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The Disablement Process in Patients With Pulmonary Disease

DU Jette, DSc, PT, is Program Director and Associate Professor, Graduate Program in Physical Therapy, Graduate School for Health Studies, Simmons College, 300 The Fenway, Boston, MA 02115 (USA) (djette@vmsvax.simmons.edu), and Physical Therapist, Rehabilitation Services Department, Beth Israel Deaconess Medical Center, Boston, Mass.
D Manago, PT, is Physical Therapist, Hughston Sports Medicine Hospital, Atlanta, Ga.
E Medved, PT, is Staff Physical Therapist, West Haven Veterans Medical Center, West Haven, Conn.
A Nickerson, PT, is Physical Therapist, Morton Hospital, Taunton, Mass.
T Warzycha, PT, is Physical Therapist, Meeting Street Center, East Providence, RI.
MC Bourgeois, PT, CCS, is Coordinator of Outpatient Chest Physical Therapy and Home Care, Rehabilitation Services Department, Beth Israel Deaconess Medical Center.
CC Zadai, PT, CCS, is Director, Rehabilitation Services Department, Beth Israel Deaconess Medical Center.
Mr Manago, Mr Medved, Ms Nickerson, and Ms Warzycha were graduate students, Graduate Program in Physical Therapy, Graduate School for Health Studies, Simmons College, at the time this study was done.

Background and Purpose. 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. Subjects were 154 patients with chronic pulmonary disease (64% female, 36% male; mean age=59 years, SD=14, range=24–86). Methods. 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. Results. 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). Conclusion and Discussion. 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.

Key Words: Disablement • Functional limitation • Pulmonary disease • Six-minute walk

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