Health and Rehabilitation Sciences: Physiotherap

Cason, Katherine Mary

Thesis (MScPhysio)--Stellenbosch University, 2022.ENGLISH SUMMARY: Background: Pulmonary rehabilitation (PR) is recommended to be essential in the management of Chronic Obstructive Pulmonary Disease (COPD) patients. PR consists of a multidisciplinary approach including various components with patient- tailored exercise training as the cornerstone for effective results. Measuring exercise capacity is necessary to identify exercise limitations and personalise the prescription of exercise training. Cardiopulmonary exercise testing (CPET) identifies limitations but is expensive and often inaccessible in clinical settings. Field tests are increasingly being used to measure functional exercise capacity and their parameters could inform exercise training prescription. The aims of this thesis were to 1.) identify which field tests are being used to assess exercise capacity of COPD patients and to describe if and how the test data is used to inform exercise prescription, 2.) design a validation study in which we can compare the physiological responses evoked when completing a simple field test to those of the CPET in the COPD population.
Methods: A scoping review according to the JBI methodology was undertaken to identify studies reporting on field tests measuring exercise capacity in the COPD population. After a two-reviewer screening process, the studies’ characteristics, participants information, field tests methods, clinical utility, and possible prescription ability were extracted (Chapter 2). Subsequently, the findings from the scoping review were used to inform the design of a randomised cross-over study. This study design aim is to compare the Three Minute Sit-to-Stand Test (3M-STST) to CPET and to identify comparable or associated parameters for exercise limitation identification and informing exercise training prescription (Chapter 3).
Results: The scoping review search returned 3269 citations with 93 final full text studies eligible for inclusion. Papers were predominantly from high income economy countries and included samples presenting with moderate to severe COPD stages. A total of 28 different tests were identified as measuring exercise capacity and categorised according to five main descriptors: Upper Limb, Combined Function, Sit-To-Stand, Step or Walk tests. Normative values for these tests are not commonly reported and was mainly identified in Walk tests. Only five of the 28 tests were used to suggest prescribing exercise training. The study designed was planned according to the research guidelines of Stellenbosch University, was approved by the health research ethics committee, and obtained funding from the Harry Crossley Foundation.
Conclusion: This thesis identified numerous different clinical field tests developed to measure exercise capacity in COPD. While some of the tests can be used to predict outcome or physical activity levels, only a small number of tests are used for exercise prescription. To address the gap in the literature we designed a study to compare the physiological responses elicited by 3M-STST with the gold standard CPET. The outcome of the study will identify the parameters which can be used to facilitate patient targeted exercise prescription. Clinicians and researchers can now use the information summarised in this thesis to identify a field test aligned with their specific needs and context. There is a need to standardise terminology, procedures, and exercise prescription in the COPD population for future use.AFRIKAANSE OPSOMMING: Agtergrond: Pulmonale rehabilitasie (PR) word aanbeveel as noodsaaklike behandeling vir chroniese obstruktiewe longsiekte (KOLS) pasiënte. PR bestaan uit 'n multidissiplinêre benadering ingesluitend komponente soos berading en oefening. Die meting van oefenvermoë is nodig om die oefenings beperkings te identifiseer en die voorskrif van oefenopleiding te verpersoonlik. Die goue standaard, kardiopulmonale oefeningstoetsing (KPOT) is duur en dikwels ontoeganklik in kliniese omgewings. Veldtoetse word toenemend gebruik om die funksionele oefenvermoë te meet, en hul afgemete parameters kan die voorskrif van oefenopleiding inlig. Die doel van hierdie proefskrif is om te identifiseer watter veldtoetse gebruik word om die oefenkapasiteit van KOLS pasiënte te bepaal en om te beskryf of en hoe die toetsdata gebruik word om oefenvoorskrif in hierdie populasie in te lig. Tweedens, om 'n bekragtigingsstudie te ontwerp waarin ons die fisiologiese reaksies wat by die voltooiing van 'n eenvoudige veldtoets met die van die KPOT in KOLS pasiënte kan vergelyk.
Metode: 'N Omvattende oorsig volgens die JBI -metodologie is gedoen om dokumente te identifiseer wat verslag doen oor veldtoetse in die KOLS populasie. Na 'n siftingsproses van twee beoordelaars is die artikel se eienskappe, inligting oor deelnemers, veldtoetse, kliniese nut en moontlike voorskrifvermoë onttrek (Hoofstuk 2). Vervolgens is die bevindinge van die omvangryke oorsig gebruik om die ontwerp van 'n gerandomiseerde kruisstudie in te lig wat daarop gemik was om die drie-minute sit-tot-staan-toets (3M-STST) met KPOT te vergelyk en te identifiseer watter parameters vergelykbaar is of assosiasies kan hê met mekaar om oefenbeperking te identifiseer en voorskrif in te lig. (Hoofstuk 3). Hierdie protokolontwerp het befondsing ontvang.
Resultate: Die ondersoek na die omvang van die hersiening het 3269 aanhalings opgelewer, met 93 finale volledige teksvraestelle wat in aanmerking kom vir opname. Papiere kom hoofsaaklik uit lande met 'n hoë inkomste -ekonomie en berig meestal matige tot ernstige KOLS-stadiums. Sewe-en-twintig verskillende toetse is geïdentifiseer as die meting van oefenvermoë en is gekategoriseer volgens vyf hoofbeskrywers. Stap en looptoetse het die mees robuuste protokol standaard riglyne en protokolle, maar die omgewing word dikwels aangepas. Normatiewe waardes vir hierdie toetse word nie algemeen gerapporteer nie en word hoofsaaklik in looptoetse geïdentifiseer. Slegs vyf van die 28 toetse is gebruik om oefening voor te skryf.
Gevolgtrekking: Hierdie tesis het 28 verskillende kliniese veldtoetse geïdentifiseer wat ontwikkel is om die oefenkapasiteit by KOLS te meet. Alhoewel sommige van die toetse gebruik kan word om die uitkoms of vlakke van fisieke aktiwiteit te voorspel, word slegs 'n klein aantal toetse vir oefenvoorskrif gebruik. Om die leemte in die literatuur aan te spreek, het ons 'n studie ontwerp om die fisiologiese reaksies wat deur 3M-STST veroorsaak is, te vergelyk met die goue standaard KPOT. Die uitslag van die studie sal die parameters identifiseer wat gebruik kan word om pasiëntgerigte oefenvoorskrif te vergemaklik. Klinici en navorsers kan nou die inligting wat in hierdie tesis opgesom is, gebruik om 'n veldtoets te identifiseer wat in lyn is met hul spesifieke behoeftes en konteks. Daar is 'n behoefte om die terminologie, prosedures en voorskrifte by die KOLS -populasie te standaardiseer.Master

Measuring Exercise Capacity in Chronic Obstructive Pulmonary Disease (COPD) patients.

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