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      The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease

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          Abstract

          No current patient-centred instrument captures all dimensions of physical activity in chronic obstructive pulmonary disease (COPD). Our objective was item reduction and initial validation of two instruments to measure physical activity in COPD.

          Physical activity was assessed in a 6-week, randomised, two-way cross-over, multicentre study using PROactive draft questionnaires (daily and clinical visit versions) and two activity monitors. Item reduction followed an iterative process including classical and Rasch model analyses, and input from patients and clinical experts.

          236 COPD patients from five European centres were included. Results indicated the concept of physical activity in COPD had two domains, labelled “amount” and “difficulty”. After item reduction, the daily PROactive instrument comprised nine items and the clinical visit contained 14. Both demonstrated good model fit (person separation index >0.7). Confirmatory factor analysis supported the bidimensional structure. Both instruments had good internal consistency (Cronbach's α>0.8), test–retest reliability (intraclass correlation coefficient ≥0.9) and exhibited moderate-to-high correlations (r>0.6) with related constructs and very low correlations (r<0.3) with unrelated constructs, providing evidence for construct validity.

          Daily and clinical visit “PROactive physical activity in COPD” instruments are hybrid tools combining a short patient-reported outcome questionnaire and two activity monitor variables which provide simple, valid and reliable measures of physical activity in COPD patients.

          Abstract

          Both PROactive hybrid tools are simple, valid, and reliable measures of physical activity in COPD patients http://ow.ly/LJqP8

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          Most cited references20

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          Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.

          Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
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            Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.

            Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific mortality in COPD subjects. From a population-based sample recruited in Copenhagen in 1981-3 and 1991-4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories (very low, low, moderate, and high). Dates and causes of hospital admissions and mortality were obtained from Danish registers. Adjusted associations between physical activity and hospital admissions for COPD and mortality were obtained using negative binomial and Cox regression models, respectively. After adjustment for relevant confounders, subjects reporting low, moderate or high physical activity had a lower risk of hospital admission for COPD during the follow up period than those who reported very low physical activity (incidence rate ratio 0.72, 95% confidence interval (CI) 0.53 to 0.97). Low, moderate and high levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality (hazard ratio (HR) 0.76, 95% CI 0.65 to 0.90) and respiratory mortality (HR 0.70, 95% CI 0.48 to 1.02). No effect modification was found for sex, age group, COPD severity, or a background of ischaemic heart disease. Subjects with COPD who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality. The recommendation that COPD patients be encouraged to maintain or increase their levels of regular physical activity should be considered in future COPD guidelines, since it is likely to result in a relevant public health benefit.
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              lordif: An R Package for Detecting Differential Item Functioning Using Iterative Hybrid Ordinal Logistic Regression/Item Response Theory and Monte Carlo Simulations.

              Logistic regression provides a flexible framework for detecting various types of differential item functioning (DIF). Previous efforts extended the framework by using item response theory (IRT) based trait scores, and by employing an iterative process using group-specific item parameters to account for DIF in the trait scores, analogous to purification approaches used in other DIF detection frameworks. The current investigation advances the technique by developing a computational platform integrating both statistical and IRT procedures into a single program. Furthermore, a Monte Carlo simulation approach was incorporated to derive empirical criteria for various DIF statistics and effect size measures. For purposes of illustration, the procedure was applied to data from a questionnaire of anxiety symptoms for detecting DIF associated with age from the Patient-Reported Outcomes Measurement Information System.
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                Author and article information

                Journal
                Eur Respir J
                Eur. Respir. J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                October 2015
                11 June 2015
                : 46
                : 4
                : 988-1000
                Affiliations
                [1 ]Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
                [2 ]Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
                [3 ]Universitat Pompeu Fabra (UPF), Barcelona, Spain
                [4 ]FCS Blanquerna, Research Group in Physiotherapy (GReFis), Universitat Ramon Llull, Barcelona, Spain
                [5 ]National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
                [6 ]Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences and Respiratory Division, University Hospital Leuven, Leuven, Belgium
                [7 ]Department of Critical Care Medicine and Pulmonary Services, Thorax Foundation, Athens, Greece
                [8 ]Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
                [9 ]ELEGI Colt Laboratory, Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
                [10 ]Value Evidence and Outcomes, GlaxoSmithKline R&D, Uxbridge, UK
                [11 ]Health Services and Nursing Research, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
                [12 ]Almirall S.A., Barcelona, Spain
                [13 ]Lung Foundation Netherlands, Amersfoort, The Netherlands
                [14 ]PRO Expert, Novartis Pharma, Basel, Switzerland
                [15 ]Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
                [16 ]Health Economics and Outcomes Research, AstraZeneca R&D, Mölndal, Sweden
                [17 ]A full list of the PROactive consortium members and their affiliations can be found in the Acknowledgements section
                Author notes
                Judith Garcia-Aymerich, Centre for Research in Environmental Epidemiology, Doctor Aiguader 88, 08003 Barcelona, Spain. E-mail: jgarcia@ 123456creal.cat
                Article
                ERJ-01830-2014
                10.1183/09031936.00183014
                4589432
                26022965
                42bf2963-81d0-4441-95ef-33adab00c446
                Copyright ©ERS 2015

                ERJ Open articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 03 October 2014
                : 22 March 2015
                Funding
                Funded by: European Commission http://doi.org/10.13039/501100000780
                Award ID: IMI JU # 115011
                Categories
                Original Articles
                COPD
                1

                Respiratory medicine
                Respiratory medicine

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