Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : OC05 - OC08 Full Version

Correlation of Six Minute Walking Test, Sit to Stand Test and Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/58723.17229
V Meghashri, A Raveesha, Guruprasad, Charchit Mehta, Manchu Deepthi

1. Senior Resident, Department of General Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 2. Professor, Department of General Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 3. Assistant Professor, Department of Pulmonology, Sri Devaraj Urs Academy of Higher Education and Research, Karnataka, India. 4. Senior Resident, Department of General Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka,India. 5. Senior resident, Department of General Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India.

Correspondence Address :
Dr. V Meghashri,
Door No. 430,17th Cross,1st Stage, Visveshwara Nagar, Mysuru-570008, Karnataka, India.
E-mail: meghashri.hk@gmail.com

Abstract

Introduction: Assessment of functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients helps in determining the severity of the disease. While spirometry is the gold standard, six Minutes Walk Test (6MWT) and one minute Sit To Stand Test (STST) are simple and practical tests to assess exercise capacity and physical condition.

Aim: To find the diagnostic accuracy of these of 6MWT and one minute STST in comparison with spirometry.

Materials and Methods: This cross-sectional study was conducted in the Department of General Medicine at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, from January 2019 to December 2019. All cases of COPD diagnosed using GOLD 2018 criteria were included in the study. Patients performed 6MWT and one minute STST. Heart rate, blood pressure, oxygen saturation, SpO2, dyspnea, and fatigue (Borg scale) were noted pretest and post-test. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. A p-value<0.05 was considered statistically significant.

Results: The mean age of the patients was 64.09±8.31,while there were 112 (94.9%) males and 6 (5.1%) female. Overall, 81.54% of the participants had severe/very severe COPD group, walked <332.49 meters, and only 18.46% could walk more than 332.50 m. SpO2 decreased from 93.98±0.82 to 91.75±1.39. During the one minute STST SpO2 decreased from 93.98±0.82 to 91.75±1.39. A positive correlation was observed between the one minute STST, and it had good predictive validity in predicting COPD as compared with spirometry (area under the curve of 0.915 95% CI 0.866 to 0.963, p-value <0.001). 6MWT has a sensitivity of 81.54%, the specificity of 79.25%, and one minute STST had a sensitivity of 89.23%, specificity of 67.92% in predicting COPD.

Conclusion: In a remote clinical setting where spirometry is not available, 6MWT and one minute STST are the best methods for assessing COPD severity.

Keywords

Exercise capacity, Functional capacity, Sensitivity, Smokers, Specificity

India has an increasing burden of chronic respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD) and asthma occur more commonly (1). Chronic obstructive pulmonary disease is a progressive inflammatory disease of the lung characterised by chronic bronchitis, airway thickening, and emphysema. Chronic obstructive pulmonary disease is a major cause of morbidity and mortality and is predicted to become the 3rd leading cause of death worldwide in 2030 (2). Globally, it accounts for around 5% of the mortality. Around 90% of COPD deaths are from low-income and middle-income countries. In India, approximately 30 million people were diagnosed with COPD. Worldwide, the mortality rate caused by COPD was identified highest in India (3).

Pulmonary Function Tests (PFT) are considered to be the “gold standard” for the diagnosis of COPD. Spirometry, lung volumes and diffusion capacity of the lung for carbon monoxide are the three basic components of pulmonary function testing. COPD can affect each of these components. Spirometry airflow measures or PFT results are used to measure the severity of COPD. The exercise capacity in patients with COPD can be assessed using the six Minutes Walk Test (6MWT). The primary outcome measure in 6MWT is the distance walked in six minute. It can be used to evaluate the benefit of pulmonary rehabilitation (4),(5),(6). It is associated with poor health-related quality of life. Hence, it is considered as a potentially useful biomarker in COPD (7). A six minute walk distance <350 m indicates a significant increase in the rate of mortality in patients with COPD (8). The Sit To Stand Test (STST) is considered as a simple and practical test to identify assess the functional capacity in COPD patients. The inability to perform the movements of standing up and sitting down is associated with mortality and with impairment of function and mobility (9). The STST can be used to indirectly determine exercise tolerance as well as the lower extremity skeletal muscle function (6).

Shah H et al., found that at the end of 6MWT and STST, there was a significant difference in heart rate, systolic and diastolic blood pressure (10). Thus, concluded that the STST and 6MWT can be used to assess cardiovascular endurance in COPD. Gurses HN et al., conducted a cross-sectional study in COPD patients in which a moderate correlation wasidentified between 30 and 60 seconds STS tests and 6MWT (11). Reychler G et al., concluded that STST can be used to assess functional exercise capacity in COPD patients, and also that STST had good repeatability (12).

One of the major goals in COPD management should be the improvement in functional status as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Several tests are now available to measure functional exercise capacity. The 6MWT and STST are the most commonly used clinical exercise tests. The relationship between the 6MWT and pulmonary function test in stable COPD remains limited in data. The aim of the present study was to evaluate the functional capacity among COPD patients by the STST and 6MWT and also to compare results of both tests to parameters of pulmonary function test.

Material and Methods

This cross-sectional study was conducted in the Department of General Medicine at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, from January 2019 to December 2019. All cases of COPD diagnosed using GOLD 2018 criteria (13) were recruited into the study consecutively, by convenient sampling till the sample size was reached. The study was approved by the Institutional human Ethics Committee (IEC 130) and informed written consent was obtained from all participants.

Inclusion criteria: Clinically stable patients, above 40 years of age, with COPD as defined by GOLD 2018 criteria (FEV1/FVC<0.7), and free of acute exacerbations were included in the study.

Exclusion criteria: Patients with ischaemic heart disease/left heart failure, those with resting heart rate >120 bpm and systolic blood pressure >180 mmHg and diastolic blood pressure >120 mmHg, patients with neurological, musculoskeletal and peripheral vascular disease in lower extremities, anaemia, asthma, pneumonia, lung cancer, tuberculosis, asthma COPD overlap syndrome and other respiratory illness limiting patient’s movements were excluded from the study.

Sample size estimation: Sample correlation coefficient=0.6, population correlation coefficient=0.5, Power (%)=80, Alpha Error (%) =5, sided=2. The estimated sample size was 72. However, 118 patients were finally included.

Study Procedure

The COPD patients who satisfied the inclusion criteria underwent spirometry, one minute Sit To Stand Test (STST) and six minute walk distance (6MWT). Age, gender, weight and height of patients were noted.

Statistical Analysis

Chronic obstructive pulmonary disease severity by spirometry, 6MWT distance and STST are primary outcome variables. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. The predictability of 6MWT and STST was assessed by Receiver Operating (ROC) curve analysis. The area under the ROC curve along with its 95% CI and p-value are presented. Based on the ROC analysis, it was decided to consider 332.49,332.50 and 15.49,15.50 as the cut-off values. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. The p-value<0.05 was considered statistically significant. The IBM Statistical Package for Social Sciences (SPSS) version 22.0 was used for statistical analysis (14).

Results

A total of 118 subjects were included in the final analysis. The mean age of the population was 64.09±8.31 with 112 (94.9%) males and 6 (5.1%) females. Based on spirometry findings, a majority (54) of the patients had severe COPD (Table/Fig 1).

The mean 6MWT of the study population was 332.54±67.03, and the SpO2 decreased from 93.98±0.82 to 91.75±1.39. The mean STST was 15.03±2.41, after which the SpO2 decreased from 93.98±0.82 to 91.75±1.39 (Table/Fig 2).

The 6MWT had sensitivity of 81.54% (95% CI 69.97% to 90.08%), the specificity of 79.25% (95% CI 65.89% to 89.16%) in predicting severe COPD spirometry. Diagnostic accuracy of 6MWT was 80.51% (95% CI 72.20% to 87.2%) [Table/Fig-3,4].

The STST had sensitivity of 89.23% (95% CI: 79.06% to 95.56%) and specificity was 67.92% (95% CI: 53.68 to 80.08%) in predicting severe COPD spirometry. Diagnostic accuracy was 79.66% (95% CI: 71.27% to 86.51%) [Table/Fig-5,6]. The 6MWT has good performancepredictive validity in predicting severe COPD as indicated by Area Under Curve (AUC) of 0.92 (95% CI 0.874 to 0.966, p-value <0.001). STST has good predictive validity in predicting severe COPD as indicated by Area under curve (AUC) of 0.915 (95% CI 0.866 to 0.963, p-value <0.001).

Discussion

Chronic obstructive pulmonary disease has been defined as a preventable and treatable disease (15) and proper diagnosis and management of this disease consequently include evaluation of exercise tolerance aimed at improved orientation towards pulmonary rehabilitation (16),(17). Spirometry though is the gold standard test in assessing COPDs; requires high cost, considerable skill and is not easily available at the peripheral center (18). The 6MWT is a simple tool widely used for assessing functional capacity in COPDs. It is easy to perform, reproducible, and inexpensive (19). The STST is a simple and practical test, widely adopted to evaluate functionality in community-dwelling elderly (9). The present study was conducted to evaluate the functional status by the STST and 6MWT in patients with COPD and to compare results of both tests to parameters of pulmonary function tests so that they can be considered as an alternative to spirometry at places where it is not available.

A positive correlation was observed between the 6MWT and spirometry and 6MWT showed good predictive validity in predicting COPD as indicated by the area under the curve of 0.920 (95% CI 0.874 to 0.966, p-value<0.001). The study demonstrated a relationship between the 6MWT and desaturation and heart rate. There was a decrease in SpO2 during the 6MWT, from 93.98±0.82 to 91.75±1.39, similar to that seen in a study by van Gestel AJ et al., (20), but they had a decrease of 7.2%. Meena M et al., (21), reported that 6MWT correlated positively to all spirometer parameters post FVC% predicted (p-value <0.0001).

The 6MWT showed a sensitivity of 81.54% in predicting COPD and the specificity of 79.25%. Van Gestel AJ et al., reported the number of steps taken per day related to the number of repetitions in the one minute STST among COPD patients (20). Although the one minute STST and 6MWT involve different movements, they both elicited similar physiological responses. During the one minute STST, there was a decrease in SpO2 from 93.98±0.82 to 91.75±1.39 almost similar to that noted in the 6MWT. This is similar with previous studies that found a decrease in SpO2 of 1-2% in the one minute STS test (22),(23).

In the present study, a positive correlation was observed between the one minute STST with a good predictive validity in predicting COPD as indicated by the area under the curve of 0.915 (p-value<0.001). The one minute STST had a sensitivity of 89.23% in predicting COPD, specificity was 67.92%. Vaidya T et al., also demonstrated the utility of the one minute STST in the assessment of COPD patients and reported that its ability to detect a change in exercise tolerance is similar to 6MWT (24).

Limitation(s)

There were only few women included in the study. Spirometric parameters, such as Diffusing capacity of the lungs for Carbon monoxide (DLCO) and airway resistance, were not assessed in the present study. Obesity is associated with decreased lung function measures, and the study population did not include obese patients. It is recommended to include a larger cohort with a significant number of women exclusively designed to evaluate the effect of gender on the clinical manifestations of COPD.

Conclusion

The gold standard for the diagnosis of COPD is considered to be the pulmonary function tests. Several tests are now available to measure functional exercise capacity. Most commonly used clinical exercise tests are 6MWT and STST. Spirometry which is the gold standard for grading severity of COPD, will not be available in remote clinical settings and hence, 6MWT and one minute STST are the best methods for assessing the severity.

References

1.
Salvi S, Kumar GA, Dhaliwal RS, Paulson K, Agrawal A, Koul PA, et al. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990–2016. Lancet Glob Health. 2018;6(12):e1363-74. [crossref] [PubMed]
2.
Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27(2):397-12. [crossref] [PubMed]
3.
Koul PA. Chronic obstructive pulmonary disease: Indian guidelines and the road ahead. Lung India Off Organ Indian Chest Soc. 2013;30(3):175-77. [crossref] [PubMed]
4.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-17. [crossref] [PubMed]
5.
Zanini A, Chetta A, Gumiero F, Della Patrona S, Casale S, Zampogna E, et al. Six- minute walking distance improvement after pulmonary rehabilitation is associated with baseline lung function in complex COPD patients: a retrospective study. Bio Med Res Int. 2013;2013:483162. [crossref] [PubMed]
6.
Polkey MI, Spruit MA, Edwards LD, Watkins ML, Pinto-Plata V, Vestbo J, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalisation. Am J Respir Crit Care Med. 2013;187(4):382-86. [crossref] [PubMed]
7.
Celli B, Tetzlaff K, Criner G, Polkey MI, Sciurba F, Casaburi R, et al. The 6-minute- walk distance test as a chronic obstructive pulmonary disease stratification tool. Insights from the COPD Biomarker Qualification Consortium. Am J Respir Crit Care Med. 2016;194(12):1483-93. [crossref] [PubMed]
8.
Zhang Q, Li YX, Li XL, Yin Y, Li RL, Qiao X, et al. A comparative study of the five- repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients. Int J Chron Obstruct Pulmon Dis. 2018;13:2833. [crossref] [PubMed]
9.
Morita AA, Bisca GW, Machado FV, Hernandes NA, Pitta F, Probst VS, et al. Best protocol for the sit-to-stand test in subjects with COPD. Respir Care. 2018;63(8):1040-49. [crossref] [PubMed]
10.
Shah H, Bhatt F. Comparison of the Sit To Stand test with Six Minute Walk Test in patients with Chronic Obstructive Pulmonary Disease. Int J Curr Res. 2016;8(7):34345-49.
11.
Gurses HN, Zeren M, Kulli HD, Durgut E. The relationship of sit-to-stand tests with 6-minute walk test in healthy young adults. Medicine (Baltimore). 2018;97(1). [crossref] [PubMed]
12.
Reychler G, Boucard E, Peran L, Pichon R, Le Ber Moy C, Ouksel H, et al. One minute sit to stand test is an alternative to 6MWT to measure functional exercise performance in COPD patients. Clin Respir J. 2018;12(3):1247-56. [crossref] [PubMed]
13.
Global Strategy for the Diagnosis, Management and Prevention of COPD . Global Initiative for Chronic Obstructive Lung Disease (GOLD); 2017. Available from: http://goldcopd.org
14.
IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
15.
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-55. [crossref] [PubMed]
16.
Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64.
17.
Spruit MA, Pitta F, Garvey C, ZuWallack RL, Roberts CM, Collins EG, et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J. 2014;43(5):1326-27. [crossref] [PubMed]
18.
Karanth MS, Awad NT. Six minute walk test: a tool for predicting mortality in chronic pulmonary diseases. J Clin Diagn Res. 2017;11(4):OC34.
19.
Enfield K, Gammon MS, Floyd MJ, Falt MC, Patrie MJ, Platts-Mills TA, et al. Six-minute walk distance in patients with severe end-stage COPD: association with survival after inpatient pulmonary rehabilitation. J Cardiopulm Rehabil Prev. 2010;30(3):195. [crossref] [PubMed]
20.
Van Gestel AJ, Clarenbach CF, Stöwhas AC, Rossi VA, Sievi NA, Camen G, et al. Predicting daily physical activity in patients with chronic obstructive pulmonary disease. PloS One. 2012;7(11):e48081. [crossref] [PubMed]
21.
Meena M, Singh R, Singh A, Motapothula U. Correlation of 6-minute-walk test with functional profile in stable patients with COPD. Chest. 2020;158(4):A1765. [crossref]
22.
Zanini A, Aiello M, Cherubino F, Zampogna E, Azzola A, Chetta A, et al. The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients. Int J Chron Obstruct Pulmon Dis. 2015;10:2423. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/58723.17229

Date of Submission: Jun 27, 2022
Date of Peer Review: Aug 03, 2022
Date of Acceptance: Sep 27, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 28, 2022
• Manual Googling: Aug 30, 2022
• iThenticate Software: Sep 23, 2022 (14%)

ETYMOLOGY: Author Origin

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