From the Guidelines
A basic mobility assessment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) should include evaluation of the patient's functional capacity, exercise tolerance, and respiratory status during movement, as outlined in the American Thoracic Society/European Respiratory Society statement 1. The assessment should begin with vital sign monitoring including oxygen saturation, heart rate, respiratory rate, and blood pressure both at rest and during activity.
- Physical therapists or healthcare providers should assess the patient's ability to perform basic transfers (bed to chair), walking distance (typically using the 6-minute walk test or a shorter 2-minute walk test if the patient is more severely limited), and stair climbing if applicable to the patient's home environment.
- Oxygen desaturation during these activities should be carefully monitored, with supplemental oxygen provided as needed to maintain saturation above 88-90%.
- The modified Borg scale (0-10) can be used to assess the patient's perceived dyspnea and exertion during activities.
- Functional assessments like the Timed Up and Go test (normal is under 10 seconds) provide objective measures of mobility. The assessment should also include evaluation of breathing pattern, use of accessory muscles, and coordination of breathing with movement, as these factors can impact functional capacity and quality of life in patients with AECOPD 1. This comprehensive mobility assessment helps determine appropriate exercise prescription, need for assistive devices, oxygen requirements during activity, and readiness for discharge, ultimately guiding rehabilitation interventions to improve functional capacity and quality of life in patients with AECOPD, as supported by the European Respiratory Society and European Society of Intensive Care Medicine task force on physiotherapy for critically ill patients 1.
From the Research
Basic Mobility Assessment for AECOPD
The basic mobility assessment for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is crucial for determining the severity of the condition and guiding treatment.
- The de Morton Mobility Index (DEMMI) is a feasible and valid mobility assessment tool in hospitalized patients with AECOPD, as demonstrated by a study published in 2019 2.
- This study found that the DEMMI showed convergent validity with the 6-minute walk distance (6MWD) and gait velocity measures, indicating its effectiveness in assessing mobility in AECOPD patients.
- Another study published in 2018 found that changes in forced expiratory volume in one second (FEV1%) and peripheral oxygen saturation (SpO2) were not influenced by any independent measure, making them robust measures to follow up on outpatients with AECOPD 3.
- The study also found that being underweight or overweight, having increased dyspnea, previous exacerbations, and severe comorbidities negatively affected patients' outcomes.
Mobility Assessment Tools
Several mobility assessment tools can be used to evaluate patients with AECOPD, including:
- The 6-minute walk distance (6MWD) 2
- Gait velocity measures 2
- The de Morton Mobility Index (DEMMI) 2
- Forced expiratory volume in one second (FEV1%) 3
- Peripheral oxygen saturation (SpO2) 3
- The COPD assessment test (CAT) 3, 4
- The modified British Medical Research Council (mMRC) questionnaire 3, 4
- The modified Borg scale (MBS) 4
Clinical Variables Associated with Mobility Assessment
Several clinical variables are associated with mobility assessment in AECOPD patients, including: