Propriedades psicométricas do sit-to-stand test na população com hipertensão pulmonar: uma revisão sistemática

Abstract

Pulmonary hypertension (PH) is considered a complex clinical syndrome, characterized by increased pulmonary arterial pressure. Patients present with limitation of daily activities with increased dyspnea related to exertion, systemic muscle dysfunction and functional decline. Currently, tools for indirect assessment of exercise tolerance are performed by field tests, including the sit-to-stand test (STS). Different STS protocols have been described and used at PH, thus, establishing the properties of psychometric measurements of this test in this population becomes fundamental for the use and prescription with valid and reliable measures in these patients. Objective: To determine the psychometric properties (validity, reliability [internal consistency and measurement error], hypothesis testing for construct validity and responsiveness) and achieved repetitions of the different STS protocols in individuals with PH. Methods: This is a systematic review that included studies with patients with PH who were evaluated by the STS test (protocols: 1 minute (1-STS), 30 seconds (30-STS) or 5 repetitions (5-STS)). Searches for studies were performed on PubMed, EMBASE, SciELO, Cochrane Library, and Web of Science platforms following the PICOT strategy (population: adults with PH; intervention: assessment of exercise capacity with the STS; comparator: control group or reference values; outcomes: psychometric properties; type of studies: randomized or quasirandomized clinical trials and observational studies) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We used Rayyan software for export, data analysis and study selection. The risk of bias was conducted by the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual and the evidence quality analysis by the modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). The protocol was registered on the PROSPERO platform (CRD42021244271). All evaluation steps were conducted by two independent researchers, in case of disagreement, a third evaluator was consulted. Results: 6,357 articles were identified, of which 1,310 articles were excluded due to duplication. Of the 5,047 remaining articles that went on to analyze titles and abstracts, only 7 went on to full-text analysis and of these only 3 (González-Saiz et al., 2017, Kahraman et al., 2020 and Nakazato et al., 2021) articles were included for analysis, assessment of risk of bias and quality of evidence. Four psychometric properties were evaluated: 2 assessed validity between groups, one assessed responsiveness and one assessed reliability. Of these, 3 psychometric properties obtained moderate quality of evidence: responsiveness of the 5-STS (7.5±1.4 to 6.0±1.1 (p<0.001)), the convergent validity of the 30-STS (30-STS vs 6MWT r=0.660; p<0.001) and 1-STS (1-STS vs Accelerometer r=0.593; p=0.006). One study had a low quality of evidence on the validity between groups of 30-STS (30-STS and NYHA Class II 13.68(3.34) vs 30-STS and NYHA Class III 10.25 (3.49); p= 0.004) and another very low on 30-STS reliability (ICC 0.95(0.90–0.97). Conclusion: We conclude that there is a scarcity of studies on STS protocols in PH and, given the findings, we can infer that 5-STS was considered responsive and that the 30-STS and 1-STS protocols showed valid convergent validity in PH. The validity between the groups and the reliability of the methods were reliable. Despite the few studies using do STS methodologies, it seems that the protocols are relevant for this population. Thus, we suggest that more studies with greater size and with methodological rigor are sampled for the indication and interpretation of the use of TS in the population with PH.