The systematic review by LEONARDI et al [22] conducted following COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations [23][24][25], summarises the performance-based measures applied in hospitalised patients with ECOPD, with measurement properties tested to this population. The findings from the review will be used to recommend the markers that have already been tested for this specific population to make up the performance-based toolkit.…”

“…FIGURE 1Performance-based toolkit development process based on DE VET et al[20], with categories taken from International Classification of Functioning, Disability and Health (ICF) definitions[14] and LEONARDI et al[22]. ECOPD: exacerbation of COPD.…”