WHAT IS THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE IN THE ONE-MINUTE SIT-TO-STAND TEST DURING REMOTE INTERVENTIONS?

H.M. Che¹, L. McDonnell², H. Shannon¹

¹University College London, London, United Kingdom, ²Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the world. Current evidence suggests pulmonary rehabilitation to be the most effective therapeutic strategy to improve health status in this population. With the COVID-19 pandemic and the poor uptake of pulmonary rehabilitation for various reasons, a home-based rehabilitation programme could potentially improve the uptake and adherence of exercise in patients with COPD. Hence, an outcome measure that is suitable to be carried out in home settings will also be required for assessing the effectiveness of such a programme.

Purpose: The one-minute sit-to-stand test could be useful in determining the effectiveness of a remote exercise-based programme as patients can easily perform it within their home settings. As part of the validation process, the aim of this study was to calculate the minimal clinically important difference (MCID) for the one-minute sit-to-stand test following a remote exercise-based intervention.

Methods: A comprehensive remote exercise-based intervention was developed at St Thomas’ Hospital, U.K., for patients with COPD. The one-minute sit-to-stand test, COPD Assessment Test and Medical Research Council dyspnoea scale were completed before and after the exercise programme. Participants were asked to score their change in health status after the programme using the Global Rating of Change questionnaire. Data were analysed retrospectively. Anchor-based methods were used to evaluate the MCID of the one-minute sit-to-stand test for remote exercise-based interventions.

Results: In total, complete data were available from 106 patients with COPD who completed the one-minute sit-to-stand test before and after their remote exercise-based programme. The remote exercise-based intervention was effective, with statistically significant improvements in exercise capacity and quality of life outcomes between baseline and post-intervention (p<0.001). The median (IQR) improvement of the one-minute sit-to-stand test after the programme was 3 (1-5) repetitions. Changes in one-minute sit-to-stand repetitions were only weakly correlated with changes in the dyspnoea scale, COPD Assessment Test and the Global Rating of Change questionnaire (r=-0.15, -0.12 and 0.09, respectively); no significant correlation was found between changes in the one-minute sit-to-stand test and these selected outcome measures. Using anchor-based approaches, the estimated MCID for the one-minute sit-to-stand test was three repetitions.

Conclusions: The one-minute sit-to-stand is responsive to to changes following remote exercise-based interventions in patients with COPD. Results suggested an improvement of at least three repetitions to be clinically meaningful. However, as the one-minute sit-to-stand test only displayed weak and statistically non-significant associations with the selected external anchors, anchors that display stronger correlations will be required to increase the robustness of the MCID estimates.

Implications: The ability of the one-minute sit-to-stand test to detect physical improvement in patients after a remote exercise-based programme suggests that it could be used as an alternative to the other field tests that require more space, highly trained staff or specialist equipment for assessing the effectiveness of home-based interventions. The MCID provides a starting point for ensuring that changes are clinically important, although further testing with alternative anchors is needed to clarify this finding.

Funding acknowledgements: No funding was received for this study.

Keywords:
Chronic Obstructive Pulmonary Disease
Remote interventions
Sit-to-stand test

Topics:
Disability & rehabilitation
Community based rehabilitation
Cardiorespiratory

Did this work require ethics approval? No

Reason: This was a service evaluation using retrospective data. Informed consent was obtained from all participants.