title: The Manchester Respiratory Activities of Daily Living questionnaire: development, reliability, validity, and responsiveness to pulmonary rehabilitation.
abstract: OBJECTIVE
  Because there is no respiratory-specific activities of daily living (ADL) scale for use in older patients, our aim was to design and develop the Manchester Respiratory ADL questionnaire (MRADL) and to assess its validity in older patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  The MRADL is a composite of the most discriminative questions from the Nottingham Extended ADL Questionnaire (NEADL) and the Breathing Problems Questionnaire (BPQ).
  
  
  METHODS
  A University teaching hospital.
  
  
  METHODS
  Participants were 188 (104 men) COPD out-patients aged 60 to 93 (mean 77) years and 55 (23 men) normal controls (NCs) aged 70 to 90 (mean 78) years. Exclusions were confusion and acute respiratory exacerbation/use of oral corticosteroid within 6 weeks.
  
  
  METHODS
  A subgroup of COPD subjects completed a pulmonary rehabilitation program (PR) to assess responsiveness of the MRADL to intervention.
  
  
  METHODS
  All subjects completed MRADL and NEADL scales, and 15 COPD subjects (11 men) completed an 8-week PR program.
  
  
  RESULTS
  Mean (SE) 1-second forced expiratory volume (FEV1) in COPD subjects was 0.94 (0.03) liters, and in NCs it was 1.96 (0.07) liters. MRADL discriminated better between COPDs and NCs than did the NEADL in terms of sensitivity (90% vs 76%; X2 = 4.8, P = .02) and negative predictive value (84% vs 69%; X2 = 4.5, P = .03). MRADL responded to changes during PR: pre versus post mean (SE) score 11.2 (1.1) vs 13.4 (1.1); (t = 3.09; P = .008), but NEADL was unchanged. MRADL showed high consistency (Cronbach alpha 0.91). 95% confidence limits of repeatability were -0.63 to +0.26 (P = .42) for MRADL and -0.53 to +0.26 (P = .50) for NEADL.
  
  
  CONCLUSIONS
  MRADL is a reliable and valid self-report scale for assessment of physical disability in older COPD patients. It is responsive to pulmonary rehabilitation.
authors.affiliation: Department of Geriatric Medicine, The Manchester School of Physiotherapy, Manchester Royal Infirmary, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Yohannes
authors.forename: J
authors.initials: J
authors.lastname: Roomi
authors.forename: S
authors.initials: S
authors.lastname: Winn
authors.forename: M J
authors.initials: MJ
authors.lastname: Connolly
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005853:Geriatrics; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000534:rehabilitation*; D008297:Male; D008448:Maximal Expiratory Flow Rate; D008875:Middle Aged; D012044:Regression Analysis; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D006113:United Kingdom