Browsing by Author "Marques, Alda"
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- Adventitious respiratory sounds to monitor lung function in pulmonary rehabilitationPublication . Jácome, Cristina; Cruz, Joana; Marques, AldaBackground: Peak expiratory flow (PEF) has been traditionally used to monitor lung function in patients with chronic obstructive pulmonary disease (COPD) before pulmonary rehabilitation (PR) sessions. However, PEF mainly reflects changes in large airways and it is known that COPD primarily targets small airways. Adventitious respiratory sounds (ARS - crackles and/or wheezes), are related to changes within lung morphology and are significantly more frequent in patients with acute exacerbations of COPD. Thus, ARS may be also useful for the routine monitoring of lung function during PR programs. Objective: This study explored the convergent validity of ARS and PEF in patients with COPD. Methods: 24 stable patients (66±9y; FEV1 71±19% pred) participating in a PR program were included. Assessments were conducted immediately before one PR session. Presence of ARS (crackles and/or wheezes) at posterior right chest was first assessed by a physiotherapist using a digital stethoscope (ds32a, ThinkLabs, CO, USA). Resting dyspnea was collected using the modified Borg scale (0-10) and PEF with a peak flow meter (Micro I, Carefusion, UK). Independent t-tests, Pearson and point-biserial correlations were used. Results: ARS were present in 5 participants (20.8%). Patients with ARS had a lower PEF than patients without ARS (294±62 l/min vs. 419±128l/min; p=0.048). PEF was negatively correlated with presence of ARS (r=-0.41; p=0.048). Resting dyspnea was negatively correlated with PEF (r=-0.41; p=0.039), but not with ARS (r=0.21; p=0.32). Conclusions: Findings suggest that both ARS and PEF offer complementary information before a PR session, but that ARS provide additional information on the patents’ respiratory status. Further research correlating ARS and PEF with patients’ performance and progression during PR is needed to strengthen the usefulness of assessing these parameters in PR.
- Assessing caregiving experience in COPD: content validity of the Zarit Burden InterviewPublication . Cruz, Joana; Marques, Alda; Souto-Miranda, Sara; Goldstein, Roger; Brooks, DinaCaring for a relative with COPD influences multiple dimensions of carers' lives. Several instruments have been used to assess the caregiving experience in COPD,1 e.g. the Zarit Burden Interview (ZBI). This instrument was originally developed for use in carers of people with dementia, however, its applicability in COPD has not been tested. This study explored the content validity of the ZBI in carers of patients with COPD. Ten carers (68.2±6.9yrs, all female) of patients with COPD (74.7±5.3yrs, all male, FEV1=49.2±19.0%pred) participated in cognitive debriefing interviews. They were asked to complete the ZBI and verbalise their thinking process to assess the adequacy of its content and instructions. Interviews were recorded and transcribed for further analysis using the qualitative data analysis software (WebQDA). Responses to the ZBI were also analysed to explore floor/ceiling effects. From the 22 items of the ZBI, 6 items were relevant for all carers and 11 items were not relevant for at least one participant. Five of these 11 items were not relevant for ≥40% of the sample and were related to stress for providing care, embarrassment about patient’s behaviour and impacts on social/leisure time. The remaining 5 items were not consensual. Overall, the ZBI was well-understood although 8 items were less clear for some carers. They suggested: improving questions (n=1) and scoring (n=5); eliminating item 4 (n=2); including 2 questions about the caregiving context (n=1). Responses were mostly distributed in the option ‘Never/Not at all’. The ZBI in its current form should not be used to assess carer experience among those caring for patients with COPD. 1Cruz, J et al. Resp Med 2017;128:13-27
- Assessing caregiving experience in COPD: Content validity of the Zarit Burden Interview in Canadian and Portuguese caregiversPublication . Selzler, Anne-Marie; Brooks, Dina; Marques, Alda; Souto-Miranda, Sara; Goldstein, Roger; Cruz, JoanaInformal caregivers play an important role in chronic disease management but their experience is often neglected. The objective of this study was to explore the content validity of the Zarit Burden Interview (ZBI) in caregivers of individuals with COPD in Canada and Portugal.
- Cardiorespiratory physiotherapy as a career choice-perspective of students and physiotherapists in PortugalPublication . Marques, Alda; Oliveira, Ana; Machado, Ana; Jácome, Cristina; Cruz, Joana; Pinho, Tânia; Hall, Andreia; Alvelos, Helena; Brooks, DinaWe investigated Portuguese physiotherapy students' and physiotherapists' (1) perceptions of cardiorespiratory physiotherapy (CRP); (2) factors that influenced their decision to pursue a career in CRP; and (3) suggestions to develop CRP. Online surveys were disseminated to final year students and physiotherapists. A number of 189 students (mean age 23 [SD 6] years; 78% ♀) and 375 physiotherapists (mean age 31 [SD 8] years; 78% ♀) participated. Students' opinions about CRP were positively influenced by lecturers (n = 112, 69%), clinical experiences (n = 110, 68%), and scientific evidence (n = 93, 57%). Only 13% of students were "extremely interested" in specializing in CRP. Interest in the area and clinical exposure were the main factors influencing students to pursue a career in CRP. A percentage of 15 of responding physiotherapists were working in CRP. Their decision to pursue a CRP career was most influenced by their interest in the area (n = 37, 67%) and opportunity to work in acute settings (n = 31; 56%). Main suggestions to develop CRP were (1) include placements in CRP; (2) emphasize health promotion within the curriculum; and (3) develop CRP skills in broader contexts and training. Strategies focusing on changing the curriculum, increasing exposure to CRP, providing good mentorship, developing health promotion activities, and creating postgraduate courses may increase the attractiveness for CRP.
- Characteristics of patients with COPD using mobile apps in daily lifePublication . Araújo Oliveira, Ana Luisa; Flora, Sofia; Santos, Liliana; Morais, Nuno; Ribeiro, Jose; Silva, Fernando; Silva, Candida; Carreira, Bruno; Caceiro, Ruben; Kumar, Dinesh; Marques, Alda; Brooks, Dina; Burtin, Chris; Cruz, Joana
- Concurrent validity of the Portuguese version of the Brief physical activity assessment toolPublication . Cruz, Joana; Jácome, Cristina; Morais, Nuno; Oliveira, Ana; Marques, AldaIntroduction: Physical activity (PA) is recognised as an important health enhancing behaviour and should be routinely assessed in clinical practice to identify insufficiently active people. Activity monitors, such as accelerometers, provide objective assessment of free-living PA being the preferred assessment method in research settings. However, they are too expensive to be used in resource-constrained clinical settings. Several PA questionnaires have already been validated to the European Portuguese but some of them take too long to complete, hence unfeasible for use in clinical practice. Shorter PA assessment tools are, therefore, needed. Objectives: To explore the relationship between the Portuguese version of a short PA questionnaire, the Brief physical activity assessment tool (Brief-PA tool), and the International Physical Activity Questionnaire short form (IPAQ-sf), which is a valid and reliable PA assessment tool already tested in the Portuguese population. A secondary aim was to explore the test-retest reliability of the Brief-PA tool. Methods: The Brief-PA tool1 consists of 2 questions which assess the frequency and duration of moderate and vigorous PA undertaken in a ‘usual’ week. The total score is obtained by summing the results of the two questions (range 0-8). People with a score ≥4 are considered ‘sufficiently active’. Since the tool is not available in Portuguese, a linguistic adaptation was conducted using the forward- and back-translation method. Then, 86 healthy volunteers (49.518.1 years, age range 20-69; 53 female) completed the Brief-PA tool and the IPAQ-sf. A sub-sample (n=56, 43.118.1 years, 37 female) completed the Brief-PA tool one week later. Spearman’s rank correlation coefficient (ρ) was used to assess correlations between the Brief-PA total score with IPAQ-sf results (MET-min/week). Percentage of agreement (%agreement) and Cohen’s kappa were used to assess the agreement between categorical scores obtained from the two measures (i.e., ‘sufficiently’ and ‘insufficiently’ active) and test-retest reliability of the Brief-PA tool. Results: Significant correlations were found between the Brief-PA tool and the IPAQ-sf (ρ=0.721, p<0.001). The Brief-PA tool identified 34.8% sufficiently active participants while the IPAQ-sf identified 59.3%. Agreement between measures was moderate (%agreement=70.9%, kappa=0.450). Test-retest reliability of the Brief-PA tool was substantial (%agreement=89.3%, kappa=0.755). Conclusions: The Brief-PA tool seems to be valid and reliable for assessing PA in the Portuguese adult population, although the agreement with the IPAQ-sf was only moderate. Further research assessing the validity of the Brief-PA tool with objective measures is needed.
- Construct validity and reliability of the Informal Caregiver Burden Assessment Questionnaire (QASCI) in caregivers of patients with COPDPublication . Hipólito, Nádia; Martins, Sara; Ruivo, Adriana; Flora, Sofia; Silva, Cândida G.; Marques, Alda; Brooks, Dina; Cruz, JoanaIntroduction: COPD often leads to loss of independence in daily activities which may increase the dependency on the informal caregiver, resulting in caregiving burden. Several instruments have been used to assess caregiving burden in COPD; however, their measurement properties have been poorly investigated in this population. This study assessed the construct validity and reliability of the Informal Caregiver Burden Assessment Questionnaire (QASCI) in informal caregivers of patients with COPD. Methods: Participants completed the QASCI (higher scores indicate higher burden) and the following questionnaires to assess construct validity: Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS) and World Health Organization Quality of Life Instrument – Short Form (WHOQOL-Bref). QASCI was completed again one week later to assess test-retest reliability. Statistical analyses included: Pearson’s (r) or Spearman’s (ρ) correlations (construct validity); Cronbach’s α (internal consistency); Intraclass Correlation Coefficient (ICC2,1, test-retest reliability) and Standard Error of Measurement (SEM), Minimal Detectable Change (MDC95) and Bland and Altman 95% Limits of Agreement (LoA). Results: Fifty caregivers (62.7 ± 9.8 years, 88% female; patients’ FEV1 = 45.2 ± 21.3%predicted) participated. QASCI mean score was 28.5 ± 19.8 (moderate burden). QASCI was positively correlated with ZBI (r = 0.908; p < 0.01), HADS anxiety (r = 0.613; p < 0.01) and depression (ρ = 0.634; <0.01) and negatively correlated with WHOQOL-Bref ( 0.476 to 0.739) (all p < 0.01). Cronbach’s α was 0.793 for the QASCI total score (subscales: 0.747–0.932). The ICC2,1 was 0.924, SEM 2.8 and MDC95 7.8, and the LoA were 18.3 to 11.1. Conclusions: The QASCI seems to be a promising measure to assess burden levels associated with informal caregiving in COPD.
- Construct Validity of the Brief Physical Activity Assessment Tool for Clinical Use in COPDPublication . Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Paixão, Cátia; Rebelo, Patrícia; Flora, Sofia; Januário, Filipa; Valente, Carla; Andrade, Lília; Marques, AldaIntroduction Low physical activity (PA) levels are associated with poor health‐related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice. Objectives This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD, and explored differences in age, sex and COPD grades. Methods After linguistic adaptation of the tool to Portuguese, 110 patients (66.4±9.6yrs, 72.7% male, FEV1=59.3±25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous‐ and moderate‐intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA=1952‐5724 counts‐per‐min[CPM]); vigorous PA, VPA=5725‐∞CPM; moderate‐to‐vigorous PA, MVPA=1952‐∞CPM; daily steps), through: Spearman’s correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data. Results The BPAAT was weakly to moderately correlated with accelerometry (0.394≤ρ≤0.435, p<0.05), except for VPA (p=0.440). This was also observed in age (<65/≥65yrs), COPD grades (GOLD 1‐2/3‐4), and in male patients (0.363≤ρ≤0.518, p<0.05 except for VPA). No significant correlations were found in female patients (p>0.05). The BPAAT correctly identified 73.6% patients as ‘insufficiently active’ and 26.4% as ‘sufficiently active’. Agreement was fair to moderate (0.36≤kappa≤0.43; 73.6%≤%agreement≤74.5%; 0.50≤sensitivity≤0.52; 0.84≤specificity≤0.91, 0.55≤PPV≤0.79, 0.72≤NPV≤0.82). Conclusion The BPAAT may be useful to screen patients’ PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients.
- COPD profiles and treatable traits using minimal resources: Identification, decision tree and longitudinal stabilityPublication . Marques, Alda; Souto-Miranda, Sara; Machado, Ana; Oliveira, Ana; Jácome, Cristina; Cruz, Joana; Enes, Vera; Afreixo, Vera; Martins, Vitória; Andrade, L; Valente, Carla; Ferreira, Diva; Simão, Paula; Brooks, Dina; TavaresBackground: Chronic obstructive pulmonary disease (COPD) is highly heterogeneous and complex. Hence, personalising assessments and treatments to this population across different settings and available resources imposes challenges and debate. Research efforts have been made to identify clinical phenotypes or profiles for prognostic and therapeutic purposes. Nevertheless, such profiles often do not describe treatable traits, focus on complex physiological/pulmonary measures which are frequently not available across settings, lack validation and/or their stability over time is unknown. Objective: To identify profiles and their treatable traits based on simple and meaningful measures; to develop and validate a profile decision tree; and to explore profiles’ stability over time in people with COPD. Methods: An observational, prospective study was conducted with people with COPD. Clinical characteristics, lung function, symptoms, impact of the disease (COPD assessment test–CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. Pulmonary and extrapulmonary (i.e., physical, symptoms and health status, and behavioural/life-style risk factors) treatable traits were identified in each profile based on the established cut-offs for each measure available in the literature. The decision tree was developed with 70% and validated with 30% of the sample, cross-sectionally. Agreement between the profile predicted by the decision tree and the profile defined by the clustering procedure was determined using Cohen’s Kappa. Stability was explored over time with a stability score defined as the percentage ratio between the number of timepoints that a participant was classified in the same profile (most frequent profile for that participant) and the total number of timepoints (i.e., 6). Results: 352 people with COPD (67.4±9.9 years; 78.1% male; FEV1=56.2±20.6% predicted) participated and 90 (67.6±8.9 years; 85.6% male; FEV1=52.1±19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree was composed by the CAT, age and FEV1% predicted and had an agreement of 71.7% (Cohen’s Kappa=0.62, p<0.001) with the actual profiles. 48.9% of participants remained in the same profile whilst 51.1% moved between two (47.8%) and three (3.3%) profiles over time. The overall stability of profiles was 86.8±15%. Conclusion: Profiles and treatable traits can be identified in people with COPD with simple and meaningful measures possibly available even in minimal-resource settings. Regular assessments are recommended as people with COPD may change profile over time and hence their needs of personalised treatment.
- COPD profiles and treatable traits using minimal resources: Identification, decision tree and stability over timePublication . Marques, Alda; Souto-Miranda, Sara; Machado, Ana; Oliveira, Ana; Jácome, Cristina; Cruz, Joana; Enes, Vera; Afreixo, Vera; Martins, Vitória; Andrade, Lília; Valente, Carla; Ferreira, Diva; Simão, Paula; Brooks, Dina; Tavares, Ana HelenaBackground and objective: Profiles of people with chronic obstructive pulmonary disease (COPD) often do not describe treatable traits, lack validation and/or their stability over time is unknown. We aimed to identify COPD profiles and their treatable traits based on simple and meaningful measures; to develop and validate a decision tree and to explore profile stability over time. Methods: An observational, prospective study was conducted. Clinical characteristics, lung function, symptoms, impact of the disease (COPD Assessment Test—CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. A decision tree was developed and validated cross-sectionally. Stability was explored over time with the ratio between the number of timepoints that a participant was classified in the same profile and the total number of timepoints (i.e., 6). Results: 352 people with COPD (67.4 ± 9.9 years; 78.1% male; FEV1 = 56.2 ± 20.6% predicted) participated and 90 (67.6 ± 8.9 years; 85.6% male; FEV1 = 52.1 ± 19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree included CAT (< 18 or ≥ 18 points); age (< 65 or ≥ 65 years) and FEV1 (< 48 or ≥ 48% predicted) and had an agreement of 71.7% (Cohen’s Kappa = 0.62, p < 0.001) with the actual profiles. 48.9% of participants remained in the same profile whilst 51.1% moved between two (47.8%) or three (3.3%) profiles over time. Overall stability was 86.8 ± 15%. Conclusion: Four profiles and treatable traits were identified with simple and meaningful measures possibly available in low-resource settings. A decision tree with three commonly used variables in the routine assessment of people with COPD is now available for quick allocation to the identified profiles in clinical practice. Profiles and treatable traits may change over time in people with COPD hence, regular assessments to deliver goal-targeted personalised treatments are needed.