The Manchester Respiratory Activities of Daily Living questionnaire: Development, reliability, validity, and responsiveness to pulmonary rehabilitation

OBJECTIVES: Because there is no respiratory-specific activities of daily li ving (ADL) scale for use in older patients, our aim was to design and devel op the Manchester Respiratory ADL questionnaire (MRADL) and to assess its v alidity in older patients with chronic obstructive pulmonary disease (COPD) . DESIGN: The MRADL is a composite of the most discriminative questions from the Nottingham Extended ADL Questionnaire (NEADL) and the Breathing Problem s Questionnaire (BPQ). SETTING: A University teaching hospital. PARTICIPANTS: Participants were 188 (104 men) COPD out-patients aged 60 to 93 (mean 77) years and 55 (23 men) normal controls (NCs) aged 70 to 90 (mea n 78) years. Exclusions were confusion and acute respiratory exacerbation/u se of oral carticosteroid within 6 weeks. INTERVENTION: A subgroup of COPD subjects completed a pulmonary rehabilitat ion program (PR) to assess responsiveness of the MRADL to intervention. MEASUREMENTS: All subjects completed MRADL and NEADL scales, and 15 COPD su bjects (11 men) completed an 8-week PR program. RESULTS: Mean (SE) 1-second forced expiratory volume (FEV1) in COPD subject s was 0.94 (0.03) liters, and in NCs it was 1.96 (0.07) liters. MRADL discr iminated better between COPDs and NCs than did the NEADL in terms of sensit ivity (90% vs 76%; x(2) = 4.8, P = .02) and negative predictive value (84% vs 69%; x(2) = 4.5, P = .03). MRADL responded to changes during PR: pre ver sus post mean (SE) score 11.2 (1.1) vs 13.4 (1.1); (t = 3.09; P = .008), bu t NEADL was unchanged. MRADL showed high consistency (Cronbach alpha 0.91). 95% confidence limits of repeatability were -0.63 to +0.26 (P = .42) for M RADL and -0.53 to +0.26 (P =.50) for NEADL. CONCLUSIONS: MRADL is a reliable and valid self-report scale for assessment of physical disability in older COPD patients. It is responsive to pulmona ry rehabilitation.