Elaboration of a French version of the Duke Activity Status Index questionnaire and performance to predict functional capacity

Background: Guidelines recommend detecting poor functional capacity (VO_2max < 14 ml.kg^-1.min^-1) to assess preoperative cardiac risk. This screening is performed via a cardiopulmonary exercise test (CPET), the self-reported inability to climb two flights of stairs, or the use of the Duke Activity Status Index (DASI) questionnaire, which has shown a significant correlation with VO_2max and postoperative outcomes. The objectives of the present study were: 1) to create a French version of the DASI questionnaire (FDASI); 2) to assess its diagnostic performance in predicting functional capacity.

Methods: Consecutive adult patients undergoing CPET for medical or preoperative evaluation were prospectively included between May 2020 and March 2021. All patients were asked to complete FDASI as a self-questionnaire and report their inability to climb two flights of stairs.

Results: 122 patients were included. Test-retest reliability was 0.88 and 23 (19%) patients experienced a VO_2max < 14 ml.kg^-1.min^-1. There was a significant positive relationship between FDASI and VO_2max: r² = 0.32; p < 0.001. ROC_AUC was 0.81 [95%CI: 0.73-0.89]. The best FDASI score threshold was 36 points, leading to sensitivity and specificity values of 87% [74-100] and 68% [56-79], respectively. Besides, sensitivity and specificity were 35% [17-56] and 92% [86-97] for the self-reported inability to climb two flights of stairs.

Conclusion: A FDASI score of 36 represents a reliable threshold the clinicians could routinely use to identify patients with a VO_2max < 14 ml.kg^-1.min^-1. FDASI could advantageously replace the self-reported inability to climb two flights of stairs.