Predictors of increasing disability in activities of daily living among people with advanced respiratory disease: a multi-site prospective cohort study, England UK.

Attrition was high: 40% of participants withdrew or were lost to follow-up, largely due to death or illness. This means the results may not apply to the most severely affected patients. The study was conducted during the first year of the Covid-19 pandemic. Nearly all participants were physically and socially isolating, and 63% reported reduced physical activity. This context may have influenced the disability trajectories and the relationship between isolation and function. Data collection relied on self-reported postal surveys, which are subject to recall bias and may not capture acute fluctuations in condition. The analysis of trajectories was descriptive rather than quantifiable, and healthy patient bias in the retained sample may underestimate the impact of certain factors on disability.

The study was supported by non-U.S. government funding. The funder had no role in the study design, data collection, analysis, interpretation, or writing of the report.

Do not assume that mobility limitation predicts a decline in all daily activities. The study found it predicted worsening in instrumental tasks (like shopping and cooking) but did not predict decline in basic self-care tasks (like washing and dressing). Additionally, the high dropout rate means these findings may not apply to patients with the most severe disease or those closest to end of life.