Performance-based outcome measures for physical capacity and functional ability among patients with pulmonary embolism

Abstract

Abstract Introduction Pulmonary embolism (PE) is a serious health condition with up to 50 % of patients experiencing persisting symptoms with shortness of breath, pain, reduced physical performance and psychological distress, also known as post-PE syndrome. This condition has received increasing attention, including recommendations of assessing physical capacity to identify patients who may benefit from rehabilitation interventions to increase functional ability and health. However, as the PE population is heterogeneous compared to other cardiac patient groups, outcome measures for assessing physical capacity traditionally used in cardiac rehabilitation may not be reliable. This scoping review aims to map the performance-based outcome measures (PBOM) used in research literature to measure physical capacity in a PE population, to map the nature of the research and investigate the psychometric properties of the identified instruments in a PE population. Methods The methodology of the review process was guided by the Joanna Briggs Institute (JBI) framework for scoping reviews and reporting followed the PRISMA guidelines. Results The search identified a total of 4585 potentially relevant studies of which 234 studies met the inclusion criteria. A substantial part of studies (190 studies) was on a CTEPH population (chronic thromboembolic pulmonary hypertension), a condition developed by just 1-2% of patients with PE. The majority of included research articles originated from Europe (51%) and Asia (36%). Ten different PBOMs were identified for measuring physical capacity in a PE/CTEPH population, with 6MWT and CPET as the far most commonly used and the Bruce protocol/Modified Bruce protocol and Incremental Shuttle Walk test (ISWT) as third and fourth. No studies were identified reporting on psychometric properties of the 10 PBOMs in a PE / CTEPH population. Conclusions No studies were identified reporting on validity or reliability of any of the 10 identified PBOMs in a PE/CTEPH population. Thus, there is a need for conducting studies that establish the reliability, validity and responsiveness of PBOMs in a PE population, to enable identification of at-risk patients and to monitor effects of treatment and rehabilitation interventions.