The disablement process in patients with pulmonary disease.

Abstract

The purposes of this study were (1) to describe the disabilities of patients with pulmonary disease and (2) to examine the relationships among impairments, functional limitations, and disability, as described by the disablement process model. Subjects were 154 patients with chronic pulmonary disease (64% female, 36% male; mean age = 59 years, SD = 14, range = 24-86). Information was abstracted from physical therapy records, including measurements of pulmonary impairment, 6-minute walk distance (6MWD), and Functional Status Questionnaire (FSQ) scores. Multivariate analyses were used to examine the relationships among measurements of impairment, 6MWD, and FSQ scores. Mean FSQ scores ranged from 52.6 for instrumental activities of daily living to 83.3 for basic activities of daily living, where 100 represents the highest level of ability. Fifty percent of patients were not working because of health problems. Percentage of predicted 1-second forced expiratory volume (FEV1), oxyhemoglobin saturation, and the ratio of FEV1 to forced vital capacity were related to 6MWD but not to FSQ scores. The 6MWD was associated with scales of the FSQ, including basic activities of daily living (R2 = .24), instrumental activities of daily living (R2 = .35), and social activity (R2 = .26). Patients entering a pulmonary rehabilitation program have clinically important disabilities. The results support the use of the disablement process model and suggest that different and important information is obtained from measurements of impairment, functional limitation, and disability in patients with pulmonary disease.