Glittre-ADL test to assess functional capacity in patients with heart failure and reduced ejection fraction: Reproducibility, minimal detectable change, and cutoff point

Abstract

Background: Cardiopulmonary exercise testing (CPET) is the gold standard for functional capacity assessment, although it is costly and not easily accessible. The Glittre-ADL test may be a low-cost alternative for patients with heart failure.

Objective: To establish a cutoff point for functional capacity of patients with heart failure using the Glittre-ADL test. We also assessed agreement, reliability, and minimal detectable change.

Methods: This cross-sectional study was conducted with 78 patients (aged 21 to 65 years) with heart failure and reduced ejection fraction (functional classes II and III of the New York Heart Association). Test-retest reliability was measured using the intraclass correlation coefficient (ICC), while receiver operating characteristic (ROC) curves were used to determine whether ADL-time, could distinguish between patients with peak oxygen consumption (VO_2peak) < 16 versus those ≥ 16 ml/kg/min.

Results: A cutoff point of 255 s (76 % sensitivity [95 % CI 58, 89] and 72 % specificity [95 % CI 56, 85]) was established based on the total time spent on Glittre-ADL test; the area under the curve was 0.773 (95 % CI 0.663, 0.861; p < 0.0001). Regarding agreement, a significant correlation was found between test and retest (r = 0.83, r² = 0.69, p < 0.001). Intraclass correlation coefficient, absolute reliability, and minimal detectable change were 0.84 (95 % CI 0.45, 0.94; p < 0.001), 3.2 %, and 8.8 % (23.1 s), respectively.

Conclusion: Glittre-ADL test showed good reproducibility in repeated tests. Thus, the cutoff point established by our study can be used in clinical practice instead of CPET to identify patients with severe heart failure.

Keywords: Cardiac insufficiency; Exercise tolerance; Heart function tests; Sensitivity and specificity; Submaximal exercise.