Systematic review of the association between exercise tests and patient-reported outcomes in patients with chronic obstructive pulmonary disease

Abstract

Introduction Chronic obstructive pulmonary disease (COPD) is an increasingly common cause of death worldwide. Its cardinal symptoms include breathlessness and severely reduced exercise capacity. Several patient-reported outcome (PRO) measures are used to assess health-related quality of life (HRQoL), functional performance, and breathlessness in patients with COPD. Exercise testing is employed to measure functional performance objectively, which is generally believed to impact on overall HRQoL. However, the extent to which commonly used laboratory- and field-based exercise test results correlate with PROs has not been systematically assessed. Materials and methods A search of Embase, MedLine, and the Cochrane Library identified primary publications in English that reported data on the correlations (Pearson’s r or Spearman’s ρ ) between the outcomes of exercise tests and HRQoL and breathlessness PROs. Studies reporting on the following tests were included: 6-minute walk test (6MWT), 12MWT, incremental and endurance shuttle walk tests, incremental and endurance cycle ergometer tests, and treadmill tests. Results Of 3,205 articles screened, 28 were deemed eligible for inclusion. The most commonly reported HRQoL PRO measure was the St George’s Respiratory Questionnaire (13 studies), and the most commonly reported breathlessness PRO measure was the Baseline Dyspnea Index (six studies). The St George’s Respiratory Questionnaire appears to correlate very weakly to moderately with the 6MWT, and breathlessness PROs appear to be moderately to strongly associated with 6MWT outcomes. Across all studies, the 6MWT was the most commonly reported exercise test. Very few publications reporting associations between other exercise tests and PRO measures were found. Conclusion This review found evidence to support the association of 6MWT outcomes with HRQoL and breathlessness PROs. There were limited data showing correlations with the outcomes of other exercise tests. Further work is required to examine the associations between these PROs and exercise test outcomes.

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

“…Punekar and colleagues systematically reviewed the strength of the available evidence supporting correlations between the outcomes of different exercise tests and PROs most commonly used to assess HRQoL and dyspnea [11]. They concluded that only a limited amount of studies have focused on the correlations between exercise test outcomes and PROs in patients with COPD.…”

“…The available evidence indicates a very weak to moderate negative correlation between 6-min walking distance (6MWD) and HRQoL, measured with the St. George's Respiratory Questionnaire (SGRQ). The relationship between PROs for dyspnea and 6MWD showed contrasting results, with both moderate to strong positive and negative correlations being reported [11]. So, it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD.…”

Review of Drug Development Guidance to Treat Chronic Obstructive Pulmonary Disease: US and EU Perspectives

“…demonstrated that although oxygen kinetic factors were altered in patients with COPD compared with healthy controls, these factors did not correlate with clinical outcomes, such as time to hospitalization and/or death. Furthermore, a recent meta‐analysis comparing exercise capacity tests to COPD PROs, such as the SGRQ, found significant yet weak‐to‐moderate associations . It should be noted that the meta‐analysis results were obtained from 13 studies reporting associations between the 6MWT and the SGRQ PRO, with the majority of studies having relatively small sample sizes across a spectrum of the disease.…”

European Respiratory Society International Congress, Madrid, 2019: nontuberculous mycobacterial pulmonary disease highlights

“…From a clinical trial perspective, end-points that have an impact on patients' lives, including functional outcomes that can be applied effectively in studies, are needed [ 28 , 52 , 53 ]. Traditionally, the 6MWD test has been used as a measure of functional status in NTM disease.…”