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Title: Habitual gait speed : a novel prognostic marker in COPD?
Author: Kon, Samantha Swee Chin
ISNI:       0000 0004 6495 6853
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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Forced expiatory volume in one second (FEV1) is the most widely accepted marker in COPD. However, COPD is now well recognised as a multisystem and heterogeneous disease, and it is unlikely that a single marker could reflect the complex range of observed pathophysiologic changes. Exercise intolerance is a common symptom in COPD, and reflects both lung and skeletal muscle dysfunction. Logistical issues often mean physical performance is not routinely measured objectively in all clinical settings. Gait speed is an easy, quick to perform established measure of physical performance in the elderly, and has been recommended as a “vital sign” or “global marker of well-being” that reflects biological rather than chronological age. Functional decline is common to both ageing and COPD but gait speed has not been validated in COPD. In 586 patients with stable COPD, usual gait speed over 4 metres (4MGS) had excellent reliability and showed concurrent validity with well-established measures in COPD. Stratification according to slow 4MGS identified significant impairments in exercise capacity and poor health-related quality of life. Subsequent studies showed that 4MGS was responsive to intervention with pulmonary rehabilitation (n=301) and longitudinal decline at one year (n=162). Using both distribution- and anchor-based approaches the minimum clinically important difference was estimated to be 0.11ms-1. In a cohort of patients with stable COPD (n=402), slower 4MGS was associated with significantly increased risk of all-cause mortality at three years, and provided prognostic information independent of FEV1. In a prospective cohort of 213 patients admitted to hospital with an acute exacerbation of COPD, slower 4MGS was associated with significantly increased odds of all-cause readmission at 90 days. The 4MGS is a reliable measure of physical performance that has potential utility as a simple assessment tool to provide a more comprehensive assessment of patients with COPD.
Supervisor: Polkey, Michael ; Cullinan, Paul ; Man, William Sponsor: Medical Research Council ; National Institute for Health Research
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral