Arnaud Chambellan

For reasons of availability and cost, patients are sent home increasingly early, with limited follow-up due to the complexity and size of medical devices. In this context, researchers from IETR and MIPS laboratories are working on a device which should monitor the progress of a patient, in order to detect early the aggravation of a disease such as Chronic Obstructive Pulmonary Disease (COPD) or diabetes with walking disorders. The device is based on flexible piezoelectric thin films (3 µm thick) that can be used as podiatric sensors and have been developed by the IETR laboratory. The originality of this work lies both in the approach to the design of the gait-monitoring device—because it was carried out directly in consultation with a doctor from the University Hospital of Nantes and a podiatrist—and in the portability of the device, which should eventually allow the follow-up of a patient at home. For this study, the flexible piezoelectric sensors have been elaborated using a Chemical Solution Deposition (CSD) process and a commercial aluminum (Al) foil as substrate. In order to increase the flexibility of sensors and to aid its insertion in a shoe, piezoelectric films have been encapsulated by lamination into polyethylene terephthalate (PET, 150 μm). In this paper, the elaboration and characterization of flexible piezoelectric sensors, analog-to-digital converter and wireless communication protocol used for data transmission are presented.

Background: the improvement of PA remains a major goal in COPD. Apart from the common benefits of PR, it is unclear which PA parameters assessed by accelerometry best reflect the change in daily physical activity behavior after a home-based PR. Aim: we hypothesized that the change in daily light PA is the most sensitive factor after a home based PR. Methods: 51 COPD patients undergoing home-based PR in 3 different cities in France were analyzed using accelerometers at the beginning and 6 months after home-based PR. Results: the time spent in light PA and the number of steps per day are increased, from 3:53 ± 1:49 to 4:16 ± 1:56 (p=0.003) and from 5362 ± 3176 to 5865 ± 3286 (p=0.039) respectively. We do not observe a change in time spent in moderate PA. Rainfall and daytime temperature influenced pedometry and light PA measures. Conclusion: an increase in time of light intensity PA was observed in patients undergoing a home-based PR, which represents an essential first step against sedentarity. This was not observed about the time in moderate PA which is the common goal in a general population. In chronic diseases such as COPD, we encourage the use of time in light PA that is most sensitive to depict the change in PA behavior.

Introduction: The recently developed daily and clinical visit PROactive physical activity in COPD (PPAC) instruments are hybrid tools to objectively quantify the level of physical activity and the difficulties experienced in everyday life. Our aim was to translate these instruments for the French-speaking chronic obstructive pulmonary disease (COPD) community worldwide and evaluate the influence of weather and pollution on difficulty score. Methods: The translation procedure was conducted following the guidelines for cross-cultural adaptation process. The translated clinical visit (C-PPAC) was tested among COPD patients in France. A retest was conducted after an interval of at least 2 weeks. The C-PPAC difficulty score was then tested to see how sensitive it was to the influence of weather and outdoor pollution. Results: One hundred and seventeen COPD patients (age 65± 9 years; FEV1: 51± 20%) from 9 regions in France were included. The French version of C-PPAC was found comprehensible by the patients with an average score of 4.8/5 on a Likert-scale. It showed good internal consistency with Cronbach’s α> 0.90 and a good test retest reliability with an intraclass correlation coefficient of ≥ 0.80. The difficulty score was negatively correlated with duration of daylight (ρ=− 0.266; p< 0.01) and influenced by the intensity of rainfall (light vs. heavy rainfall: 68± 16 vs. 76± 14 respectively, p=0.045). The score was lower in patients receiving long term oxygen therapy (60± 15 vs. 71± 15, p< 0.01), but not correlated with the pollution indices. Conclusion: The French versions of the questionnaires of the PPAC instruments are accepted and comprehensible to COPD patients. The difficulty score of C-PPAC is sensitive to duration of daylight and rainfall. Such weather factors must be taken into consideration when evaluating the physical activity behavior using these tools in COPD.

Background: Measurement of quadriceps muscular force is recommended in individuals with COPD, notably during a pulmonary rehabilitation program (PRP). However, the tools used to measure quadriceps maximal voluntary contraction (QMVC) and the clinical relevance of the results, as well as their interpretation for a given patient, remain a matter of debate. The objective of this study was to estimate the minimally important difference (MID) of QMVC using a fixed dynamometer in individuals with COPD undergoing a PRP. Methods: Individuals with COPD undergoing a PRP were included in this study. QMVC was measured using a dynamometer (MicroFET2) fixed on a rigid support according to a standardized methodology. Exercise capacity was measured by 6-minute walk distance (6MWD) and evaluation of quality of life with St George’s respiratory questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) total scores. All measures were obtained at baseline and the end of the PRP. The MID was calculated using distribution-based methods. Results: A total of 157 individuals with COPD (age 62.9±9.0 years, forced expiratory volume in 1 second 47.3%±18.6% predicted) were included in this study. At the end of the PRP, the patients had improved their quadriceps force significantly by 8.9±15.6 Nm (PPPP Conclusion: Measurement of QMVC using a fixed dynamometer is a simple and valuable tool capable of assessing improvement in quadriceps muscle force after a PRP. We suggest an MID of 7.5 Nm to identify beneficial changes after a PRP intervention.

The change in the sit-to-stand test after a pulmonary rehabilitation is not influenced by the initial valuehttp://ow.ly/i2CI30eqprD

Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naïve asthma and/or respiratory allergy. The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.

Background: The 1-minute sit-to-stand (STS) test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD). There is a need to provide the minimal important difference (MID) of this test in pulmonary rehabilitation (PR). Methods: COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC). Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods. Results: Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD) (r=0.574; P-3), age (r=-0.453; P=0.001), being on long-term oxygen treatment (r=-0.454; P=0.017), and the QMVC (r=0.424; P=0.031). The multivariate analysis explained 75.8% of the variance of 1-minute STS repetitions. The improvement of the 1-minute STS repetitions at the end of PR was 3.8±4.2 (P-3). It was mainly correlated with the change in QMVC (r=0.572; P=0.004) and 6MWD (r=0.428; P=0.006). Using the distribution-based analysis, an MID of 1.9 (standard error of measurement method) or 3.1 (standard deviation method) was found. With the 6MWD as anchor, the receiver operating characteristic curve identified the MID for the change in 1-minute STS repetitions at 2.5 (sensibility: 80%, specificity: 60%) with area under curve of 0.716. Conclusion: The 1-minute STS test is simple and sensitive to measure the efficiency of PR. An improvement of at least three repetitions is consistent with physical benefits after PR.