Prognostic value of the five-repetition sit-to-stand test for mortality in people with chronic obstructive pulmonary disease - 27/10/21

Doi : 10.1016/j.rehab.2021.101598

Francesc Medina-Mirapeix, PhD ¹, Elisa Valera-Novella, PhD ², Jaume Morera-Balaguer, PhD ³, Roberto Bernabeu-Mora, MD ^1,^4,^⁎
¹ Department of Physiotherapy, University of Murcia, and Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
² Department of Physiotherapy, University of Murcia, Spain
³ Department of Physical Therapy, University CEU Cardenal Herrera, Elx, Spain
⁴ Department of Pneumology, Hospital General Universitario Morales Meseguer, Murcia, Spain

^⁎Corresponding author:-Roberto Bernabeu-Mora, Division of Pneumology, Hospital Morales Meseguer, Department of Physical Therapy, University of Murcia, Avda Marqués de los Velez s/n. 30008, Murcia, Spain, +34968360900, +34968360994Division of Pneumology, Hospital Morales Meseguer, Department of Physical TherapyUniversity of MurciaAvda Marqués de los Velez s/nMurcia30008Spain

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Wednesday 27 October 2021
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Highlights

•	The five-repetition sit-to-stand test (5-STS) is a measure for predicting mortality in patients with chronic obstructive pulmonary disease (COPD).
•	The 5-STS has a cut-off for discriminating survival slight better than the 6-min walk test.
•	The cut-off for the 5-STS for 5-year all-cause-mortality was 15.98 sec.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Prognostic studies suggest that some musculoskeletal and functional capacity tests are independently associated with mortality in chronic obstructive pulmonary disease (COPD), but comparing their prognostic value is difficult because of differences in the selected covariates for regression modelling in those studies.

Objectives

To assess the prognostic value of five musculoskeletal and functional capacity tests in predicting mortality risk in patients with COPD after adjusting for existing and confounding prognostic factors and to compare their ability to correctly discriminate the mortality of individual participants using the 6-min walk test (6MWT). We hypothesized that the examined tests have different prognostic value.

Methods

Prospective and longitudinal study. A total of 137 patients with stable COPD (mean [SD] age 67 [8.33] years; 87% male) were recruited from a hospital in Spain during 2014 and followed for 5 years (2014-2019). No one refused and only one was lost to follow-up. The outcome measure was 5-year all-cause mortality.

Results

A total of 37 patients died within 5 years. All musculoskeletal tests were associated with 5-year all-cause mortality in Cox proportional-hazards regression models. However, only the five-repetition sit-to-stand test (5-STS) score was an independent prognostic factor (hazard ratio 1.04 per sec, 95% confidence interval 1.01-1.08) after adjusting for history of heart disease, number of previous severe exacerbations, and dyspnoea. This model explained 50.7% of the variance in mortality. This test exhibited similar discriminative ability as the 6MWT for 5-year mortality (area under the receiver operating characteristic curve: 0.741 vs 0.722; p=0.92), and a highly prognostic cut-off for discriminating (15.98 sec). This cut-off had higher likelihood ratios (LRs) than the 6MWT cut-off (∼350 m), especially for negative LRs (1/LR-: 7.69 vs 2.00).

Conclusions

The 5-STS is an objective measure for predicting mortality in patients with COPD and has good discriminative ability, with a cut-off for discriminating survival slight better than the 6MWT. The prognostic value of the other tests remains to be confirmed.

Le texte complet de cet article est disponible en PDF.

Keywords : 6MWT, Chronic obstructive pulmonary disease, Predictors, 5-STS, Mortality