Contribuições do teste de AVD-Glittre em adultos com fibrose cística: um estudo longitudinal observacional

Abstract

Introduction: Cystic Fibrosis (CF) is an autosomal recessive disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Advances in diagnosis and treatment have led to increased survival after highly effective modulating therapy (HMT). The Glittre-ADL test has great potential for clinical use, since it uses tasks similar to activities of daily living (ADL). Objectives: To evaluate the performance of CF adults in performing the Glittre-ADL by comparing it with the six-minute walk test (6MWT). Specific objectives: to correlate the results of both tests with lung function and health-related quality of life (HRQoL); to evaluate the association of physical activity (PA) and respiratory physiotherapy (RF) with respiratory muscle strength (RMS), TGlittre time, 6MWD and HRQoL. Methodology: The first study evaluated 34 CF adults, comparing them with 34 subjects from a control group (CG). The following were evaluated: TGlittre, 6MWD, PFP, RMS, handgrip strength (HGS) and HRQoL through the Cystic Fibrosis Questionnaire-Revised (CFQ-R). Results: In the TGlittre, 25 (73.5%) CF patients and 10 (29.4%) of the CG exceeded a time >120% in relation to the predicted. In the 6MWT, 14 (41.2%) CF patients and 10 (29.4%) CG participants covered a distance <80% of the predicted distance. The second TGlittre was compared to the first TGlittre, there was a decrease in total time for both CF (p<0.0001) and CG (p=0.0001). TGlittre time correlated with 6MWD (rs=-0.641, p<0.0001), HGS (rs=-0.364, p=0.034), SpO2 (rs=-0.463, p=0.006) and CFQ-R “digestive symptoms” (rs=0.376, p=0.028). TGlittre was lower in patients habitual physical activity (PHA) (3.10 (2.49–3.39) min vs. 3.28 (2.95–3.53) min, p=0.016). The second study included 24 people with CF. Measurements were taken at baseline (T1) and after 1 year (T2). Median body mass index (BMI) increased significantly between T1 and T2 [19.8 (18–24) kg/m2 to 21.4 (19–24) kg/m2 (P = 0.038). There was a significant reduction in TGlittre both in absolute values [3.10 (2.52–3.39) vs. 2.40 (2.00–3.00) min, P = 0.001] and in predicted values [127 (116–150) vs. 108 (102–140) % predicted, P = 0.001]. The 6MWD increased in relation to the absolute values [545 (463–654) vs. 617 (540–658) m, P = 0.041]. The HFA showed an increase in HGS between T1 and T2 (P = 0.031). The FR increased the “treatment burden” domain of the CFQ-R between T1 and T2 (P = 0.049). Conclusions: The TGlittre seemed to be more effective than the 6MWT to detect limitations in effort. There is a relationship between the performance in the TGlittre and the 6MWT, HGS, and HFA level. In CF adults, field tests are good tools to capture longitudinal changes. There was a gain in BMI. Furthermore, there is an interrelationship between HFA and HGS, and between FR and HRQoL.