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Rating the Pulmonary Impairment According to the AMA Guides, 6th Ed. and Its Correlation With the Physical Performance Status on Individuals With COPD: Case Series FREE TO VIEW

Armando Miciano, MD
Chest. 2011;140(4_MeetingAbstracts):872A. doi:10.1378/chest.1117149
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PURPOSE: The objectives were to quantify the pulmonary impairment of individuals with COPD using the Rating Permanent Impairment due to Pulmonary Dysfunction (RPIPD), a formal assessment of whole person impairment (WPI) due to pulmonary diseases by the AMA Guides to Evaluation of Permanent Impairment, Sixth Edition and investigate the correlation between pulmonary impairment and scores from Physical Performance Tests (PPT).

METHODS: A retrospective study was done in a Comprehensive Outpatient Rehabilitation Facility. The Self-Administered Co-morbidity Questionnaire identified 48 of 100 subjects (22 men;26 women) afflicted with COPD affecting their functional status. RPIPD and PPT scores (6- Minute Walk Test [6MWT], Berg Balance Scale [BBS}, & Dynamic Gait Index [DGI]) were also recorded. The RPIPD key factor consisted of five items based on objective tests: FVC, FEV1, FEV1/FVC, DLco, and VO2max. Spearman's correlation coefficients (r) were used to examine associations between RPIPD and PPT results. An alpha of .10 was used for statistical tests.

RESULTS: The RPIPD was sub-categorized by Impairment Class (IC), resulting in: 21% Class 1 (minimal); 21% Class 2 (mild); 23% Class 3 (moderate); and, 35% Class 4 (severe) WPI. RPIPD percentage ranged from 2-65% (mean 35% WPI). The RPIPD Severity Grades (SG) were: 15% Grade A, 13% Grade B, 10% Grade C, 21% Grade D, and 41% Grade E. There was a statistically significant negative correlation between RPIPD-SG and: 1) 6MWT distance (r= -.330, p=.022);2) 6MWT speed (r= - .331, p=.021);and, 3) 6MWT metabolic equivalents, METS level, (r= -.331, p=.021). There were no significant correlations between RPIPD percentage & IC and BBS & DGI. Most COPD outpatients scored in the Severity Grade E, and the SG had a statistically significant negative effect on the 6MWT scores.

CONCLUSIONS: The study found individuals with COPD and moderate to severe pulmonary impairments had the capacity for short walking distance, slow walking speed, and low energy expenditure. Further research into RPIPD application amongst other patient populations, such as Restrictive Lung Disease or Pulmonary Hypertension, would be beneficial.

CLINICAL IMPLICATIONS: These findings suggest that the RPIPD is a reliable indicator of physical performance status, and would be valuable as an alternative to PPT in a busy clinical practice.

DISCLOSURE: The following authors have nothing to disclose: Armando Miciano

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