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

Elena Gimeno-Santos, Yogini Raste, Heleen Demeyer, Zafeiris Louvaris, Corina de Jong, Roberto A Rabinovich, Nicholas S Hopkinson, Michael I Polkey, Ioannis Vogiatzis, Maggie Tabberer, Fabienne Dobbels, Nathalie Ivanoff, Willem I de Boer, Thys van der Molen, Karoly Kulich, Ignasi Serra, Xavier Basagaña, Thierry Troosters, Milo A Puhan, Niklas Karlsson, Judith Garcia-Aymerich, PROactive consortium, Nathalie Ivanoff, Niklas Karlsson, Solange Corriol-Rohou, Ian Jarrod, Damijen Erzen, Caterina Brindicci, Tim Higenbottam, Mario Scuri, Paul McBride, Nadia Kamel, Margaret Tabberer, Thierry Troosters, Fabienne Dobbels, Judith Garcia-Aymerich, Karoly Kulich, Alastair Glendenning, Katja Rudell, Frederick J Wilson, Michael I Polkey, Nick S Hopkinson, Royal Brompton, Ioannis Vogiatzis, Enkeleida Nikai, Thys van der Molen, Corina De Jong, Roberto A Rabinovich, Bill MacNee, Milo A Puhan, Anja Frei, Elena Gimeno-Santos, Yogini Raste, Heleen Demeyer, Zafeiris Louvaris, Corina de Jong, Roberto A Rabinovich, Nicholas S Hopkinson, Michael I Polkey, Ioannis Vogiatzis, Maggie Tabberer, Fabienne Dobbels, Nathalie Ivanoff, Willem I de Boer, Thys van der Molen, Karoly Kulich, Ignasi Serra, Xavier Basagaña, Thierry Troosters, Milo A Puhan, Niklas Karlsson, Judith Garcia-Aymerich, PROactive consortium, Nathalie Ivanoff, Niklas Karlsson, Solange Corriol-Rohou, Ian Jarrod, Damijen Erzen, Caterina Brindicci, Tim Higenbottam, Mario Scuri, Paul McBride, Nadia Kamel, Margaret Tabberer, Thierry Troosters, Fabienne Dobbels, Judith Garcia-Aymerich, Karoly Kulich, Alastair Glendenning, Katja Rudell, Frederick J Wilson, Michael I Polkey, Nick S Hopkinson, Royal Brompton, Ioannis Vogiatzis, Enkeleida Nikai, Thys van der Molen, Corina De Jong, Roberto A Rabinovich, Bill MacNee, Milo A Puhan, Anja Frei

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.

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com

Copyright ©ERS 2015.

Figures

FIGURE 1
FIGURE 1
Study visits and assessments. PRO: patient-reported outcome; CRQ: chronic respiratory questionnaire; CCQ: clinical chronic obstructive pulmonary disease questionnaire; CAT: chronic obstructive pulmonary disease assessment test; HADS: hospital anxiety and depression scale; COPD: chronic obstructive pulmonary disease; mMRC: modified Medical Research Council dyspnoea scale; SAE: serious adverse event; 6MWT: 6-min walk test. #: assessments could be split between visit 1 and visit 2; ¶: in the exacerbated patients group only.
FIGURE 2
FIGURE 2
Flowchart of the iterative process for the item reduction process.
FIGURE 3
FIGURE 3
Conceptual frameworks of a) the daily version of PROactive Physical Activity in COPD (chronic obstructive pulmonary disease) (D-PPAC) and b) the clinical visit version of PROactive Physical Activity in COPD (C-PPAC) instruments: final domains and items.
FIGURE 4
FIGURE 4
Person-item maps and overall fit of the model for factors 1 (“amount”) and 2 (“difficulty”) of the daily version of PROactive physical activity in COPD (chronic obstructive pulmonary disease) (D-PPAC) and the clinical visit version of the PROactive Physical Activity in COPD (C-PPAC) instruments. These plots indicate that the final items are well targeted to the patients and cover a wide range of the factor measured. Person separation index (PSI) values indicate that each factor is precise enough to differentiate between different patients’ physical activity experiences. a) D-PPAC final items of factor 1 in combination with final variables of Dynaport; b) C-PPAC final items of factor 1 in combination with final variables of Dynaport; c) D-PPAC final items of factor 1 in combination with final variables of Actigraph; d) C-PPAC final items of factor 1 in combination with final variables of Actigraph; e) D-PPAC final items of factor 2; f) C-PPAC final items of factor 2.

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Source: PubMed

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