PDF(Pubmed)
Abstract：
BACKGROUND: Reduced mobility is a central feature of COPD. Assessment of mobility outcomes that can be measured digitally (digital mobility outcomes (DMOs)) in daily life such as gait speed and steps per day is increasingly possible using devices such as pedometers and accelerometers, but the predictive value of these measures remains unclear in relation to key outcomes such as hospital admission and survival.
METHODS: We conducted a systematic review, nested within a larger scoping review by the MOBILISE-D consortium, addressing DMOs in a range of chronic conditions. Qualitative and quantitative analysis considering steps per day and gait speed and their association with clinical outcomes in COPD patients was performed.
RESULTS: 21 studies (6076 participants) were included. Nine studies evaluated steps per day and 11 evaluated a measure reflecting gait speed in daily life. Negative associations were demonstrated between mortality risk and steps per day (per 1000 steps) (hazard ratio (HR) 0.81, 95% CI 0.75-0.88, p<0.001), gait speed (<0.80 m·s-1) (HR 3.55, 95% CI 1.72-7.36, p<0.001) and gait speed (per 1.0 m·s-1) (HR 7.55, 95% CI 1.11-51.3, p=0.04). Fewer steps per day (per 1000) and slow gait speed (<0.80 m·s-1) were also associated with increased healthcare utilisation (HR 0.80, 95% CI 0.72-0.88, p<0.001; OR 3.36, 95% CI 1.42-7.94, p=0.01, respectively). Available evidence was of low-moderate quality with few studies eligible for meta-analysis.
CONCLUSIONS: Daily step count and gait speed are negatively associated with mortality risk and other important outcomes in people with COPD and therefore may have value as prognostic indicators in clinical trials, but the quantity and quality of evidence is limited. Larger studies with consistent methodologies are called for.
METHODS: We conducted a systematic review, nested within a larger scoping review by the MOBILISE-D consortium, addressing DMOs in a range of chronic conditions. Qualitative and quantitative analysis considering steps per day and gait speed and their association with clinical outcomes in COPD patients was performed.
RESULTS: 21 studies (6076 participants) were included. Nine studies evaluated steps per day and 11 evaluated a measure reflecting gait speed in daily life. Negative associations were demonstrated between mortality risk and steps per day (per 1000 steps) (hazard ratio (HR) 0.81, 95% CI 0.75-0.88, p<0.001), gait speed (<0.80 m·s-1) (HR 3.55, 95% CI 1.72-7.36, p<0.001) and gait speed (per 1.0 m·s-1) (HR 7.55, 95% CI 1.11-51.3, p=0.04). Fewer steps per day (per 1000) and slow gait speed (<0.80 m·s-1) were also associated with increased healthcare utilisation (HR 0.80, 95% CI 0.72-0.88, p<0.001; OR 3.36, 95% CI 1.42-7.94, p=0.01, respectively). Available evidence was of low-moderate quality with few studies eligible for meta-analysis.
CONCLUSIONS: Daily step count and gait speed are negatively associated with mortality risk and other important outcomes in people with COPD and therefore may have value as prognostic indicators in clinical trials, but the quantity and quality of evidence is limited. Larger studies with consistent methodologies are called for.
摘要：
背景：活动度降低是COPD的主要特征。越来越可能使用计步器和加速度计等设备来评估日常生活中可以数字测量的移动性结果（数字移动性结果（DMO）），例如步态速度和每天的步数。但这些指标对住院和生存等关键结局的预测价值尚不清楚.
方法：我们进行了系统评价，嵌套在MOBILISE-D联盟的更大范围审查中，解决一系列慢性病中的DMO。对COPD患者进行了定性和定量分析，考虑了每天的步数和步态速度及其与临床结局的关系。
结果：纳入21项研究（6076名参与者）。9项研究评估了每天的步数，11项研究评估了反映日常生活中步态速度的指标。死亡风险与每天步数（每1000步数）之间存在负相关（风险比（HR）0.81，95％CI0.75-0.88，p<0.001），步态速度（<0.80m·s-1）（HR3.55，95％CI1.72-7.36，p<0.001）和步态速度（每1.0m·s-1）（HR7.55，95％CI1.11-51.3，p=0.04）。每天步数减少（每1000步）和步态速度缓慢（<0.80m·s-1）也与医疗保健利用率增加有关（HR0.80，95％CI0.72-0.88，p<0.001；OR3.36，95％CI1.42-7.94，p=0.01，分别）。现有证据质量低-中等，很少有研究有资格进行荟萃分析。
结论：每日步数和步态速度与COPD患者的死亡风险和其他重要结局呈负相关，因此在临床试验中可能具有作为预后指标的价值。但是证据的数量和质量是有限的。需要具有一致方法的更大研究。
方法：我们进行了系统评价，嵌套在MOBILISE-D联盟的更大范围审查中，解决一系列慢性病中的DMO。对COPD患者进行了定性和定量分析，考虑了每天的步数和步态速度及其与临床结局的关系。
结果：纳入21项研究（6076名参与者）。9项研究评估了每天的步数，11项研究评估了反映日常生活中步态速度的指标。死亡风险与每天步数（每1000步数）之间存在负相关（风险比（HR）0.81，95％CI0.75-0.88，p<0.001），步态速度（<0.80m·s-1）（HR3.55，95％CI1.72-7.36，p<0.001）和步态速度（每1.0m·s-1）（HR7.55，95％CI1.11-51.3，p=0.04）。每天步数减少（每1000步）和步态速度缓慢（<0.80m·s-1）也与医疗保健利用率增加有关（HR0.80，95％CI0.72-0.88，p<0.001；OR3.36，95％CI1.42-7.94，p=0.01，分别）。现有证据质量低-中等，很少有研究有资格进行荟萃分析。
结论：每日步数和步态速度与COPD患者的死亡风险和其他重要结局呈负相关，因此在临床试验中可能具有作为预后指标的价值。但是证据的数量和质量是有限的。需要具有一致方法的更大研究。
