Validity of the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire (GPPAQ) Walking Pace Question in Chinese and British Hemodialysis Patients

Abstract

Background Exercise capacity is a strong predictive factor of mortality in hemodialysis patients. Hence, it is urgently needed to explore convenient and effective assessment tools to evaluate exercise capacity. Objective To validate the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire (GPPAQ) walking pace question in Chinese and British hemodialysis patients. Methods From January 2018 to September 2020, 40 hemodialysis patients from a Chinese tertiary hospital and 39 patients from Leicester Renal Network in the United Kingdom were assessed exercise capacity and walking speed using DASI and GPPAQ walking pace question, respectively. Meanwhile, the shuttle walking test (SWT) and gait speed test in short physical performance battery (SPPB) were conducted with the two cultural groups to validate the DASI and the GPPAQ walking pace question. The validity of DASI was tested by correlation analysis, and the validity test of GPPAQ pace problem was by analysis of variance, respectively. Results There was a positive correlation between DASI and the incremental shuttle walking test (ISWT) in hemodialysis patients in China and the United Kingdom (rChina=0.39, rsUK=0.60; P<0.05) , but no correlation with the endurance shuttle walking test (ESWT) (P>0.05) . According to the self-assessment results of the pace problem in the GPPAQ, Chinese hemodialysis patients were classified into four categories: slow pace, steady pace, brisk pace, and fast pace, the objectively measured SPPB pace range of the 4 types of patients overlapped, and there was no significant difference in the average SPPB pace (P>0.05) . British hemodialysis patients were classified into three categories: slow pace, steady pace, and brisk pace, there was a statistically significant difference in the average SPPB pace measured objectively among the three types of patients (P<0.05) . Among them, the average SPPB pace of self-assessed slow pace patients was lower than that of self-assessed steady pace and brisk pace (P<0.05) . Conclusion DASI can effectively measure the exercise capacity of hemodialysis patients in China and the United Kingdom. In the two cultural groups, GPPAQ walking pace question could not assist patients inaccurately assessing their gait speed. However, it has potential utility for distinguishing between "slow" and "not slow" gait speed.

Keywords

• renal dialysis|walking pace|exercise capacity|duke activity status index|general practice physical activity questionnaire|validity of results