Functional capacity assessment in women with scleroderma using the AVD-Glittre test

Abstract

Introduction: Scleroderma is an autoimmune disease chronic, whose aetiology is unknown, and the vast majority of cases do occur in women. It is characterized by skin connective tissue disorder with skin thickening, vasculopathy, and internal organs fibrosis. The
clinical manifestations of skin, bones and joints, and cardiopulmonary are described in scleroderma that affect functional capacity, quality of life and activities of daily living (ADLs) impairment. Although the disease has been widely studied over the years, there are still scientific gaps to be filled. Example of them, it is the understanding improvement of the functional capacity indicators. Although several testes are available to assess the functionality of patients with scleroderma, few involve upper limb mobility, which is essential for ADL. Objective: The objective of the present study was to evaluate the functional capacity in women with scleroderma
during simulated ADLs and, in addition, to correlate these findings with physical function and hand function. Methods: This was a cross-sectional study that included female subjects diagnosed with scleroderma in outpatient treatment (n = 33) and also a group of female control subjects (n = 30) that consisted of healthy volunteers matched for age, weight, height and body mass index. Participants underwent the Glittre ADL-test, pulmonary function (including spirometry and carbon monoxide diffusion capacity measurement-DLco), manual dynamometry, and the Scleroderma Health Assessment Questionnaire-Disability Index (SHAQ-DI) and Cochin Hand Functional Scale (CHFS) questionnaires. Results: The women with scleroderma had significantly higher CHFS and SHAQ-DI scores and lower handgrip strength values than the controls (all with P ˂ 0.0001). Forced vital capacity (FVC) and DLco were
lower than 80% of the predicted value in women with scleroderma. For the Glittre ADL-test, the median values for total time, manual time, and the manual time/total time ratio were higher in the women with scleroderma than in the controls. The total time required by the women with scleroderma to perform the multiple tasks of the Glittre ADL-test was approximately 44% longer than expected. The strongest correlations were observed between manual time and physical capacity measurements involving activities performed with the hands: CHFS (rs = 0.70, P ˂ 0.0001) and SHAQ-DI (rs = 0.73, P ˂ 0.0001). In addition, we observed no significant correlations between the Glittre ADL-test time measurements and pulmonary function parameters; however, the drop in peripheral oxygen saturation during the Glittre ADL-test was significantly correlated with the FVC (rs = -0.58, P = 0.0004), DLco (rs = -0.62, P = 0.0001), and FVC/DLco ratio (rs = 0.41, P = 0.018). Conclusion: With the results of this research, perspectives are opened to incorporate the Glittre ADL-test into the clinical evaluation of scleroderma patients for assessing treatment response and disease progression.