Fatores associados com atividade e participação de indivíduos com doença pulmonar obstrutiva crônica em uso de oxigenoterapia domiciliar prolongada: uma análise baseada na classificação internacional de funcionalidade, incapacidade e saúde

Abstract

Introduction: Patients with Chronic Obstructive Pulmonary Disease (COPD) on Long-Term Oxygen Therapy (LTOT) have systemic changes and limitations resulting from continuous oxygen therapy. Through the analysis from the perspective of the International Classification of Functionality (ICF), it is possible to measure how the exercise capacity and muscle strength that are part of the Body Functions and Structures component influence the limitation of activities and restriction in social participation and the dysfunctions of the Activities and Participation component have some association with mental health aspects, such as symptoms of anxiety and depression, and with quality of life. Objective: to assess whether exercise capacity and muscle strength are associated with physical activity, the activity of daily life (ADL), and social participation; and to verify whether there is an association between physical activity, ADL, and social participation with anxiety and depression symptoms and quality of life in patients with stable COPD using LTOT. Method: Cross-sectional study with patients with stable COPD on LTOT. Physical activity was assessed by the Actigraph GT3X® accelerometer, time and percentage of time in light physical activity (LPA), physical activity of moderate to vigorous intensity (MVPA), time and percentage of sedentary time, and the number of steps per day. AVD by London Chest Activity of Daily Living (LCADL) and social participation by Assessment of Life Habits (LIFE-H). The assessment of exercise capacity was performed using the 6-minute Step Test (6MST), muscle strength by handgrip strength (HGS), symptoms of anxiety and depression and quality of life by the Hospital Anxiety and Depression Scale (HADS) and Chronic Respiratory Questionnaire (CRQ), respectively. Shapiro-Wilk test was used to verify the normality of the data. Spearman and Pearson correlation coefficients were used to determine the associations between the variables. Multivariate linear regression analysis was used to assess predictors of the level of physical activity, ADL, social participation, symptoms of anxiety and depression and quality of life. P <0.05 was considered as statistically significant. Results: Fifty-seven participants were included in the study. In an analysis of the association between the modifiable factors of exercise capacity and muscle strength with physical activity, ADL and social participation, the highest number of steps climbed in the 6MST showed an association with less limitation during the ADLs in the LCADL (ρ = -0.356, p = 0.024) and greater social participation in LIFE-H (ρ = 0.321, p = 0.036). Better handgrip muscle strength was associated with physical activity with less time spent on LPA as percentage (ρ = -0.347, p=0.011), more time spent on MVPA (ρ=0,451, p=0.009), most percentage of MVPA (ρ = 0.483, p= 0.002) and less sedentary time (ρ = -0.366, p=0.020). Furthermore, better handgrip muscle strength was associated with less impairment in ADL on the LCADL (ρ = - 0.25, p=0.054) and better social participation in the LIFE-H (ρ = 0.25, p=0.059). Greater dependence for performing ADLs at LCDAL and worse social participation at LIFE-H were associated with more frequent symptoms of depression at HADS (ρ = -0.441, p = 0.001; ρ = - 0.402, p = 0.002). The level of physical activity, ADL, and social participation did not show a significant association with HADS anxiety. Greater independence in ADLs and greater social participation were associated with better quality of life in the total CRQ score (ρ = -0.322, p = 0.018; ρ = 0.329, p = 0.014). Specifically, greater independence in the ADL was associated with less impairment in the CRQ fatigue domain (ρ=0.509, p=0.000), and better social participation was associated with less impairment in the CRQ self-control domain (ρ = 0.358, p = 0.007). The level of physical activity, ADL and social participation did not show significant associations with other CRQ domains. In the multivariate linear regression analysis, the 6MWT explained 16% of the variation in the number of steps per day (p = 0.01), 11% of the LCADL (p = 0.02) and 10% of the LIFE-H (p = 0,03). LIFE-H and the number of steps per day explained 21.4% of the variation in HADS-D (p = 0.042). LIFE-H and the number of steps per day explained 24.8% of the variation in the quality of life in the total CRQ score (p = 0.042). Conclusion: In patients with COPD on LTOT, better muscle strength and exercise capacity are associated with better physical and daily life activities and greater social participation. The impairment of physical and daily life activities and social participation in COPD on LTOT is associated with more frequent depression symptoms and worse quality of life.