Paper
Saturday, July 24, 2004
Longitudinal Decline in Functional Performance: Chronic Obstructive Pulmonary Disease
Janet L. Larson, RN, PhD, FAAN, Margaret K. Covey, RN, PhD, and Mary C. Kapella, RN, PhD. College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| Learning Objective #1: Describe the rate of decline in functional performance for people with chronic obstructive pulmonary disease |
| Learning Objective #2: Describe factors that contribute to decline in functional performance for people with chronic obstructive pulmonary disease |
Research problem. People with chronic obstructive pulmonary disease (COPD) experience a decline in daily physical activity and functional performance that ultimately affects their quality of life. We examined factors that contribute to this process with a prospective longitudinal study of lung function, symptoms, functional capacity and functional performance. Methods. We conducted an initial assessment and followed 88 people for three years. At baseline the means (SD) were: age, 65 (6); forced expiratory volume in 1 second, 51 (19) % predicted; ratio of residual volume to total lung capacity, 56 (8.5); diffusion capacity, 61 (22) % predicted; Chronic Respiratory Disease Questionnaire (CRQ) Dyspnea, 26 (7); CRQ Fatigue, 17 (4.5); 6 minute distance walk (6MD), 1313 (292)feet; peripheral muscle strength, 83 (15) % predicted; and Functional Performance Inventory (FPI) total score, 2.2 (0.4). Results. The FPI total score declined by 1% of the baseline level each year. The rate of change for FPI total score was significantly correlated with the rate of change for the 6MD (r=0.51), peripheral muscle strength (r=0.26), CRQ Dyspnea (r=0.36) and CRQ Fatigue (r=0.39). Using multiple linear regression 39% of the variance in rate of change for FPI total score was accounted for by the rate of change for 6MD, CRQ Fatigue and CRQ Dyspnea. Conclusion. These results indicate that the worsening of fatigue and dyspnea and the deterioration in functional capacity contributed to the decline in functional performance. Functional capacity and dyspnea have long been the focus of many interventions, but these findings highlight the need to also address the issue of fatigue in COPD.
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