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      Patterns, Trajectories, and Predictors of Functional Decline after Hospitalization for Acute Exacerbations in Men with Moderate to Severe Chronic Obstructive Pulmonary Disease: A Longitudinal Study

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          Abstract

          Background

          Hospitalization for acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD) is common, but little is known about the impact of hospitalization on the development of disability. The purpose of this study was to determine the rate and time course of functional changes 3 months after hospital discharge for AE-COPD compared with baseline levels 2 weeks before admission, and to identify predictors of functional decline.

          Methods

          This was a prospective study including 103 patients (age mean, 71 years; standard deviation, 9.1 years) who were hospitalized with AE-COPD. Number of dependencies in Activities of Daily Living (ADLs) was measured at the preadmission baseline and at weeks 6 and 12 after discharge. Patterns of improvement, no change, and decline were defined over 3 consecutive intervals (baseline and weeks 6 and 12). Trajectories grouped patients with similar time courses of disability. Recovery was defined as returning to baseline function after functional decline. Univariate and multivariate multiple logistic regression was used to determine predictors of functional decline after week 12.

          Results

          Six trajectories of functional changes were found. From baseline to 12 weeks, 50% of patients continued to have the same function whereas 31% experienced functional decline after 6 weeks; 16.7% recovered over subsequent weeks. At week 12, as a consequence of all trajectories, 38% of patients showed functional declines compared with baseline function, 57% had not declined, and 6 improved. Length of stay (odds ratio [OR] = 1.12;95% [confidence interval] CI 1.03–1.22), dyspnea (OR = 1.85; 95% CI 1.05–3.26), and frailty (OR = 3.97; 95% CI 1.13–13.92) were independent predictors of functional decline after 12 weeks.

          Conclusions

          Hospitalization for AE-COPD is a risk factor for the progression of disability. More than one third of patients hospitalized for AE-COPD declined during the 12 weeks following discharge, with most of this decline occurring by week 6.

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          The development of a comorbidity index with physical function as the outcome.

          Dianne Groll, Teresa To, Claire Bombardier … (2005)
          Physical function is an important measure of success of many medical and surgical interventions. Ability to adjust for comorbid disease is essential in health services research and epidemiologic studies. Current indices have primarily been developed with mortality as the outcome, and are not sensitive enough when the outcome is physical function. The objective of this study was to develop a self-administered Functional Comorbidity Index with physical function as the outcome. The index was developed using two databases: a cross-sectional, simple random sample of 9,423 Canadian adults and a sample of 28,349 US adults seeking treatment for spine ailments. The primary outcome measure was the SF-36 physical function (PF) subscale. The Functional Comorbidity Index, an 18-item list of diagnoses, showed stronger association with physical function (model R(2) = 0.29) compared with the Charlson (model R(2) = 0.18), and Kaplan-Feinstein (model R(2) = 0.07) indices. The Functional Comorbidity Index correctly classified patients into high and low function, in 77% of cases. This new index contains diagnoses such as arthritis not found on indices used to predict mortality, and the FCI explained more variance in PF scores compared to indices designed to predict mortality.
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            The minimal detectable change cannot reliably replace the minimal important difference.

            Dan Turner, Holger Schünemann, Lauren Griffith … (2010)
            We compared the minimal important difference (MID) with the minimal detectable change (MDC) generated by distribution-based methods. Studies of two quality-of-life instruments (Chronic Respiratory Questionnaire [CRQ] and Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ]) and two physician-rated disease-activity indices (Pediatric Ulcerative Colitis Activity Index [PUCAI] and Pediatric Crohn's Disease Activity Index [PCDAI]) provided longitudinal data. The MID values were calculated from global ratings of change (small change for CRQ and RQLQ; moderate for PUCAI and PCDAI) using receiver-operating characteristic (ROC) curve and mean change. Results were compared with five distribution-based strategies. Of the methods used to calculate the MDC, the 95% limits of agreement and the reliable change index yielded the largest estimates. In the patient-rated psychometric instruments, 0.5 SD was always greater than 1 standard error of measurements (SEM), and both fell between the mean change and the ROC estimates, on two of four occasions. The reliable change index came closest to MID of moderate change. For patient-rated psychometric instruments, 0.5 SD and 1 SEM provide values closest to the anchor-based estimates of MID derived from small change, and the reliable change index for physician-rated clinimetric indices based on moderate change. Lack of consistency across measures suggests that distribution-based approaches should act only as temporary substitutes, pending availability of empirically established anchor-based MID values.
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              The assessment of frailty in older people in acute care.

              Sarah N Hilmer, Vidya Perera, Sarah Mitchell … (2009)
              Develop a measure of frailty for older acute inpatients to be performed by non-geriatricians. The Reported Edmonton Frail Scale (REFS) was adapted from the Edmonton Frail Scale for use with Australian acute inpatients. With acute patients aged over 70 years admitted to an Australian teaching hospital, we validated REFS against the Geriatrician's Clinical Impression of Frailty (GCIF), measures of cognition, comorbidity and function, and assessed inter-rater reliability. REFS was moderately correlated with GCIF (n = 105, R = 0.61, P < 0.01), Mini-Mental State Examination impairment (n = 61, R = 0.49, P < 0.001), Charlson Comorbidity Index (n = 59, R = 0.51, P < 0.001) and Katz Daily Living Scale (n = 59, R = 0.51, P < 0.001). Inter-rater reliability of REFS administered by two researchers without medical training was excellent (kappa = 0.84, n = 31). In this cohort of older acute inpatients, REFS is a valid, reliable test of frailty, and may be a valuable research tool to assess the impact of frailty on prognosis and response to therapy.
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                Author and article information

                Contributors
                Stelios Loukides: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 14 June 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 6
                Electronic Location Identifier: e0157377
                Affiliations
                [1 ]Department of Physical Therapy, Universidad of Murcia, Murcia, Spain
                [2 ]Division of Pneumology, Hospital Morales Meseguer, Murcia, Spain
                [3 ]Department of Physical Therapy, EUSES University of Girona, Girona, Spain
                University of Athens, GREECE
                Author notes

                Competing Interests: The corresponding author, on behalf of all authors, hereby declares and states the absence of any eventual or potential competing interest (neither financial nor nonfinancial). Subsequently, there are no restrictions or sources of altering their adherence to PLOS ONE policies on sharing data or materials. On another note, none of the authors have served or currently serve on the editorial board of the journal; none of them have acted as an expert witness in relevant legal proceedings either, and none of the authors sit on a committee for any organization that may benefit from publication of the paper submitted.

                Conceived and designed the experiments: FMM RBM GGG EVN MGS JAGV. Performed the experiments: FMM RBM GGG. Analyzed the data: FMM RBM GGG. Contributed reagents/materials/analysis tools: FMM RBM GGG EVN MGS JAGV. Wrote the paper: FMM RBM GGG EVN. Designed the software used in analysis: FMM RBM GGG.

                Article
                Publisher ID: PONE-D-16-10891
                DOI: 10.1371/journal.pone.0157377
                PMC ID: 4907520
                PubMed ID: 27300577
                SO-VID: 7e490c2e-a5db-4fff-8f2e-e2a6f9b8493a
                Copyright © © 2016 Medina-Mirapeix et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 15 March 2016
                Date accepted : 28 May 2016
                Page count
                Figures: 1, Tables: 3, Pages: 11
                Funding
                Funded by: AstraZeneca España
                Funded by: Menarini
                Funded by: funder-id http://dx.doi.org/10.13039/100008648, Pfizer Foundation;
                The corresponding author hereby declares that the study was supported by AstraZeneca, Menarini and Pfizer. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Pulmonology
                Subject: Chronic Obstructive Pulmonary Disease
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Medicine and Health Sciences
                Subject: Pulmonology
                Subject: Dyspnea
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Hospitalizations
                Subject: People and Places
                Subject: Demography
                Subject: Death Rates
                Subject: Biology and Life Sciences
                Subject: Population Biology
                Subject: Population Metrics
                Subject: Death Rates
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Educational Attainment
                Subject: Medicine and Health Sciences
                Subject: Pharmacology
                Subject: Drug Research and Development
                Subject: Medicine and Health Sciences
                Subject: Geriatrics
                Subject: Frailty
                Custom metadata
                Data Availability Data may compromise the privacy of study participants and may not be shared publicly. Data are available upon request to the authors.

                ScienceOpen disciplines: Uncategorized
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