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Research Corner: Outcome Measures in Cardiopulmonary Physical Therapy: Focus on the Glittre ADL-Test for People with Chronic Obstructive Pulmonary Disease


The AMPS has not been validated in people with COPD in whom dyspnea plays a significant role in limiting function. [...] the Glittre ADL test was developed to address the need for a more representative, objective assessment of function in people with COPD.12 TEST ADMINISTRATION The Glittre ADL test is a standardized test that uses ADLI ike activities that involve rising from a chair, lifting, carrying, and bending.12 The primary outcome is the time taken to complete the test. Scores on ADL-test 2 were, on average, 0.37 min less than those for ADL-test 1 95% Cl (- 0.20 to -0.54). [...] the learning effect was considered to be 7% to the total ADL-time.

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									                                             Research Corner:
    Outcome Measures in Cardiopulmonary Physical Therapy:
         Focus on the Glittre ADL-Test for People with
           Chronic Obstructive Pulmonary Disease
                                Gail Dechman, BScPT, PhD;1 Susan A. Scherer, PT, PhD2

                              School of Physiotherapy, Dalhousie University, Halifax, NS

       School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, Denver, CO

INTRODUCTION                                                          progression in people with a chronic disease may result
                                                                      in activity limitation that could decrease the symptoms of
    The primary goal of physical rehabilitation for people            interest. Such a change could erroneously be interpreted
with chronic lung disease, including chronic obstructive              as an improvement in health status. For instance, people
lung disease (COPD), is to improve function. In terms of the          who experience dyspnea while climbing stairs may stop
International Classification of Functioning, Disability and           doing this activity and take the elevator instead. When
Health (ICF),1 physical therapy typically focuses on improv-          questioned, this person may no longer report dyspnea
ing activity, which may result in increased participation             when climbing stairs. The person may not be trying to hide
in pursuits that are meaningful to the individual. A com-             the truth, but may have forgotten the discomfort once it no
monly used and related concept is functional status. Keith2           longer occurs.
described functional status as “physical function including
activity restrictions and fitness; psychological function                 Objective, performance-based tests avoid many of the
including affective and cognitive functioning, social func-           difficulties noted above. The six-minute walk test (6MWT)
tion including limitations in usual roles or major activity,          is the most frequently used objective test of functional
social integration, social contact, and intimacy.” There are          capacity for people with respiratory disease.13 Patients are
2 primary methods of assessing functional status--question-           told to walk as far as possible, in 6 minutes, over a 100
naires and performance-based tests. The most frequently               foot, level, indoor course. The psychometric properties of
used tools are questionnaires. Generic questionnaires such            the test have been examined in detail and the test has been
as the Functional Status Questionnaire,3 Extended Activities          shown to be a reliable measure of the distance walked in
of Daily Living scale,4 and the SF-365 are available. How-            people with COPD when it is conducted according to stan-
ever, disease specific questionnaires such as the Chronic             dardized guidelines.13,14 The length of the hallway used for
Respiratory Questionnaire,6 the St. George’s Respiratory              the walk,15 the instructions given to the subject,16 the type
Questionnaire,7 and the Pulmonary Functional Status and               and amount of encouragement given,16 and the number of
Dyspnea Questionnaire8 are commonly used for people                   learning trials17 have all been shown to affect test perfor-
with chronic lung disease. Questionnaires are generally               mance and reliability. The test is simple to administer and
inexpensive, quick to administer, and allow patients to               generally well accepted by patients but it does not assess
express their perception of their function. However, there            how walking ability affects functional status or participa-
are a number of disadvantages associated with the use of              tion, as it is defined in the ICF model. Furthermore, it does
questionnaires.9-12 Specifically, patients’ responses may             not assess how dyspnea during unsupported arm activi-
be affected by social and personal expectations of the                ties8,18,19 such as making beds, shelving dishes and doing
purpose of the questionnaire. Also, responses may change              the laundry affects functional status. As the prevalence of
depending on a patient’s cognition or psychological status.           COPD in women increases20-23 the definition and assess-
In some circumstances, patients may state that they are               ment of function will likely need to expand to include
capable of completing a task but do not consider the time             more of these activities of daily living (ADL). Most objec-
required to complete the activity. Without additional infor-          tive tests of physical performance, like the 6MWT, focus
mation that is difficult to quantify, a patient may appear to         on mobility dysfunction or on people having severe limita-
function well when this is not the case. Another difficulty           tions.24-27 In contrast, the Assessment of Motor and Process
associated with the use of questionnaires is that disease             Skills (AMPS) is a 26 item test that measures the quality of a
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