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Johnson L1, Munro M2, Smith R1, White C2
1King's College London, School of Population, Health and Environmental Sciences, London, United Kingdom, 2King's College London, London, United Kingdom
Background: Chronic obstructive pulmonary disease (COPD) is a progressive and irreversible lung disease. People with COPD spend more time sedentary than healthy individuals due to exertional dyspnoea and fatigue. There is increasing evidence of the detrimental effects of both sedentary behaviour (SB) and the amount of uninterrupted sedentary time that can lead to the development of secondary health conditions for people living with long term conditions. Therefore it is important to be able to effectively measure SB to allow the development and evaluation of interventions to reduce it in people with COPD.
Purpose: The aim of this study was to systematically review evidence on the reliability and validity of currently used subjective and objective measures of SB in people with COPD.
Methods: A systematic search of six electronic databases was conducted from inception until June 2017. Screening, data extraction and analysis was conducted by at least two authors. Studies were included in the review if they evaluated at least one measurement property of a relevant objective or subjective measure of SB in people with COPD. The measurement properties and methodological quality of included studies were evaluated using the COSMIN four-point checklist. Due to substantial clinical and methodological heterogeneity across studies a meta-analysis was not feasible. The narrative synthesis includes a best evidence summary determined from methodological quality, measurement properties, number of studies and consistency of results as described by Terwee and the Cochrane Back Review Group.
Results: Of the 6596 study titles retrieved, eight studies (cross-sectional, cohort or evaluation) involving 302 adults with COPD, evaluating six objective and six subjective measures of SB met the inclusion criteria and were included in the review. No studies defined SB, however four questionnaires evaluated self-reported sedentary time in minutes and five accelerometers were used to detect positional change and reported one or more of, time spent in each position, metabolic equivalents and physical activity levels. No studies evaluated intra- or inter-rater reliability, four studies reported test-retest reliability of self-report measures or objective activity monitors. Four studies reported absolute agreement and/or concurrent validity and three studies reported criterion validity when comparing either subjective and objective measures or two objective measures of SB. Finally, one study evaluated predictive validity between a self-report measure and COPD severity. The methodological quality of all included studies was rated as poor. This was due to small numbers of participants in the majority of studies, lack of a comparison with a ´gold standard´ or missing data and flaws in statistical analysis in some.
Conclusion(s): There is insufficient evidence from a small number of poor quality studies of the measurement properties of outcome measures of SB for people with COPD on which to make recommendations.
Implications: Further research is required to establish the measurement properties of outcome measures for SB in people with COPD. Researchers should focus on developing a standardised definition of SB, identifying a gold standard for comparison and increasing sample size to increase confidence in findings.
Keywords: COPD, measurement properties, sedentary behaviour
Funding acknowledgements: Unfunded
Purpose: The aim of this study was to systematically review evidence on the reliability and validity of currently used subjective and objective measures of SB in people with COPD.
Methods: A systematic search of six electronic databases was conducted from inception until June 2017. Screening, data extraction and analysis was conducted by at least two authors. Studies were included in the review if they evaluated at least one measurement property of a relevant objective or subjective measure of SB in people with COPD. The measurement properties and methodological quality of included studies were evaluated using the COSMIN four-point checklist. Due to substantial clinical and methodological heterogeneity across studies a meta-analysis was not feasible. The narrative synthesis includes a best evidence summary determined from methodological quality, measurement properties, number of studies and consistency of results as described by Terwee and the Cochrane Back Review Group.
Results: Of the 6596 study titles retrieved, eight studies (cross-sectional, cohort or evaluation) involving 302 adults with COPD, evaluating six objective and six subjective measures of SB met the inclusion criteria and were included in the review. No studies defined SB, however four questionnaires evaluated self-reported sedentary time in minutes and five accelerometers were used to detect positional change and reported one or more of, time spent in each position, metabolic equivalents and physical activity levels. No studies evaluated intra- or inter-rater reliability, four studies reported test-retest reliability of self-report measures or objective activity monitors. Four studies reported absolute agreement and/or concurrent validity and three studies reported criterion validity when comparing either subjective and objective measures or two objective measures of SB. Finally, one study evaluated predictive validity between a self-report measure and COPD severity. The methodological quality of all included studies was rated as poor. This was due to small numbers of participants in the majority of studies, lack of a comparison with a ´gold standard´ or missing data and flaws in statistical analysis in some.
Conclusion(s): There is insufficient evidence from a small number of poor quality studies of the measurement properties of outcome measures of SB for people with COPD on which to make recommendations.
Implications: Further research is required to establish the measurement properties of outcome measures for SB in people with COPD. Researchers should focus on developing a standardised definition of SB, identifying a gold standard for comparison and increasing sample size to increase confidence in findings.
Keywords: COPD, measurement properties, sedentary behaviour
Funding acknowledgements: Unfunded
Topic: Cardiorespiratory; Outcome measurement; Health promotion & wellbeing/healthy ageing
Ethics approval required: No
Institution: KIng''''s College London
Ethics committee: College Research Ethics Committee
Reason not required: Secondary research
All authors, affiliations and abstracts have been published as submitted.
