Predictors of disability in activities of daily living in people with advanced respiratory disease

Abstract

<b>Background:</b> Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Targeted rehabilitation could help maintain independence, but indicators for timing interventions in this population are currently lacking. <b>Aim:</b> To identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. <b>Method:</b> Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). Self-reported disability in basic (Barthel Index) and instrumental (Lawton–Brody IADL Scale) ADLs were assessed monthly for 6-months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined independent predictors of increasing disability in basic and instrumental ADLs over time. <b>Results:</b> Between March 2020 and January 2021, 110 NSCLC, 72 COPD, and 19 ILD participants were recruited: 151 completed ≥3 timepoints and were included in the longitudinal analysis. Four distinct individual trajectories of ADL disability were identified: increasing, decreasing, fluctuating, and no-change. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1.41 [CI: 1.14-1.74], p=0.002), adjusted for diagnosis, symptom severity, disability in basic and instrumental ADLs, age, sex, living alone, assistive device use, and reduced physical activity, at baseline. <b>Conclusion:</b> Mobility limitation could be used as a referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs.