Search

Background: The COPD Assessment Test (CAT) is a recently introduced instrument to assess health-related quality of life in COPD. We aimed to evaluate the longitudinal change in CAT following Pulmonary Rehabilitation (PR), and test the relationship between CAT and CRQ-Self Report (SR) over time. We hypothesised that the CAT would show similar responsiveness to PR as the CRQ-SR both in the short and medium-term., Methods: 118 COPD patients completed an eight-week outpatient multidisciplinary PR programme. CAT, CRQ-SR and the incremental shuttle walk (ISW) were measured prior to starting PR (T1), completion of PR (T2) and 6 months after completion of PR (T3)., Results: There was a significant improvement in CAT, CRQ-SR and ISW immediately following PR (p < 0.001). Although there was decline between T2 and T3, CAT, CRQ-SR and ISW remained significantly better at T3 compared with T1 (ANOVA p < 0.001). Both between T1-T2 and between T2-T3, change in CAT correlated significantly with change in CRQ (both r = -0.44 and p < 0.001). The slope of the relationship between CAT change and CRQ-SR change at T1-T2 and T2-T3 was not significantly different (ANCOVA: intercept p = 0.79, interaction effect p = 0.95)., Conclusions: In COPD, the CAT score is immediately responsive to PR and remains improved at 6 months. There is no significant difference in the short and medium term changes in the CAT and CRQ-SR following PR. We propose that for most clinical indications for assessing health-related quality of life in COPD, the CAT is a robust and practical alternative to longer-established instruments such as the CRQ-SR.

Quantification of daily physical activity is of clinical interest in chronic obstructive pulmonary disease (COPD). Objective measures using activity monitors may take several days to obtain reliable results. The aim of our study was to evaluate the Stanford Seven-Day Physical Activity Recall questionnaire (PAR) against the SenseWear armband (SWA) and compare its validity with three other physical activity questionnaires. 43 COPD patients wore the SWA for 7 days. Patients completed the PAR, Baecke, Physical Activity Scale for the Elderly (PASE) and Zutphen questionnaires. Spearman rank correlation, intraclass correlation coefficients (ICC) and receiver-operating characteristics (ROC) curves were used to assess the relationship between the questionnaires and SWA. Assessed by PAR, time spent at ≥3.0 metabolic equivalents (METs) correlated significantly (r=0.54, p<0.001) with equivalent measures from SWA, with an ICC of 0.40. No relationship was seen between the other questionnaires and the SWA. The PAR predicted active patients (≥30 min at ≥3.0 METs or a physical activity level (PAL) ≥1.55) and very inactive patients (PAL <1.40) with an area under ROC curve of 0.83, 0.77 and 0.70, respectively. While the PAR did not measure physical activity sufficiently accurately to make individual recommendations, it was able to identify COPD patients at extremes of the physical activity spectrum, potentially reducing the number of patients requiring direct measurement.

Objective: To present recommendations for conservative strategies to improve the management of uncomplicated back pain and to evaluate the financial crisis currently facing the workers' compensation system due in part to rapidly rising medical costs., Background: Medical costs in the workers' compensation system have risen at an alarming rate placing a tremendous burden on the cost of doing business in the United States. Historically, treatment for back pain in the United States has been a pathology-based approach; the literature supports a functional restorative approach for clinical efficacy and cost effectiveness., Design: Narrative overview of the literature., Methods: Computerized databases were searched for relevant literature in the English language from the years 1994-2004, including: Alternative Health Watch; Cochrane Database of Systematic Reviews; Pre-CINAHL; CINAHL; MEDLINE; AgeLine; SPORT Discus. A narrative synthesis of the literature was written from retrieved articles., Discussion: A history and overview of the workers' compensation system is presented. Concerns regarding rising medical costs and recommendations for strategies to improve cost and quality of care with an emphasis on ergonomic and functional restoration recommendations are made., Conclusion: A percentage of costs in the workers' compensation system go towards treating uncomplicated back pain; recurrences and chronicity of back pain are key contributors to these costs, which are currently increasing. Ergonomic advice plays a key role in helping the patient with musculoskeletal injuries heal faster and prevent costly flare-ups. Conservative care, which includes chiropractic manipulation, ergonomic recommendations, and exercise rehabilitation with an emphasis on coordination and endurance training, is supported by the literature as a possible method of cost containment.