Background-Supplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) and ... more Background-Supplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) and exercise hypoxaemia improves exercise capacity and dyspnoea. However, the benefit of oxygen during pulmonary rehabilitation in these patients is still unknown. Methods-Twenty five patients with stable COPD (mean (SD) forced expiratory volume in one second (FEV 1 ) 0.76 (0.29) l and 30.0 (9.89)% predicted, arterial oxygen tension (PaO 2 ) 8.46 (1.22) kPa, arterial carbon dioxide tension (PaCO 2 ) 6.32 (1.01) kPa) and significant arterial desaturation on exercise (82.0 (10.4)%) were entered onto a pulmonary rehabilitation programme. Patients were randomised to train whilst breathing oxygen (OT) (n = 13) or air (AT) (n = 12), both at 4 l/min. Assessments included exercise tolerance and associated dyspnoea using the shuttle walk test (SWT) and Borg dyspnoea score, health status, mood state, and performance during daily activities. Results-The OT group showed a significant reduction in dyspnoea after rehabilitation compared with the AT group (Borg mean diVerence -1.46 (95% CI -2.72 to -0.19)) but there were no diVerences in other outcome measures: SWT diVerence -23.6 m (95% CI -70.7 to 23.5), Chronic Respiratory Disease Questionnaire 3.67 (95% CI -7.70 to 15.1), Hospital Anxiety and Depression Scale 1.73 (95% CI -2.32 to 5.78), and London Chest Activity of Daily Living Scale -2.18 (95% CI -7.15 to 2.79). At baseline oxygen significantly improved SWT (mean diVerence 27.3 m (95% CI 14.7 to 39.8) and dyspnoea (-0.68 (95% CI -1.05 to -0.31)) compared with placebo air. Conclusions-This study suggests that supplemental oxygen during training does little to enhance exercise tolerance although there is a small benefit in terms of dyspnoea. Patients with severe disabling dyspnoea may find symptomatic relief with supplemental oxygen.
Background and Purpose. There is significant research supporting the role of pulmonary rehabilita... more Background and Purpose. There is significant research supporting the role of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD). However, less is known about real-life clinical rehabilitation services. Data were analysed from a clinical pulmonary rehabilitation service provided in the UK, consisting of seven weeks' twiceweekly training and education. Method. A retrospective study. Baseline measures consisted of activity of daily living, mood state, spirometry, exercise tolerance using the Incremental Shuttle Walk Test (ISWT) and health status using the St George's Hospital Respiratory Questionnaire (SGRQ). Responders to pulmonary rehabilitation were defined as those with a mean reduction of four points on the SGRQ and a mean increase of 48 metres on the ISWT. Results. One hundred and eight patients entered the programme and 91 completed it. All outcomes showed statistically and clinically significant change after the rehabilitation programme. Responder analysis showed that 37% of patients achieved benefits for both the SGRQ and the ISWT. Twenty-eight per cent of patients were non-responders for both; 17% benefited for the SGRO only and 14% improved their exercise tolerance. Patients with restrictive disease ( n = 11) showed large mean ISWT score of 98.2 m (Standard deviation (SD) 69.4 m) ( p <0.01), as did patients with moderate COPD ( n = 30), who scored a mean ISWT change of 77.3 m (SD 92.0 m) ( p < 0.01) and a SGRQ score of -7.6 (SD 13.7) ( p < 0.01), and those with mild COPD ( n = 12), who scored a mean ISWT change of 62.5 m (SD 87.4 m) ( p <0.01) and a mean SGRQ change of -3.7 (SD 8.1) ( p <0.01). Patients with severe COPD ( n = 23) showed a smaller mean change in . However, analysis of variance (ANOVA ) showed no statistical differences between the groups ( p = 0.13). Conclusions. Clinical pulmonary rehabilitation programmes are effective for most patients. However, for patients with more severe impairment, maximal gains may be harder, or take longer, to achieve. Patients with restrictive disease appear to do well, although future trials will be needed to test this supposition.
Objetivo: Traduzir a escala London Chest Activity of Daily Living (LCADL) para o português e veri... more Objetivo: Traduzir a escala London Chest Activity of Daily Living (LCADL) para o português e verificar se essa versão é reprodutível em pacientes com doença pulmonar obstrutiva crônica (DPOC) grave no Brasil. Métodos: Foram realizadas a tradução da escala LCADL para o português e a tradução retrógrada dessa versão em português para o inglês. Essa primeira versão em português foi aplicada a 8 pacientes com DPOC, e possíveis dificuldades em relação ao texto foram investigadas. As principais dificuldades encontradas foram discutidas com os autores da escala, chegando-se a uma versão final do instrumento. Essa versão final foi aplicada duas vezes a 31 pacientes com DPOC por dois observadores separadamente em um primeiro dia. Após 15-20 dias, essa mesma versão foi aplicada novamente aos mesmos pacientes por um dos observadores. No primeiro dia os pacientes foram submetidos à prova de função pulmonar e ao teste de caminhada de seis minutos (TC6). Resultados: A versão brasileira da escala LCADL demonstrou excelente reprodutibilidade no escore total e na maioria das questões, com um coeficiente alfa de Cronbach interobservador de 0,97 (IC95%: 0,89-0,97; p < 0,05) e um coeficiente alfa de Cronbach intra-observador de 0,96 (IC95%: 0,83-0,96; p < 0,05). O escore total dessa versão apresentou correlação negativa com o volume expiratório forçado no primeiro segundo em litros (r = -0,49; p < 0,05) e a distância percorrida no TC6 (r = -0,56; p < 0,05). Conclusão: A versão brasileira da escala LCADL é um instrumento confiável, reprodutível e válido para avaliar a dispnéia durante atividades de vida diária em pacientes com DPOC grave.
International Journal of Chronic Obstructive Pulmonary Disease, Dec 1, 2008
Little is known about self-effi cacy in COPD and its role as a mediator of goal attainment after ... more Little is known about self-effi cacy in COPD and its role as a mediator of goal attainment after rehabilitation. We hypothesized that higher baseline self effi cacy may facilitate goal attainment. Methods: 48 COPD patients completed pulmonary rehabilitation, self-effi cacy was measured using the COPD Self Effi cacy Scale (CSES). Personal goals were used as self reported outcome. Relationships were evaluated between CSES and St George's Hospital Respiratory Questionnaire (SGRQ); depression; using Brief Assessment Schedule Cards (BASDEC), London Chest Activity of Daily Living Scale (LCADL) and exercise tolerance; using Six-Minute Walking Distance (6MWD) and muscle strength. Results: 74 Stable COPD patients, mean FEV 1 1.2 (0.6) l, age 68.1 (10.2) years were recruited. 51 patients completed rehabilitation and 48 of those CSES and reported goal attainment. 94 goals were documented. Baseline self effi cacy did not differ according to whether goal was achieved or not. Relationships were evident between CSES and SGRQ (r = -0.53), 6MWD (r = 0.36), BASDEC (r = -0.31), LCADL (r = -0.33) (all p Յ 0.01), but not FEV 1 , pack years or muscle strength. There was a signifi cant improvement in CSES scores pre to post rehabilitation, mean difference (95% CI) 0. 27 (0.04 to 0.51). Conclusions: Self effi cacy, using the CSES, improves with rehabilitation but baseline self effi cacy does not appear to infl uence goal attainment.
Objective swallowing assessment is indicated in the management of patients with Duchenne muscular... more Objective swallowing assessment is indicated in the management of patients with Duchenne muscular dystrophy (DMD). Surface electromyography (sEMG) provides a non-invasive, objective method of quantifying muscle activity. It was hypothesised that the measurement of sEMG activity during swallowing would distinguish between preserved and disordered swallow function in DMD. This comparative study investigated the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group for masseter (61.77 vs. 5.07; p B 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p B 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p B 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients, justifying further study.
Introduction: A number of questionnaires are currently used to assess HRQOL in NCFB, however litt... more Introduction: A number of questionnaires are currently used to assess HRQOL in NCFB, however little is known about their validity in this condition. Aims: To assess the validity of HRQOL questionnaires in NCFB. Methods: A search was conducted on Embase, Pubmend, Medline, PsychINFO and Cochrane Library. Studies (including abstracts) were selected if assessed internal consistency, repeatability and responsiveness of a HRQOL tools. Analysis used descriptive and qualitatively methods. Results: Nine (3 abstracts) out of 392 studies were included. Four questionnaires were identified, but only QOL-B was disease specific for NCFB. Internal consistency ranged from moderate to very good and repeatability was very good. Studies that reported responsiveness, supported SGRQ, LCQ and QOL-B. Conclusions: A few studies support adequate validity of HRQOL questionnaires in NCFB. SGRQ and QOL-B were the most frequently studied questionnaires, but these have 37 items or more. There is a need for brief, disease specific, well validated HRQOL questionnaires in NCFB.
International Journal of Language & Communication Disorders, Mar 1, 2013
Objective swallowing assessment is indicated in the management of patients with Duchenne muscular... more Objective swallowing assessment is indicated in the management of patients with Duchenne muscular dystrophy (DMD). Surface electromyography (sEMG) provides a non-invasive, objective method of quantifying muscle activity. It was hypothesised that the measurement of sEMG activity during swallowing would distinguish between preserved and disordered swallow function in DMD. This comparative study investigated the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group for masseter (61.77 vs. 5.07; p B 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p B 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p B 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients, justifying further study.
This study assesses the validity, reliability, and responsiveness of the Dutch version of the Lon... more This study assesses the validity, reliability, and responsiveness of the Dutch version of the London Chest Activity of Daily Living scale (LCADL). The English LCADL version was translated into Dutch and then back-translated to English to check if the translation was conceptually equivalent to the original LCADL. Measurement properties were evaluated in191 patients with chronic obstructive pulmonary disease (COPD) (70 males; age 62 AE 9 years; FEV 1 33 AE 10% pred). Construct validity was assessed using diseasespecific health status, generic functional status, and functional and peak exercise capacity (Wmax). LCADL was completed twice to assess testretest reliability. Responsiveness was assessed after 8 to 12 weeks inpatient pulmonary rehabilitation. LCADL correlated significantly with the St. George Respiratory Questionnaire (r ¼ 0.24 to 0.64), functional status (r ¼ 0.45 to 0.82), walking distance (r ¼ À0.3 to À0.58), and Wmax (À0.27 to À0.38) and Wmax % pred (À0.26 to À0.43). Test-retest reliability was high (ICC 0.87 to 0.98). The smallest detectable change for the LCADL total and domain score self-care, domestic, physical, and leisure was 4.5, 2.9, 3.3, 4.9, and 2.2, respectively. Improvement in LCADL after PR correlated significantly with improvement in Chronic Respiratory Questionnaire (À0.43; P < 0.001). The Dutch LCADL is a reliable, valid, and responsive instrument to assess limitations in performing activities of daily living in patients with severe COPD.
SIGLEAvailable from British Library Document Supply Centre- DSC:3831. 03767(5) / BLDSC - British ... more SIGLEAvailable from British Library Document Supply Centre- DSC:3831. 03767(5) / BLDSC - British Library Document Supply CentreGBUnited Kingdo
Diversos questionários desenvolvidos em língua inglesa visam avaliar especificamente a limitação ... more Diversos questionários desenvolvidos em língua inglesa visam avaliar especificamente a limitação pela dispnéia durante actividades da vida diá ria (AVD) em doentes com doença pulmonar obstrutiva crónica (DPOC), como a escala London
Journal of Cardiopulmonary Rehabilitation, Mar 1, 2001
The addition of noninvasive positive pressure ventilation (NPPV) to an exercise training (ET) pro... more The addition of noninvasive positive pressure ventilation (NPPV) to an exercise training (ET) program in severe chronic obstructive pulmonary disease (COPD) may produce greater benefits in exercise tolerance and quality of life than after training alone. Forty-five patients with severe stable COPD-mean (SD) FEV 1 0.96 (0.31) L, Pa O 2 65.4 (9.07) mm Hg, Pa CO 2 45.6 (7.89) mm Hg-were randomized to domiciliary NPPV ϩ ET (n ϭ 23) or ET alone (n ϭ 22). Exercise capacity and health status were assessed at baseline and after an 8-wk training program. There was a significant improvement in mean shuttle walk test (SWT) in the NPPV ϩ ET group: from 169 (112) to 269 (124) m (p ϭ 0.001), compared with the ET group: 205 (100) to 233 (123) m (p ϭ 0.19); mean difference (95% confidence interval [CI]): 72 (12.9 to 131) m. Repeated measures analysis of variance (ANOVA) showed that the differences between the two groups became evident only in the final 4 wk of the training program with a mean end study difference (95% 1CI) of 65.8 (17.1 to 114) m. There was a significant improvement in the Chronic Respiratory Disease Questionnaire (CRDQ) of mean (SD) 24.0 (17.4) (p ϭ Ͻ 0.001) in the NPPV ϩ ET group and 11.8 (15.8) (p ϭ 0.003) points in the ET group; mean difference: 12.3 (1.19 to 23.4). Only the NPPV ϩ ET group demonstrated a significant improvement in arterial oxygenation; mean difference: 3.70 mm Hg (0.37 to 7.27). This study suggests that domiciliary NPPV can be used successfully to augment the effects of rehabilitation in severe COPD.
Health-related quality of life or health status is significantly impaired in bronchiectasis. Ther... more Health-related quality of life or health status is significantly impaired in bronchiectasis. There is a paucity of brief, simple-to-use, disease-specific health status measures. The aim of this study was to develop and validate the Bronchiectasis Health Questionnaire (BHQ), a new health status measure that is brief and generates a single overall score. Patients with bronchiectasis were recruited from two outpatient clinics, during a clinically stable stage. The development of the questionnaire followed three phases: item generation and item reduction using Rasch analysis, validation, and repeatability testing. The BHQ was translated into 11 languages using standardised methodology. 206 patients with bronchiectasis completed a preliminary 65-item questionnaire. 55 items were removed due to redundancy or poor fit to the Rasch model. The final version of the BHQ consisted of 10 items. Internal consistency was good (Cronbach's α=0.85). Convergent validity of the BHQ with the St George's Respiratory Questionnaire was high (r= −0.82; p<0.001) and moderate with lung function (forced expiratory volume in 1 s % predicted r= −0.27; p=0.001). There was a significant association between BHQ scores and number of exacerbations of bronchiectasis in the last 12 months (p<0.001), hospital admissions (p=0.001) and computed tomography scan bronchiectasis pulmonary lobe counts (p<0.001). BHQ scores were significantly worse in patients with sputum bacterial colonisation versus no colonisation (p=0.048). The BHQ was highly repeatable after 2 weeks (intraclass correlation coefficient 0.89). The BHQ is a brief, valid and repeatable, self-completed health status questionnaire for bronchiectasis that generates a single total score. It can be used in the clinic to assess bronchiectasis from the patient's perspective.
Background-Supplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) and ... more Background-Supplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) and exercise hypoxaemia improves exercise capacity and dyspnoea. However, the benefit of oxygen during pulmonary rehabilitation in these patients is still unknown. Methods-Twenty five patients with stable COPD (mean (SD) forced expiratory volume in one second (FEV 1 ) 0.76 (0.29) l and 30.0 (9.89)% predicted, arterial oxygen tension (PaO 2 ) 8.46 (1.22) kPa, arterial carbon dioxide tension (PaCO 2 ) 6.32 (1.01) kPa) and significant arterial desaturation on exercise (82.0 (10.4)%) were entered onto a pulmonary rehabilitation programme. Patients were randomised to train whilst breathing oxygen (OT) (n = 13) or air (AT) (n = 12), both at 4 l/min. Assessments included exercise tolerance and associated dyspnoea using the shuttle walk test (SWT) and Borg dyspnoea score, health status, mood state, and performance during daily activities. Results-The OT group showed a significant reduction in dyspnoea after rehabilitation compared with the AT group (Borg mean diVerence -1.46 (95% CI -2.72 to -0.19)) but there were no diVerences in other outcome measures: SWT diVerence -23.6 m (95% CI -70.7 to 23.5), Chronic Respiratory Disease Questionnaire 3.67 (95% CI -7.70 to 15.1), Hospital Anxiety and Depression Scale 1.73 (95% CI -2.32 to 5.78), and London Chest Activity of Daily Living Scale -2.18 (95% CI -7.15 to 2.79). At baseline oxygen significantly improved SWT (mean diVerence 27.3 m (95% CI 14.7 to 39.8) and dyspnoea (-0.68 (95% CI -1.05 to -0.31)) compared with placebo air. Conclusions-This study suggests that supplemental oxygen during training does little to enhance exercise tolerance although there is a small benefit in terms of dyspnoea. Patients with severe disabling dyspnoea may find symptomatic relief with supplemental oxygen.
Background and Purpose. There is significant research supporting the role of pulmonary rehabilita... more Background and Purpose. There is significant research supporting the role of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD). However, less is known about real-life clinical rehabilitation services. Data were analysed from a clinical pulmonary rehabilitation service provided in the UK, consisting of seven weeks' twiceweekly training and education. Method. A retrospective study. Baseline measures consisted of activity of daily living, mood state, spirometry, exercise tolerance using the Incremental Shuttle Walk Test (ISWT) and health status using the St George's Hospital Respiratory Questionnaire (SGRQ). Responders to pulmonary rehabilitation were defined as those with a mean reduction of four points on the SGRQ and a mean increase of 48 metres on the ISWT. Results. One hundred and eight patients entered the programme and 91 completed it. All outcomes showed statistically and clinically significant change after the rehabilitation programme. Responder analysis showed that 37% of patients achieved benefits for both the SGRQ and the ISWT. Twenty-eight per cent of patients were non-responders for both; 17% benefited for the SGRO only and 14% improved their exercise tolerance. Patients with restrictive disease ( n = 11) showed large mean ISWT score of 98.2 m (Standard deviation (SD) 69.4 m) ( p <0.01), as did patients with moderate COPD ( n = 30), who scored a mean ISWT change of 77.3 m (SD 92.0 m) ( p < 0.01) and a SGRQ score of -7.6 (SD 13.7) ( p < 0.01), and those with mild COPD ( n = 12), who scored a mean ISWT change of 62.5 m (SD 87.4 m) ( p <0.01) and a mean SGRQ change of -3.7 (SD 8.1) ( p <0.01). Patients with severe COPD ( n = 23) showed a smaller mean change in . However, analysis of variance (ANOVA ) showed no statistical differences between the groups ( p = 0.13). Conclusions. Clinical pulmonary rehabilitation programmes are effective for most patients. However, for patients with more severe impairment, maximal gains may be harder, or take longer, to achieve. Patients with restrictive disease appear to do well, although future trials will be needed to test this supposition.
Objetivo: Traduzir a escala London Chest Activity of Daily Living (LCADL) para o português e veri... more Objetivo: Traduzir a escala London Chest Activity of Daily Living (LCADL) para o português e verificar se essa versão é reprodutível em pacientes com doença pulmonar obstrutiva crônica (DPOC) grave no Brasil. Métodos: Foram realizadas a tradução da escala LCADL para o português e a tradução retrógrada dessa versão em português para o inglês. Essa primeira versão em português foi aplicada a 8 pacientes com DPOC, e possíveis dificuldades em relação ao texto foram investigadas. As principais dificuldades encontradas foram discutidas com os autores da escala, chegando-se a uma versão final do instrumento. Essa versão final foi aplicada duas vezes a 31 pacientes com DPOC por dois observadores separadamente em um primeiro dia. Após 15-20 dias, essa mesma versão foi aplicada novamente aos mesmos pacientes por um dos observadores. No primeiro dia os pacientes foram submetidos à prova de função pulmonar e ao teste de caminhada de seis minutos (TC6). Resultados: A versão brasileira da escala LCADL demonstrou excelente reprodutibilidade no escore total e na maioria das questões, com um coeficiente alfa de Cronbach interobservador de 0,97 (IC95%: 0,89-0,97; p < 0,05) e um coeficiente alfa de Cronbach intra-observador de 0,96 (IC95%: 0,83-0,96; p < 0,05). O escore total dessa versão apresentou correlação negativa com o volume expiratório forçado no primeiro segundo em litros (r = -0,49; p < 0,05) e a distância percorrida no TC6 (r = -0,56; p < 0,05). Conclusão: A versão brasileira da escala LCADL é um instrumento confiável, reprodutível e válido para avaliar a dispnéia durante atividades de vida diária em pacientes com DPOC grave.
International Journal of Chronic Obstructive Pulmonary Disease, Dec 1, 2008
Little is known about self-effi cacy in COPD and its role as a mediator of goal attainment after ... more Little is known about self-effi cacy in COPD and its role as a mediator of goal attainment after rehabilitation. We hypothesized that higher baseline self effi cacy may facilitate goal attainment. Methods: 48 COPD patients completed pulmonary rehabilitation, self-effi cacy was measured using the COPD Self Effi cacy Scale (CSES). Personal goals were used as self reported outcome. Relationships were evaluated between CSES and St George's Hospital Respiratory Questionnaire (SGRQ); depression; using Brief Assessment Schedule Cards (BASDEC), London Chest Activity of Daily Living Scale (LCADL) and exercise tolerance; using Six-Minute Walking Distance (6MWD) and muscle strength. Results: 74 Stable COPD patients, mean FEV 1 1.2 (0.6) l, age 68.1 (10.2) years were recruited. 51 patients completed rehabilitation and 48 of those CSES and reported goal attainment. 94 goals were documented. Baseline self effi cacy did not differ according to whether goal was achieved or not. Relationships were evident between CSES and SGRQ (r = -0.53), 6MWD (r = 0.36), BASDEC (r = -0.31), LCADL (r = -0.33) (all p Յ 0.01), but not FEV 1 , pack years or muscle strength. There was a signifi cant improvement in CSES scores pre to post rehabilitation, mean difference (95% CI) 0. 27 (0.04 to 0.51). Conclusions: Self effi cacy, using the CSES, improves with rehabilitation but baseline self effi cacy does not appear to infl uence goal attainment.
Objective swallowing assessment is indicated in the management of patients with Duchenne muscular... more Objective swallowing assessment is indicated in the management of patients with Duchenne muscular dystrophy (DMD). Surface electromyography (sEMG) provides a non-invasive, objective method of quantifying muscle activity. It was hypothesised that the measurement of sEMG activity during swallowing would distinguish between preserved and disordered swallow function in DMD. This comparative study investigated the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group for masseter (61.77 vs. 5.07; p B 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p B 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p B 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients, justifying further study.
Introduction: A number of questionnaires are currently used to assess HRQOL in NCFB, however litt... more Introduction: A number of questionnaires are currently used to assess HRQOL in NCFB, however little is known about their validity in this condition. Aims: To assess the validity of HRQOL questionnaires in NCFB. Methods: A search was conducted on Embase, Pubmend, Medline, PsychINFO and Cochrane Library. Studies (including abstracts) were selected if assessed internal consistency, repeatability and responsiveness of a HRQOL tools. Analysis used descriptive and qualitatively methods. Results: Nine (3 abstracts) out of 392 studies were included. Four questionnaires were identified, but only QOL-B was disease specific for NCFB. Internal consistency ranged from moderate to very good and repeatability was very good. Studies that reported responsiveness, supported SGRQ, LCQ and QOL-B. Conclusions: A few studies support adequate validity of HRQOL questionnaires in NCFB. SGRQ and QOL-B were the most frequently studied questionnaires, but these have 37 items or more. There is a need for brief, disease specific, well validated HRQOL questionnaires in NCFB.
International Journal of Language & Communication Disorders, Mar 1, 2013
Objective swallowing assessment is indicated in the management of patients with Duchenne muscular... more Objective swallowing assessment is indicated in the management of patients with Duchenne muscular dystrophy (DMD). Surface electromyography (sEMG) provides a non-invasive, objective method of quantifying muscle activity. It was hypothesised that the measurement of sEMG activity during swallowing would distinguish between preserved and disordered swallow function in DMD. This comparative study investigated the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group for masseter (61.77 vs. 5.07; p B 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p B 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p B 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients, justifying further study.
This study assesses the validity, reliability, and responsiveness of the Dutch version of the Lon... more This study assesses the validity, reliability, and responsiveness of the Dutch version of the London Chest Activity of Daily Living scale (LCADL). The English LCADL version was translated into Dutch and then back-translated to English to check if the translation was conceptually equivalent to the original LCADL. Measurement properties were evaluated in191 patients with chronic obstructive pulmonary disease (COPD) (70 males; age 62 AE 9 years; FEV 1 33 AE 10% pred). Construct validity was assessed using diseasespecific health status, generic functional status, and functional and peak exercise capacity (Wmax). LCADL was completed twice to assess testretest reliability. Responsiveness was assessed after 8 to 12 weeks inpatient pulmonary rehabilitation. LCADL correlated significantly with the St. George Respiratory Questionnaire (r ¼ 0.24 to 0.64), functional status (r ¼ 0.45 to 0.82), walking distance (r ¼ À0.3 to À0.58), and Wmax (À0.27 to À0.38) and Wmax % pred (À0.26 to À0.43). Test-retest reliability was high (ICC 0.87 to 0.98). The smallest detectable change for the LCADL total and domain score self-care, domestic, physical, and leisure was 4.5, 2.9, 3.3, 4.9, and 2.2, respectively. Improvement in LCADL after PR correlated significantly with improvement in Chronic Respiratory Questionnaire (À0.43; P < 0.001). The Dutch LCADL is a reliable, valid, and responsive instrument to assess limitations in performing activities of daily living in patients with severe COPD.
SIGLEAvailable from British Library Document Supply Centre- DSC:3831. 03767(5) / BLDSC - British ... more SIGLEAvailable from British Library Document Supply Centre- DSC:3831. 03767(5) / BLDSC - British Library Document Supply CentreGBUnited Kingdo
Diversos questionários desenvolvidos em língua inglesa visam avaliar especificamente a limitação ... more Diversos questionários desenvolvidos em língua inglesa visam avaliar especificamente a limitação pela dispnéia durante actividades da vida diá ria (AVD) em doentes com doença pulmonar obstrutiva crónica (DPOC), como a escala London
Journal of Cardiopulmonary Rehabilitation, Mar 1, 2001
The addition of noninvasive positive pressure ventilation (NPPV) to an exercise training (ET) pro... more The addition of noninvasive positive pressure ventilation (NPPV) to an exercise training (ET) program in severe chronic obstructive pulmonary disease (COPD) may produce greater benefits in exercise tolerance and quality of life than after training alone. Forty-five patients with severe stable COPD-mean (SD) FEV 1 0.96 (0.31) L, Pa O 2 65.4 (9.07) mm Hg, Pa CO 2 45.6 (7.89) mm Hg-were randomized to domiciliary NPPV ϩ ET (n ϭ 23) or ET alone (n ϭ 22). Exercise capacity and health status were assessed at baseline and after an 8-wk training program. There was a significant improvement in mean shuttle walk test (SWT) in the NPPV ϩ ET group: from 169 (112) to 269 (124) m (p ϭ 0.001), compared with the ET group: 205 (100) to 233 (123) m (p ϭ 0.19); mean difference (95% confidence interval [CI]): 72 (12.9 to 131) m. Repeated measures analysis of variance (ANOVA) showed that the differences between the two groups became evident only in the final 4 wk of the training program with a mean end study difference (95% 1CI) of 65.8 (17.1 to 114) m. There was a significant improvement in the Chronic Respiratory Disease Questionnaire (CRDQ) of mean (SD) 24.0 (17.4) (p ϭ Ͻ 0.001) in the NPPV ϩ ET group and 11.8 (15.8) (p ϭ 0.003) points in the ET group; mean difference: 12.3 (1.19 to 23.4). Only the NPPV ϩ ET group demonstrated a significant improvement in arterial oxygenation; mean difference: 3.70 mm Hg (0.37 to 7.27). This study suggests that domiciliary NPPV can be used successfully to augment the effects of rehabilitation in severe COPD.
Health-related quality of life or health status is significantly impaired in bronchiectasis. Ther... more Health-related quality of life or health status is significantly impaired in bronchiectasis. There is a paucity of brief, simple-to-use, disease-specific health status measures. The aim of this study was to develop and validate the Bronchiectasis Health Questionnaire (BHQ), a new health status measure that is brief and generates a single overall score. Patients with bronchiectasis were recruited from two outpatient clinics, during a clinically stable stage. The development of the questionnaire followed three phases: item generation and item reduction using Rasch analysis, validation, and repeatability testing. The BHQ was translated into 11 languages using standardised methodology. 206 patients with bronchiectasis completed a preliminary 65-item questionnaire. 55 items were removed due to redundancy or poor fit to the Rasch model. The final version of the BHQ consisted of 10 items. Internal consistency was good (Cronbach's α=0.85). Convergent validity of the BHQ with the St George's Respiratory Questionnaire was high (r= −0.82; p<0.001) and moderate with lung function (forced expiratory volume in 1 s % predicted r= −0.27; p=0.001). There was a significant association between BHQ scores and number of exacerbations of bronchiectasis in the last 12 months (p<0.001), hospital admissions (p=0.001) and computed tomography scan bronchiectasis pulmonary lobe counts (p<0.001). BHQ scores were significantly worse in patients with sputum bacterial colonisation versus no colonisation (p=0.048). The BHQ was highly repeatable after 2 weeks (intraclass correlation coefficient 0.89). The BHQ is a brief, valid and repeatable, self-completed health status questionnaire for bronchiectasis that generates a single total score. It can be used in the clinic to assess bronchiectasis from the patient's perspective.
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