International Journal of COPD (Mar 2017)
The Barthel index-dyspnea a tool for respiratory rehabilitation: reply to the letter by Chuang [Letter of clarification]
Abstract
Mauro Carone,1 Michele Vitacca,2 Mara Paneroni,2 Paola Baiardi,3 Antonio Spanevello,4,5 Giorgio Bertolotti6 1Respiratory Division, ICS MAUGERI SPA SB, Institute of Cassano Murge (BA) IRCCS, Italy; 2Respiratory Rehabilitation Division, ICS MAUGERI SPA SB, Institute of Lumezzane (BS) IRCCS, Italy; 3Scientific Direction, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Italy; 4Respiratory Rehabilitation Division, ICS MAUGERI SPA SB, Institute of Tradate (VA) IRCCS, Italy; 5Respiratory Diseases Unit, University of Insubria, Varese; 6Psychology Unit, ICS MAUGERI SPA SB, Institute of Tradate (VA) IRCCS, Italy We read the remarkable letter by Chuang.1 We thank him for his valid suggestions on our paper. Interestingly, he focused on the two dimensions of the Barthel index-dyspnea (BI-d), which was exactly our goal. As rehabilitators, our goal is to provide patients with physical therapy depending on their health status and to improve their respiratory function. We need to verify and demonstrate the efficacy and the outcomes of respiratory rehabilitation, supported by physical therapy. For these reasons, we need an assessment device that measures respiratory improvement during daily motor activities that should be monitored.The modified Barthel index2 is a well-consolidated and widely used instrument to assess the performance of a person in a predetermined and fixed set of activities of daily living (ADLs). By proposing BI-d,3 we aimed to develop a scale to measure how dyspnea precludes or reduces the same ADLs, with the ultimate goal of globally assessing the effectiveness of rehabilitation. Hence, an assessment method that measures the impact of dyspnea on activities monitored by a rehabilitation program is of utmost importance for rehabilitators. Large part of Chuang’s letter is based on the Chronic Respiratory Questionnaire-dyspnea (CRQ-d). The CRQ-d is a health-related quality of life (health status) questionnaire, with a dyspnea “domain”.4 However, for our purposes, the CRQ-d is too individualized as each subject selects five activity items – “the most important” – out of 26 listed activities. Therefore, each subject may choose different items from other subjects in the same study group. Due to this significant methodology, CRQ was standardized recently into a version that contains a total of only five items with a dyspnea domain, all of which have to be responded.5 View the original paper by Vitacca et alView the original letter by Chuang
