Administering the D-PPAC

To administer the D-PPAC, it is important to consider both the objective assessment of physical activity via an activity monitor and the participant-reported questionnaire. Below you will find some useful information on how to administer both:

  1. Administering the activity monitor

The PROactive instrument make use of two outputs form the activity monitors: number of daily steps (steps/day) and vector magnitude units per minute (VMU/min).

Two activity monitors have been validated for use as part of the PROactive hybrid instruments: the Actigraph G3Tx (Actigraph, Pensacola, FL, United States) and the Dynaport MoveMonitor (McRoberts BV, The Hague, The Netherlands). Either one of them can be used, but they both require a specific factor conversion, in order to produce results that are comparable. Other activity monitors may be used in the future, once they have undergone a well-defined validation procedure

The physical activity of the participant should be ojectively assessed with an activity monitor during seven consecutive days. The activity monitor measurement days used should be concurrent with the questionnaire. They must be included within the period of recall covered by the questionnaire.

The person with COPD will be provided with an activity monitor the day before the first measurement day. The person should be instructed on the following:

  • To wear the activity monitors continuously throughout the day and, if possible, also during the night. We want to measure all of their physical activity. 
  • To behave like they are not wearing the device. 
  • To only take off the monitor when they take a bath/shower or when they go for a swim. 
  • Depending on the activity monitor and the battery duration, to charge the activity monitors overnight.
  • To wear the monitors when experiencing exacerbations and when resting outside of their regular ‘sleeping’ hours.

To obtain valid measurements from the activity monitor, at least three days with ≥8 hours of wearing time are required1. These three days should be in the same week, do not need to be consecutive, and could cover weekdays or weekend days without distinction.

Note: While we only use two outcomes from the activity monitors (daily steps and VMUs per minute) to calculate the experienced amount of physical activity assessed by the PROactive score; these monitors provide much richer information on the amount of physical activity that can be used to inform about the physical activity performed by people with COPD..

2. Administering D-PPAC questionnaire

Individuals will be provided with a diary including the daily questionnaires. They should be instructed to complete the diary each evening just prior to bedtime, reflecting back on their experiences of ‘today’. 

This questionnaire is designed for an electronic administration. An electronic diary with all daily questionnaires will be provided to the participant together with the activity monitor. 

Study personnel should be trained on the following procedures to introduce individuals to the D-PPAC questionnaire:

  • To sit down with the patient at the beginning of the study and show them an example of the D-PPAC diary in the mode or device on which it is to be administered.
  • To remind patients that there are no right or wrong answers and there is no time limit.
  • To inform the patient that the questionnaire is to be completed every evening, just before going to bed.
  • To instruct patients to reflect on their day and answer the questions based on how they felt generally over the day.
  • To highlight for patients that the D-PPAC has 9 items (7 questions and 2 outputs from the activity monitor). 
  • All items are to be answered daily for the study period as specified in the study protocol.
  • If a patient is unsure how to answer an item, to instruct the patient to select the answer that best describes how they feel.

Note: Regardless of the language tested, it is expected that the D-PPAC questionnaire can be completed in less than 5min.

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References

  1. Rabinovich RA, Louvaris Z, Raste Y, Langer D, Van Remoortel H, Giavedoni S, et al. Validity of physical activity monitors during daily life in patients with COPD. Eur Respir J. 2013;42(5):1205–15. 
  2. Demeyer, H. et al. Objectively Measured Physical Activity in Patients with COPD : Recommendations from an International Task Force on Physical Activity. J. COPD Found. 8, 528–550 (2021)
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