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Construct validity and reliability of the Informal Caregiver Burden Assessment Questionnaire (QASCI) in caregivers of patients with COPD

Publication . Hipólito, Nádia; Martins, Sara; Ruivo, Adriana; Flora, Sofia; Silva, Cândida G.; Marques, Alda; Brooks, Dina; Cruz, Joana

Introduction: 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.

2022-12Journal article

Open access

Phenotyping Adopters of Mobile Applications Among Patients With COPD: A Cross-Sectional Study

Publication . Flora, Sofia; Hipólito, Nádia; Brooks, Dina; Marques, Alda; Morais, Nuno; Silva, Cândida; Silva, Fernando; Ribeiro, José; Caceiro, Rúben; Carreira, Bruno; Burtin, Chris; Pimenta, Sara; Cruz, Joana; Oliveira, Ana

Effectiveness of technology-based interventions to improve physical activity (PA) in people with COPD is controversial. Mixed results may be due to participants' characteristics influencing their use of and engagement with mobile health apps. This study compared demographic, clinical, physical and PA characteristics of patients with COPD using and not using mobile apps in daily life. Patients with COPD who used smartphones were asked about their sociodemographic and clinic characteristics, PA habits and use of mobile apps (general and PA-related). Participants performed a six-minute walk test (6MWT), gait speed test and wore an accelerometer for 7 days. Data were compared between participants using (App Users) and not using (Non-App Users) mobile apps. A sub-analysis was conducted comparing characteristics of PA–App Users and Non-Users. 59 participants were enrolled (73% Male; 66.3 ± 8.3 yrs; FEV1 48.7 ± 18.4% predicted): 59% were App Users and 25% were PA-App Users. Significant differences between App Users and Non-App Users were found for age (64.2 ± 8.9 vs. 69.2 ± 6.3yrs), 6MWT (462.9 ± 91.7 vs. 414.9 ± 82.3 m), Gait Speed (Median 1.5 [Q1–Q3: 1.4–1.8] vs. 2.0 [1.0–1.5]m/s), Time in Vigorous PA (0.6 [0.2–2.8] vs. 0.14 [0.1–0.7]min) and Self-Reported PA (4.0 [1.0–4.0] vs. 1.0 [0.0–4.0] Points). Differences between PA–App Users and Non-Users were found in time in sedentary behavior (764.1 [641.8–819.8] vs. 672.2 [581.2–749.4] min) and self-reported PA (4.0 [2.0–6.0] vs. 2.0 [0.0–4.0] points). People with COPD using mobile apps were younger and had higher physical capacity than their peers not using mobile apps. PA-App Users spent more time in sedentary behaviors than Non-Users although self-reporting more time in PA.

2021-11-04Journal article

Open access

Precisão de duas pulseiras desportivas (smartbands) de diferente valor comercial na contagem de passos: um estudo exploratório

Publication . Silva, Inês; Machado, Pedro; Flora, Sofia; Cruz, Joana

Introdução: A crescente recomendação da prática de atividade física tem levado à necessidade de monitorização em contexto real. As pulseiras desportivas comerciais (smartbands) são uma possibilidade, uma vez que permitem obter o número de passos realizados e servir como ferramentas motivacionais. No entanto, a maioria destes dispositivos não se encontram validados. Este estudo pretendeu avaliar a validade de duas smartbands de diferente valor comercial, no lado dominante e não-dominante, e comparar o seu desempenho. Métodos: 11 indivíduos saudáveis (33,7±11,4 anos; dominância direita n=11) utilizaram 4 smartbands de duas marcas (Garmin Vivosmart 4, Xiaomi Mi Band 4) no punho esquerdo e direito, enquanto caminhavam durante 3 minutos a uma velocidade autodeterminada. O número de passos foi obtido através das smartbands e contagem manual (critério). O erro percentual absoluto médio (MAPE) e os limites do acordo (LA) foram utilizados para avaliar a precisão das smartbands. Os LA foram também utilizados para comparar resultados entre local (direito, esquerdo) e dispositivos. Resultados: O MAPE das smartbands foi abaixo de 10%, independentemente da marca e localização. No entanto, as smartbands Garmin apresentaram valores inferiores de MAPE (Esquerdo: 3,6±2,9%; Direito: 4,6±4,7%) e LA mais restritos (Esquerdo: -35,7/9,1; Direito: -45,7/50,6 passos). A diferença dos resultados foi mais reduzida entre as smartbands Garmin (LA: -37,6/69,1 passos) e os dispositivos localizados no lado direito (LA: -72,2/96,3 passos). Conclusões: As smartbands apresentam um erro aceitável para a monitorização de passos na população em geral, embora a smartband Garmin apresente melhores resultados. Estudos futuros são necessários para suportar estes resultados.

2022-07-29Journal article

Open access

Construct Validity of the Brief Physical Activity Assessment Tool for Clinical Use in COPD

Publication . Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Paixão, Cátia; Rebelo, Patrícia; Flora, Sofia; Januário, Filipa; Valente, Carla; Andrade, Lília; Marques, Alda

Introduction 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.

2021-01-23Journal article

Open access

Technological features of smartphone apps for physical activity promotion in patients with COPD: A systematic review

Publication . Silva, J.; Hipólito, N.; Machado, P.; Flora, S.; Cruz, J.

Introduction: Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD. Methods: A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features). Results: Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories ‘Measuring and monitoring’ and ‘Support and Feedback’ were present in all apps. Overall, the most implemented features were ‘progress in visual format’ (n=13), ‘advice on PA’ (n=14) and ‘data in visual format’ (n=10). Only three apps included social features, and two included a web-based version of the app. Conclusions: The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients’ PA levels.

2023-07Journal article

Open access