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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.
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 1 School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, Denver, CO 2 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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