Diferença mínima clinicamente significante para o teste de endurance realizado em esteira em pacientes com DPOC após Programa de Reabilitação Pulmonar
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Data
2014-06-30
Autores
Manzano, Beatriz Martins [UNIFESP]
Orientadores
Jardim, Jose Roberto de Brito [UNIFESP]
Tipo
Tese de doutorado
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Introdução: A capacidade de exercício é um importante desfecho a ser avaliado em pacientes com DPOC. Para isso são utilizados testes de exercício, dentre os quais o teste de endurance em esteira. No entanto, não está claro qual o mínimo de mudança para esse teste que permita ao paciente reconhecer uma real mudança no seu estado funcional, que é a diferença mínima clinicamente significante (DMCS). Levando-se em consideração que o teste em esteira é mais representativo das atividades diárias, é necessário avaliar a resposta da capacidade de exercício a um programa de treinamento através da determinação da DMCS para o teste de endurance em esteira, baseada em uma avaliação do paciente que contemple tanto as melhoras físicas quanto na qualidade de vida. Objetivos: Determinar a DMCS para o teste de endurance realizado em esteira ergométrica em pacientes com DPOC submetidos a um programa de reabilitação pulmonar. Materiais e método: Foram coletados dados antropométricos, valores espirométricos, dados dos testes de endurance, teste incremental, TC6’ e qualidade de vida por meio do SGRQ de pacientes do Centro de Reabilitação Pulmonar da Universidade Federal de São Paulo pré e pós-programa de reabilitação pulmonar. Foi utilizada uma variável âncora obtida através de avaliação de cinco especialistas na área de reabilitação pulmonar, que classificaram os pacientes em dois grupos, “melhorou” ou “não melhorou” após analisarem os resultados dos testes incrementais, endurance, TC6’ e qualidade de vida pré e pós-reabilitação. Essa classificação “melhorou” ou “não melhorou” foi a variável âncora utilizada para estabelecer a DMCS para o teste de endurance. Análise estatística: Dados foram apresentados em valores de média ± desvio-padrão para variáveis contínuas e número absoluto (porcentagem) para variáveis categóricas. Teste t pareado para comparação entre variáveis pré e pós-reabilitação pulmonar. Teste t independente para comparação entre os grupos “melhorou” e “não melhorou”. Utilizou-se a curva ROC para cálculo da sensibilidade e especificidade e para identificar o ponto de corte que estabeleceu a DMCS. Resultados: Dados de 99 pacientes foram analisados. Média de idade de 67 ± 9,5 anos, sexo masculino, DPOC leve 4 (4,2%), moderado 23 (24%), grave 46 (47,9%) e muito grave 23 (24%). Entre os grupos “melhorou” e “não melhorou” houve diferença estatisticamente significante para o TE (997,4 m versus 100,8 m; p<0,001). A DMCS estabelecida para distância do TE em valores absolutos foi de 280 metros ou 37% do valor basal, enquanto que o tempo de teste foi 292 segundos ou 36%. Os valores percentuais mostraram-se mais sensíveis do que os valores absolutos (sensibilidade 0,84 vs 0,81 e 0,85 vs 0,74, respectivamente). Conclusões: A DMCS para o teste de endurance em esteira é de 280 metros ou 292 segundos, que correspondem à mudanças de 37% e 36% em relação ao valor basal, respectivamente, sendo os valores percentuais mais sensíveis do que os valores absolutos.
Background: Exercise capacity is an important outcome to be evaluated in patients with COPD. Treadmill endurance test can be used to asses exercise capacity. However, it is not known the minimal change perceived by patients like real change in their functional capacity, which is the minimal important difference. As walking on treadmill is closer to the daily activity – walking – the knowledge of its MID is essential to evaluate the response of a patient with COPD after a pulmonary rehabilitation program, based on physical and quality of life. Objectives: To determine the MID for the treadmill endurance test for patients with COPD after a pulmonary rehabilitation program and establish if this MID is better expressed as absolute or percentage change. Methods: The obtained data included anthropometric data, spirometry, treadmill endurance and incremental test, 6MWD and quality of life through Saint George’s Respiratory Questionnaire (SGRQ) from patients of the Pulmonary Rehabilitation Center of the Federal University of São Paulo. It was used the method which considers specialists’ opinion in the area of pulmonary rehabilitation to classify the patients into two groups, “improved” and “unimproved” after the analysis of pre and post-rehabilitation results of the treadmill endurance and incremental tests, 6MWD and quality of life evaluated through SGRQ. The classifications “improved” and “unimproved” obtained from the specialists’ opinion was the anchor variable used to establish the MID for the endurance test. Statistics: Data were presented in average values ± standard deviation for the continuous variables and absolute number (percentage) for the categorical variables. Changes in walking distance and time of the endurance test were expressed in absolute values (meters and seconds respectively) and in percentage of the basal values. Paired t test was used to compare the pre and post-rehabilitation variables; and independent t test was used to compare the “improved” and “unimproved” groups. The sensitivity and specificity of the changes in the endurance test for the discrimination between the individuals classified into the groups “improved ” or “unimproved” were calculated and the corresponding ROC (Receive Operator Characteristic Curve) were obtained. Results: Data from 99 patients were used for analysis. The average age was 67 ± 9.5 years, most of them were men (76.8%), including patients with mild (4.2%), moderate (24%), severe (47.9%) and very severe COPD (4.2%). Difference between “improved” and “unimproved” groups were statistically significant (997.4 m versus 100.8 m; p<0.001).The MID established for the distance of the endurance test in absolute value was of 280 meters or 37% and 292 seconds or 36%. Percentage values are more sensitive than absolute ones (sensitivity 0.84 vs 0.81 and 0.85 vs 0.74, respectively). Conclusion: The MID for the treadmill endurance test is 280 meters or 92 seconds; a change of 37% in the distance or 36% in the basal duration time also represent the MID. We found that the percentage values are more sensitive than absolute values.
Background: Exercise capacity is an important outcome to be evaluated in patients with COPD. Treadmill endurance test can be used to asses exercise capacity. However, it is not known the minimal change perceived by patients like real change in their functional capacity, which is the minimal important difference. As walking on treadmill is closer to the daily activity – walking – the knowledge of its MID is essential to evaluate the response of a patient with COPD after a pulmonary rehabilitation program, based on physical and quality of life. Objectives: To determine the MID for the treadmill endurance test for patients with COPD after a pulmonary rehabilitation program and establish if this MID is better expressed as absolute or percentage change. Methods: The obtained data included anthropometric data, spirometry, treadmill endurance and incremental test, 6MWD and quality of life through Saint George’s Respiratory Questionnaire (SGRQ) from patients of the Pulmonary Rehabilitation Center of the Federal University of São Paulo. It was used the method which considers specialists’ opinion in the area of pulmonary rehabilitation to classify the patients into two groups, “improved” and “unimproved” after the analysis of pre and post-rehabilitation results of the treadmill endurance and incremental tests, 6MWD and quality of life evaluated through SGRQ. The classifications “improved” and “unimproved” obtained from the specialists’ opinion was the anchor variable used to establish the MID for the endurance test. Statistics: Data were presented in average values ± standard deviation for the continuous variables and absolute number (percentage) for the categorical variables. Changes in walking distance and time of the endurance test were expressed in absolute values (meters and seconds respectively) and in percentage of the basal values. Paired t test was used to compare the pre and post-rehabilitation variables; and independent t test was used to compare the “improved” and “unimproved” groups. The sensitivity and specificity of the changes in the endurance test for the discrimination between the individuals classified into the groups “improved ” or “unimproved” were calculated and the corresponding ROC (Receive Operator Characteristic Curve) were obtained. Results: Data from 99 patients were used for analysis. The average age was 67 ± 9.5 years, most of them were men (76.8%), including patients with mild (4.2%), moderate (24%), severe (47.9%) and very severe COPD (4.2%). Difference between “improved” and “unimproved” groups were statistically significant (997.4 m versus 100.8 m; p<0.001).The MID established for the distance of the endurance test in absolute value was of 280 meters or 37% and 292 seconds or 36%. Percentage values are more sensitive than absolute ones (sensitivity 0.84 vs 0.81 and 0.85 vs 0.74, respectively). Conclusion: The MID for the treadmill endurance test is 280 meters or 92 seconds; a change of 37% in the distance or 36% in the basal duration time also represent the MID. We found that the percentage values are more sensitive than absolute values.
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MANZANO, Beatriz Martins. Diferença mínima clinicamente significante para o teste de endurance realizado em esteira em pacientes com DPOC após Programa de Reabilitação Pulmonar. 2014. Tese (Doutorado) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2014.