[Which parameters should be chosen to evaluate daily activities of the patients with chronic lung disease?].
In Japan medically handicapped persons are given government support. Currently the government uses selection criteria including FEV1, PaO2, and dyspnea rating to identify level 3 handicaps, however, these criteria lack a scientific basis. The purpose of this study was to investigate the validity of the current criteria and to try to create more appropriate one. We retrospectively reviewed the clinical records of 204 cases with chronic lung disease (COPD 111, non-COPD 93). The accuracy of the current criteria was assessed by sensitivity and specificity. To find the parameters that could determine ADL, we searched for clinical parameters using simple logistic regression models, ROC curves, and cross-table analyses. To compare the accuracy of the current and newly created criteria, we assessed the sensitivity, specificity of the two criteria. Sensitivity, specificity, and overall accuracy of the current criteria were 77.6%, 74.8%, and 75.5%, respectively, however, the positive predictive value was low (46.4%). The results of the screening of the parameters showed that the following three parameters were useful discriminators of ADL: (1) supplemental oxygen use, (2) MRC scale > or =4, and (3) 6-minute walking distance <340 m. The newly created criteria using these three parameters showed better sensitivity, specificity, and overall accuracy (81.6%, 80.7%, and 80.9%, respectively) than those of the current criteria. The positive predictive value also improved. In conclusion, our results suggest that the newly created criteria that include the 6-minute walking distance are more suitable than the criteria currently used to assess the ADL of the patients with chronic respiratory disease.
Ando
Morihide
M
Department of Respiratory Medicine, Ogaki Municipal Hospital.
Okazawa
Mitsushi
M
Mori
Atsushi
A
Sakakibara
Hiroki
H
D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000592:standards*; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies; D016138:Walking / Q000502:physiology*