Minimal clinically important difference of 3-minute chair rise test and the DIRECT questionnaire after pulmonary rehabilitation in COPD patients

Jonathan Lévesque, Anestis Antoniadis, Pei Zhi Li, Frédéric Herengt, Christophe Brosson, Jean-Marie Grosbois, Alain Bernady, Anthony Bender, Murielle Favre, Antoine Guerder, Pascale Surpas, Thomas Similowski, Bernard Aguilaniu, Jonathan Lévesque, Anestis Antoniadis, Pei Zhi Li, Frédéric Herengt, Christophe Brosson, Jean-Marie Grosbois, Alain Bernady, Anthony Bender, Murielle Favre, Antoine Guerder, Pascale Surpas, Thomas Similowski, Bernard Aguilaniu

Abstract

Background: The 3-minute chair rise test (3-minute CRT) and the Disability Related to COPD Tool (DIRECT) are two reproducible and valid short tests that can assess the benefit of pulmonary rehabilitation (PR) in terms of functional capacity and dyspnea in everyday activities.

Methods: We determined the minimal clinically important difference (MCID) of the DIRECT questionnaire and 3-minute CRT using distribution methods and anchor encroaches with a panel of eight standard tests in a cohort of 116 COPD patients who completed a PR program in real-life settings.

Results: The estimated MCID for the 3-minute CRT and DIRECT scores was five repetitions and two units, respectively, using separate and combined independent anchors. The all-patient (body mass index-obstruction-dyspnea-exercise [BODE] scores 0-7), BODE 0-2 (n=42), and BODE 3-4 (n=50) groups showed improvements greater than the MCID in most tests and questionnaires used. In contrast, the BODE 5-7 group (n=24) showed improvements greater than MCID in only the 3-minute CRT, 6-minute walk test, endurance exercise test, and DIRECT questionnaire.

Discussion and conclusion: This study demonstrates that the short and simple DIRECT questionnaire and 3-minute CRT are responsive to capture the beneficial effects of a PR program in COPD patients, including those with severe disease.

Trial registration number: NCT03286660.

Keywords: COPD; MCID; chair tests; outcomes assessment; pulmonary rehabilitation; tools.

Conflict of interest statement

Disclosure Financial support for this study was provided by an unrestricted grant from Boehringer Ingelheim, France. BA reports grants and other from Boehringer Ingelheim, France, during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cumulative number of repetitions during the 1-minute STST and 3-minute CRT. Notes: COPD patients were stratified by BODE score (0–2, n=42; 3–4, n=50; 5–7, n=24) and the number of repetitions (mean ± SD) during the 1-minute STST and 3-minute CRT was calculated. The numbers on the x-axis in black represent the mean ±SD values for the entire patient cohort (n=116). Abbreviations: BODE, body mass index-obstruction-dyspnea-exercise; 1-min STST, 1-minute sit-to-stand test; 3CRT, 3-minute chair rise test.

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