Larsson P.1, Borge C.R.1,2, Nygren-Bonnier M.3,4, Lerdal A.1,2, Edvardsen A.5
1Lovisenberg Diaconal Hospital, Oslo, Norway, 2University of Oslo, Oslo, Norway, 3Karolinska Institutet, Stockholm, Sweden, 4Karolinska University Hospital, Stockholm, Sweden, 5LHL-klinikkene, Glittre, Nittedal, Norway
Background: There is a need for simple tests that can be used in settings where standard field walking tests, such as the six-minute walk test (6MWT), are difficult or impossible to administer to evaluate physical performance in patients with chronic obstructive pulmonary disease (COPD). The Short Physical Performance Battery (SPPB) is a simple screening tool for lower extremity function. It consists of three sub tests: a standing balance test, four-meter gait speed, and five sit-to-stand. Each sub test is scored from 0-4 and then summarized into the SPPB score (range 0-12), with higher scores reflecting better performance. Little information exists on how the SPPB may be useful for evaluating change in physical performance following pulmonary rehabilitation in COPD.
Purpose: The aims of this study were to a) evaluate change in SPPB scores and SPPB sub scores among patients with COPD during a four-week, pulmonary rehabilitation program b) explore possible relationships between SPPB scores and exercise capacity, dyspnea, disease-specific quality of life (DSQL), and pulmonary function at baseline, and c) explore if change in SPPB scores are related to changes in exercise capacity, dyspnea, and DSQL during pulmonary rehabilitation.
Methods: This quasi-experimental study recruited patients consecutively from a pulmonary rehabilitation hospital (LHL-klinikkene, Glittre, Norway). The final sample included 45 patients in GOLD stages II-IV (mean age: 69 ± 6 years). The SPPB, 6MWT, modified Medical Research Council (mMRC) dyspnea scale, and COPD assessment test (CAT) were administered at baseline and at the end of the pulmonary rehabilitation program. Predicted forced expiratory volume in one second (FEV1%) were assessed at baseline only.
Results: Short physical performance battery scores improved from the beginning to the end of pulmonary rehabilitation (mean change: 1.2 ± 1.7 points, p 0.001), showing a moderate Cohen´s d effect size (0.7). Out of the three SPPB sub tests, only the four-meter gait speed and the five sit-to-stand improved significantly, (mean change: 0.3 ± 0.5 points, p 0.001 and 0.9 ± 0.7 points, p 0.001, showing a moderate (0.5) and large (0.9) effect size respectively. There were moderate correlations between SPPB scores and 6MWD (r = 0.50, p 0.001) and SPPB scores and mMRC dyspnea scores (r = -0.45,
p = 0.003) at baseline, but not between SPPB scores and FEV1% or SPPB scores and CAT scores. Change in SPPB scores was not associated with changes in 6MWD or mMRC dyspnea score. Change in CAT scores was not analyzed because of missing post-test data.
Conclusion(s): The full SPPB and two of the SPPB sub tests (four-meter gait speed and five sit-to-stand) can be useful tools for evaluating the effect of pulmonary rehabilitation on physical performance in patients with in COPD.
Implications: The SPPB may be a useful supplement to the more commonly employed 6MWT both because the SPPB is a short and simple test that allow us to measure physical performance more often and in different settings than the 6MWT, and also because it most likely measures a different aspect of physical performance (strength vs. endurance).
Funding acknowledgements: This study received a grant from Lovisenberg Diaconal Hospital.
Topic: Outcome measurement
Ethics approval: This study was approved by the regional ethics review Board, REC South East. (REK2014/1499-3).
All authors, affiliations and abstracts have been published as submitted.
