Association between contextual and clinical factors and disability in people with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) develops as a multifaceted and complex disorder, with clinical and functional repercussions.

OBJECTIVE: To investigate the association among contextual factors (personal and environmental) and clinical features and the disability of COPD patients, with emphasis on activity and social participation.

METHODS: A cross-sectional study with stable COPD participants (n = 47) was conducted to assess personal and clinical characteristics, activity of daily living using the London Chest Activity of Daily Living scale (LCADL), disability by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and environmental factors by the Craig Hospital Inventory of Environmental Factors (CHIEF). Statistical analysis was performed by the multivariate method.

RESULTS: In the LCADL predictive analysis, the variables forced expiratory volume in 1 second (FEV1 ), dyspnea levels 3-4 by the modified Medical Research Council scale (mMRC), and active level of regular physical activity were included in the final model (adjusted R2  = 0.523). In addition, WHODAS was influenced by CHIEF physical structure score and mMRC 1-2 and mMRC 3-4 grades (adjusted R2  = 0.500).

CONCLUSIONS: Disability is a complex in COPD patients and encompasses a prominent role of dyspnea levels in the prediction of activity and participation. Multivariate models presented clinical and contextual factors as functional predictors that included the physical structure of the environment in the determination of social participation.