Browsing by Author "Valente, Carla"
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- 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.
- Motivos para a Prática de Atividade Física e Atividade Física Atual em pessoas com DPOCPublication . Pimenta, Sara; Raposo, João; Alves-Guerreiro, José; Flora, Sofia; Caceiro, Rúben; Morais, Nuno; Oliveira, Ana; Silva, Cândida G.; Valente, Carla; Andrade, L; Raínho, André; Martins, Vitória; Marques, Alda; Cruz, JoanaIntrodução e objetivos: A inatividade física está associada a um maior risco de exacerbações, hospitalizações e mortalidade em pessoas com doença pulmonar obstrutiva crónica (DPOC). A motivação é um dos fatores-chave para a adoção de um estilo de vida mais ativo. Porém, os motivos para a prática de atividade física (AF) em pessoas com DPOC têm sido pouco estudados, embora sejam relevantes para o desenvolvimento de intervenções de promoção de AF efetivas e sustentáveis. Assim, exploraram-se os motivos para o exercício que as pessoas com DPOC valorizam e a sua relação com a AF atual. Material e Métodos: Realizou-se um estudo observacional transversal em pessoas com DPOC clinicamente estáveis recrutadas em 4 hospitais e 1 centro de saúde. Os motivos para o exercício foram avaliados através do Exercise Motivation Inventory – 2 (EMI-2; 5 dimensões e 14 fatores motivacionais; valores mais altos correspondem a motivos mais valorizados). O comportamento atual de AF foi avaliado através de acelerometria [ActiGraph GT3X+; duração (min/dia) em AF ligeira e moderada-a-vigorosa (AFMV), n.º passos/dia]. Foram usadas medidas de estatística descritiva e correlação de Spearman para avaliar a relação entre os dados do EMI-2 e de acelerometria. Resultados: Foram incluídos 79 participantes (67,4±8,2 anos; 82,3% homens; 43,3% GOLD 3). O fator motivacional mais pontuado foi “manter-se saudável” (mediana [Q1-Q3] 4,7 [3,3–5]) e o que obteve um menor valor foi o “reconhecimento social” (0,8 [0–2,8]). Relativamente às dimensões, os “Motivos de Saúde” 4,1 [3,1–4,7] foram os mais valorizados. Em média, os participantes realizaram 5365,1±3239,1 passos/dia, despenderam 133,6±72,5 min/dia em AF ligeira e 30,5±25,6 min/dia em AFMV. As correlações entre a AF e os fatores e dimensões motivacionais do EMI-2 não apresentaram significância estatística (ρ≤0,194, p>0,05). Conclusões: Embora as pessoas com DPOC valorizem motivos relacionados com a dimensão “saúde”, nenhum dos fatores motivacionais se correlacionou fortemente com a AF atual. Os resultados realçam a natureza multifatorial e complexa da AF e a necessidade de explorar a relação de outros fatores na motivação e AF desta população.
- Relationship between fatigue, physical activity and health-related factors in COPDPublication . Vieira, Ana; Dias, Diana; Miguel, Eunice; Matos, Telma; Flora, Sofia; Silva, Cândida G.; Morais, Nuno; Oliveira, Ana; Caceiro, Rúben; Silva, Fernando; Ribeiro, José; Silva, Sónia; Martins, Vitória; Valente, Carla; Burtin, Chris; Brooks, Dina; Marques, Alda; Cruz, JoanaFatigue is highly prevalent in COPD and may be associated with reduced physical activity (PA) and poor outcomes. This study explored the relationship between fatigue, objectively measured PA and health-related factors in people with COPD. Fatigue was assessed with the Checklist of Individual Strength (CIS20) and CIS20-Subjective Fatigue (CIS20-SF) and PA with Actigraph GT3X monitors (moderate-to-vigorous PA, MVPA; total PA; steps/day). Dyspnoea (modified Medical Research Council, mMRC), exercise tolerance (6-min walk distance, 6MWD), lung function (spirometry) and GOLD A-D were collected. Spearman (ρ) and Pearson (r) correlations and multiple regressions were performed. Variables entered the model if correlation≥0.2. 54 patients participated (68±7 years; 82% men) and 69% reported fatigue (CIS20-SF≥27). Fatigue was significantly correlated with MVPA, steps/day, mMRC, 6MWD, GOLD A-D and FEV1pp (Table 1). In regression models for CIS20 (p=.001; r2=.61) and CIS20-SF (p=.003; r2=.56), dyspnoea was the only significant variable. People with higher scores of fatigue present lower PA levels, although the relationship is weak. Dyspnoea appears to have the largest influence on fatigue.
- Reliability and validity of the international physical activity questionnaire short-form (IPAQ-sf) in COPDPublication . Flora, Sofia; Hipólito, Nádia; Santos, Liliana; Januário, Filipa; Silva, Sónia; Valente, Carla; Andrade, L; Rodrigues, Fátima; Marques, Alda; Cruz, JoanaPhysical activity (PA) may improve COPD prognosis, thus its assessment and promotion are crucial. The International Physical Activity Questionnaire Short-Form (IPAQ-sf) is widely used for assessing PA but there is limited evidence on its clinimetric properties in COPD. We assessed the test-retest reliability and validity of the IPAQ-sf in patients with COPD. Fifty-five participants (68.6±7.8yrs, 48 males, FEV1 52.3±22.5%pred) completed the IPAQ-sf, wore an accelerometer for 7 days and completed a second IPAQ-sf. Test-retest reliability/agreement was assessed with: Intraclass Correlation (ICC, 95%CI), 95% Limits of Agreement (LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for continuous variables; %agreement for categories (“active” vs “inactive”). Validity was assessed with Spearman’s correlations (ρ) between the IPAQ-sf (METs-min/week, time in vigorous [VPA] and moderate PA [MPA] per week) and accelerometry [time in MVPA, VPA and MPA per week] for continuous variables; %agreement, Cohen’s kappa, sensitivity and specificity (95%CI) for categories. Reliability was acceptable (ICC=0.738, 0.629→0.873) but with wide LoA (-5713→4793.3 METs-min/week). SEM and MDC95 were 1844.7 and 5113.3 METs-min/week, respectively. %agreement of the two IPAQ-sf was 85.5% (kappa=0.660, 0.444→0.876). Significant correlations were found between METsmin/week and accelerometry (0.515≤ρ≤0.596), except for VPA (p>0.05). %agreement between tools was 67.3% (kappa=0.350, 0.279→0.571) with high sensitivity (0.89, 0.887→0.891) but low specificity (0.46, 0.46→0.47). The IPAQ-sf could be used as PA measurement tool in COPD although caution is needed to avoid misclassification.
- The ABCD assessment tool: relationship with the clinical outcomes of patients with COPDPublication . Marques, Alda; Miranda, Sara; Paixão, Cátia; Valente, Carla; Andrade, Lília; Cruz, Joana; Jácome, Cristina; Machado, AnaThe ABCD assessment tool for patients with chronic obstructive pulmonary disease (COPD) has recently been revised. Few studies have evaluated patients’ clinical characteristics based on this classification, although it may be important to adjust interventions to patients’ specific needs. This study explored the distribution of the most used clinical outcomes in patients with COPD across ABCD groups. A cross sectional study was conducted. Patients with COPD were recruited from routine pulmonology appointments and primary care centres in Portugal. Assessments included a spirometric test, quadriceps muscle strength (QMS) with handheld dynamometer, inspiratory muscle strength with the maximal inspiratory pressure (MIP), functional performance with the 1-minute sit-to-stand test (1-min STS) and health-related quality of life with the Saint George Respiratory Questionnaire (SGRQ). Patients were classified into ABCD groups based on the modified British Medical Research Council dyspnoea questionnaire and history of exacerbations in the previous year. One-way ANOVA and Bonferroni corrections for multiple comparisons were used to explore differences between groups. Three hundred and twenty-nine patients with COPD (253 (77%) male, 67±10 years old, forced expiratory volume in one second 60±25 % of predicted, forced vital capacity 81±23 % of predicted, body mass index 28±16 kg/m2; 73 (22%) GOLD I, 133 (40%) GOLD II, 90 (27%) GOLD III, 33 (10%) GOLD IV) participated. Group A was the most prevalent (131; 40%), followed by groups B (95; 29%), D (70; 21%) and C (33; 10%). Patients from groups B and D, which are the most symptomatic, presented the worst results for all outcomes (Figure 1). Patients from ABCD groups present different clinical characteristics. The ABCD classification appears to be important to discriminate patients with worst outcomes, hence it may be useful to personalise treatments according to patients’ needs and clinical characteristics.