To administer the C-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 physical activity of the participant should be objectively assessed with an activity monitor during seven consecutive days. The PROactive instrument will use two outputs derived from this assessment: the number of daily steps (steps/day) and the vector magnitude units per minute (VMU/min).
Two activity monitors have already been validated to be used as part of the PROactive hybrid instruments1: 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 person with COPD will be provided with the activity monitor the day before the first measurement day. The person should be instructed on the following:
- To wear the activity monitor continuously throughout the day and, if possible, also during the night. It is important 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 monitor overnight.
- To wear the monitor 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 required2. These three days should happen on the same week of assessment, but they do not need to be consecutive, and could cover either weekdays or weekend days.
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.
A booklet can be provided to the patients to record any abnormalities during the wearing as well as usual bed-time and wake up. For a single study all patients should either wear the monitor for 24h or wear the monitor from waking up to bed-time in the evening. If the monitor is worn for 24h the analysis needs to be caried out on data obtained from 7:00 am to 22:00 pm  in order to have correct readings of VMU.
2. Administering the C-PPAC questionnaire
The person will be asked to fill the C-PPAC questionnaire at the end of the 7-day objective measurement period. The questionnaire can be filled through an electronic-handheld device, a web-based system, or using paper and pen.
Study personnel should be trained on the following procedures to introduce individuals to the C-PPAC questionnaire:
- To sit down with the patient at the beginning of the study and show them an example of the C-PPAC diary in the mode or device on which it is to be administered.
- To remind participants that there are no right or wrong answers and there is no time limit to complete the questionnaire.
- To instruct participants to reflect on their past seven days and answer the questions based on how they felt generally over these past seven days, the period they were wearing the activity monitor.
- To remind participants that all items are to be answered (this is particularly important for the paper-pen format).
- If a participant is unsure how to answer an item, to instruct them to select the answer that best describes how they feel.
If a paper C-PPAC is used, it should be checked for completeness by the research staff at the time of administration, and omissions should be pointed out and corrected by the participant.
It is important to highlight that the paper-pencil diaries may have some potential limitations, including the inability to: (i) determine respondent compliance with data entry, the inability to (ii) track respondent entries and/or compliance in real time, (iii) the inability to prevent skipped items or responses, or (iv) as well as the inability to prevent marking more than one response for the same question. Thus, it is advised to check data quality upon receipt of the questionnaire completed by the participant.
Note: Based on data from the initial validation study, most patients with a range of COPD severities are able to complete the C-PPAC electronically in 3-7 minutes.
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References
- 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.
- Demeyer H, Mohan D, Burtin C, Vaes AW, Heasley M, Bowler MERP, et al. Objectively Measured Physical Activity in Patients with COPD : Recommendations from an International Task Force on Physical Activity. J COPD Found. 2021;8(4):528–50.