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BACKGROUND/RATIONALE:
Advanced chronic obstructive pulmonary disease (COPD) is associated with oxygen desaturation leading to serious complications including reduced functional performance and decreased survival. Long-term oxygen therapy (LTOT) can improve clinical outcomes in COPD, but the optimal target of oxygen saturation that translates into improvements is not known. Standard methods to evaluate patients for LTOT performed in the clinical setting underestimate oxygen needs of these patients when measured with ambulatory techniques. Our previous work has extended ambulatory oximetry monitoring by simultaneously measuring activity with accelerometers and in this way link oxygen desaturation to four distinct categories of daily activity: walking, slow/intermittent walking, active-not-walking and resting. Our preliminary data confirm that patients with chronic lung disease are markedly inactive, and that these patients experience significant oxygen desaturation during the period of time they are active, but not walking - an activity category that is not assessed by the standard evaluations. This proposal will focus on the utility and efficacy of a new approach to evaluate patients for oxygen desaturation, specifically whether the Continuous-Scale Physical Function Performance test, an assessment that utilizes a range of domestic tasks, can more accurately predict oxygen desaturation in the home environment than the standard assessments.
OBJECTIVE(S):
Objective #1: Estimate the sensitivity, specificity, positive predictive value, negative predictive value and total prediction error of each of the 10 tasks of the functional assessment to predict oxygen saturation during four categories of daily living.
Functional Assessment: Continuous Physical Functional Performance Test
Desaturation: oxygen saturation <90% measured by pulse oximetry
Categories of Daily Living: Rest, Active-Not-Walking, Short/Intermittent-Walking and Walking as defined by accelerometers.
Objective #2: Determine the optimal combination test to achieve the best prediction of oxygen desaturation in each daily activity category. Estimate the sensitivity, specificity, positive predictive value, negative predictive value and total prediction error of the optimal combination test in predicting oxygen desaturation.
METHODS:
134 patients with COPD will undergo functional testing and a 2-day ambulatory monitor while wearing two accelerometers and a wearable pulse oximeter. Data will be analyzed using logistic, classification and rank regression analyses to determine the combination of tasks that predict oxygen desaturation.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
We hypothesize that this novel approach to assessing oxygen desaturation will lead to the development of a clinical assessment tool that accurately predicts the individual, temporal profile of oxygen desaturation as patients live freely in their home environment. The results of this pilot work will provide preliminary data on which to base a larger study that will determine whether a comprehensive prescription/management plan for LTOT that is designed using activity/saturation profile data from individual patients will improve key clinical outcomes, such as morbidity, symptoms, health-related quality of life and, perhaps, the daily activity profile itself.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Rehabilitation, Quality of Care
Keywords:
Chronic lung disease, Functional status, Nursing
MeSH Terms:
none
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