  avaliar a aplicabilidade da escala london chest activity of daily 
 living ( lcadl ) , em pacientes em lista de transplante pulmonar .
  estudo transversal com 26 pacientes em lista de espera para transplante de 
 pulmo , de ambos os sexos , entre maio e setembro de 2010 tratados no programa de 
 reabilitao pulmonar , complexo hospitalar santa casa de misericrdia de porto 
 alegre , em porto alegre , rs . todos os pacientes foram submetidos ao teste de 
 caminhada de seis minutos ( tc6 ) e a teste de funo pulmonar e foram obtidos os 
 escores das escalas lcadl e de borg modificada para dispneia e fadiga das pernas . 

o teste alfa de cronbach foi utilizado para verificar a consistncia interna da 
 escala lcadl .
a anlise de regresso linear foi utilizada para identificar 
 associaes entre o escore total em porcentagem da escala lcadl e as variveis 
 estudadas .
  segundo os resultados da lcadl , 69% dos pacientes indicaram que suas atividades 
 de vida diria so muito comprometidas pela dispnia .
houve associaes negativas estatisticamente 
 significativas entre o escore total da escala lcadl e distncia percorrida no tc6 
 (  = 0,087 ; p < 0,001 ) e trabalho realizado no tc6 (  = 0,285 ; p < 0,001 ) , 
 quando os dados foram ajustados por idade e vef1 .
  esses achados sugerem que a escala lcadl  um instrumento til para avaliar o 
 desempenho funcional dos pacientes em listas de transplante pulmonar .
the prevalence of respiratory diseases has increased substantially in recent years , and 
 respiratory diseases have come to play a major role in the morbidity and mortality 
 profiles of the population . a public health problem , copd ranked fourth among the 
 leading causes of death worldwide in 2006 , and by 2020 , it is estimated that it will be 
 the third leading cause of mortality worldwide . 




  in chronic lung disease patients who have severe progressive impairment and a high level 
 of inactivity ,
lung transplantation is recommended as an essential therapeutic 
 intervention , being an effective treatment option . 


 
the most common 
 indications for this intervention are emphysema ( in 36% ) , idiopathic pulmonary fibrosis 
 ( in 20% ) , and cystic fibrosis ( in 16% ) . 


 
in transplantation candidates , 
 assessment of their level of physical activity is an important tool for quantifying the 
 impact of the disease on their activities of daily living ( adl ) . 


 
the six - minute walk distance ( 6mwd ) is also considered a good marker of functional 
 capacity in adl , and the use of the six - minute walk test ( 6mwt ) is recommended in the 
 assessment of patients with exercise - induced lung disease or cardiovascular disease , 
 given that it provides an overall analysis of the respiratory , cardiac , and metabolic 
 systems . 


 
another way of assessing the functional status of a patient is 
 to use scales or questionnaires . 


 
the use of questionnaires or scales has 
 shown the impact that the disease has on the level of physical activity and the quality 
 of life of chronic disease patients , indirectly reflecting the degree to which the 
 disease interferes with their adl . 


 
currently , there are few validated 
 scales to investigate the impairment of functional capacity in chronic lung disease 
 patients , especially in severely impaired patients who are candidates for lung 
 transplantation . 


  the london chest activity of daily living ( lcadl ) scale is a tool aimed at assessing the 
 level of dyspnea during adl .
it has four domains : self - care ; household activities ; 
 physical activity ; and leisure activities . 




  the lcadl scale ,
which is 
 considered an inexpensive and user - friendly instrument , can be a feasible clinical tool 
 for assessment and monitoring of dyspnea - related functional impairment in chronic lung 
 disease patients , as well as for pre- and post - intervention assessment . although this 
 instrument has been validated for use in copd patients ,
there are few studies evaluating 
 the use of this scale in lung disease patients already on the waiting list for lung 
 transplantation .
the objective of the present study was to evaluate the applicability of 
 the lcadl scale in patients on the waiting list for lung transplantation by assessing 
 the psychometric properties of the scale and the relationship between the scale scores 
 and the 6mwt results .
this was a cross - sectional study involving patients treated at the pulmonary 
 rehabilitation program in the pereira filho ward of the complexo hospitalar 
 santa casa de misericrdia de porto alegre , located in the city of porto 
 alegre , brazil .
all male and female patients who were on the waiting list for lung 
 transplantation between may and september of 2010 and who gave written informed consent 
 were included in the study .
patients who had cognitive or motor limitations , as well as 
 those who had had respiratory infection in the three weeks before the assessment , were 
 excluded from the study .
the version of the lcadl scale used in the present study has been validated for use in 
 brazil . 


 
the lcadl scale consists of 15 questions divided into four 
 domains : self - care ; household activities ; physical activity ; and leisure activities . 

each question in each domain is scored by patients on a 0 - 5 scale , with 5 representing 
 the greatest dyspnea - related impairment in adl . the total
score can range from 0 to 75 
 points , with higher values translating to greater limitation in adl .
in addition , the 
 lcadl scale has a multiple - choice question , i.e. , question 16 , which refers to specific 
 information about dyspnea - related impairment in adl in any situation and to which 
 patients are required to answer " quite a bit " , " slightly " , or " not at all " .
the lcadl 
 scale , which was administered as an interview by the same researcher , was interpreted on 
 the basis of its total score ( expressed as a percentage ) .
the 6mwt was performed in accordance with the american thoracic society 
 recommendations , 


  considering reference equations for healthy 
 adults . 


 
the six - minute walk work ( 6mww ) was calculated by multiplying 
 distance walked by body weight ( in kg ) . 


 
before and after the 6mwt , 
 patients were assessed for their perception of dyspnea and leg fatigue with the modified 
 borg scale .
all pulmonary function tests were carried out in accordance with the technical standards 
 and the acceptability and reproducibility criteria of the american thoracic 
 society / european respiratory society . 


 
flow - volume curves were obtained 
 with a koko spirometer ( ferraris respiratory , louisville , co , usa ) .
continuous variables are expressed as 
 means and 95% cis , and categorical variables are expressed as absolute and relative 
 frequencies .
bivariate and multivariate linear regression analyses were performed to 
 identify possible associations between the lcadl scale results and the covariates of 
 interest ( 6mwd , 6mww , age , fev1 , and the borg scale scores ) .
initially , all 
 covariates that had a p < 0.10 in the univariate analysis were included in the 
 multivariate model .
the next step was to exclude the covariates that were found to have 
 critical p values ( values that were not significant ) one by one .
this step was repeated 
 until all variables remaining in the model had a p < 0.05 . the internal consistency 
 of the lcadl scale was measured with cronbach 's alpha coefficient , which investigates 
 specific correlations between total and domain scores . for the purpose of calculating 
 this coefficient , values of p  0.70 are considered adequate . 


  in 
 addition , the proportion of patients with minimum and maximum scores ( floor / ceiling 
 effect ) was calculated .
the present study included 26 subjects , 10 ( 38% ) of whom were male .
table 1characteristics of the sample of patients on the waiting list for lung 
 transplantation . 


variableresultbmi , kg / m 
 23.8  30.2fev1 , % of predicted35.1  17.4fvc , % of predicted43 . 8  14.9fvc / fev1 
 0.67  0.236mwd , m331.4  118.76mww , m / kg101.9  30.2bmi : body mass index;6mwd : six - minute walk distance;6mww : six - minute walk work .
. in the sample as a whole , 14 ( 54% ) and 12 ( 46% ) of the patients had obstructive and 
 restrictive lung disease , respectively .
the patients included in the present study had 
 the following diagnoses : pulmonary fibrosis , 13 ( 50% ) ; copd , 4 ( 15% ) ; cystic fibrosis , 2 
 ( 8% ) ; bronchiectasis , 3 ( 12% ) ; and others , 4 ( 15% ) .
the mean total lcadl score ( expressed as a percentage ) was 36% . in the sample as whole , 

16 patients achieved a total lcadl score above 50% . in 69% of the cases ,
the answer to 
 the qualitative question on the lcadl scale , i.e. , question 16 , which refers to the 
 level of dyspnea - related impairment in adl , was " quite a bit " .
the overall alpha value was 0.89 , and the alpha values for each domain ranged from 0.72 
 to 0.94 .
there was no floor or ceiling effect .   in the univariate analysis , the 6mwd ,
the modified borg scale scores , and the 6mww 
 showed significant associations with the total lcadl score ( expressed as a percentage ; 
 table 2 ) . 

table 2univariate analysis of the total score on the london chest activity of 
 daily living scale ( expressed as a percentage).variable95% cipage , years0.226 0.222 to 0.6740.323diagnosis 
 copd0.000 
 pulmonary fibrosis 16.325 34.000 to 1.3510.070 
 cystic fibrosis 8.244 26.362 to 9.8740.372 
 bronchiectasis 9.658 30.574 to 11.2590.365 
 others 10.746 27.024 to 5.5320.196fev1 , % of predicted0.373 0.001 to 0.7410.0056mwd , m
0.079 0.132 to  0.0270.002modified borg scale score 0.056 2.461 to 2.3490.9646mww , m / kg 0.348 0.563 to  0.1330.0026mwd : six - minute walk distance6mww : six - minute walk work 
  : six - minute walk distance : six - minute walk work in the multivariate analysis , the 6mwd ( figure 1 ) 
 and the 6mww showed a significant inverse association with the total lcadl score 
 ( expressed as a percentage ; table 3 ) . 

figure 1relationship between the total score on the london chest activity of daily 
 living scale ( expressed as a percentage ) and the six - minute walk distance 
 ( 6mwd ) .
(  = 0.103 ; p < 0.001 ) . 
 
 table 3multivariate analysis of the total score on the london chest activity of 
 daily living scale ( expressed as a percentage).variable95% cip6mwd , m0.087 
 0.128 to  
 0.046 < 0.0016mww , m / kg0.285 
 0.448 to  
 0.123
< 0.0016mwd : six - minute walk distance6mww : six - minute walk work 
  : six - minute walk distance : six - minute walk work
the objective of the present study was to evaluate the applicability of the lcadl scale 
 in patients on the waiting list for lung transplantation .
this instrument was found to 
 have good reliability and to be associated with the 6mwd and the 6mww .
our data showed 
 that the total lcadl score was inversely associated with these parameters in the study 
 population .
. 


  showed that the lcadl scale correlated with the 6mwd in copd 
 patients .
when we compared the lcadl scores with the different diagnoses of patients , we 
 found no significant differences .
however , we observed that copd patients had higher 
 scores on the lcadl scale than did those with other diagnoses
. the lack of significance 
 in the differences among the different diagnoses might be due to a lack of power for 
 this analysis .
recent studies have reported a negative correlation between movement intensity during 
 adl in copd patients in the self - care domain and the total lcadl score . 




the reported results suggest that lower movement intensity during adl translates to a 
 higher total score on the lcadl scale , indicating greater functional impairment in adl . 

when we evaluated the association between the 6mww and the lcadl scores , we also found 
 it to be significant .
one group of authors 


  proposed that functional 
 performance during exercise would be better expressed by the product of 6mwd and body 
 weight than by the analysis of 6mwd alone , because subjects perform specific work when 
 walking , given that they transport their own body over a given distance over a given 
 time . in the present study , the lcadl scale was found to have high internal consistency 
 ( alpha ) , with the overall alpha value being 0.90 and the alpha values for each domain 
 ranging from 0.72 to 0.94 .
previous studies have demonstrated that the lcadl scale has 
 high internal consistency when administered to copd patients .
one study 



 reported an alpha value of 0.98 , which demonstrates that the lcadl scale is a valid 
 measure of dyspnea during adl .
another study 


  showed that the brazilian 
 portuguese - language version of the lcadl scale is reproducible , having an alpha value of 
 0.86 . in the present study ,
69% of the patients in the sample achieved a total lcadl score 
 ( expressed as a percentage ) above 50% , i.e. , they showed severe dyspnea - related 
 limitation in their adl .
a recent study has suggested the use of a cut - off point of 50% , 
 with a score equal to or greater than 50% indicating severe dyspnea - related limitation 
 in adl . 


 
in addition , we should take into account that most of the study 
 sample reported that dyspnea significantly affects their adl , which leads us to believe 
 that dyspnea can impose major restrictions on these patients .
the presence of dyspnea 
 has been considered a severe limitation to physical and social activities , having a 
 direct impact on the quality of life of patients with chronic obstructive or restrictive 
 respiratory disease and leading to a marked increase in morbidity and 
 mortality . 


  in the univariate analysis ,
the modified borg scale score ( dyspnea ) showed no 
 significant association with the total lcadl score ( expressed as a percentage ) .
this 
 finding might be associated with the fact that the borg scale has poor reproducibility , 
 which has been reported in other studies , given the difficulty that patients have in 
 classifying their level of dyspnea because of desensitization . 


  in this 
 sense
, the lcadl scale can be a useful and user - friendly tool for assessing patients on 
 the waiting list for lung transplantation , especially those experiencing significant 
 impairment in adl , in whom dyspnea is an incapacitating symptom , even for routine 
 activities . 




 
the fev1 was not significantly associated with the total lcadl score 
 ( expressed as a percentage ) .
one explanation for this finding is that , although 
 fev1 provides a useful description of the severity of the disease - related 
 pulmonary changes , it does not systematically assess the impact that the disease has on 
 the patients ' ability to perform their adl because of dyspnea . 




 
these findings can be 
 attributed to the fact that functional classification scales are more strongly related 
 to patient symptoms and clinical status , neither of which are directly related to 
 age . 




 
one explanation for the lack of association between the lcadl 
 scale results and patient age in the present study is the fact that the sample did not 
 include older patients .
one group of authors 


  found a strong negative 
 correlation between age and functional capacity , which is evidence that physical aspects 
 are more impaired by advancing age than are mental aspects .
however , despite the 
 limited number of patients , it was possible to determine that the lcadl scale behaves 
 appropriately with regard to psychometric properties , as well as being strongly 
 associated with the 6mwd and the 6mww , which are objective measures . in conclusion ,
the lcadl scale proved to have instrumental reliability , as well as being 
 correlated with conventional objective measures of the level of physical activity .
the 
 fact that the lcadl scale performed well in patients on the waiting list for lung 
 transplantation suggests that this instrument can be a valid and feasible tool to assess 
 dyspnea during adl .
 objective : to evaluate the applicability of the london chest activity of daily living 
 ( lcadl ) scale in patients on the waiting list for lung transplantation . methods : this was a cross - sectional study , conducted between may and september of 2010 , 
 involving 26 male and female patients on the waiting list for lung transplantation 
 and treated at the pulmonary rehabilitation program in the complexo 
 hospitalar santa casa de misericrdia de porto alegre , located in the 
 city of porto alegre , brazil . 
 we evaluated the patients using the six - minute walk 
 test ( 6mwt ) and pulmonary function tests . 
 we also obtained the lcadl scores , as 
 well as the modified borg scale scores for sensation of dyspnea and leg fatigue . 
 
 cronbach 's alpha coefficient was used to determine the internal consistency of the 
 lcadl scale . 
 linear regression analysis was used in order to identify associations 
 between the total lcadl score ( expressed as a percentage ) and the variables 
 studied . 
 results : according to the lcadl scale results , 69% of the patients reported that the 
 performance of their activities of daily living was significantly impaired by 
 their dyspnea . 
 the internal consistency of the lcadl scale was 0.89 . 
 after 
 adjusting for age and fev1 , we found that the total lcadl scale score 
 showed statistically significant negative associations with the six - minute walk 
 distance (  = 0.087 ; p < 0.001 ) and the six - minute walk work (  = 0.285 ; p 
 < 0.001 ) . 
 conclusions : our findings suggest that the lcadl scale is a useful tool for assessing patients 
 on the waiting list for lung transplantation . 
OBJETIVO:
MTODOS:
RESULTADOS:
CONCLUSES:
Introduction
Methods
Results
Discussion