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The self-reported Physical Activity Scale for the Elderly (PASE) is a valid and clinically applicable measure in lung cancer

Supportive Care in Cancer volume 23, pages 3211–3218 (2015)Cite this article

Abstract

Purpose

Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensus as to the best method for assessment. The Physical Activity Scale for the Elderly (PASE) is a commonly used questionnaire. The aim of this study was to assess the clinimetric properties of the PASE in lung cancer, specifically validity, predictive utility and clinical applicability (floor/ceiling effects, responsiveness and minimal important difference [MID]).

Methods

This is a prospective observational study. Sixty-nine participants (62 % male, median [IQR] age 68 years [61–74]) with lung cancer completed the PASE at diagnosis at 2, 4 and 6 months. Additional measures included movement sensors (steps/day), physical function, health-related quality of life, functional capacity (6-min walk distance [6MWD]), and muscle strength. Spearman’s rank correlation coefficient was used to assess relationships. Linear regression analyses were conducted to determine predictive utility of the PASE for health status at 6 months. Responsiveness (effect size) and MID (distribution-based estimation) were calculated.

Results

The PASE was administered on 176 occasions. The PASE had moderate convergent validity with movement sensors (rho = 0.50 [95 %CI = 0.29–0.66], p < 0.005) and discriminated between participants classed as sedentary/insufficient/sufficient according to PA guidelines (p < 0.005). The PASE had fair-moderate construct validity with measures of physical function (rho = 0.57 [95 %CI = 0.46–0.66], p < 0.005), 6MWD (rho = 0.40 [95 %CI = 0.23–0.55], p < 0.005), and strength (rho = 0.37 [95 %CI = 0.18–0.54], p < 0.005). The PASE (at diagnosis) exhibited predictive utility for physical function (Bcoef = 0.35, p = 0.008) and quality of life (Bcoef = 0.35, p = 0.023) at 6 months. A small floor effect was observed (3 %); however, there was no ceiling effect. There was a small responsiveness to change (effect size = 0.23) and MID between 17 and 25 points.

Conclusions

The PASE is a valid measure of self-reported PA in lung cancer.

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References

  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer http://globocan.iarc.fr, Accessed 10 November 2014

  2. Jones L, Eves N, Haykowsky M, Freedland S, Mackey J (2009) Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol 10:598–605

    Article  PubMed  Google Scholar 

  3. Tanaka K, Akechi T, Okuyama T, Nishiwaki Y, Uchitomi Y (2002) Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. J Pain Symptom Manage 23:417–423

    Article  PubMed  Google Scholar 

  4. Schmitz K, Courneya K, Matthews C, Demark-Wahnefried W, Galvao D, Pinto B, Irwin M, Wolin K, Segal R, Lucia A, Schneider C, von Gruenigen V, Schwartz A (2010) ACSM roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42:1409–1426

    Article  PubMed  Google Scholar 

  5. Coups E, Park B, Feinstein M, Steingart R, Egleston B, Wilson D, Ostroff J (2009) Physical activity among lung cancer survivors: changes across the cancer trajectory and associations with quality of life. Cancer Epidemiol Biomarkers Prev 18:664–672

    PubMed Central  Article  PubMed  Google Scholar 

  6. Granger CL, McDonald CF, Irving L, Clark R, Gough K, Murnane A, Mileshkin L, Krishnasamy M, Denehy L (2014) Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer 83:292–299

    Article  PubMed  Google Scholar 

  7. Grutsch J, Wood P, Du-Quiton J, Reynolds J, Lis C, Levin R, Ann Daehler M, Gupta D, Quiton D, Hrushesky W (2011) Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. J Circadian Rhy 9:4–4

    Article  Google Scholar 

  8. Granger C, McDonald C, Irving L, Clark RA, Gough K, Murnane A, Mileshkin L, Krishnasamy M, Denehy L (2014) Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer 83:292–299

    Article  PubMed  Google Scholar 

  9. Westerterp K (2009) Assessment of physical activity: a critical appraisal. Eur J Appl Physiol 105:823–828

    Article  PubMed  Google Scholar 

  10. de Vet H, Terwee C, Mokkink L, Knol D (2011) Measurement in Medicine—a practical guide. Cambridge University Press

  11. Portney L (2000) Foundations of clinical research applications to practice. Prentice Hall, New Jersey

    Google Scholar 

  12. de Vet H, Terwee C, Ostelo R, Beckerman H, Knol D, Bouter L (2006) Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes. 4

  13. Washburn R, Smith K, Jette A, Janney C (1993) The physical activity scale for the elderly (PASE) - Development and evaluation. J Clin Epidemiol 46:153–162

    CAS  Article  PubMed  Google Scholar 

  14. Forsén L, Loland NW, Vuillemin A, Chinapaw MJM, van Poppel MNM, Mokkink LB, van Mechelen W, Terwee CB (2010) Self-administered Physical Activity Questionnaires for the Elderly: A systematic review of measurement properties. Sports Med 40:601–623

    Article  PubMed  Google Scholar 

  15. Schuit AJ (1997) Validity of the physical activity scale for the elderly (PASE): According to energy expenditure assessed by the doubly labeled water method. J Clin Epidemiol 50:541–546

    CAS  Article  PubMed  Google Scholar 

  16. Washburn RA (1999) Physical Activity Scale for the Elderly (PASE): the relationship with activity measured by a portable accelerometer. J Sports Med Phys Fitness 39:336–340

    CAS  PubMed  Google Scholar 

  17. Mokkink L, Terwee C, Knol D, Stratford P, Alonso J, Patrick D, Bouter L, de Vet H (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22–22

    PubMed Central  Article  PubMed  Google Scholar 

  18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. BMJ 85:867–872

    Google Scholar 

  19. Granger C, Denehy L, McDonald C, Irving L, Clark R (2014) Physical activity measured using global positioning system tracking in nonsmall cell lung cancer: an observational study. Integr Cancer Ther 13:482–492

    Article  PubMed  Google Scholar 

  20. Oken M, Creech R, Tormey D, Horton J, Davis T, McFadden E, Carbone P (1982) Toxicity And response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    CAS  Article  PubMed  Google Scholar 

  21. Washburn RA (2002) The Physical Activity Scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 83:193–200

    Article  PubMed  Google Scholar 

  22. WHO (2010) Global recommendations on physical activity for health. Geneva: World Health Organization. ISBN: 9789241599979:1–58

  23. Webber SC (2009) Monitoring mobility in older adults using Global Positioning System (GPS) watches and accelerometers: a feasibility study. J Aging Phys Act 17:455–467

    PubMed  Google Scholar 

  24. Clark R, Weragoda N, Paterson K, Telianidis S, Williams G (2014) A pilot investigation using global positioning systems into the outdoor activity of people with severe traumatic brain injury. J Neuroeng Rehabil. 11

  25. Aaronson N, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman S, de Haes J (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    CAS  Article  PubMed  Google Scholar 

  26. American Thoracic Society (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  27. Colinet B (2005) A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index. Br J Cancer 93:1098–1105

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  28. Terwee C, Mokkink L, van Poppel M, Chinapaw M, van Mechelen W, de Vet H (2010) Qualitative attributes and measurement properties of physical activity questionnaires: a checklist. Sports Med 40:525–537

    Article  PubMed  Google Scholar 

  29. Cohen JW (1988) Statistical power analysis for the behavioral sciences. Lawrence Arlbaum Associates

  30. Husted J, Cook R, Farewell V, Gladman D (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468

    CAS  Article  PubMed  Google Scholar 

  31. Liu RDK, Buffart LM, Kersten MJ, Spiering M, Brug J, van Mechelen W, Chinapaw MJM (2011) Psychometric properties of two physical activity questionnaires, the AQuAA and the PASE, in cancer patients. BMC Med Res Methodol 11:30–30

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  32. Guyatt G, Walter S, Norman G (1987) Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 40:171–178

    CAS  Article  PubMed  Google Scholar 

  33. Walters S, Brazier J (2003) What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health Qual Life Outcomes. 1

  34. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M (2008) A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. Int J Behav Nutr Phys Act. 5

  35. Terwee C, Bot S, de Boer M, van der Windt D, Knol D, Dekker J, Bouter L, de Vet H (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  36. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395

    Article  PubMed  Google Scholar 

  37. Novoa N, Varela G, Jimenez M, Aranda J (2009) Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients. Interact Cardiovasc Thorac Surg 9:934–938

    Article  PubMed  Google Scholar 

  38. Guyatt G, Osoba D, Wu A, Wyrwich K, Norman G (2002) Methods to explain the clinical significance of health status measures. Mayo Clin Proc 77:371–383

    Article  PubMed  Google Scholar 

  39. Holland A, Hill C, Rasekaba T, Lee A, Naughton M, McDonald C (2010) Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Am J Phys Med Rehab 91:221–225

    Article  Google Scholar 

  40. Lee I, Shiroma E, Lobelo F, Puska P, Blair S, Katzmarzyk P (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380:219–229

    PubMed Central  Article  PubMed  Google Scholar 

  41. Holmes M, Chen W, Feskanich D, Kroenke C, Colditz G (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293:2479–2486

    CAS  Article  PubMed  Google Scholar 

  42. Meyerhardt J, Giovannucci E, Holmes M, Chan A, Chan J, Colditz G, Fuchs C (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24:3527–3534

    Article  PubMed  Google Scholar 

  43. Ibrahim E, Al-Homaidh A (2011) Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol 28:753–765

    Article  PubMed  Google Scholar 

  44. Granger C, McDonald C, Berney S, Chao C, Denehy L (2011) Exercise intervention to improve exercise capacity and health-related quality of life for patients with non-small cell lung cancer: a systematic review. Lung Cancer 72:139–153

    CAS  Article  PubMed  Google Scholar 

  45. Cavalheri V, Tahirah F, Nonoyama M, Jenkins S, Hill K (2014) Exercise training for people following lung resection for non-small cell lung cancer—a Cochrane systematic review. Cancer Treat Rev. 585–594

  46. Crandall K, Maguire R, Campbell A, Kearney N (2014) Exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer (NSCLC): a systematic review. Surg Oncol 23:17–30

    Article  PubMed  Google Scholar 

  47. Jones LW, Watson D, Herndon JE 2nd, Eves ND, Haithcock BE, Loewen G, Kohman L (2010) Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer. Cancer 116:4825–4832

    Article  PubMed  Google Scholar 

  48. Egan C, Deering B, Blake C, Fullen B, McCormack N, Spruit M, Costello R (2012) Short-term and long-term effects of pulmonary rehabilitation on physical activity in COPD. Respir Med 106:1671–1679

    Article  PubMed  Google Scholar 

  49. Granger C, McDonald C, Parry S, Oliveira C, Denehy L (2013) Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BMC Cancer. 13

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Acknowledgments

The authors would like to thank the The University of Melbourne, Royal Melbourne Hospital, Austin Hospital and Peter MacCallum Cancer Centre physiotherapy and respiratory medicine departments; Dr Ross Clark; and the participants for their contribution to the study.

Conflicts of interest

CG is funded by a National Health and Medical Research Council (NHMRC) Translating Research Into Practice Fellowship, Australia. One of the studies which contributed data was supported by a Victorian Cancer Agency Grant, Australia. The authors declare no conflicts of interest. The authors do not have a financial relationship with the organisation that sponsored the research. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

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Affiliations

  1. Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Melbourne, Victoria, 3010, Australia

    Catherine L Granger, Selina M Parry & Linda Denehy

  2. Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Melbourne, Victoria, 3010, Australia

    Catherine L Granger

  3. Institute for Breathing and Sleep, Studley Road, Heidelberg, Victoria, 3084, Australia

    Catherine L Granger & Linda Denehy

Authors
  1. Catherine L Granger
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  2. Selina M Parry
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Correspondence to Catherine L Granger.

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Granger, C.L., Parry, S.M. & Denehy, L. The self-reported Physical Activity Scale for the Elderly (PASE) is a valid and clinically applicable measure in lung cancer. Support Care Cancer 23, 3211–3218 (2015). https://doi.org/10.1007/s00520-015-2707-8

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Keywords

  • Physical activity
  • Lung cancer
  • Clinimetric properties
  • Questionnaires
  • Self-report