Reliability and Validity of Patient-Reported, Rater-Based, and Hybrid Physical Activity Assessments in COPD: A Systematic Review

Figures & data

Figure 1. PRISMA Flow Diagram.

Table 1. Characteristics of the study population.

Author, Year	Sample size	Gender (M/F)	BMI M (SD)	Age (years) M (SD)	FEV1 (%) M (SD)	FEV1/FVC M (SD)	COPD severity	Reliability and validity reported
Pitta [17], 2005	13	10/3	23.00 (5.00)	61.00 (8.00)	33.00 (10.00)	NA	Moderate - severe	Validity only
Moore [15], 2009	76	NS	28.20 (6.70)	71.10 (9.60)	46.30 (18.50)	41.70 (13.10)	Moderate - severe	Validity only
Moy [20], 2009	17	17/0	28.00 (4.00)	73.00 (8.00)	57.00 (22.00)	NA	Mild = 1; Moderate = 10; Severe = 2; Very severe = 4	Validity & reliability
Donaire-Gonzalez [14], 2011	172	161/11	47.00 (28.00)	70.00 (8.00)	52.00 (15.00)	54.00 (13.00)	Mild = 8; Moderate = 80; Severe = 57; Very severe = 14	Validity only
Gouzi [22], 2011	129	85/44	24.70 (4.40)	61.30 (9.60)	56.60 (22.80)	NA	Moderate - severe	Reliability only
Slinde [18], 2011	68	26/42	25.30 (5.50)/ 23.70 (4.40)^ε	66.00 (6.00)/ 64.00 (7.00)^ε	41.00 (16.00)/ 44.00 (15.00)^ε	NA	Severe	Validity only
DePew [21], 2012	67	38/29	28.90 (6.86)	71.40 (7.91)	46.70 (19.98)	NA	Moderate - severe	Validity only
Garfield [1], 2012	43	18/25	25.90 (5.60)	68.00 (9.00)	46.00 (22.00)	NA	Moderate – very severe	Validity only
Van Gestel [19], 2012	70	49/21	25.00 (7.70)	62.40 (7.40)	43.00 (22.00)	43.60 (15.00)	Mild = 23.9%; Moderate = 8.5%; Severe = 31; Very severe = 36.6	Validity only
Hunt [4], 2013	24	18/6	27.60 (4.30)	74.40 (7.90)	54.00 (13.00)	47.80 (12.90)	Mild = 5; Moderate = 7; Severe = 12; Very severe = 0	Validity & reliability
Nyssen [16], 2013	30	23/7	24.60 (4.70)	68.00 (10.00)	48.00 (14.90)	NA	Moderate – severe	Validity only
Gimeno-Santos [8], 2015	236	160/76	27.00 (5.50)	67.40 (8.40)	57.00 (20.50)	46.90 (13.20)	Mild = 34; Moderate = 108; Severe = 71; Very severe = 22	Validity & reliability

M (SD) = Mean (Standard Deviation), BMI = Body mass index, FEV1% = percentage of Forced expiratory volume in 1 s predicted value, FVC = forced vital capacity, ^ε= males/females, NA = Not available, NS = not specified.

Table 3. Comparison of validity and reliability across PA measures.

Concurrent Validity
Reference standards used for concurrent validity	PA measure	Correlation Coefficients (r)
Energy Expenditure with SAB	PAR	0.83
	YPAS	0.40
	ZPAC	0.01–0.50
PA Level (SAB and actigraph for MARCA and SAB for others)	MARCA	0.66–0.74
	Modified Baecke	0.15
	PASE	0.19
Time Spent in PA (min)	PAR	0.54
	YPAS	0.38–0.41
	ZPAC	0.18
Construct Validity
Reference standards used for concurrent validity	PA measure	Correlation Coefficients
6MWD	C-PPAC	0.62
	D-PPAC	0.55
	YPAS	0.37–0.40
Reliability
Test Retest Intervals	PA measure	ICC values
4 h	MARCA	0.95–0.96
1 week	QUANTAP	0.92
1 week	C-PPAC	0.90–0.92
Daily	D-PPAC	0.74–0.87

PA = physical activity, 6MWD = six-minute walk distance, ICC = intraclass correlation coefficient, SAB = SenseWear armband, Actigraph = actigraph GT3X, min = minutes.

Table 2. Reliability of various subjective physical activity measures.

Author, Year; Questionnaire	Type of reliability	Outcomes measured for reliability	Test retest interval	Reliability measures
Moy [20], 2009; Activity checklist	Test retest	Number of activities	Over 14 days	Intra subject coefficient of variation in number of daily activities: Median CV = 0.28; IQR 0.22–0.32
Gouzi [22], 2011; Quantification de l’ Activité Physique (QUANTAP)	Intra rater	Responses to questionnaire	1 week	Intra-observer correlation coefficient (CI) between test 1 and test 2: ICC = 0.92 (NA)
DePew [21], 2013; Physical Activity Scale for the Elderly (PASE)	Test retest	PASE scores	5–7 days	Pearson’s r = 0.75 BA plot
DePew [21], 2013; Stanford Brief Assessment Scale (SBAS)	Test retest	SBAS scores	5–7 days	Kappa coefficient K = 0.41
Hunt [4], 2013; Multimedia Activity Recall in Children and Adults (MARCA)	Test retest	MVPA ≥ 3 METs (min/day), TDEE (MET.min)	4 h	ICC, limits of agreement for TDEE: ICC = 0.95- 0.96, −196 to + 164 MET.min ICC, limits of agreement for MVPA ≥ 3 METs: ICC = 0.93–0.95, −61 to + 66 min/day
Gimeno-Santos [8], 2015 PROactive Physical Activity in COPD (PPAC) tools: Clinical PAC (C-PPAC)	Test rest; Internal consistency	Amount of activity (PAQ + DAM) Amount of activity (PAQ + DAM)	1 week	Intra class correlation (CI) coefficient for amount of PA using PAQ and DAM combined between: Week 1 and week 2 = ICC 0.92 (NA) Intra class correlation (CI) coefficient for amount of PA using PAQ and Actigraph combined between: Week 1 and week 2 = ICC 0.90 (NA) Internal consistency for D-PPAC factor 1 items using PAQ and DynaPort for examination 1 and 2: Cronbach’s α = 0.813 and 0.800 Internal consistency for D-PPAC factor 1 items using PAQ and Actigraph for examination 1 and 2: Cronbach’s α = 0.803 and 0.781
Gimeno-Santos [8], 2015; PROactive Physical Activity in COPD (PPAC) tools: Daily PAC (D-PPAC)	Test rest; Internal consistency	Amount of activity (PAQ + DAM) Amount of activity (PAQ + DAM)	1 week	Intra class correlation (CI) coefficient for amount of PA using PAQ and DAM combined between: Day 1of week 1and day 1 of week 2 = ICC 0.74 (NA) Day 2 of week1 and day 2 of week 2 = ICC 0.84 (NA) Day 3 of week1 and day 3 of week 2 = ICC 0.80 (NA) Day 4 of week1 and day 4 of week 2 = ICC 0.74 (NA) Day 5 of week1 and day 5 of week 2 = ICC 0.75 (NA) Day 6 of week1 and day 6 of week 2 = ICC 0.88 (NA) Day 7 of week1 and day 7 of week 2 = ICC 0.86 (NA) Intra class correlation (CI) coefficient for amount of PA using PAQ and Actigraph combined between: Day 1of week 1and day 1 of week 2 = ICC 0.81 (NA) Day 2 of week1 and day 2 of week 2 = ICC 0.81 (NA) Day 3 of week1 and day 3 of week 2 = ICC 0.82 (NA) Day 4 of week1 and day 4 of week 2 = ICC 0.73 (NA) Day 5 of week1 and day 5 of week 2 = ICC 0.71 (NA) Day 6 of week1 and day 6 of week 2 = ICC 0.87 (NA) Day 7 of week1 and day 7 of week 2 = ICC 0.87 (NA) Internal consistency for D-PPAC factor 1 items using PAQ and DynaPort for examination 1 and 2: Cronbach’s α = 0.862 and 0.845 Internal consistency for D-PPAC factor 1 items using PAQ and Actigraph for examination 1 and 2: Cronbach’s α = 0.860 and 0.839

MVPA = moderate to vigorous physical activity, METs = metabolic equivalents, min/day = minutes per day, TDEE = total daily energy expenditure, MET.min = MET minutes, ICC = intra class correlation coefficient, CV = coefficient of variation, CI = confidence interval, IQR = interquartile range, NA = not available, BA plot = Bland Altman plot.

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