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- Is the international physical activity questionnaire (IPAQ-sf) valid to assess physical activity in patients with COPD? Comparison with accelerometer dataPublication . Cruz, Joana; Jácome, Cristina; Marques, AldaIntroduction: The International Physical Activity Questionnaire short form (IPAQ-sf) is primarily designed for physical activity (PA) surveillance, presenting good psychometric properties in people with an age range of 15-69 years. However, studies conducted in older people have shown conflicting results, suggesting that it may not be adequate for this population. Therefore, the use of the IPAQ-sf for the assessment of PA in patients with chronic conditions such as chronic obstructive pulmonary disease (COPD), in which patients are frequently older, remains unclear. Objective: To preliminary evaluate the validity and test-retest reliability of the IPAQ-sf in patients with COPD. Methods: This exploratory cross-sectional study included 10 patients with COPD (71.6±7.3 years old, 7 male, FEV1 77.2±20.7%predicted). Participants completed the IPAQ-sf on two occasions separated by 1 week and wore an accelerometer (Actigraph GT3X+) for 7 consecutive days. The following statistical analyses were conducted: 1) Pearson’s correlation coefficient (r) to assess correlations between the results obtained from the IPAQ-sf (PA in METs-min/week; sitting time in min/day) and the accelerometer (PA: total moderate-to-vigorous physical activity [MVPA] per week and recommended MVPA per week – i.e., MVPA conducted in bouts of at least 10-min as internationally recommended1; sedentary time in min/day); 2) percentage of agreement (%agreement) and Cohen’s kappa to assess the agreement between categorical scores obtained from the two measures (i.e., ‘sufficiently’ and ‘insufficiently’ active patients); 3) Intraclass Correlation Coefficient (ICC2,1) and 95% limits of agreement (LoA) to assess test-retest reliability and agreement. Results: Significant correlations were found between IPAQ-sf METs-min/week and total MVPA (r=0.729, p=0.017), but not between METs-min/week and recommended MVPA (r=0.346, p=0.327) or between IPAQ-sf sitting time and accelerometer-based sedentary time (r=-0.383, p=0.308). Agreement between the IPAQ-sf and accelerometer-based data in identifying ‘sufficiently’ and ‘insufficiently’ active patients was low (total MVPA: kappa=-0.538, %agreement=20%; recommended MVPA: kappa=-0.087, %agreement=50%). Test-retest reliability of the IPAQ-sf was poor to moderate (PA: ICC2,1=0.439 [-0.267→0.838]; sedentary time: ICC2,1=0.511 [-0.178→0.864]) and the agreement was low (PA: LoA: -10361→4548 METs-min/week; sedentary time: LoA: -194→148 min/day). Conclusions: Findings suggest that the IPAQ-sf has limited validity and reliability in the assessment of PA in patients with COPD. Further research with a larger sample is needed to support these findings. 1American College of Sports Medicine (ACSM) (2011). Med Sci Sports Exerc, 43(7), 1334-59.
- Health-Related Physical Fitness of Children and Adolescents in PortugalPublication . Pinto, Joana Batista de Castro; Cruz, Joana Patricia Santos; Pinho, Tânia Maria Pereira de; Marques, Alda Sofia Pires de DiasObjectives: To establish normative values for health-related physical fitness (HRPF) measures in Portuguese children and adolescents. Secondarily, to explore the relationship between the HRPF and physical activity. Methods: HRPF was assessed in 354 children (6-17 years old, 152 males), through body mass index (BMI), incremental shuttle walk test (ISWT), hand-held dynamometry (HHD), modified sit-and-reach test (MSRT) and timed up and go (TUG). Physical activity was assessed with the "Assessment of Physical Activity Level Questionnaire" (APALQ). Normative values were then calculated as mean (95% confidence intervals) considering gender and four age groups (6-8; 9-11; 12-14; 15-17). Two-way ANOVAs were used to verify the effect of age, gender and age*gender interaction and Pearson’s coefficient correlations to assess relationships between HRPF and physical activity. Results: Except for the MSRT (p=0.036), no age*gender interaction effects were observed. The ISWT and TUG test presented a significant difference among age groups (p<0.05). Male children presented a better performance in the ISWT (p<0.001) and HHD (p=0.028) than females. Children had moderate physical activity levels except for the 6-8 age group, and there was a weak but significant association between HRPF tests and physical activity (-0.2430.05). Conclusions: These normative values will allow physical therapists to identify children with reduced performance and prescribe exercise accordingly. Active lifestyles should be encouraged in this population as better physical activity levels are related to better HRFP.
- Relationship between 1-minute sit-to-stand and respiratory muscle strength in COPDPublication . Alves, Ana; Miranda, Sara; Machado, Ana; Paixão, Cátia; Oliveira, Ana; Rebelo, Patrícia; Cruz, Joana; Jácome, Cristina; Marques, AldaBackground: It has been suggested that patients with chronic obstructive pulmonary disease (COPD) with respiratory muscle weakness achieve poorer results in exercise capacity tests, namely in the six-minute walk test (6MWT). The 1-minute sit-to-stand test (1-min STST) is simple to perform and a reliable and valid indicator of functional exercise capacity that correlates well with the 6MWT. However, its association with respiratory muscle strength in COPD is poorly studied. Objective: To explore the relationship between the 1-min STST and maximum inspiratory (MIP) and expiratory pressures (MEP) in patients with COPD. Methods: A cross-sectional study was conducted in the center and north regions of Portugal. Outpatients with COPD were recruited from routine pulmonology appointments. The 1-min STST and MIP/MEP were collected and predicted percentages (pp) of MIP/MEP were calculated using the equation set by Neder and colleagues. Correlations between the number of repetitions in the 1-min STST and MIPpp/MEPpp were explored by sex using Spearman coefficient correlation. Results: 376 outpatients with COPD (66.3±10.2y; 76.1%♂; FEV1 61.1±23.4pp; 101.6±8.0% ♂MIPpp; 79.2±5.2% ♀MIPpp; 110.9±8.1% ♂MEPpp; 76.7±6.5% ♀MEPpp) were included in this study. When the correlation was assessed by sex, low positive correlations were found between 1-min STST and MIP/MEPpp in males (r=0.37, p<0.001) (Fig.1). There was no significant correlation between 1-min STST and of MIP/MEPpp in females (p>0.05). Conclusion: 1-min STST correlated significantly with predicted respiratory muscle strength in male patients with COPD. Patients with respiratory muscle impairment seem to have worse functional capacity than those with better MIP and MEP. Thus, respiratory muscle training may play an important role in the improvement of functional capacity in patients with COPD with respiratory muscle weakness.
- Interesses e necessidades de formação em Fisioterapia Cardiorrespiratória em Portugal: Um estudo do GIFCR-APFISIOPublication . Cruz, Joana; Almeida, Miguel; Pinto, Joana; Morais, Nuno; Silva, Alexandre; Barbosa, Marisela; Azevedo, Natália; Gagulic, Sandra; Oliveira, Ana; Machado, Filipa; Jácome, Cristina; Marques, AldaIntrodução e objetivos: A educação profissional permite aos fisioterapeutas manter, desenvolver e melhorar os conhecimentos e competências necessários à prestação de serviços de elevada qualidade. A Fisioterapia Cardiorrespiratória (FCR) é uma das áreas em crescimento em Portugal e no mundo, sendo fundamental adequar a oferta formativa às necessidades da prática clínica. Este estudo pretendeu identificar as necessidades e interesses de formação dos fisioterapeutas e estudantes na área da FCR. Materiais e Métodos: O Grupo de Interesse em Fisioterapia Cardiorrespiratória da Associação Portuguesa de Fisioterapeutas (GIFCR-APFISIO) desenvolveu e realizou um inquérito online (google forms) entre março–abril 2018 a fisioterapeutas e estudantes de Fisioterapia em Portugal, com interesse/prática em FCR, a fim de se: 1) conhecer a tipologia e área(s) de formação preferencial/necessária; 2) identificar questões práticas (regime, duração, local, custo). O inquérito foi divulgado através do Facebook do GIFCR-APFISIO e via e-mail aos associados da APFISIO, escolas e instituições de saúde. Foi realizada análise descritiva. Resultados: 193 pessoas (32±9 anos; 155 mulheres; 21 estudantes) responderam ao inquérito. As tipologias de formação preferenciais foram: cursos (n=155), workshops (n=100) e encontros com especialistas/masterclasses (n=74). As áreas preferenciais foram: raciocínio clínico em FCR (n=126), reabilitação respiratória ou cardíaca no doente crónico (n=102 e n=90) ou agudo (n=84 e n=70), fisiologia do exercício avançada (n=89) e avaliação do doente respiratório (n=83) ou cardíaco (n=75). O regime de formação presencial foi o mais votado, idealmente aos fins-de-semana (n=126) ou em regime ‘pós-laboral e fim-de-semana’ (n=105), com duração de 2–3 dias (n=146). Um custo entre 100–300€ foi considerado adequado (n=144). As regiões consideradas preferenciais para formação foram Lisboa (n=79), Porto (n=60) e Aveiro (n=40). Conclusões: Com base nestes resultados, o GIFCR-APFISIO organizou já 2 cursos e 1 jornadas de atualização em FCR. Estes dados irão permitir adequar a oferta formativa às necessidades de fisioterapeutas e estudantes de fisioterapia, em Portugal.
- Reference values for respiratory muscle strength in portuguese healthy peoplePublication . Alves, Ana; Miranda, Sara; Machado, Ana; Paixão, Cátia; Oliveira, Ana; Rebelo, Patrícia; Cruz, Joana; Jácome, Cristina; Marques, AldaBackground: Maximal inspiratory (MIP) and expiratory pressures (MEP) are measures to assess respiratory muscle strength. Reference values are population-specific and are lacking for the respiratory muscle strength of the Portuguese population. Overcoming this absence is important, to avoid over- or underestimation of such values and to facilitate the identification of Portuguese individuals with respiratory muscle weakness, so tailored interventions can be delivered. Reference values for respiratory muscle strength in portuguese healthy people. Objective: To determine reference values for MIP and MEP in middle aged and older Portuguese healthy people. Methods: A cross-sectional study was conducted in the north and center regions of Portugal. Healthy participants were recruited from community centers. MIP and MEP were assessed using a respiratory pressure gauge (MicroRPM, CareFusion, Kent, United Kingdom). Descriptive statistics were used to determine reference values by age decades (50-59; 60-69; 70-79 and >80 years) and sex. Independent sample t-tests were used to analyse differences between sex in each age decade and one-way ANOVA with Bonferroni-correction to compare age decades. Results: A total of 164 healthy participants were included in this study (67.7±9.7yrs, n=79♂, 28.0±4.8kg/m2). MIP and MEP reference values are shown in table 1. MIP and MEP values were higher in males (92.3±26.3; 139.1±35.2 cmH2O) than in females (78.3±23.4; 104.3±25.6 cmH2O) (p<0.001). MIP mean values were significantly different among age decades (F=5.4; p=0.002), specifically between 50-59 and >80years decades (p=0.01) and between 60-69 and >80years decades (p=0.003). The mean values of MEP were not significantly different across age decades. Conclusion: In Portuguese healthy people, respiratory muscle strength differs between males and females and among age decades. This is part of an ongoing work that will increase the sample size to characterise respiratory muscle strength in the Portuguese healthy population.
- 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
- Methodologies to assess muscle co-contraction during gait in people with neurological impairment – A systematic literature reviewPublication . Rosa, Marlene; Marques, Alda; Demain, Sara; Metcalf, Cheryl D.; Rodrigues, JoãoTo review the methodologies used to assess muscle co-contraction (MCo) with surface electromyography (sEMG) during gait in people with neurological impairment.
- Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysisPublication . Marques, Alda; Jácome, Cristina; Rebelo, Patrícia; Paixão, Cátia; Oliveira, Ana; Cruz, Joana; Freitas, Célia; Rua, Marília; Loureiro, Helena; Peguinho, Cristina; Marques, Fábio; Simões, Adriana; Santos, Madalena; Martins, Paula; André, Alexandra; De Francesco, Sílvia; Martins, Vitória; Brooks, Dina; Simão, PaulaPulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.
- 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.
- 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.