Development of an unsupported arm exercise test in patients with chronic obstructive pulmonary disease
Exercise intolerance is one of the most distressing consequences of Chronic Obstructive Pulmonary Disease (COPD) for the majority of patients. Intolerance not only occurs in performing lower body activities, but is manifested with simple daily activities such as lifting, bathing, dressing, grooming, and washing involving the upper body. Many patients experience extreme dyspnea even at low exercise intensities which is debilitating and leads to marked deterioration in their quality of life (QOL). This dissertation contains two studies. The first study focuses on developing an unsupported arm exercise test for patients with COPD. In current pulmonary rehabilitation, there is no validated unsupported arm exercise test available. In order to better assess the performance of arm involved daily activities in patients with COPD, a validated unsupported arm exercise test is needed. Therefore, a six-minute pegboard and ring test (PBRT) was developed in this study, and its reliability and validity were also examined thoroughly in patients with COPD. This study has shown that PBRT is a valid and reliable test to measure arm functional capacity in patients with COPD, and patients with COPD have a reduced performance of unsupported arm exercise compared with healthy people. The second study compares two QOL questionnaires for patients with COPD. Many QOL questionnaires are available in the current pulmonary literature. However, the problem for clinicians and researchers is the uncertainty in choosing a suitable instrument. The St. George's Respiratory Disease Questionnaire (SGRQ) is much more widely used than the Pulmonary Functional Status & Dyspnea Questionnaire - Modified version (PFSDQ-M) in measuring the QOL in patients with COPD. Why this is so is unclear since no studies have directly contrasted these two instruments. This study compared the SGRQ and PFSDQ-M in terms of relationships between different components of the questionnaires, and with certain physiological variables. Both the PFSDQ-M and SGRQ seem to adequately to assess health related QOL in patients with COPD. For studies focusing on the evaluation of physical functioning performance in patients with COPD, the PFSDQ-M is likely a better assessment to use.