Source: Annual Congress 2013 –The best abstracts in pulmonary rehabilitation and chronic care (sponsored by MOTEK Medical)
Disease area: Airway diseases

Abstract

Background Gait speed is a consistent predictor of adverse outcomes such as disability and mortality in community elders (Studenski 2011). We have recently shown that the 4 metre gait speed (4GS) is a quick, reliable measure in COPD patients that correlates with exercise capacity and health related quality of life (Kon 2012).
Aim To determine the responsiveness of 4GS to pulmonary rehabilitation (PR) and longitudinal change; determine the Minimum Clinically Important Difference (MID) of 4GS in COPD.
Methods 4GS, ISW (incremental shuttle walk), MRC and SGRQ (St.George’s Respiratory Questionnaire) were measured pre and post an 8-week PR programme in 301 COPD patients. In 139 patients, 4GS was measured 1 year apart. Paired t tests were used to compare outcomes with PR. Correlations between change in 4MGS and other measures were assessed using Pearson’s correlation. MID was assessed using distribution and anchor based methods.
Results Baseline characteristics: age 71years (64,76); FEV₁pred 49%(32,63); MRC3 (2,4); M:F 165:136. There was a significant change in 4GS with PR (mean change 0.08m/s, p<0.0001). Changes in 4GS correlated significantly with changes in ISW (r=0.3) and SGRQ (r=0.2). Minimal Detectable Change at 95% confidence interval was 0.11m/s. MID was 0.11m/s anchored to ISW and 0.09m/s in those feeling “better” or “much better” post PR. At 1 year the mean change in 4GS was -0.03m/s. Patients who reduced their ISW by the known MID (>47.5m) at 1 year showed a mean change of -0.11m/s.
Conclusion The 4GS in a simple to use assessment tool which is responsive to PR and changes with time. Distribution and anchor based methods support a MID of 0.11m/s.

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S. S. C. Kon, J. L. Canavan, A. L. Clark, C. M. Nolan, S. E. Jones, P. Cullinan, M. I. Polkey, W. D. C. Man (Harefield, United Kingdom). Responsiveness and minimum clinically important difference of the 4 metre gait speed in chronic obstructive pulmonary disease. Eur Respir J 2013; 42: Suppl. 57, 4655

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