Development and validation of a standardized measure of activity of daily living in patients with severe COPD: the London Chest Activity of Daily Living scale (LCADL)

Activities of daily living (ADL) may be severely restricted in patients wit h COPD and assessment requires evaluation of the impact of disability and h andicap on daily life. This study is concerned with the development and val idation of a standardized 15-item questionnaire to assess routine ADL. Sixty (33 male, 27 female) patients with severe COPD, mean (SD) FEV1 0.91 ( 0.43)1, median (range) age 70 (50- 82) years, completed a 59-item ADL list previously generated by open-ended interview and by literature review. Pati ents also performed the Shuttle Walk Test (SWT), and completed the St Georg e's Respiratory Questionnaire (SGRQ), the Nottingham Extended Activity of D aily Living Questionnaire (EADL) and the Hospital Anxiety and Depression sc ore (HAD). Criteria for item reduction in the development of The London Chest ADL scal e (LCADL) consisted of removal of items where the majority of respondents s howed no limitation in the activity (n = 19), where there was no associatio n with perception of global health (n = 9), where an association with age o r gender was detected (n = 4), or where items showed poor reliability on te st re-test (n = 9). Fifteen items were identified as core activities of dai ly living. The LCADL was then compared with other measures of health status in these p atients. There were good correlations with the SGRQ activity and impact com ponents (rho = 0.70; P < 0.0001) and (rho = 0.58; P < 0.0001), respectively , and EADL (rho = 0.45; P < 0.001), and a moderate correlation with HAD anx iety (rho = 0.28; P < 0.03). There was a significant relationship between t he SWT and LCADL (rho = 0.58; P < 0.0001), suggesting a relationship betwee n impaired exercise performance and lower ADL scores. There was evidence of high internal consistency of the questionnaire with Chronbach's alpha of 0 .98. These findings suggest that the LCADL scale is a valid tool for the assessm ent of ADL in patients with severe COPD.