Browsing by Subject "Physical frailty"

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    Frailty transitions and associated clinical outcomes in patients with stable COPD: A longitudinal study
    (2020-04-03) Bernabeu Mora, Roberto; Oliveira Sousa, Silvana Loana de; Sánchez Martínez, Piedad; García Vidal, José Antonio; Gacto Sánchez, Mariano; Medina Mirapeix, Francesc; Fisioterapia
    Background: Although frailty is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients, evidence on the frequency of frailty transition is scarce. Aims: The present study aimed to describe the frailty status transition rates over a 2-year period and their associated clinical outcomes in stable COPD patients, and to determine predictors of improvement in frailty status. Methods: We prospectively included 119 patients with stable COPD (mean age ± SD, 66.9 ± 7.9 years) over a follow-up period of 2 years. Frailty was assessed using the Fried criteria (unintentional weight loss, weakness, exhaustion, low activity level, and slow walking speed). Several demographic, clinical, and health-related variables were measured. We calculated the rates for each of the frailty transitions (no change, improvement, or worsening) between baseline and 2 years. Outcomes were compared using one-way analysis of variance and predictors of improvement were identified in multivariate logistic regression. Results: After 2 years of follow-up, 21 (17.6%) patients had an improved frailty status, 14 (11.7%) had worsened, and 84 (70.5%) had maintained the same frailty status. The worsening group (vs no change group) had greater dyspnea (p = 0.013) and disability (p = 0.036) and lower handgrip strength (p = 0.001). In contrast, the improved group (vs no change group) had greater handgrip (p<0.001) and quadriceps strength (p = 0.032). Furthermore, the improved group had greater handgrip strength (p<0.001), quadriceps strength (p = 0.003), physical activity (p = 0.008), and lower disability (p = 0.019) than the worsening group. Additionally, we determined that the 5STS test (≤ 13.6s) and exacerbations (≥ 2) were independent predictors for improvement in frailty status [adjusted OR 9.46, p = 0.058 and adjusted OR 0.12, p = 0.026, respectively]. Conclusions: Frailty is a dynamic process for approximately one-third of patients with stable COPD and transitions in frailty status are associated with significant changes in clinical outcomes. The 5STS and exacerbations were independent predictors of improvement in frailty status.
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    Physical frailty characteristics have a differential impact on symptoms as measured by the CAT score: an observational study
    (2018-07-16) Medina Mirapeix, Francesc; Bernabeu Mora, Roberto; Giménez Giménez, Luz María; Escolar Reina, Pilar; Gacto Sánchez, Mariano; Oliveira-Sousa, Silvana Loana de; Fisioterapia
    BACKGROUND: The physical frailty status affects the health status of patients with chronic obstructive pulmonary disease (COPD). The objective was to determine if the individual physical frailty characteristics have a differential impact on the CAT score. METHODS: This observational study included 137 patients with stable COPD. Physical frailty was measured with unintentional weight loss, low physical activity, exhaustion, slow walking speed and low grip strength and health status assessed with the COPD Assessment test (CAT). The following variables were evaluated as potential determinants of CAT: sex, age, body mass index, smoking, dyspnea, exacerbations, comorbidities, %FEV1, %FVC, anxiety and depression. RESULTS: The prevalence of characteristics for individual frailty was as follows: low grip strength, 60.6%; low physical activity, 27.0%; exhaustion, 19.7%; slow walking speed, 9.5%; and unintentional weight loss, 7.3%. A total of 17.5% of the patients were non-frail, 73.7% were pre-frail and only 8.7% were frail. One of the five frailty characteristics, exhaustion (adjusted β coefficient 5.12 [standard error = 1.27], p = 0.001) was an independent determinant of CAT score in the final regression model which was adjusted by other independent determinants of CAT (dyspnea, exacerbations and anxiety). CONCLUSIONS: Due to the fact that exhaustion is a frequent and relevant psychological symptom on CAT score of patients with COPD, interventions should reduce that stress. Future research should explore how exhaustion persists or remits over time.