Segurança e confiabilidade dos testes de capacidade funcional em pacientes com doença pulmonar crônica: supervisão remota (vídeochamada) versus supervisão direta

Abstract

Introduction: attributed to the COVID-19 pandemic, on-site pulmonary rehabilitation was suspended, especially because of chronic pulmonary patients are part of the risk group. In this context, a home-based rehabilitation with remote access has been used. As the assessments cannot be carried out in person either, it is important to investigate the safety and feasibility of applying field tests in the home environment. objective: to compare the safety and reliability of the modified incremental step test, 5-repeat (STS-5) and one-minute (STS-1) sit-to-stand test, and timed up and go test (TUG) in patients with disease chronic lung disease performed at home with direct supervision of the evaluator and with remote supervision by video call, in addition to evaluating the patient's experience with the performance of tests by video call, analyzing the feasibility of performing the functional capacity tests, analyzing and comparing the safety of the performing functional capacity tests performed under direct and remote supervision and comparing physiological responses and perceived exertion among the best tests performed under direct and remote supervision. Method: 50 patients with clinical diagnosis of COPD, bronchiectasis or cystic fibrosis, who attended our pulmonary rehabilitation clinic at Universidade Nove de Julho, were evaluated. All tests were performed in two days, separated by at least 48 hours and, at most, one week. On one day, the patients performed the tests by video call, using the WhatsApp® app or using the Skype® app, and on another day, the tests were carried out at the patient's home in the presence of the evaluator. On the same day, before the tests, weight and height were collected. The order of application (remote or directly supervised) was randomized, as well as the order of tests for each day. Results: Of the 50 patients evaluated, 30 had a diagnosis of COPD, 18 of bronchiectasis and 2 of cystic fibrosis. There was no difference in the best test performed on direct and remote supervision in MIST (71 ± 54 versus 76 ± 59; p = 0.66), TUG (8.71 ± 3.54 versus 8.58 ± 3.26; p = 0.84), STS-5 (12.28 ± 4.42 versus 12.04 ± 4.36; p = 0.80) and STS-1 (22 ± 5 versus testing by remote supervision: 23 ± 7; p = 0.27). All tests demonstrated good internal data consistency (cobrach alpha: MIST = 0.982, TUG = 0.988, STS-5 = 0.980, STS-1 = 0.938) and reliability [CCI (95%): MIST = 0.98 (0 .96 - 0.99), TUG = 0.99 (0.98 - 0.99), STS-5 = 0.98 (0.99 - 0.99) and STS-1 = 0.94 (0. 88 – 0.96)]. Patients reported “good” MIST sound quality [4 (4 – 5)], and “very good” interaction with the evaluator and video call sound and video quality [5 (5 – 5) and 5 (4 – 5) respectively]. Intercurrences or adverse events were observed only for MIST (1 patient with knee pain, 3 patients with intermittent internet signal). Conclusion: The tests with remote supervision were safe and presented with excellent reliability for both the main outcomes and physiological variables.