title: Relationship and responsiveness of three upper-limb tests in patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To determine (1) the relationship among three common upper-limb tests for patients with chronic obstructive pulmonary disease (COPD): unsupported upper limb exercise test (UULEX), 6-minute pegboard and ring test (6PBRT), and a muscle-strength test using a hand-held dynamometer; and (2) the responsiveness of these three tests to changes after pulmonary rehabilitation that included a resistance arm-training programme.
  
  
  METHODS
  The study was a secondary analysis of a randomized controlled trial (RCT). The UULEX and the 6PBRT were used to measure peak arm exercise capacity and arm function, respectively. A handheld dynamometer was used to measure elbow and shoulder flexion force. We analyzed baseline data for all participants in the RCT, as well as baseline and post-PR data for those who completed 6-week follow-up testing.
  
  
  RESULTS
  36 patients with COPD (mean forced expiratory volume in 1 second [FEV1]=35% [SD 15%] predicted; age 66 [9] y) participated, of whom 13 completed an arm-training programme. The correlations among the test results ranged from 0.41 to 0.81 (p<0.0001). Standardized response means were 1.0 for muscle force of elbow flexion, 1.2 for shoulder flexion, and 1.8 for the 6PBRT and UULEX.
  
  
  CONCLUSIONS
  Although the three tests (UULEX, 6PBRT, and muscle-strength test using a hand-held dynamometer) are intended to measure different constructs, they were moderately to highly correlated with one another. The 6PBRT, UULEX, and muscle-strength test were demonstrated to be responsive to the resistance arm-training programme.
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre ; Department of Physical Therapy ; St. John's Rehabilitation Hospital, Toronto.
authors.forename: Tania
authors.initials: T
authors.lastname: Janaudis-Ferreira
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre ; School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University ; Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Hill
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre ; Department of Physical Therapy ; Department of Medicine, University of Toronto.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Goldstein
authors.affiliation: Department of Community Medicine and Rehabilitation, Umeå University, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Wadell
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre ; Department of Physical Therapy.
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
keywords: chronic obstructive pulmonary disease; exercise test; upper limb