Feasibility of Home-based Functional Status Assessment of Chronic Obstructive Pulmonary Disease Patients Recovering from an Exacerbation

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Se solicitó a los pacientes que durante 6min diesen tantas vueltas como pudiesen al circuito. Durante la prueba no se les animó verbalmente. Se colocaron 2 escalones separados (de 17cm de altura y 27cm de profundidad), uno enfrente del otro, para mantener los movimientos de subida y bajada que requiere la prueba original.Modificado a partir de Skumlien et al.<a class="elsevierStyleCrossRef" href="#bib0220">14</a>, con permiso de Elsevier." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Valeiro, Carme Hernández, Anael Barberán-Garcia, Diego A. Rodríguez, Jesús Aibar, Lourdes Llop, Jordi Vilaró" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Valeiro" ] 1 => array:2 [ "nombre" => "Carme" "apellidos" => "Hernández" ] 2 => array:2 [ "nombre" => "Anael" "apellidos" => "Barberán-Garcia" ] 3 => array:2 [ "nombre" => "Diego A." 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Each line represents the mADL-Test VO2 values (mean values with standard deviation) of the 17 patients together and for each assessment visit. The VO2 values are plotted minute by minute. From the second minute the VO2 profile reaches a plateau (P=NS). NS, non-significant." ] ] ] "textoCompleto" => "IntroductionFunctional status refers to the ability of patients to cope with their Activities of Daily Living (ADL). Chronic Obstructive Pulmonary Disease<a class="elsevierStyleCrossRef" href="#bib0005">1</a> (COPD) affects the capacity of patients to perform their ADL.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Moreover, a poor functional status is a risk factor for exacerbations.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> After an exacerbation, functional status may not return to the previous level, and this can cause patients to enter a negative cycle where the more exacerbations they suffer, the worse their functional status becomes.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The result is an eventual increase in mortality and health care burden.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Despite their importance, recovery patterns of functional status after a COPD exacerbation have been poorly studied.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Home-based programs, such as home hospitalization (HH),<a class="elsevierStyleCrossRef" href="#bib0035">7</a> are successful care services for COPD patients. However, functional capacity assessment outside the hospital or laboratory setting has been rarely studied.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> The home setting is unsuitable for most of the standard exercise field tests, such as the Six Minute Walking Test (6MWT)<a class="elsevierStyleCrossRef" href="#bib0045">9</a>; however, some performance tests for small settings have been suggested in recent years. Puhan et al.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> found that the results of the sit-to-stand test are associated with mortality in stable COPD patients. Jones et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> found the five-repetition sit-to-stand test to be a practical functional measurement, even at the bedside. And the Chester step-test may also be a suitable method.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Even so, those tests could underestimate the daily functional limitations of patients, because they rely mostly on the use of lower limbs, whereas most of the common ADLs combine both extremeties.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> The ideal test would be one in which the patients have to reproduce the most common ADLs in their own environment.The Glittre ADL-Test<a class="elsevierStyleCrossRef" href="#bib0070">14</a> (ADL-Test) was specifically developed for valid and reliable functional status assessment of COPD patients in terms of both performance and capacity.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> It reproduces the 5 most common ADLs in a 10-m long corridor, and requires the use of both extremities.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> In stable COPD patients, the ADL-Test induces a sub-maximal steady-state physiological response,<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a> it discriminates the functional capacity of COPD patients from healthy people,<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and it is also reproducible<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and responsive to pulmonary rehabilitation.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> However, the ADL-Test has not been tested in COPD patients recovering from an exacerbation or in the home setting.Our research group had already tested the ADL-Test in stable COPD patients in a hospital setting.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> In this study, we first aimed to determine whether it was also suitable for the home setting, and then attempted to follow-up ADL-Test performance during the early recovery phase of a COPD exacerbation. We achieved these objectives by studying post-exacerbation COPD patients included in an HH program.MethodsWe conducted a prospective observational feasibility study. Subjects were consecutively recruited in the HH unit of the Hospital Clinic in Barcelona (Spain) between March and June 2011. The study protocol was approved by the independent Hospital's Ethics Committee, and all participating patients signed the consent form.PopulationDuring the study period, all COPD patients admitted to the HH<a class="elsevierStyleCrossRef" href="#bib0095">19</a> program due to an exacerbation were invited to take part in the study. We were not able to calculate a sample size due to the exploratory nature of the research.No changes were made to the existing HH care protocol.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Briefly, patients were admitted to the HH program if they did not meet criteria for imperative hospitalization (such as need for mechanical ventilation) or had been admitted to the hospital for less than 48 hours. HH exclusion criteria included: not domiciled in the healthcare area or admitted from a nursing home; lung cancer and other advanced neoplasm; extremely poor social conditions; severe neurological or cardiac comorbidities; and no phone at home. During HH, patients were visited daily by a skilled respiratory nurse. Standard pharmacological treatment was given, following national guidelines<a class="elsevierStyleCrossRef" href="#bib0100">20</a> in force at the time of the study, and the comprehensive therapeutic approach was adapted to the needs of each patient. Discharge visit (V0) was scheduled and carried out by both the nurse and the medical staff.Specific inclusion criteria for this study were: (1) COPD diagnosis following GOLD criteria<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and (2) COPD exacerbation as the sole admission diagnosis. We excluded patients with muscular, skeletal, cardiac or cognitive conditions that could impede performance of the ADL-Test or compromise the safety of the test.ProtocolPatients were assessed by a respiratory physiotherapist during 3 home visits: at the time of discharge to HH (V0), 10 days post-discharge (V10post) and 1 month post-discharge (V30post). To ensure the well-being of the patients, V0 measurements were obtained over 2 consecutive days. The day before the planned discharge, we performed the clinical assessment (questionnaires). We explained the test, and the patients were invited to simulate 1 lap of the test to minimize the learning effect. On the day of discharge, patients performed the functional status assessment under supervision of the medical staff, to ensure their safety. The following V10post and V30post visits were carried out fully in one day each one.Functional Status AssessmentFunctional status was assessed using a modified version of the original Glittre ADL-Test<a class="elsevierStyleCrossRef" href="#bib0070">14</a> (mADL-Test) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We introduced 2 changes: first, the original outcome goal of 5 laps<a class="elsevierStyleCrossRef" href="#bib0070">14</a> was replaced by a self-paced time-limited test, so for this study the main outcome variable was the number of laps that the patient could cover in 6min on the first, the second and the third visits. Secondly, the original 2-step staircase was replaced by 2 steps placed separately, one in front of the other. This improved the portability of the equipment without affecting the work-load of the original test (i.e., the new steps had the same height and width as the original ones).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Patients were shown how to perform the mADL-Test correctly and safely: subjects had to complete the mADL-Test laps as fast as they could in 6min, they could stop if they were in pain, too exhausted, or for any other reason. If the research team detected any alarm signs, the test would be stopped.All patients were connected through a face mask to a portable gas analyzer (Fitmate, Cosmed; Rome, Italy) to assess whether their physiological response during the test was similar to the original test.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> All patients had to complete the tests without supplementary oxygen, or if they were already receiving oxygen therapy, after 20min of wash-out. Oxygen uptake (VO2) and ventilation (VE) were measured breath by breath. The equipment was calibrated before each assessment and carried by the patient inside the same backpack used for the test. However, the final weight was adjusted according to the device (1.5kg) and the gender of the patient, as stated in the original test. Finally, heart rate and oxygen saturation were continuously monitored with a hand-held pulse oximeter (3Xi Konica Minolta; Osaka, Japan).Clinical AssessmentOn each assessment visit the following patient-reported outcomes were obtained, always in the same order: (1) dyspnea level: modified Medical Research Council dyspnea scale<a class="elsevierStyleCrossRef" href="#bib0105">21</a> (mMRC), (2) dyspnea related to ADL: London Chest Activities of Daily Living questionnaire<a class="elsevierStyleCrossRef" href="#bib0110">22</a> (LCADL), (3) health status: COPD Assessment Test<a class="elsevierStyleCrossRef" href="#bib0115">23</a> (CAT) and (4) physical activity: modified Baecke questionnaire for older people<a class="elsevierStyleCrossRef" href="#bib0120">24</a> (mBaek) administered only on V0 and V30post visits.In addition, the patients performed a handgrip dynamometry<a class="elsevierStyleCrossRef" href="#bib0050">10</a> to explore upper limb muscle strength. The test was performed first with the dominant hand, and the best measurement (1 out of 3, for each hand) was used for statistical analysis.Secondary variables such as socio-demographical and other clinical data were obtained from the clinical history.Statistical AnalysisStatistical analysis was carried out using PASW (SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0, Chicago, IL, USA). Initially, the normality of the data was assessed through the Shapiro–Wilk test. Due to small sample size, non-parametric tests were used. Wilcoxon signed-rank tests were used for comparisons between visits. Results are expressed as median (Mdn) and Interquartile range (IQR), otherwise indicated. All tests were two-tailed, and the level of significance was set at P<.05. For metabolic response analysis (VO2 and VE), last minute values of the mADL-Test were used. Physiological VO2 profile of the mADL-Test was analyzed with Friedman test.ResultsDuring 2011, 71 COPD patients were admitted to the HH program due to exacerbation. However, only 29 patients (41%) were admitted during the recruitment phase of this study and invited to participate. Unfortunately, 10 patients were excluded: 5 with neoplasia, 4 with movement disturbances, 1 with cardiac instability (New York Heart Association<a class="elsevierStyleCrossRef" href="#bib0125">25</a> class IV), and 2 declined the invitation. Consequently, 17 patients were included. The general characteristics of the sample were (Mdn and IQR): 66 (60–84) years, 15 were men, and FEV1 was 38% (29%–44%) of predicted. More information about the study population at the time of inclusion is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The mADL-Tests performance is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The majority of the patients increased, gradually and significantly, the number of laps (4, 5 and 5, P<.05) during follow up (L0, L10post and L30post, respectively). Overall, 12 out of 17 patients increased ≥1 lap between V0 and V30post. Nevertheless, whereas the number of laps increased, the final values of VO2 and VE did not improve significantly between the first and the last assessment (P=.331 and P=.244, respectively). However, exercise performance improvement, represented by an increment of the peak VO2, was observed. Moreover, patients presented lower basal HR and higher basal saturation, indicating improved physical status.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The physiological response of the test showed a steady-state VO2 profile from the second minute up to the end of the test (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which is representative of sub-maximal tests such as the 6MWT.<a class="elsevierStyleCrossRef" href="#bib0130">26</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The mADL-T was suitable for any location; it was well tolerated by all patients, and no adverse events were reported. None of the patients were excluded for logistical issues (such as the size of the home), and there were no significant difficulties in carrying the mADL-Test equipment or setting up the test in each patient's home.Clinical AssessmentThe clinical evolution of the patients after HH discharge is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Overall, patients continued to improve their clinical status during follow-up. The CAT score improved significantly in the first 10 days, and the mMRC level also showed a tendency to improve (P<.05 and P=.058, respectively). Both variables had improved by the end of the study.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The self-care domain of the LCADL questionnaire showed significant improvement during follow-up (P=.017), as well as the mBaek (P=.004). Specifically, according to mBaek questionnaire criteria<a class="elsevierStyleCrossRef" href="#bib0120">24</a> 4 patients became highly active by 1 month post-discharge, while only 5 patients remained inactive (29% of the total population).DiscussionThis study has shown the mADL-Test to be a suitable tool for measuring the functional status of moderate-to-very-severe post-exacerbation COPD patients in the home setting. We have also shown that functional status, measured by the mADL-Test, continues to improve in the first 10 first days after HH discharge.Functional status is related to COPD clinical outcomes, and therefore its assessment is relevant to patient management, although there is no gold standard test<a class="elsevierStyleCrossRef" href="#bib0040">8</a> and difficulties are sometime encountered. The clinical status of the patient – stable and exacerbated phase – and the care setting – hospital and outpatient environments – can make this task difficult. Specifically, exercise field tests can be challenging in home-based programs due to space limitations. After previous evaluation of the Glittre test,<a class="elsevierStyleCrossRef" href="#bib0090">18</a> we aimed to explore the feasibility of using it to assess functional status in the home setting. In this study, the mADL-Test was found to be suitable for home use, even in post-exacerbation COPD patients with only one evaluator. However, for the purpose of this study, we modified the original Glittre test to facilitate set-up and performance of the test in different home settings. The work-load of the original test remained unchanged, although the lay-out was modified. The mADL-Test physiological profile is analogous to the original test.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> We also established the number of laps completed by the patient in 6min as the main outcome. The aim was to obtain comparable physiological records from all the subjects, and avoid the possible ‘floor’ effect that has been described when patients are instructed to complete a fixed number of laps.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> In addition, recent studies have shown that the Glittre test is reproducible<a class="elsevierStyleCrossRef" href="#bib0080">16</a> with suitable instructions. However, we did not validate our modifications against a gold standard test or the original one, and therefore our results should be treated with caution.The originality of our study also lies in the contribution of new data on the natural functional recovery of post-exacerbation COPD patients: the mADL-Test performance improves in the first 10 days following HH discharge. In our study, despite its limited sample size, performance of the mADL-test improved in parallel with the clinical improvement shown by patients. Symptoms improved by the end of the study (significant improvement in dyspnea level, health status and physical activity) along with an improvement in cardiopulmonary variables (lower HR at the begging of the test, higher SpO2 at the end of the test, and a tendency toward peak V02 improvement). We acknowledge that the metabolic response of the test did not significantly differ between visits, even though median VO2 values would seem to increase during follow-up. One possible explanation, together with the small sample size, is that clinical recovery, such a reduction in mMRC, might have allowed patients to increase the number of laps without a significant increase in oxygen uptake. It should be noted that our patients did not participate in any pulmonary rehabilitation program after discharge, so we speculate that the slight recovery might be a result of the previous treatment received (within an integrated care unit) and the small margin of improvement without supplementary treatment (such as exercise training). In addition, sub-maximal exercise tests have been shown to be better than incremental test in detecting functional changes in COPD patients,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> which would explain the response to the mADL-Test during the recovery phase after an exacerbation. The 6MWT has already been shown to achieve significant improvement 1 month after discharge in untrained post-exacerbation COPD patients,<a class="elsevierStyleCrossRefs" href="#bib0030">6,28</a> whereas other studies failed to detect any improvement at 6-week follow-up using the incremental shuttle walking test.<a class="elsevierStyleCrossRefs" href="#bib0145">29,30</a> In addition, there were no safety concerns during performance of any of the tests, so we believe that the mADL-Test is a good option for functional status assessment of COPD patients, even during the recovery phase of an exacerbation.Finally, some other limitations of this study should be mentioned. We could not calculate the sample size in advance, since this was a feasibility study with no previously recorded data. This may have contributed to the insufficient statistical power obtained in some comparisons, such as establishing a correlation between mADL-Test results and clinical variables. Also, the vast majority of our patients were male, and therefore, results cannot be generalized to both genders. Lastly, it is important to note that 7 out of the 17 patients had to perform the mADL-Test without their supplementary oxygen therapy in order to record physiological parameters, and we believe this could explain some of the variability seen in our results.In conclusion, the mADL-Test is effective in measuring overall functional status in the home setting. It can be particularly useful in home care units and as a means of assessing other non-COPD patients with potentially altered functional status.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> More research into the mADL-Test properties is needed, as well as more studies to fully clarify the recovery pattern after a COPD exacerbation.ConclusionsThe findings of this study suggest that the mADL-Test is a feasible and safe tool for assessing the functional status of moderate-to-very-severe COPD patients recovering from an exacerbation at home. Post-exacerbation functional status treated in a HH program improves 10 days after discharge. Undoubtedly, larger studies are warranted to confirm and expand these results.Conflict of InterestWe have no conflict of interest to declare.FundingThis work was partially supported by NEXES UE-FP7 (CIP-ICT-PSP-2007-1) 225,025 and SEPAR0123/09." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres631374" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec644203" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres631375" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec644204" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Protocol" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Functional Status Assessment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Assessment" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Clinical Assessment" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of Interest" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-30" "fechaAceptado" => "2015-10-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec644203" "palabras" => array:5 [ 0 => "Chronic Obstructive Pulmonary Disease" 1 => "Exacerbation" 2 => "Home hospitalization" 3 => "Activities of Daily Living" 4 => "Exercise test" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec644204" "palabras" => array:5 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Exacerbación" 2 => "Hospitalización domiciliaria" 3 => "Actividades de la vida diaria" 4 => "Prueba de ejercicio" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe Glittre Activities of Daily Living Test (ADL-Test) is a reliable functional status measurement for stable Chronic Obstructive Pulmonary Disease (COPD) patients in a laboratory setting. We aimed to adapt the test to the home setting (mADL-Test) and to follow-up the functional status recovery of post-exacerbation COPD patients included in a home hospitalization (HH) program. MethodWe assessed 17 exacerbated moderate-to-very-severe COPD patients in 3 home visits: at discharge to HH (V0), 10 days (V10post) and 1 month after discharge (V30post). Patients completed the mADL-Test (laps, VO2 and VE), COPD assessment test (CAT), London Chest ADL Test (LCADL), modified Medical Research Council (mMRC) and upper limb strength (handgrip). ResultsThe number of laps of the mADL-Test (4, 5 and 5, P<.05), CAT (19, 12 and 12, P<.01), mMRC (2, 1.5 and 1, P<.01) and the self-care domain of the LCADL (6, 5 and 5, P<.01) improved during follow-up (V0, V10post and V30post, respectively). No significant changes were evidenced in VO2, VE or handgrip. ConclusionOur results suggest that the mADL-Test can be performed in the home setting after a COPD exacerbation, and that functional status continues to improve 10 days after HH discharge." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa prueba de actividades de la vida diaria de Glittre (prueba ADL) es, en un entorno de laboratorio, una medida fiable del estado funcional de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. Nos propusimos adaptar la prueba para poder llevarla a cabo en el entorno domiciliario (Test ADLm) y supervisar la recuperación del estado funcional de pacientes con EPOC después de una exacerbación atendida en hospitalización domiciliaria (HD). MétodoEvaluamos a 17 pacientes con EPOC de moderada a muy intensa y exacerbación en tres visitas domiciliarias: el día del alta de la HD (V0), al cabo de 10 días (V10post) y un mes después del alta (V30post). Los pacientes realizaron la prueba ADLm (vueltas a un circuito, VO2 y VE), la prueba de evaluación de la EPOC (CAT), el Cuestionario de ADL London Chest (LCADL), la Escala del Medical Research Council modificada (MRCm) y una dinamometría de las extremidades superiores (fuerza de prensión). Resultadosel número de vueltas al circuito en la prueba ADLm (4, 5 y 5, p<0,05), el CAT (19, 12 y 12, p<0,01), la MRCm (2, 1,5 y 1, p<0,01) y el dominio de cuidado personal del LCADL (6, 5 y 5, p<0,01) mejoraron durante el seguimiento (V0, V10post y V30post, respectivamente). No se constataron cambios significativos en el VO2, el VE o la fuerza de prensión. ConclusiónNuestros resultados indican que, tras una exacerbación de la EPOC, es factible realizar la prueba ADLm en el entorno domiciliario, y que el estado funcional continúa mejorando diez días después del alta de la HD." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Valeiro B, Hernández C, Barberàn-Garcia A, Rodríguez DA, Aibar J, Llop L, et al. Viabilidad de la evaluación domiciliaria del estado funcional de pacientes con enfermedad pulmonar obstructiva crónica en fase de recuperación de una exacerbación. Arch Bronconeumol. 2016;52:256–261." ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Reprinted and modified from Ref. <a class="elsevierStyleCrossRef" href="#bib0070">14</a> with permission of the publisher, Elsevier." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 948 "Ancho" => 5312 "Tamanyo" => 159882 ] ] "descripcion" => array:1 [ "en" => "mADL-Test. Patients were instructed to do as many laps as they could in 6min. They were not verbally encouraged during the test. Two separate steps (17cm high and 27cm deep) were placed one in front the other to mimic the climbing movements required by the original test." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1105 "Ancho" => 1519 "Tamanyo" => 82037 ] ] "descripcion" => array:1 [ "en" => "VO2 physiological profile in the three follow-up visits. Each line represents the mADL-Test VO2 values (mean values with standard deviation) of the 17 patients together and for each assessment visit. The VO2 values are plotted minute by minute. From the second minute the VO2 profile reaches a plateau (P=NS). NS, non-significant." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "BMI, Body Mass Index; HH, home hospitalization: FEV1, force expiratory volume during the first second; FVC, forced vital capacity; LTOT, long term oxygen therapy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Participants, n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (60–84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender, male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking history, pack-year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (20–150) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI, kg/m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6 (24.2–30.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of HH stay, days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Modified Charlson Index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Forced spirometry</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV1, L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (0.98–1.44) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV1, % predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (31–47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV1/FVC, ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (39–55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">GOLD</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Formers users of LTOT, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (40) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035928.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the Study Group." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "VO2, oxygen uptake; VO2/kg, oxygen uptake per kilogram per minute; VE, ventilation; bpm, beats per minute." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N=17 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V10post \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V30post \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Functional capacity</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Laps, n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3–5.5)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3.5–7)<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Metabolic parameters</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO2, mL/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">906 (833–1009) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">961 (915–1241) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1008 (793–1349) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO2/kg, mL/kg/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (10–15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (10,16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VE, L/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (23–31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (25–37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (24–36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">O2saturation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basal, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (90–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (92–96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (92–96) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 (81–92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (85–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (84–93) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Heart rate</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basal, bpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (73–96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (70–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (71–92)<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final, bpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104 (93–117) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 (86–108) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (84–119) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Level of perceived exertion<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basal dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basal fatigue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final fatigue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035929.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "V0 and V10post." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "V10post and V30post." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "V0 and V30post." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "Borg modified score. P-values <.05." ] ] ] "descripcion" => array:1 [ "en" => "Cardiopulmonary and Physiological Response of the mADL-Test." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviations: mMRC, Modified Medical Research Council dyspnea scale; LCADL, London Chest Activities of Daily Living questionnaire; CAT, COPD Assessment Test questionnaire; N/A, not available." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N=17 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V10post \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V30post \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">mMRC score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5 (1–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1–1)<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LCADL score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (11–25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (13–23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (13–18) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Self-care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (4–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–6)<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Domestic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0–5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Physical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leisure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (3–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3–4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CAT score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (11–26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (7–16)<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (8–15)<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Modified Baecke score<a class="elsevierStyleCrossRef" href="#tblfn0035">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (7–16)<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low active, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (65) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate active, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High active, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Handgrip dynamometry<a class="elsevierStyleCrossRef" href="#tblfn0040">d</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dominant hand, kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (22–37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (23–38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (20–36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-dominant hand, kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (21–34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (19–36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (19–33) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035930.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "V0 and V30post." ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "V0 and V10post." ] 2 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "c" "nota" => "Subjects with total score under 9 are considered low active, between 9 and 16 moderate active and above 16 high active." ] 3 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "d" "nota" => "Handgrip dynamometry: n=16, one patient had a neuromuscular upper extremities disease and was excluded of this assessment. 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Original Article

Feasibility of Home-based Functional Status Assessment of Chronic Obstructive Pulmonary Disease Patients Recovering from an Exacerbation

Viabilidad de la Evaluación Domiciliaria Del Estado Funcional de Pacientes Con Enfermedad Pulmonar Obstructiva Crónica en Fase de Recuperación de Una Exacerbación

Beatriz Valeiroa, Carme Hernándezb, Anael Barberàn-Garciaa,c, Diego A. Rodríguezd,c, Jesús Aibare, Lourdes Llope, Jordi Vilaróf,

Corresponding author

jordivc@blanquerna.url.edu

Corresponding author.

a Hospital Clínic de Barcelona, Institut Clínic del Tòrax (ICT), Servei de Pneumologia, Centre de Diagnòstic Respiratori, Institut d’Investigacions Biomèdiques August Pi i Sunyner (IDIBAPS), Universitat de Barcelona, Barcelona, Cataluña, Spain

b Unitat d’Atenció Integrada, Direcció Mèdica i d’Infermeria, Hospital Clínic, CIBER en Enfermedades Respiratorias (CIBERES), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Cataluña, Cataluña, Spain

c Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Mallorca, Spain

d Hospital del Mar-Parc de Salut Mar, Servei de Pneumologia, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Cataluña, Spain

e Departament de Direcció Mèdica i d’Infermeria, Hospital Clínic, Barcelona, Cataluña Spain

f Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Grup de Recerca en Salut, Activitat Física i Esport (SAFE), Barcelona, Cataluña, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Functional status refers to the ability of patients to cope with their Activities of Daily Living &#40;ADL&#41;&#46; Chronic Obstructive Pulmonary Disease<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> &#40;COPD&#41; affects the capacity of patients to perform their ADL&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Moreover&#44; a poor functional status is a risk factor for exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> After an exacerbation&#44; functional status may not return to the previous level&#44; and this can cause patients to enter a negative cycle where the more exacerbations they suffer&#44; the worse their functional status becomes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The result is an eventual increase in mortality and health care burden&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Despite their importance&#44; recovery patterns of functional status after a COPD exacerbation have been poorly studied&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Home-based programs&#44; such as home hospitalization &#40;HH&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> are successful care services for COPD patients&#46; However&#44; functional capacity assessment outside the hospital or laboratory setting has been rarely studied&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The home setting is unsuitable for most of the standard exercise field tests&#44; such as the Six Minute Walking Test &#40;6MWT&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#59; however&#44; some performance tests for small settings have been suggested in recent years&#46; Puhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> found that the results of the sit-to-stand test are associated with mortality in stable COPD patients&#46; Jones et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> found the five-repetition sit-to-stand test to be a practical functional measurement&#44; even at the bedside&#46; And the Chester step-test may also be a suitable method&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Even so&#44; those tests could underestimate the daily functional limitations of patients&#44; because they rely mostly on the use of lower limbs&#44; whereas most of the common ADLs combine both extremeties&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The ideal test would be one in which the patients have to reproduce the most common ADLs in their own environment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Glittre ADL-Test<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> &#40;ADL-Test&#41; was specifically developed for valid and reliable functional status assessment of COPD patients in terms of both performance and capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It reproduces the 5 most common ADLs in a 10-m long corridor&#44; and requires the use of both extremities&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In stable COPD patients&#44; the ADL-Test induces a sub-maximal steady-state physiological response&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> it discriminates the functional capacity of COPD patients from healthy people&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and it is also reproducible<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and responsive to pulmonary rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; the ADL-Test has not been tested in COPD patients recovering from an exacerbation or in the home setting&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our research group had already tested the ADL-Test in stable COPD patients in a hospital setting&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In this study&#44; we first aimed to determine whether it was also suitable for the home setting&#44; and then attempted to follow-up ADL-Test performance during the early recovery phase of a COPD exacerbation&#46; We achieved these objectives by studying post-exacerbation COPD patients included in an HH program&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a prospective observational feasibility study&#46; Subjects were consecutively recruited in the HH unit of the Hospital Clinic in Barcelona &#40;Spain&#41; between March and June 2011&#46; The study protocol was approved by the independent Hospital&#39;s Ethics Committee&#44; and all participating patients signed the consent form&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Population</span><p id="par0030" class="elsevierStylePara elsevierViewall">During the study period&#44; all COPD patients admitted to the HH<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> program due to an exacerbation were invited to take part in the study&#46; We were not able to calculate a sample size due to the exploratory nature of the research&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">No changes were made to the existing HH care protocol&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Briefly&#44; patients were admitted to the HH program if they did not meet criteria for imperative hospitalization &#40;such as need for mechanical ventilation&#41; or had been admitted to the hospital for less than 48 hours&#46; HH exclusion criteria included&#58; not domiciled in the healthcare area or admitted from a nursing home&#59; lung cancer and other advanced neoplasm&#59; extremely poor social conditions&#59; severe neurological or cardiac comorbidities&#59; and no phone at home&#46; During HH&#44; patients were visited daily by a skilled respiratory nurse&#46; Standard pharmacological treatment was given&#44; following national guidelines<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in force at the time of the study&#44; and the comprehensive therapeutic approach was adapted to the needs of each patient&#46; Discharge visit &#40;V<span class="elsevierStyleInf">0</span>&#41; was scheduled and carried out by both the nurse and the medical staff&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Specific inclusion criteria for this study were&#58; &#40;1&#41; COPD diagnosis following GOLD criteria<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and &#40;2&#41; COPD exacerbation as the sole admission diagnosis&#46; We excluded patients with muscular&#44; skeletal&#44; cardiac or cognitive conditions that could impede performance of the ADL-Test or compromise the safety of the test&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Protocol</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients were assessed by a respiratory physiotherapist during 3 home visits&#58; at the time of discharge to HH &#40;V<span class="elsevierStyleInf">0</span>&#41;&#44; 10 days post-discharge &#40;V<span class="elsevierStyleInf">10post</span>&#41; and 1 month post-discharge &#40;V<span class="elsevierStyleInf">30post</span>&#41;&#46; To ensure the well-being of the patients&#44; V<span class="elsevierStyleInf">0</span> measurements were obtained over 2 consecutive days&#46; The day before the planned discharge&#44; we performed the clinical assessment &#40;questionnaires&#41;&#46; We explained the test&#44; and the patients were invited to simulate 1 lap of the test to minimize the learning effect&#46; On the day of discharge&#44; patients performed the functional status assessment under supervision of the medical staff&#44; to ensure their safety&#46; The following V<span class="elsevierStyleInf">10post</span> and V<span class="elsevierStyleInf">30post</span> visits were carried out fully in one day each one&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Functional Status Assessment</span><p id="par0050" class="elsevierStylePara elsevierViewall">Functional status was assessed using a modified version of the original Glittre ADL-Test<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> &#40;mADL-Test&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; We introduced 2 changes&#58; first&#44; the original outcome goal of 5 laps<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> was replaced by a self-paced time-limited test&#44; so for this study the main outcome variable was the number of laps that the patient could cover in 6<span class="elsevierStyleHsp" style=""></span>min on the first&#44; the second and the third visits&#46; Secondly&#44; the original 2-step staircase was replaced by 2 steps placed separately&#44; one in front of the other&#46; This improved the portability of the equipment without affecting the work-load of the original test &#40;i&#46;e&#46;&#44; the new steps had the same height and width as the original ones&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were shown how to perform the mADL-Test correctly and safely&#58; subjects had to complete the mADL-Test laps as fast as they could in 6<span class="elsevierStyleHsp" style=""></span>min&#44; they could stop if they were in pain&#44; too exhausted&#44; or for any other reason&#46; If the research team detected any alarm signs&#44; the test would be stopped&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All patients were connected through a face mask to a portable gas analyzer &#40;Fitmate&#44; Cosmed&#59; Rome&#44; Italy&#41; to assess whether their physiological response during the test was similar to the original test&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> All patients had to complete the tests without supplementary oxygen&#44; or if they were already receiving oxygen therapy&#44; after 20<span class="elsevierStyleHsp" style=""></span>min of wash-out&#46; Oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41; and ventilation &#40;VE&#41; were measured breath by breath&#46; The equipment was calibrated before each assessment and carried by the patient inside the same backpack used for the test&#46; However&#44; the final weight was adjusted according to the device &#40;1&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41; and the gender of the patient&#44; as stated in the original test&#46; Finally&#44; heart rate and oxygen saturation were continuously monitored with a hand-held pulse oximeter &#40;3Xi Konica Minolta&#59; Osaka&#44; Japan&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Clinical Assessment</span><p id="par0065" class="elsevierStylePara elsevierViewall">On each assessment visit the following patient-reported outcomes were obtained&#44; always in the same order&#58; &#40;1&#41; dyspnea level&#58; modified Medical Research Council dyspnea scale<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> &#40;mMRC&#41;&#44; &#40;2&#41; dyspnea related to ADL&#58; London Chest Activities of Daily Living questionnaire<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> &#40;LCADL&#41;&#44; &#40;3&#41; health status&#58; COPD Assessment Test<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> &#40;CAT&#41; and &#40;4&#41; physical activity&#58; modified Baecke questionnaire for older people<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> &#40;mBaek&#41; administered only on V<span class="elsevierStyleInf">0</span> and V<span class="elsevierStyleInf">30post</span> visits&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In addition&#44; the patients performed a handgrip dynamometry<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> to explore upper limb muscle strength&#46; The test was performed first with the dominant hand&#44; and the best measurement &#40;1 out of 3&#44; for each hand&#41; was used for statistical analysis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Secondary variables such as socio-demographical and other clinical data were obtained from the clinical history&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical Analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Statistical analysis was carried out using PASW &#40;SPSS Inc&#46; Released 2009&#46; PASW Statistics for Windows&#44; Version 18&#46;0&#44; Chicago&#44; IL&#44; USA&#41;&#46; Initially&#44; the normality of the data was assessed through the Shapiro&#8211;Wilk test&#46; Due to small sample size&#44; non-parametric tests were used&#46; Wilcoxon signed-rank tests were used for comparisons between visits&#46; Results are expressed as median &#40;Mdn&#41; and Interquartile range &#40;IQR&#41;&#44; otherwise indicated&#46; All tests were two-tailed&#44; and the level of significance was set at <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#46; For metabolic response analysis &#40;VO<span class="elsevierStyleInf">2</span> and VE&#41;&#44; last minute values of the mADL-Test were used&#46; Physiological VO<span class="elsevierStyleInf">2</span> profile of the mADL-Test was analyzed with Friedman test&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">During 2011&#44; 71 COPD patients were admitted to the HH program due to exacerbation&#46; However&#44; only 29 patients &#40;41&#37;&#41; were admitted during the recruitment phase of this study and invited to participate&#46; Unfortunately&#44; 10 patients were excluded&#58; 5 with neoplasia&#44; 4 with movement disturbances&#44; 1 with cardiac instability &#40;New York Heart Association<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> class IV&#41;&#44; and 2 declined the invitation&#46; Consequently&#44; 17 patients were included&#46; The general characteristics of the sample were &#40;Mdn and IQR&#41;&#58; 66 &#40;60&#8211;84&#41; years&#44; 15 were men&#44; and FEV<span class="elsevierStyleInf">1</span> was 38&#37; &#40;29&#37;&#8211;44&#37;&#41; of predicted&#46; More information about the study population at the time of inclusion is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The mADL-Tests performance is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The majority of the patients increased&#44; gradually and significantly&#44; the number of laps &#40;4&#44; 5 and 5&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41; during follow up &#40;L<span class="elsevierStyleInf">0</span>&#44; L<span class="elsevierStyleInf">10post</span> and L<span class="elsevierStyleInf">30post</span>&#44; respectively&#41;&#46; Overall&#44; 12 out of 17 patients increased &#8805;1 lap between V<span class="elsevierStyleInf">0</span> and V<span class="elsevierStyleInf">30post</span>&#46; Nevertheless&#44; whereas the number of laps increased&#44; the final values of VO<span class="elsevierStyleInf">2</span> and VE did not improve significantly between the first and the last assessment &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;331 and <span class="elsevierStyleItalic">P</span>&#61;&#46;244&#44; respectively&#41;&#46; However&#44; exercise performance improvement&#44; represented by an increment of the peak VO<span class="elsevierStyleInf">2</span>&#44; was observed&#46; Moreover&#44; patients presented lower basal HR and higher basal saturation&#44; indicating improved physical status&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The physiological response of the test showed a steady-state VO<span class="elsevierStyleInf">2</span> profile from the second minute up to the end of the test &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; which is representative of sub-maximal tests such as the 6MWT&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The mADL-T was suitable for any location&#59; it was well tolerated by all patients&#44; and no adverse events were reported&#46; None of the patients were excluded for logistical issues &#40;such as the size of the home&#41;&#44; and there were no significant difficulties in carrying the mADL-Test equipment or setting up the test in each patient&#39;s home&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Clinical Assessment</span><p id="par0100" class="elsevierStylePara elsevierViewall">The clinical evolution of the patients after HH discharge is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Overall&#44; patients continued to improve their clinical status during follow-up&#46; The CAT score improved significantly in the first 10 days&#44; and the mMRC level also showed a tendency to improve &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05 and <span class="elsevierStyleItalic">P</span>&#61;&#46;058&#44; respectively&#41;&#46; Both variables had improved by the end of the study&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The self-care domain of the LCADL questionnaire showed significant improvement during follow-up &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;017&#41;&#44; as well as the mBaek &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;004&#41;&#46; Specifically&#44; according to mBaek questionnaire criteria<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> 4 patients became highly active by 1 month post-discharge&#44; while only 5 patients remained inactive &#40;29&#37; of the total population&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study has shown the mADL-Test to be a suitable tool for measuring the functional status of moderate-to-very-severe post-exacerbation COPD patients in the home setting&#46; We have also shown that functional status&#44; measured by the mADL-Test&#44; continues to improve in the first 10 first days after HH discharge&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Functional status is related to COPD clinical outcomes&#44; and therefore its assessment is relevant to patient management&#44; although there is no gold standard test<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and difficulties are sometime encountered&#46; The clinical status of the patient &#8211; stable and exacerbated phase &#8211; and the care setting &#8211; hospital and outpatient environments &#8211; can make this task difficult&#46; Specifically&#44; exercise field tests can be challenging in home-based programs due to space limitations&#46; After previous evaluation of the Glittre test&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> we aimed to explore the feasibility of using it to assess functional status in the home setting&#46; In this study&#44; the mADL-Test was found to be suitable for home use&#44; even in post-exacerbation COPD patients with only one evaluator&#46; However&#44; for the purpose of this study&#44; we modified the original Glittre test to facilitate set-up and performance of the test in different home settings&#46; The work-load of the original test remained unchanged&#44; although the lay-out was modified&#46; The mADL-Test physiological profile is analogous to the original test&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> We also established the number of laps completed by the patient in 6<span class="elsevierStyleHsp" style=""></span>min as the main outcome&#46; The aim was to obtain comparable physiological records from all the subjects&#44; and avoid the possible &#8216;floor&#8217; effect that has been described when patients are instructed to complete a fixed number of laps&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In addition&#44; recent studies have shown that the Glittre test is reproducible<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> with suitable instructions&#46; However&#44; we did not validate our modifications against a gold standard test or the original one&#44; and therefore our results should be treated with caution&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The originality of our study also lies in the contribution of new data on the natural functional recovery of post-exacerbation COPD patients&#58; the mADL-Test performance improves in the first 10 days following HH discharge&#46; In our study&#44; despite its limited sample size&#44; performance of the mADL-test improved in parallel with the clinical improvement shown by patients&#46; Symptoms improved by the end of the study &#40;significant improvement in dyspnea level&#44; health status and physical activity&#41; along with an improvement in cardiopulmonary variables &#40;lower HR at the begging of the test&#44; higher SpO2 at the end of the test&#44; and a tendency toward peak V0<span class="elsevierStyleInf">2</span> improvement&#41;&#46; We acknowledge that the metabolic response of the test did not significantly differ between visits&#44; even though median VO<span class="elsevierStyleInf">2</span> values would seem to increase during follow-up&#46; One possible explanation&#44; together with the small sample size&#44; is that clinical recovery&#44; such a reduction in mMRC&#44; might have allowed patients to increase the number of laps without a significant increase in oxygen uptake&#46; It should be noted that our patients did not participate in any pulmonary rehabilitation program after discharge&#44; so we speculate that the slight recovery might be a result of the previous treatment received &#40;within an integrated care unit&#41; and the small margin of improvement without supplementary treatment &#40;such as exercise training&#41;&#46; In addition&#44; sub-maximal exercise tests have been shown to be better than incremental test in detecting functional changes in COPD patients&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> which would explain the response to the mADL-Test during the recovery phase after an exacerbation&#46; The 6MWT has already been shown to achieve significant improvement 1 month after discharge in untrained post-exacerbation COPD patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;28</span></a> whereas other studies failed to detect any improvement at 6-week follow-up using the incremental shuttle walking test&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> In addition&#44; there were no safety concerns during performance of any of the tests&#44; so we believe that the mADL-Test is a good option for functional status assessment of COPD patients&#44; even during the recovery phase of an exacerbation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Finally&#44; some other limitations of this study should be mentioned&#46; We could not calculate the sample size in advance&#44; since this was a feasibility study with no previously recorded data&#46; This may have contributed to the insufficient statistical power obtained in some comparisons&#44; such as establishing a correlation between mADL-Test results and clinical variables&#46; Also&#44; the vast majority of our patients were male&#44; and therefore&#44; results cannot be generalized to both genders&#46; Lastly&#44; it is important to note that 7 out of the 17 patients had to perform the mADL-Test without their supplementary oxygen therapy in order to record physiological parameters&#44; and we believe this could explain some of the variability seen in our results&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; the mADL-Test is effective in measuring overall functional status in the home setting&#46; It can be particularly useful in home care units and as a means of assessing other non-COPD patients with potentially altered functional status&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> More research into the mADL-Test properties is needed&#44; as well as more studies to fully clarify the recovery pattern after a COPD exacerbation&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">The findings of this study suggest that the mADL-Test is a feasible and safe tool for assessing the functional status of moderate-to-very-severe COPD patients recovering from an exacerbation at home&#46; Post-exacerbation functional status treated in a HH program improves 10 days after discharge&#46; Undoubtedly&#44; larger studies are warranted to confirm and expand these results&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of Interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">We have no conflict of interest to declare&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">This work was partially supported by <span class="elsevierStyleGrantSponsor" id="gs1">NEXES</span> UE-FP7 &#40;<span class="elsevierStyleGrantNumber" refid="gs1">CIP-ICT-PSP-2007-1</span>&#41; 225&#44;025 and <span class="elsevierStyleGrantSponsor" id="gs2">SEPAR</span><span class="elsevierStyleGrantNumber" refid="gs2">0123&#47;09</span>&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Glittre Activities of Daily Living Test &#40;ADL-Test&#41; is a reliable functional status measurement for stable Chronic Obstructive Pulmonary Disease &#40;COPD&#41; patients in a laboratory setting&#46; We aimed to adapt the test to the home setting &#40;mADL-Test&#41; and to follow-up the functional status recovery of post-exacerbation COPD patients included in a home hospitalization &#40;HH&#41; program&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We assessed 17 exacerbated moderate-to-very-severe COPD patients in 3 home visits&#58; at discharge to HH &#40;V<span class="elsevierStyleInf">0</span>&#41;&#44; 10 days &#40;V<span class="elsevierStyleInf">10post</span>&#41; and 1 month after discharge &#40;V<span class="elsevierStyleInf">30post</span>&#41;&#46; Patients completed the mADL-Test &#40;laps&#44; VO<span class="elsevierStyleInf">2</span> and VE&#41;&#44; COPD assessment test &#40;CAT&#41;&#44; London Chest ADL Test &#40;LCADL&#41;&#44; modified Medical Research Council &#40;mMRC&#41; and upper limb strength &#40;handgrip&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The number of laps of the mADL-Test &#40;4&#44; 5 and 5&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#44; CAT &#40;19&#44; 12 and 12&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; mMRC &#40;2&#44; 1&#46;5 and 1&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41; and the self-care domain of the LCADL &#40;6&#44; 5 and 5&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41; improved during follow-up &#40;V<span class="elsevierStyleInf">0</span>&#44; V<span class="elsevierStyleInf">10post</span> and V<span class="elsevierStyleInf">30post</span>&#44; respectively&#41;&#46; No significant changes were evidenced in VO<span class="elsevierStyleInf">2</span>&#44; VE or handgrip&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that the mADL-Test can be performed in the home setting after a COPD exacerbation&#44; and that functional status continues to improve 10 days after HH discharge&#46;</p></span>"
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            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La prueba de actividades de la vida diaria de Glittre &#40;prueba ADL&#41; es&#44; en un entorno de laboratorio&#44; una medida fiable del estado funcional de los pacientes con enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; estable&#46; Nos propusimos adaptar la prueba para poder llevarla a cabo en el entorno domiciliario &#40;Test ADLm&#41; y supervisar la recuperaci&#243;n del estado funcional de pacientes con EPOC despu&#233;s de una exacerbaci&#243;n atendida en hospitalizaci&#243;n domiciliaria &#40;HD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Evaluamos a 17 pacientes con EPOC de moderada a muy intensa y exacerbaci&#243;n en tres visitas domiciliarias&#58; el d&#237;a del alta de la HD &#40;V<span class="elsevierStyleInf">0</span>&#41;&#44; al cabo de 10 d&#237;as &#40;V<span class="elsevierStyleInf">10post</span>&#41; y un mes despu&#233;s del alta &#40;V<span class="elsevierStyleInf">30post</span>&#41;&#46; Los pacientes realizaron la prueba ADLm &#40;vueltas a un circuito&#44; VO<span class="elsevierStyleInf">2</span> y VE&#41;&#44; la prueba de evaluaci&#243;n de la EPOC &#40;CAT&#41;&#44; el Cuestionario de ADL <span class="elsevierStyleItalic">London Chest</span> &#40;LCADL&#41;&#44; la Escala del <span class="elsevierStyleItalic">Medical Research Council</span> modificada &#40;MRCm&#41; y una dinamometr&#237;a de las extremidades superiores &#40;fuerza de prensi&#243;n&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">el n&#250;mero de vueltas al circuito en la prueba ADLm &#40;4&#44; 5 y 5&#44; <span class="elsevierStyleItalic">p<span class="elsevierStyleHsp" style=""></span>&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; el CAT &#40;19&#44; 12 y 12&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; la MRCm &#40;2&#44; 1&#44;5 y 1&#44; <span class="elsevierStyleItalic">p<span class="elsevierStyleHsp" style=""></span>&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y el dominio de cuidado personal del LCADL &#40;6&#44; 5 y 5&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; mejoraron durante el seguimiento &#40;V<span class="elsevierStyleInf">0</span>&#44; V<span class="elsevierStyleInf">10post</span> y V<span class="elsevierStyleInf">30post</span>&#44; respectivamente&#41;&#46; No se constataron cambios significativos en el VO<span class="elsevierStyleInf">2</span>&#44; el VE o la fuerza de prensi&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados indican que&#44; tras una exacerbaci&#243;n de la EPOC&#44; es factible realizar la prueba ADLm en el entorno domiciliario&#44; y que el estado funcional contin&#250;a mejorando diez d&#237;as despu&#233;s del alta de la HD&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Please cite this article as&#58; Valeiro B&#44; Hern&#225;ndez C&#44; Barber&#224;n-Garcia A&#44; Rodr&#237;guez DA&#44; Aibar J&#44; Llop L&#44; et al&#46; Viabilidad de la evaluaci&#243;n domiciliaria del estado funcional de pacientes con enfermedad pulmonar obstructiva cr&#243;nica en fase de recuperaci&#243;n de una exacerbaci&#243;n&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;256&#8211;261&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Reprinted and modified from Ref&#46; <a class="elsevierStyleCrossRef" href="#bib0070">14</a> with permission of the publisher&#44; Elsevier&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 948
            "Ancho" => 5312
            "Tamanyo" => 159882
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">mADL-Test&#46; Patients were instructed to do as many laps as they could in 6<span class="elsevierStyleHsp" style=""></span>min&#46; They were not verbally encouraged during the test&#46; Two separate steps &#40;17<span class="elsevierStyleHsp" style=""></span>cm high and 27<span class="elsevierStyleHsp" style=""></span>cm deep&#41; were placed one in front the other to mimic the climbing movements required by the original test&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1105
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">VO<span class="elsevierStyleInf">2</span> physiological profile in the three follow-up visits&#46; Each line represents the mADL-Test VO<span class="elsevierStyleInf">2</span> values &#40;mean values with standard deviation&#41; of the 17 patients together and for each assessment visit&#46; The VO<span class="elsevierStyleInf">2</span> values are plotted minute by minute&#46; From the second minute the VO<span class="elsevierStyleInf">2</span> profile reaches a plateau &#40;<span class="elsevierStyleItalic">P</span>&#61;NS&#41;&#46; NS&#44; non-significant&#46;</p>"
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      2 => array:7 [
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; Body Mass Index&#59; HH&#44; home hospitalization&#58; FEV<span class="elsevierStyleInf">1</span>&#44; force expiratory volume during the first second&#59; FVC&#44; forced vital capacity&#59; LTOT&#44; long term oxygen therapy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Participants&#44; n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;60&#8211;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender&#44; male&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Smoking history&#44; pack-year</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;20&#8211;150&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6 &#40;24&#46;2&#8211;30&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Length of HH stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5 &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Modified Charlson Index</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;3&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Forced spirometry</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3 &#40;0&#46;98&#8211;1&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;31&#8211;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;39&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">GOLD</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Formers users of LTOT&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Study Group&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">VO<span class="elsevierStyleInf">2</span>&#44; oxygen uptake&#59; VO<span class="elsevierStyleInf">2</span>&#47;kg&#44; oxygen uptake per kilogram per minute&#59; VE&#44; ventilation&#59; bpm&#44; beats per minute&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&#61;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V<span class="elsevierStyleInf">0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V<span class="elsevierStyleInf">10post</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V<span class="elsevierStyleInf">30post</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Functional capacity</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Laps&#44; <span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;3&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#8211;5&#46;5&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#46;5&#8211;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Metabolic parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2</span>&#44; mL&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">906 &#40;833&#8211;1009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">961 &#40;915&#8211;1241&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1008 &#40;793&#8211;1349&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2</span>&#47;kg&#44; mL&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;10&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;10&#8211;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;10&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VE&#44; L&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;23&#8211;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;25&#8211;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;24&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">O</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">saturation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basal&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93 &#40;90&#8211;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;92&#8211;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;92&#8211;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Final&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88 &#40;81&#8211;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91 &#40;85&#8211;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;84&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Heart rate</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basal&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;73&#8211;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;70&#8211;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;71&#8211;92&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Final&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;93&#8211;117&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99 &#40;86&#8211;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;84&#8211;119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Level of perceived exertion</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basal dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Final dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basal fatigue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Final fatigue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">V<span class="elsevierStyleInf">0</span> and V<span class="elsevierStyleInf">10post</span>&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">V<span class="elsevierStyleInf">10post</span> and V<span class="elsevierStyleInf">30post</span>&#46;</p>"
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            2 => array:3 [
              "identificador" => "tblfn0015"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">V<span class="elsevierStyleInf">0</span> and V<span class="elsevierStyleInf">30post</span>&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Borg modified score&#46;</p> <p class="elsevierStyleNotepara" id="npar0025"><span class="elsevierStyleItalic">P</span>-values &#60;&#46;05&#46;</p>"
            ]
          ]
        ]
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Cardiopulmonary and Physiological Response of the mADL-Test&#46;</p>"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; mMRC&#44; Modified Medical Research Council dyspnea scale&#59; LCADL&#44; London Chest Activities of Daily Living questionnaire&#59; CAT&#44; COPD Assessment Test questionnaire&#59; N&#47;A&#44; not available&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&#61;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V<span class="elsevierStyleInf">10post</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V<span class="elsevierStyleInf">30post</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">mMRC score</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;5 &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;1&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LCADL score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;11&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;13&#8211;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;13&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Self-care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;4&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#8211;6&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Physical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;2&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leisure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;3&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;3&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CAT score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;11&#8211;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;7&#8211;16&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;8&#8211;15&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Modified Baecke score</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;7&#8211;16&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low active&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate active&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High active&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Handgrip dynamometry</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">d</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dominant hand&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;22&#8211;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;23&#8211;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;20&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-dominant hand&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;21&#8211;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;19&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;19&#8211;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            ]
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Clinical Evolution of Patients After HH Discharge&#46;</p>"
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      "titulo" => "<span class="elsevierStyleBold">References</span>"
      "seccion" => array:1 [
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                      "titulo" => "Global strategy for the diagnosis&#44; management&#44; and prevention of chronic obstructive pulmonary disease&#58; GOLD executive summary"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0145" class="elsevierStylePara elsevierViewall">The authors would like to acknowledge the patients who participated in this study and also thank the strong collaboration of the Integrated Care team of Hospital Clinic for their help on patients&#8217; recruitment and organizational efforts&#46; They would also recognize Cosmed &#40;Italy&#41; and Sonmedica &#40;Spain&#41; for providing the equipment to do the physiologic measurements at home&#46; The authors would also like to thank Bill De Felice for his altruistic collaboration in the revision of the text&#46;</p>"
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2015.11.008

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Year/Month	Html	Pdf	Total

2024 November	4	4	8
2024 October	59	34	93
2024 September	45	45	90
2024 August	65	55	120
2024 July	40	25	65
2024 June	64	31	95
2024 May	129	34	163
2024 April	42	29	71
2024 March	36	12	48
2024 February	44	25	69
2023 March	20	5	25
2023 February	56	13	69
2023 January	31	37	68
2022 December	68	35	103
2022 November	70	30	100
2022 October	60	41	101
2022 September	39	30	69
2022 August	39	40	79
2022 July	37	52	89
2022 June	32	40	72
2022 May	40	44	84
2022 April	36	27	63
2022 March	43	44	87
2022 February	23	46	69
2022 January	35	52	87
2021 December	36	54	90
2021 November	39	48	87
2021 October	38	50	88
2021 September	36	40	76
2021 August	20	38	58
2021 July	38	27	65
2021 June	59	42	101
2021 May	58	59	117
2021 April	116	128	244
2021 March	63	28	91
2021 February	41	23	64
2021 January	42	20	62
2020 December	40	31	71
2020 November	53	24	77
2020 October	50	21	71
2020 September	41	20	61
2020 August	51	28	79
2020 July	45	27	72
2020 June	42	17	59
2020 May	37	17	54
2020 April	60	32	92
2020 March	448	29	477
2020 February	65	34	99
2020 January	59	40	99
2019 December	69	28	97
2019 November	35	29	64
2019 October	30	13	43
2019 September	53	13	66
2019 August	29	14	43
2019 July	38	26	64
2019 June	30	9	39
2019 May	68	31	99
2019 April	55	25	80
2019 March	58	38	96
2019 February	34	24	58
2019 January	59	21	80
2018 December	37	39	76
2018 November	136	21	157
2018 October	239	22	261
2018 September	140	15	155
2018 May	89	0	89
2018 April	64	4	68
2018 March	155	9	164
2018 February	88	9	97
2018 January	117	8	125
2017 December	80	13	93
2017 November	22	7	29
2017 October	23	12	35
2017 September	29	16	45
2017 August	28	28	56
2017 July	23	10	33
2017 June	39	17	56
2017 May	38	25	63
2017 April	34	13	47
2017 March	27	40	67
2017 February	21	4	25
2017 January	22	9	31
2016 December	27	16	43
2016 November	39	24	63
2016 October	48	27	75
2016 September	45	14	59
2016 August	53	8	61
2016 July	2	0	2

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