FUNCTIONAL ASSESSMENT OF OLDER ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE LIVING AT HOME

Field: Health Professions (Health Sciences)

To the Editor: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity in older adults.1 The national economic burden of COPD is enormous, with an estimated $37 billion spent annually caring for patients with COPD in the United States (U.S.2). By receiving specific services in the home, including oxygen therapy and physical exercise instruction, older adults living with COPD may remain at home, rather than requiring placement in an institutionalized setting.3 Even in the absence of any improvement in lung function and quality of life, pulmonary rehabilitation has been shown to be effective in improving exercise capacity and reducing symptoms.4 This article will discuss an exploratory project testing an exercise intervention that was developed to help seniors with respiratory and mobility impairment improve their ability to perform activities of daily living (ADLs) as measured by the Manchester Respiratory Activities of Daily Living Questionnaire (MRADL), an instrument that assesses four functional domains in older community-dwelling individuals with COPD. This pilot study investigated the importance of daily low-impact exercise training as a way to optimize functional ADLs. The following research questions were addressed in this study: Was there a significant difference in the oxygen saturation of participants in this study before and after the intervention as measured using a finger-probe pulse oximeter? Was there a significant difference in the reported functional ADLs before and after the intervention as measured using the MRADL? Was there a difference in the performance of ADLs in participants classified as having moderate or severe COPD after the intervention? The design of this study was a quasiexperimental longitudinal pilot study using a convenience sample. Spirometry was used to determine participants' disease severity (moderate or severe COPD), according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging.5 One of the investigators (JDM) visited each participant at home for a total of three visits in a rural, medically underserved Texas county. Functional assessment was ascertained using the MRADL, and a comprehensive inhaled medication inventory was collected on each participant at Visit 1. All participants in this convenience sample received interventional exercise education. Each participant was encouraged to repeat these exercises for 15 minutes daily and to document completion of these exercises in a physical exercise diary. The MRADL was designed and developed as a respiratory-specific ADL scale for use in older patients.6 It has shown high consistency, with a Cronbach alpha of 0.91.6 An independent-samples t-test was conducted to compare pre- and postintervention scores on the MRADL. Paired-samples t-tests were also conducted on each item of the MRADL before and after the intervention. SPSS version 15.0 was used for data analysis (SPSS, Inc., Chicago, IL). Ten women and 15 men participated in a COPD study in rural Texas (N=25). Participants were aged 66 to 87 (mean 74.9±5.2). After the 4-week intervention of daily exercise, there was a significant increase in ability to perform ADLs, as evidenced by an increase in mean MRADL score from 18.9±3.0 to 19.6±2.7 (P<.001). Paired-samples t-tests were also conducted on each item of the MRADL before and after the intervention, yielding a statistically significant increase in 10 pairs of MRADL scores from Time 1 to Time 2 (Table 1). An independent-samples t-test was conducted to compare the MRADL scores of participants with moderate and severe COPD. There was no significant difference in scores for moderate (0.76±0.83) or severe (0.75±0.87; t(23)=–0.040, P=.97 (two-tailed)) COPD. A paired-samples t-test was conducted to evaluate the effect of the intervention on participants' oxygen saturation. There was no significant difference in the oxygen saturation of participants in this study before (95.4±2.0) and after (95.6±1.9; t(24)=−0.52, P=.61 (two-tailed)) the intervention. Despite oxygen level not improving after the intervention and there not being a difference in MRADL based on disease severity, the intervention positively affected the participants. In addition, participants' mean MRADL scores improved after the intervention, which indicates the positive effects of pulmonary rehabilitation and enhancement of functional capacity. Seventeen of 25 participants responded in the program evaluation telephone call that they were still performing their exercises, 1 month after the study concluded. A strength of this study was the examination of an understudied rural medically underserved population with COPD. These research findings apply only to the participants in the study. Additionally, the Hawthorne effect potentially threatened the external validity of this study in that participant's motivation to have the investigator regard them positively might have affected their answers.7 In this study, daily low-impact exercise training optimizes functional ADLs in participants. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. The study was performed as a capstone research project in partial fulfillment of the Doctor of Nursing Practice at Texas Woman's University. The primary author funded the study. Author Contributions: The primary and tertiary authors were influential in the study concept. The primary and secondary authors influenced the study design. All authors were involved in acquisition of subjects. The primary investigator obtained the data. The primary and secondary authors analyzed the data and prepared the manuscript. Sponsor's Role: The study did not have grant or corporate funding.