Assessment of treatable traits of functioning in hospitalized patients with exacerbation of COPD

Abstract

Hospitalized patients with exacerbation of COPD (ECOPD) often experience physical and functional impairments, limitations in daily activities, and negative impact on their quality of life and prognosis. Identifying the main treatable traits of functioning and their appropriate markers is essential for guiding individualized patient care. Objective: To develop a performance-based toolkit to assess the main treatable traits of functioning in hospitalized patients with ECOPD. Methods: This thesis is composed of four studies: STUDY 1: A systematic review that was conducted following the COSMIN guidelines to summarize and compare the measurement properties of performance-based outcome measures for functioning in hospitalized patients with ECOPD. Databases including PubMed, EMBASE, PEDro, and Cochrane were searched using terms related to functioning, hospitalized patients with ECOPD, and measurement properties. STUDY 2 (protocol): A survey-based observational study was developed to create a performance-based toolkit. The protocol included the following steps: 1) Defining treatable traits with input from physiotherapists who regularly care for hospitalized ECOPD patients and patients who have experienced at least one ECOPD requiring hospitalization; 2) Selecting the most appropriate markers for each treatable trait based on established criteria and findings from the systematic review. STUDY 3: A qualitative research was conducted using short, semi-structured face-to-face interviews with patients, analyzed using thematic analysis to explore patients’ perspectives on the impact of ECOPD on functioning during and post-hospitalization and the role of physical therapy (PT) in ECOPD management. STUDY 4: The survey-based observational study was developed and it was created the performance-based toolkit. Results: The systematic review included thirteen studies featuring nine outcome measures: 6-minute peg board ring test (6PBRT), 6-minute stepper test; 6-minute walk test (6MWT), 4-meter gait speed (4MGS), Berg balance scale (BBS), de Morton mobility index (DEMMI), handgrip strength (HGS), incremental shuttle walk test (ISWT), and maximum inspiratory pressure (MIP). Construct validity was rated as sufficient with very low quality of evidence. In the qualitative study, ten patients were enrolled, and four main themes were identified: 1) Hospitalization period – a) Perception of functioning (disability perception: balance problems and leg weakness), b) Perceptions of physical therapy (positive attitude: importance of physical therapy; types of interventions: respiratory, walking, and strength exercises; difficulties in performing physical therapy: breathlessness, fatigue and fear of falling; impact of physical therapy: physical and mental improvements); 2) Post-hospitalization – a) Perception of functioning (deterioration in body function: tiredness, breathlessness, weakness, worsened well-being; and changes in daily life), b) Lifestyle modification. Finally, 67 physiotherapists and 17 patients identified the main treatable traits, and the performance-based toolkit was developed with the respective recommended markers included: exercise tolerance (60-second sit-to-stand test [60secSTS] or 6MWT), changing basic position (60secSTS or 5-repetition sit-to-stand test), maintaining basic position (BBS or single-leg stance), and walking (6MWT or 4MGS). Additionally, depending on available resources, time, and space, may also be assessed: respiratory muscle function (MIP), muscle power function (5STS or HGS), and lifting and carrying objects, as well as hand and arm use (6PBRT or Glittre test). Conclusion: A performance-based toolkit was developed to assess relevant treatable traits of functioning in patients hospitalized with ECOPD, along with evidence-based markers for assessing them. Further studies are needed to assess the feasibility of this toolkit in this population and different hospital-based contexts.