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He W, Wang J, Feng Z, Li J, Xie Y. Effects of exercise-based pulmonary rehabilitation on severe/very severe COPD: a systematic review and meta-analysis. Ther Adv Respir Dis 2023; 17:17534666231162250. [PMID: 36946384 PMCID: PMC10037727 DOI: 10.1177/17534666231162250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Pulmonary rehabilitation (PR) has been considered to be an effective treatment method for various respiratory diseases. However, the effects of exercise-based PR on patients with severe/very severe chronic obstructive pulmonary disease (COPD) are unclear. This review aimed to investigate the effects of exercise-based PR on patients with severe/very severe COPD. METHODS PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched from inception to December 23, 2022, without language restrictions. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on patients with severe/very severe COPD were included. Study selection, data extraction, and risk of bias assessment were conducted independently. RevMan software (version 5.3) was used for meta-analysis. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS Six studies (263 patients) were identified. Compared with the control group, the 6-min walking distance [MD = 52.91, 95% CI (3.80, 102.03)], the St. George's Respiratory Questionnaire total scores [MD = -7.70, 95% CI (-14.32, -1.08)] and the Borg scale scores [MD = -0.68, 95% CI (-1.28, -0.08)] in the experimental group improved, respectively. The St. George's Respiratory Questionnaire and Borg scale scores were rated as 'moderate quality' and 'low quality', respectively, and the 6-min walking distance was rated as 'very low quality'. CONCLUSIONS Exercise-based PR may improve the exercise capacity, quality of life and dyspnea of patients with severe/very severe COPD, which can be regarded as an adjuvant treatment. High quality and large sample RCTs are needed. REGISTRATION This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No. CRD42022294085).
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Affiliation(s)
- Wenqing He
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Jiajia Wang
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Zhenzhen Feng
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Jiansheng Li
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Yang Xie
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Jinshui District, Zhengzhou, Henan 450046, People's Republic of China
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
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Shimoda M, Takao S, Kokutou H, Yoshida N, Fujiwara K, Furuuchi K, Osawa T, Nakamoto K, Tanaka Y, Morimoto K, Yano R, Okumura M, Uchiyama T, Yoshimori K, Ohta K, Senjyu H. In-hospital pulmonary rehabilitation after completion of primary respiratory disease treatment improves physical activity and ADL performance: A prospective intervention study. Medicine (Baltimore) 2021; 100:e28151. [PMID: 34889282 PMCID: PMC8663887 DOI: 10.1097/md.0000000000028151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/18/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pulmonary rehabilitation improves the physical condition of patients with chronic respiratory disease; however, there are patients who cannot leave the hospital because of their low activities of daily living (ADLs), despite the completion of primary respiratory disease treatment and rehabilitation during treatment. Therefore, this study demonstrated that those patients recovered their ADLs through in-hospital pulmonary rehabilitation after treatment completion. METHODS We prospectively studied 24 hospitalized patients who had some remaining symptoms and showed low ADL scores of 9 points or less on the short physical performance battery after undergoing treatment for respiratory disease in Fukujuji Hospital from October 2018 to October 2019, excluding 2 patients who had re-exacerbation and 1 patient who could not be examined using the incremental shuttle walk test (ISWT). After completion of the primary respiratory disease treatment, patients moved to the regional comprehensive care ward, and they received pulmonary rehabilitation for 2 weeks. In the ward, patients who could not yet leave the hospital could undergo pulmonary rehabilitation for up to 60 days. Data were evaluated three times: upon treatment completion (baseline), postrehabilitation, and 3 months after baseline. The main outcome was an improvement in the incremental shuttle walk test (ISWT) postrehabilitation. RESULTS The median age of the patients was 80 (interquartile range (IQR): 74.8-84.5), and 14 patients (58.3%) were male. The ISWT distance significantly increased postrehabilitation (median [IQR]: 60 m [18-133] vs 120 m [68-203], P < .001). The Barthel Index (BI) (P < .001), the modified Medical Research Council (P < .001), and other scale scores were also improved. Among patients with acute respiratory diseases such as pneumonia, chronic obstructive pulmonary disease, and interstitial pneumonia, ISWT and other data showed improvement at the postrehabilitation timepoint. Ten patients who could perform examinations at 3 months after baseline were evaluated 3 months after taking baseline data prior to starting rehabilitation. The ISWT showed significant improvement 3 months after baseline compared to baseline (P = .024), and the ISWT distance was maintained after rehabilitation. DISCUSSION AND CONCLUSIONS Physical activity, symptoms, mental health, and ADL status in patients who had not recovered after primary treatment completion for respiratory diseases could improve through in-hospital pulmonary rehabilitation.
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Affiliation(s)
- Masafumi Shimoda
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Satoshi Takao
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Hiroyuki Kokutou
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Naoyuki Yoshida
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Keiji Fujiwara
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Koji Furuuchi
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Takeshi Osawa
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Keitaro Nakamoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Ryozo Yano
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Masao Okumura
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Takashi Uchiyama
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Kozo Yoshimori
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Hideaki Senjyu
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
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Vitacca M, Comini L, Giardini A, Olivares A, Corica G, Paneroni M. Patients recovering from exacerbations of COPD with and without hospitalization need: could ICF score be an additional pulmonary rehabilitation outcome? Ann Med 2021; 53:470-477. [PMID: 33749452 PMCID: PMC7993391 DOI: 10.1080/07853890.2021.1900592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare disability changes measured with the Respiratory ICF Maugeri core set on COPD patients, recovering from acute exacerbation with and without hospitalization, submitted to pulmonary rehabilitation (PR). MATERIALS AND METHODS All COPD inpatients admitted for rehabilitation in 9 Respiratory Units (January-August 2019) were considered eligible. 2066 patients were included (540 discharged from an acute Hospital = Hospital group and 1526 coming from their home = Home group). Healthcare professionals filled, in a digitalized chart, the Respiratory ICF Maugeri core set (26 items), assessing ICF categories at admission and discharge. RESULTS The baseline distribution of the more severe ICF qualifiers was higher in the Hospital group (p < .001) when compared to the Home group. After rehabilitation, all patients -irrespective of hospitalization need- statistically decreased the rate of the higher ICF qualifiers (p < .0001). Hospital group improved more both the rate of qualifiers ≥2 [Δ: -21.32 (22.41) vs -15.48 (17.32), p < .001] and the rate of qualifiers 0-1 [Δ: + 18.38 (24.67) vs 13.25 (19.13), p < .001] than Home group. CONCLUSIONS Disability measured with the "Respiratory ICF Maugeri core set" after PR improves in COPD patients recovering from acute exacerbation irrespective of hospitalization need. Its use an additional outcome remains to be further elucidated.KEY MESSAGESRoutine implementation of an ICF set for chronic respiratory diseases can enhance a patient-centered approach in rehabilitation for different severity conditions.Pulmonary rehabilitation (PR) seems to improve global disability measured with the Respiratory ICF Maugeri core set in COPD patients recovering from acute exacerbation irrespective of hospitalization need, suggesting the use of ICF set as additional PR outcome.The description, through the ICF language, of rehabilitative needs of patients, coming "from-Home" and "from-Hospital" settings, could help staff and instrument organization.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, IT Department, Pavia, Italy
| | - Adriana Olivares
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Giacomo Corica
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate of the Institute of Lumezzane, Brescia, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
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Vitacca M, Ambrosino N, Belli S, Vigna M, Zampogna E, Aliani M, Piaggi G, Paneroni M. The severity of acute exacerbations of COPD and the effectiveness of pulmonary rehabilitation. Respir Med 2021; 184:106465. [PMID: 34023740 DOI: 10.1016/j.rmed.2021.106465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Pulmonary rehabilitation is effective also in patients recovering from acute exacerbations of COPD (AECOPD). We aimed to evaluate whether levels of dyspnoea affect the outcome of pulmonary rehabilitation in patients recovering from AECOPD requiring different levels of care. MATERIALS AND METHODS Retrospective data analysis of 1057 patients recovering from AECOPD requiring either hospital (Hospital group: 291) or home management (Home group: 766), undergone post AECOPD in-patient pulmonary rehabilitation. The 6-min walking distance (6MWD) test was the primary outcome, stratified by the Barthel index Dyspnoea (Bid). Data of modified Medical Research Council scale, Short Physical Performance Battery, COPD Assessment Test were also analysed, when available. RESULTS In overall population 6MWD improved significantly from 278 (129) to 335 (139) meters (p < 0.001). As compared to Home, 6MWD improved more in Hospital group [by 81.9 (79.6) vs 48.9 (94.4) meters respectively, p < 0.001] also when stratified by Bid levels (all: p < 0.01). In Hospital group, 6MWD improved significantly more in patients with Bid level 3 than levels 4 and 5 (p < 0.05). Hospital group showed a greater proportion of patients reaching the Minimal Clinically Important Difference for 6MWD (75.9 vs 56.7% in Hospital and Home group respectively p < 0.001). All other available outcome measures significantly (p < 0.01) improved independent of the Bid levels. There was no significant correlation between baseline severity of airflow obstruction and effect of the program. CONCLUSIONS In-patient pulmonary rehabilitation results in clinically meaningful improvement in patients recovering from AECOPD, independent of severity of dyspnoea. However, the levels of dyspnoea severity and the care required by AECOPD influenced the magnitude of success.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Italy
| | - Stefano Belli
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Veruno, Italy
| | - Matteo Vigna
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Pavia, Italy
| | - Elisabetta Zampogna
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Italy
| | - Maria Aliani
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Bari, Italy
| | - Giancarlo Piaggi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
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Liao LY, Chen KM, Hsu HF. Cardiopulmonary Endurance of Hospitalized Older Adults With Chronic Obstructive Pulmonary Disease. Nurs Res 2020; 69:E27-E36. [PMID: 32132378 DOI: 10.1097/nnr.0000000000000429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) could lead to poor cardiopulmonary endurance, which affects quality of life and increases the risk of rehospitalization or mortality. However, studies investigating associated factors of cardiopulmonary endurance for COPD inpatients are scant. OBJECTIVE The aim of the study was to investigate whether and how age, gender, COPD severity, body composition, dyspnea, respiratory muscle strength, and lower limb muscle strength and endurance were related to cardiopulmonary endurance in elderly inpatients with COPD. METHODS This was a cross-sectional study using a systematic sampling of older inpatients. Data of demographic characteristics such as age, gender, and disease severity were collected, and body mass index was calculated. Degrees of dyspnea were assessed by the modified Medical Research Council Dyspnea Scale. Respiratory muscle strength was reflected by the maximal inspiratory pressure and the maximal expiratory pressure. Lower limb muscle strength and endurance were assessed by a handheld dynamometer and a 30-second sit-to-stand test, respectively. Finally, cardiopulmonary endurance was assessed by a 6-minute walk test. RESULTS A total of 83 older COPD inpatients participated. The mean age was 74.01 ± 6.93 years. Cardiopulmonary endurance was associated with age, COPD severity, dyspnea, respiratory muscle strength, lower limb muscle strength, and endurance. Predictors of cardiopulmonary endurance were disease severity, dyspnea, and lower limb muscle endurance. These predictors explained 53% of the variance in cardiopulmonary endurance in older inpatients with COPD. DISCUSSION Cardiopulmonary endurance of hospitalized older adults with COPD should be strengthened by improving conditions of disease severity, dyspnea, and lower limb muscle endurance.
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Affiliation(s)
- Lin-Yu Liao
- Lin-Yu Liao, PhD, RN, is Head Nurse, Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan. Kuei-Min Chen, PhD, RN, FAAN, is Professor, Kaohsiung Medical University College of Nursing, and Kaohsiung Medical University Hospital Department of Medical Research, Taiwan. Hui-Fen Hsu, PhD, is Postdoctoral Fellow, Kaohsiung Medical University Center for Long-Term Care Research, Taiwan
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Elliott-Button HL, Johnson MJ, Nwulu U, Clark J. Identification and Assessment of Breathlessness in Clinical Practice: A Systematic Review and Narrative Synthesis. J Pain Symptom Manage 2020; 59:724-733.e19. [PMID: 31655187 DOI: 10.1016/j.jpainsymman.2019.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 01/09/2023]
Abstract
CONTEXT Breathlessness is common in chronic conditions but often goes unidentified by clinicians. It is important to understand how identification and assessment of breathlessness occurs across health care settings, to promote routine outcome assessment and access to treatment. OBJECTIVE The objective of this study was to summarize how breathlessness is identified and assessed in adults with chronic conditions across different health care settings. METHODS This is a systematic review and descriptive narrative synthesis (PROSPERO registration: CRD42018089782). Searches were conducted on Medline, PsycINFO, Cochrane Library, Embase, and CINAHL (2000-2018) and reference lists. Screening was conducted by two independent reviewers, with access to a third, against inclusion criteria. Data were extracted using a bespoke proforma. RESULTS Ninety-seven studies were included, conducted in primary care (n = 9), secondary care (n = 53), and specialist palliative care (n = 35). Twenty-five measures of identification and 41 measures of assessment of breathlessness were used. Primary and secondary care used a range of measures to assess breathlessness severity, cause, and impact for people with chronic obstructive pulmonary disease. Specialist palliative care used measures assessing broader symptom severity and function with less focus on overall quality of life. Few studies were identified from primary care. CONCLUSION Various measures were identified, reflective of the setting's purpose. However, this highlights missed opportunities for breathlessness management across settings; primary care is particularly well placed to diagnose and support breathlessness. The chronic obstructive pulmonary disease approach (where symptoms and quality of life are part of disease management) could apply to other conditions. Better documentation of holistic patient-reported measures may drive service improvement in specialist palliative care.
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Affiliation(s)
- Helene L Elliott-Button
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Ugochinyere Nwulu
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Joseph Clark
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Kjærgaard JL, Juhl CB, Lange P, Wilcke JT. Early pulmonary rehabilitation after acute exacerbation of COPD: a randomised controlled trial. ERJ Open Res 2020; 6:00173-2019. [PMID: 32083113 PMCID: PMC7024764 DOI: 10.1183/23120541.00173-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to establish whether early pulmonary rehabilitation after severe exacerbation of chronic obstructive pulmonary disease (COPD) reduces mortality and hospital admissions, and increases physical performance and quality of life compared to rehabilitation initiated later in the stable phase of COPD. Methods In a randomised controlled trial of 150 patients hospitalised with an exacerbation of COPD, participants were allocated to pulmonary rehabilitation either within 2 weeks after discharge or the same rehabilitation programme but initiated 2 months after discharge. Results Early pulmonary rehabilitation did not prolong time to first hospital admission or time to death (hazard ratio 0.79, 95% CI 0.47–1.23, p=0.33) compared to rehabilitation in stable phase. However, 2 months after inclusion, pulmonary rehabilitation resulted in a significantly better improvement in the incremental shuttle walk test (33.9 m, 95% CI 4.18–63.7, p=0.02) compared to that in the stable phase. The difference in the endurance shuttle walk test was of borderline significance (140 s, 95% CI −2.03–282.76, p=0.05), but there was no significant difference concerning the COPD assessment test (−1.43 points, 95% CI −3.44–0.59, p=0.17). Conclusion Early pulmonary rehabilitation after acute exacerbation of COPD led to a faster improvement in physical performance compared to rehabilitation initiated later in the stable phase, but did not improve survival or prolong time to hospital readmission. Early pulmonary rehabilitation shortly after #AECOPD leads to a faster recovery in physical performance than initiated in the stable phase. Adherence to rehabilitation is significantly higher when initiated shortly after an exacerbation.http://bit.ly/2S7XsT9
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Affiliation(s)
- Jakob L Kjærgaard
- Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Carsten B Juhl
- Dept of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Dept of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Peter Lange
- Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jon T Wilcke
- Dept of Internal Medicine, Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
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Costi S, Crisafulli E, Trianni L, Beghè B, Faverzani S, Scopelliti G, Chetta A, Clini E. Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients. Int J Chron Obstruct Pulmon Dis 2019; 14:3017-3023. [PMID: 31920298 PMCID: PMC6938185 DOI: 10.2147/copd.s223038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results Compared to the category of individuals with 6MWD >350 meters, those patients with 201-350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.
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Affiliation(s)
- Stefania Costi
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplants Oncology and Regenerative Medicine-University of Modena and Reggio Emilia and Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Ludovico Trianni
- Rehabilitation Unit-Hospital Villa Pineta, Pavullo Nel Frignano, Modena, Italy
| | - Bianca Beghè
- Department of Medical and Surgical Sciences-University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Silvia Faverzani
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Giuseppe Scopelliti
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enrico Clini
- Department of Medical and Surgical Sciences-University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
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Buscemi A, Pennisi V, Rapisarda A, Pennisi A, Coco M. Efficacy of osteopathic treatment in patients with stable moderate-to-severe chronic obstructive pulmonary disease: a randomized controlled pilot study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2018-0128/jcim-2018-0128.xml. [PMID: 31442204 DOI: 10.1515/jcim-2018-0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 04/02/2019] [Indexed: 11/15/2022]
Abstract
Background This randomized controlled pilot study evaluated the efficacy of osteopathic treatment in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) assessed using spirometry, COPD Assessment Test (CAT) and six minutes walking test (6MWT). The main goals were to improve the quality of life of patients with stable moderate-to-severe COPD, and to revise the parameters of the assessment tests, such as spirometry and 6MWT. Methods The study comprised several phases and patients were divided into two groups: group A (controls) received conventional pharmacological treatment with Indacaterol-Glycopyrronium and, while group B (OMT group) received both traditional therapy and osteopathic manipulative treatment (OMT) at different stages of the study. The osteopathic approach focused on maxillary sinus, vertebral-pleural ligaments, phrenic nerves, ribs, pleura, lungs, bronchi, subclavian muscles, and trapezoid and conoid ligaments. Results Overall, 32 patients were randomized and treated. Patients of the OMT group got better improvements in all tests compared to the control group: spirometry: FVC (p<0.5411), total FEV1 (p<0.5061); CAT: OMT (p<0.0005) - controls (p<0.188) 6MWT OMT (p<0.0038) - controls (p<0.5326). The clinical results collected in phase (T3) confirm those obtained in the first sessions; the results of CAT questionnaire (p<0.0005) and 6MWT (p<O, OO38) highlighted score improvements of patients treated with osteopathy compared to patients in the other group. Conclusions The results showed that the patients with COPD who received the conventional pharmacological treatment in association with the OMT therapy demonstrated a good response to the osteopathic treatment, thus leading to significant improvements in their health and wellbeing, and a better daily functioning.
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Affiliation(s)
- Andrea Buscemi
- Study Center of Italian Osteopathy, Catania, Italy
- Horus Social Cooperative, Ragusa, Italy
| | | | | | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences and Research Center on Motor Activities (CRAM), University of Catnia, 95124 Catania CT, Italy
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10
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Cox M, O'Connor C, Biggs K, Hind D, Bortolami O, Franklin M, Collins B, Walters S, Wailoo A, Channell J, Albert P, Freeman U, Bourke S, Steiner M, Miles J, O'Brien T, McWilliams D, Schofield T, O'Reilly J, Hughes R. The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation. Health Technol Assess 2019. [PMID: 29516853 DOI: 10.3310/hta22110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge. OBJECTIVE To assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care. DESIGN Parallel-group, pilot 2 × 2 factorial randomised trial with nested qualitative research and an economic analysis. SETTING Two acute hospital NHS trusts. Recruitment was carried out from September 2015 to April 2016 and follow-up was completed in July 2016. PARTICIPANTS Eligible patients were those aged ≥ 35 years who were admitted with AECOPD, who were non-acidotic and who maintained their blood oxygen saturation level (SpO2) within a prescribed range. Exclusions included the presence of comorbidities that affected the ability to undertake the interventions. INTERVENTIONS (1) Hospital EPR: muscle training delivered at the patient's hospital bed using a cycle ergometer and (2) home EPR: a pulmonary rehabilitation programme delivered in the patient's home. Both interventions were delivered by trained physiotherapists. Participants were allocated on a 1 : 1 : 1 : 1 ratio to (1) hospital EPR (n = 14), (2) home EPR (n = 15), (3) hospital EPR and home EPR (n = 14) and (4) control (n = 15). Outcome assessors were blind to treatment allocation; it was not possible to blind patients. MAIN OUTCOME MEASURES Feasibility of recruiting 76 participants in 7 months at two centres; intervention delivery; views on intervention/research acceptability; clinical outcomes including the 6-minute walk distance (6WMD); and costs. Semistructured interviews with participants (n = 27) and research health professionals (n = 11), optimisation assessments and an economic analysis were also undertaken. RESULTS Over 7 months 449 patients were screened, of whom most were not eligible for the trial or felt too ill/declined entry. In total, 58 participants (76%) of the target 76 participants were recruited to the trial. The primary clinical outcome (6MWD) was difficult to collect (hospital EPR, n = 5; home EPR, n = 6; hospital EPR and home EPR, n = 5; control, n = 5). Hospital EPR was difficult to deliver over 5 days because of patient discharge/staff availability, with 34.1% of the scheduled sessions delivered compared with 78.3% of the home EPR sessions. Serious adverse events were experienced by 26 participants (45%), none of which was related to the interventions. Interviewed participants generally found both interventions to be acceptable. Home EPR had a higher rate of acceptability, mainly because patients felt too unwell when in hospital to undergo hospital EPR. Physiotherapists generally found the interventions to be acceptable and valued them but found delivery difficult because of staffing issues. The health economic analysis results suggest that there would be value in conducting a larger trial to assess the cost-effectiveness of the hospital EPR and hospital EPR plus home EPR trial arms and collect more information to inform the hospital cost and quality-adjusted life-year parameters, which were shown to be key drivers of the model. CONCLUSIONS A full-scale randomised controlled trial using this protocol would not be feasible. Recruitment and delivery of the hospital EPR intervention was difficult. The data obtained can be used to design a full-scale trial of home EPR. Because of the small sample and large confidence intervals, this study should not be used to inform clinical practice. TRIAL REGISTRATION Current Controlled Trials ISRCTN18634494. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matthew Cox
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Katie Biggs
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Oscar Bortolami
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew Franklin
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Stephen Walters
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Allan Wailoo
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julie Channell
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Paul Albert
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Ursula Freeman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stephen Bourke
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Jon Miles
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - Tom O'Brien
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David McWilliams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Terry Schofield
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John O'Reilly
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Rodney Hughes
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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11
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Maestri R, Bruschi C, Fracchia C, Pinna GD, Fanfulla F, Ambrosino N. Physiological and clinical characteristics of patients with COPD admitted to an inpatient pulmonary rehabilitation program: A real-life study. Pulmonology 2019; 25:71-78. [DOI: 10.1016/j.pulmoe.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/24/2018] [Accepted: 07/01/2018] [Indexed: 11/16/2022] Open
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12
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Crisafulli E, Barbeta E, Ielpo A, Torres A. Management of severe acute exacerbations of COPD: an updated narrative review. Multidiscip Respir Med 2018; 13:36. [PMID: 30302247 PMCID: PMC6167788 DOI: 10.1186/s40248-018-0149-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.
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Affiliation(s)
- Ernesto Crisafulli
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enric Barbeta
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonella Ielpo
- 1Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- 2Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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13
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Gayan-Ramirez G. Relevance of nutritional support and early rehabilitation in hospitalized patients with COPD. J Thorac Dis 2018; 10:S1400-S1414. [PMID: 29928522 DOI: 10.21037/jtd.2018.03.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exacerbation of COPD is associated with a worsening of lung function and symptoms, and a serious loss in functional status and health related quality of life. It also represents the major cause for emergency hospitalization in COPD patients which places the patient at risk for developing further muscle weakness. Actually, loss of muscle function developed fast and continued to decrease over time during hospitalization and may be further compromised when disease deterioration would require the use of ventilator support. Exacerbations have long term consequences on physical performance, physical activity and health-related quality of life as recovery of skeletal muscle function is slow and incomplete and may even be compromised in case of re-exacerbation. Factors such as bed rest, reduced physical activity, hypoxia, inflammation, drug treatment and negative protein balance due to insufficient dietary intake and increased resting energy expenditure are all potential contributors to skeletal muscle weakness during exacerbation. Because low levels of physical activity and poor physical performance are predictor of hospital re-admission and are associated with lower survival in these patients, interventions to prevent the additional loss of muscle function during exacerbation or to hasten functional recovery have been recently explored. This review focuses on the knowledge regarding the potential benefit of early rehabilitation and nutritional supplementation as modifiable factors susceptible to ameliorate muscle weakness during exacerbation in hospitalized COPD patients.
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Affiliation(s)
- Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
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14
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Variability in Quality of Life Outcomes Following a Pulmonary Rehabilitation Program in Patients With COPD. J Cardiopulm Rehabil Prev 2018; 38:118-123. [DOI: 10.1097/hcr.0000000000000292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Oliveira AL, Marques AS. Outcome Measures Used in Pulmonary Rehabilitation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review. Phys Ther 2018; 98:191-204. [PMID: 29228288 DOI: 10.1093/ptj/pzx122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Conflicting results about the effects of community-based pulmonary rehabilitation in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exist, possibly because the variety of outcome measures used and the lack of appropriate measurement properties hinder the development of pulmonary rehabilitation guidelines. PURPOSE The purpose of this study was to identify and review the measurement properties of patient-reported outcome measures (PROMs) and clinical outcome measures of AECOPD that are used in pulmonary rehabilitation and that can be easily applied in a community setting. DATA SOURCES PubMed, Web of Science, Scopus, and CINAHL were searched up to July 1, 2016. STUDY SELECTION Phase 1 identified outcome measures used in pulmonary rehabilitation for AECOPD. Phase 2 reviewed the measurement properties of the identified outcome measures. DATA EXTRACTION One reviewer extracted the data and 2 reviewers independently assessed the methodological quality of the studies and the measurement properties of the outcome measures by using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations. DATA SYNTHESIS Twenty-three PROMs and 18 clinical outcome measures were found. The outcome measures most used were the St George Respiratory Questionnaire (n = 15/37 studies) and the 6-minute walk test (n = 21/37 studies). Thirty-two studies described the measurement properties of 22 PROMs and 7 clinical outcome measures. The methodological quality of the studies was mostly poor, and the measurement properties were mostly indeterminate. The outcome measure exhibiting more robust properties was the COPD Assessment Test. LIMITATIONS A Number of studies were not found with the validated search strategy used and were included a posteriori; the fact that 3 studies presented combined results- for patients who were stable and patients with exacerbation-affected the conclusions that can be drawn. CONCLUSIONS A Large variety of outcome measures have been used; however, studies on their measurement properties are needed to enhance the understanding of community pulmonary rehabilitation for AECOPD.
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Affiliation(s)
- Ana L Oliveira
- Faculty of Sports, University of Porto, Porto, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), and Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Alda S Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto-Campus Universitário de Santiago, Edifício 30, 3810-193 Aveiro, Portugal; and Institute for Research in Biomedicine (iBiMED), University of Aveiro
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16
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Koyama K, Sakamoto S, Isshiki T, Shimizu H, Kurosaki A, Homma S. The Activities of Daily Living after an Acute Exacerbation of Idiopathic Pulmonary Fibrosis. Intern Med 2017; 56:2837-2843. [PMID: 28943534 PMCID: PMC5709624 DOI: 10.2169/internalmedicine.7875-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective An acute exacerbation (AE) of idiopathic pulmonary disease (IPF) represents a life threatening condition. The activities of daily living (ADL) and quality of life of patients who survive an AE of IPF (AE-IPF) are often diminished. However, the association between AE-IPF and the ADL has yet to be evaluated. To evaluate the effect of AE-IPF on the ADL. Methods, Patients Patients treated for AE-IPF from 2010 to 2014 were identified. We retrospectively evaluated their ADL before and after AE-IPF using a modified Barthel index (BI) composed of 6 items. Results Twenty-eight of the 47 AE-IPF patients remained alive at 3 months after the onset of AE-IPF. The BI values of 22 survivors (79%) showed a full score (70 points) before the onset of AE-IPF. The evaluation of the BI scores at four weeks after the onset of AE-IPF revealed that the scores of 12 patients had decreased by >15 points and more than half of the survivors showed scores of <55. Logistic regression analyses showed that persistent hypeoxemia at 28 days after an AE, both at exertion (odds ratio, 24.20; 95% confidence interval, 2.42-242.31; p=0.009) and at rest (odds ratio, 21.00; 95% confidence interval, 2.05-215.18; p=0.010), was associated with a >15-point decrease in the BI score at 4 weeks after AE-IPF. Conclusion AE-IPF survivors with persistent hypoxemia showed diminished ADL after treatment.
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Affiliation(s)
- Kazuya Koyama
- Division of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | - Susumu Sakamoto
- Division of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | - Takuma Isshiki
- Division of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | - Hiroshige Shimizu
- Division of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University Omori Medical Center, Japan
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17
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Bellocq A, Stelianides S. [Preventive measures after acute COPD exacerbations]. Rev Mal Respir 2017; 34:499-507. [PMID: 28499637 DOI: 10.1016/j.rmr.2017.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Bellocq
- UPMC université Paris 06, Sorbonne universités, 75005 Paris, France.
| | - S Stelianides
- SSR pneumologie, pôle thorax-vaisseaux, groupe hospitalier universitaire Paris Nord Val de Seine, AP-HP, 75877 Paris, France
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18
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Atsou K, Crequit P, Chouaid C, Hejblum G. Simulation-Based Estimates of the Effectiveness and Cost-Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease in France. PLoS One 2016; 11:e0156514. [PMID: 27327159 PMCID: PMC4915708 DOI: 10.1371/journal.pone.0156514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/16/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The medico-economic impact of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is poorly documented. OBJECTIVE To estimate the effectiveness and cost-effectiveness of pulmonary rehabilitation in a hypothetical cohort of COPD patients. METHODS We used a multi-state Markov model, adopting society's perspective. Simulated cohorts of French GOLD stage 2 to 4 COPD patients with and without pulmonary rehabilitation were compared in terms of life expectancy, quality-adjusted life years (QALY), disease-related costs, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses included variations of key model parameters. PRINCIPAL FINDINGS At the horizon of a COPD patient's remaining lifetime, pulmonary rehabilitation would result in mean gain of 0.8 QALY, with an over disease-related costs of 14 102 € per patient. The ICER was 17 583 €/QALY. Sensitivity analysis showed that pulmonary rehabilitation was cost-effective in every scenario (ICER <50 000 €/QALY). CONCLUSIONS These results should provide a useful basis for COPD pulmonary rehabilitation programs.
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Affiliation(s)
- Kokuvi Atsou
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités
| | - Perrine Crequit
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités
- UPMC Univ Paris 06, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Christos Chouaid
- GRC OncoTho, Paris Est, UPEC, Créteil, CHI Créteil, Service de Pneumologie, Créteil, France
- * E-mail:
| | - Gilles Hejblum
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités
- UPMC Univ Paris 06, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
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19
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Ambrosino N, Clini EM. Response to pulmonary rehabilitation: toward personalised programmes? Eur Respir J 2015; 46:1538-40. [DOI: 10.1183/13993003.01125-2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Liao LY, Chen KM, Chung WS, Chien JY. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis 2015; 10:1703-9. [PMID: 26345529 PMCID: PMC4555970 DOI: 10.2147/copd.s90673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clinical trials identifier NCT02329873 Background Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. Objective To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. Methods A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10–30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. Results All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05). Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth day (all P<0.05). Conclusion Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.
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Affiliation(s)
- Lin-Yu Liao
- Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, Taiwan ; College of Nursing, Kaohsiung Medical University, Sanmin District, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Sanmin District, Kaohsiung, Taiwan
| | - Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Jung-Yien Chien
- Department of Medicine, Chest Hospital, Ministry of Health and Welfare, Rende District, Tainan, Taiwan
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21
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Veterans with chronic obstructive pulmonary disease achieve clinically relevant improvements in respiratory health after pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2015; 34:420-9. [PMID: 25166259 DOI: 10.1097/hcr.0000000000000079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure respiratory health and respiratory-related (RR) health care utilization in veterans with chronic obstructive pulmonary disease referred to pulmonary rehabilitation (PR) at the Cincinnati Veterans Administration (VA) Medical Center. METHODS We reviewed the records of 430 patients referred for PR from 2008 to 2010: 78 met inclusion criteria and completed PR (PR group); 92 qualified for PR but declined participation (referral group). All PR participants completed the St. George's Respiratory Questionnaire (SGRQ), BODE index, 6-minute walk test (6MWT), UCSD Shortness of Breath Questionnaire (UCSDSOBQ), Pulmonary Disease Knowledge Test, and self-reported use of short-acting bronchodilators before and after PR. All VA health care encounters during the 12 months before and after PR (PR group) or referral (referral group) were reviewed. RESULTS Respiratory health improved after PR: SGRQ (60.6 ± 15.1, 51.1 ± 16.7), BODE (4.65 ± 1.93, 3.41 ± 1.84), 6MWT (497 ± 367 m, 572 ± 397 m), UCSDSOBQ (68.3 ± 21.1, 61.0 ± 20.9), Pulmonary Disease Knowledge Test (75.9 ± 12.4%, 85.9 ± 11.1%), short-acting bronchodilator (22.5 ± 25.3, 12.8 ± 15.6 inhalations per week) (before, after PR; P < .001 for all comparisons). The RR emergency department (ED) visits (0.71 ± 1.44, 0.44 ± 0.86; P = .04) and RR hospitalizations (0.41 ± 0.73, 0.23 ± 0.51; P = .03) (visits/patient/year; pre-PR, post-PR) decreased following PR. RR ED visits and hospitalizations were the same for the PR and referral groups prior to PR but declined post-PR (0.44 ± 0.86, 0.78 ± 1.36 ED visits/patient/year; P = .05) and (0.23 ± 0.51, 0.59 ± 1.20 hospitalizations/patient/year; P = .01). Ninety-four percent of PR participants achieved the minimal clinically important difference in at least 1 univariate scale (Modified Medical Research Council, UCSDSOBQ, SGRQ, and 6MWT); 82%, 2 scales; 59%, 3 scales; and 24%, all 4 scales. CONCLUSIONS Pulmonary rehabilitation improves respiratory health in veterans with chronic obstructive pulmonary disease and decreases RR health care utilization.
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Mukharlyamov FY, Sycheva MG, Rassulova MA. [The application of cardiorespiratory training in the framework of the comprehensive programs for the medical rehabilitation of the patients presenting with chronic obstructive pulmonary disease]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2015; 92:52-61. [PMID: 26036089 DOI: 10.17116/kurort2015252-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is concerned with the modern concepts of chronic obstructive pulmonary disease. Also, it presents the international definition of "pulmonary rehabilitation". Especially much attention is given to the physical rehabilitation as one of the main and fundamental components of medical rehabilitation of the patients presenting with chronic obstructive pulmonary disease. The up-to-date approaches to the application of fitness gymnastics for the purpose of scientific research and clinical practice are considered with special reference to the combination of cyclic, static, and dynamic loads with the use of relevant modern equipment. The data on the effectiveness and safety of these rehabilitative technologies are discussed in the context of their application for further research in the field of rehabilitative medicine. Recommendations are proposed on the implementation of these methods in the current practical work.
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Affiliation(s)
- F Yu Mukharlyamov
- GBUZ 'Moskovskij nauchno-prakticheskij tsentr meditsinskoj reabilitatsii, vosstanovitel'noj i sportivnoj meditsiny' Departamenta zdravoohranenija Moskvy, ul. Zemljanoj val, 53, Moskva, Rossijskaja Federatsija, 105120
| | - M G Sycheva
- GBUZ 'Moskovskij nauchno-prakticheskij tsentr meditsinskoj reabilitatsii, vosstanovitel'noj i sportivnoj meditsiny' Departamenta zdravoohranenija Moskvy, ul. Zemljanoj val, 53, Moskva, Rossijskaja Federatsija, 105120
| | - M A Rassulova
- GBUZ 'Moskovskij nauchno-prakticheskij tsentr meditsinskoj reabilitatsii, vosstanovitel'noj i sportivnoj meditsiny' Departamenta zdravoohranenija Moskvy, ul. Zemljanoj val, 53, Moskva, Rossijskaja Federatsija, 105120
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He M, Yu S, Wang L, Lv H, Qiu Z. Efficiency and safety of pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease. Med Sci Monit 2015; 21:806-12. [PMID: 25783889 PMCID: PMC4374486 DOI: 10.12659/msm.892769] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) is able to improve dyspnea, endurance capacity, and health-related quality of life in chronic obstructive pulmonary disease (COPD) patients, but it is rarely used in China. This study aimed to assess the effectiveness and safety of PR after exacerbation of COPD. Material/Methods Patients admitted to hospital due to an exacerbation of COPD were randomized to receive either PR or routine care (control group). The PR program was performed from the second day of admission until discharge. The pre-post changes in 6-minute walk distance (6MWD), self-reported quality of life (QOL) assessed by CAT score and CRQ-SAS score, and activity of daily life assessed by ADL-D score were determined. The perceived end-effort dyspnea (Borg scale) was measured throughout the study. Results A total of 101 patients were enrolled, of whom 7 withdrew after randomization, and 94 completed this study. There were 66 patients in the PR group and 28 in the control group. The 6MWD, resting SpO2, and exercise Borg dyspnea score were significantly improved in the PR group. In addition, the PR group had greater improvement in the total CRQ-SAS score and had a lower CAT score. Significant improvements were also found in the ADL-D and BODE index in the PR group. No adverse events were recorded during exercise. Conclusions Our study provides evidence that it is safe and feasible to apply an early PR in patients with acute exacerbation of COPD.
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Affiliation(s)
- Mei He
- Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Sue Yu
- Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Lemin Wang
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Hanjing Lv
- Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhongmin Qiu
- Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Ambrosino N, Venturelli E, de Blasio F, Paggiaro P, Pasqua F, Vitacca M, Vagheggini G, Clini EM. A prospective multicentric study of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease and different clinical phenotypes. Respiration 2015; 89:141-7. [PMID: 25634602 DOI: 10.1159/000371471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recently, it has been proposed that different clinical phenotypes can be recognized in patients with chronic obstructive disease (COPD), namely predominant airway disease or parenchymal destructive changes. OBJECTIVES The aim of this prospective multicenter study was to evaluate whether these two phenotypes may influence outcomes following a pulmonary rehabilitation program (PRP). METHODS We have prospectively evaluated 364 consecutive COPD patients (70 ± 8 years, 76.3% males) admitted to a standard hospital-based PRP in 6 Italian centers. According to their phenotype, the study cohort was divided into two groups: patients with airway obstructive (group 1, n = 208) or parenchymal destructive COPD (group 2, n = 156). Before and after PRP, values of 6-min walking distance, perceived breathlessness (Medical Research Council), health-related quality of life (St. George's Respiratory Questionnaire) and respiratory muscle function (maximal inspiratory and expiratory pressure) were recorded. RESULTS PRP resulted in significant improvements in all outcome measures without any significant differences between groups. CONCLUSIONS Our study confirms that COPD patients may benefit from pulmonary rehabilitation independent of their clinical phenotype.
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Affiliation(s)
- Nicolino Ambrosino
- Weaning and Rehabilitation Unit, Auxilium Vitae Rehabilitation Center, Volterra, Italy
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Mazzoleni S, Montagnani G, Vagheggini G, Buono L, Moretti F, Dario P, Ambrosino N. Interactive videogame as rehabilitation tool of patients with chronic respiratory diseases: preliminary results of a feasibility study. Respir Med 2014; 108:1516-24. [PMID: 25087837 DOI: 10.1016/j.rmed.2014.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an interactive videogame (IV) system in addition to a supervised pulmonary rehabilitation programme (PRP) in patients with chronic respiratory diseases. DESIGN Randomised Controlled Trial comparing standard PRP (20 patients, control group: CG), and PRP + sessions of interactive videogame-aided exercises (20 patients, experimental group: EG). Lung and respiratory muscle function, arterial blood gases, exercise capacity, dyspnoea, health status and health-related quality of life (HRQL) and emotional response were measured before and after PRP. A questionnaire on acceptability of the PRP was administered. RESULTS Exercise capacity, dyspnoea and HRQL significantly improved in both groups after the PRP, whereas the EG showed a greater improvement in six-minute walk test and transitional dyspnoea index than the CG. No difference in psychological status or acceptability of PRP was observed between the two groups. CONCLUSIONS The addition of IV training was more effective for improving some parameters of exercise tolerance and dyspnoea, although did not result in better psychological status nor it was better accepted than the standard PRP in patients with chronic respiratory diseases.
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Affiliation(s)
- Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
| | - Giulia Montagnani
- Rehabilitation Bioengineering Laboratory, Volterra, Italy; Weaning and Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
| | - Guido Vagheggini
- Rehabilitation Bioengineering Laboratory, Volterra, Italy; Weaning and Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
| | - Lorenzo Buono
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Francesca Moretti
- Rehabilitation Bioengineering Laboratory, Volterra, Italy; Weaning and Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Nicolino Ambrosino
- Rehabilitation Bioengineering Laboratory, Volterra, Italy; Weaning and Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
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Crisafulli E, Morandi A, Olivini A, Malerba M, Clini EM. Rehabilitation and supportive therapy in elderly patients with Chronic Obstructive Pulmonary Disease. Eur J Intern Med 2014; 25:329-35. [PMID: 24472694 DOI: 10.1016/j.ejim.2014.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 12/23/2013] [Accepted: 01/03/2014] [Indexed: 01/29/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) very often coexists with cardiovascular, musculoskeletal and metabolic comorbidities. This condition significantly impact on the general health, function, frailty and disability of such patients, and consequently on their prognosis. Indeed, complex and recurrent symptoms of general dysfunction are commonly present and burden on the health status. Symptomatic COPD patients, even with chronic and complex comorbidities or with different degree of severity, may benefit from rehabilitation including exercise and maintenance of physical activity, in order to reducing symptoms and restoring the highest possible level of independent function. This review will focus on the associated and relevant clinical problems of these patients at the onset of disability, methods of assessment and useful non-pharmacological treatments for caring and supporting them.
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Affiliation(s)
| | | | - Alessia Olivini
- Dpt. of Internal Medicine, University of Brescia, AOU Spedali Civili, Brescia, Italy
| | - Mario Malerba
- Dpt. of Internal Medicine, University of Brescia, AOU Spedali Civili, Brescia, Italy
| | - Enrico M Clini
- Dpt. of Medical and Surgical Sciences, University of Modena, Ospedale Villa Pineta, Modena, Italy.
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Crisafulli E, Venturelli E, Biscione G, Vagheggini G, Iattoni A, Lucic S, Ambrosino N, Pasqua F, Cesario A, Clini EM. Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation. Intern Emerg Med 2014; 9:23-31. [PMID: 22113504 DOI: 10.1007/s11739-011-0727-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 11/08/2011] [Indexed: 01/10/2023]
Abstract
The role of pulmonary rehabilitation (PR) in COPD patients with lung hyperinflation has not yet been fully investigated. We retrospectively evaluated the effect of a standard PR course on exercise tolerance and symptoms according to the presence or absence of associated lung hyperinflation, as defined by lung function parameters in three Italian rehabilitation centres. In a cohort of 823 COPD patients (age 71 ± 8 years, FEV1 56 ± 18% pred.) we have systematically recorded: changes (∆) in 6-minute walking test (6MWD) as the primary outcome; dyspnoea (D); muscle fatigue (F); SO2nadir during effort; perceived breathlessness score (MRC); and specific health-related quality of life (SGRQ). Outcomes were compared between patients with lung hyperinflation (n = 283, LH) or without (n = 540 No-LH). Groups were comparable for age, body mass index, baseline exercise tolerance, and breathlessness. ∆-6MWD (+72 ± 47 vs. +62 ± 42 m, p < 0.05); ∆-D (-2.3 ± 1.7 vs. -1.9 ± 1.3 point, p < 0.05) and ∆-SO2nadir (+1.4 ± 3.0 and +0.5 ± 3.3 point, p < 0.05) were greater in LH than in No-LH. Using a multivariate linear regression model, ∆-6MWD in the LH group significantly correlated with lower functional residual capacity (p = 0.021) and baseline 6MWD (p = 0.004). Tolerance, gas exchange and perceived symptoms during effort are the parameters that gain a significant benefit from standard rehabilitation in COPD patients with a lung hyperinflation condition.
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Affiliation(s)
- Ernesto Crisafulli
- Pulmonary Rehabilitation, Villa Pineta Hospital, 41026, Pavullo (MO), Italy,
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2074] [Impact Index Per Article: 188.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Jingar A, Alaparthi GK, Vaishali K, Krishnan S, Zulfeequer, Unnikrishnan B. Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey. Lung India 2013; 30:131-8. [PMID: 23741094 PMCID: PMC3669553 DOI: 10.4103/0970-2113.110421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objective: Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs) and wards in terms of assessment and treatment. Materials and Methods: A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. Results: A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Conclusion: Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary very little with respect to certain measures taken. Assessment predominantly focused on respiratory impairment measures, followed by dyspnea-quantifying measures, with little attention given to functional exercise capacity and health-related quality of life measures. Treatment techniques given were concentrated on dyspnea-relieving strategies, airway clearance techniques and upper and lower extremity exercises, with little attention given to strength training.
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Affiliation(s)
- Aripta Jingar
- Department of Physiotherapy, Kasturba Medical College (A constituent institute of Manipal University), Mangalore, India
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Le muscle du patient atteint de bronchopneumopathie chronique obstructive en réanimation: un enjeu pour le kinésithérapeute. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0644-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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La stimulation électrique neuromusculaire au cœur des soins intensifs. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Early Rehabilitation Exercise Program for Inpatients During an Acute Exacerbation of Chronic Obstructive Pulmonary Disease. J Cardiopulm Rehabil Prev 2012; 32:163-9. [DOI: 10.1097/hcr.0b013e318252f0b2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anexo 2 Preguntas respondidas por la UETS en la GPC para el tratamiento de pacientes con EPOC. Arch Bronconeumol 2012. [DOI: 10.1016/s0300-2896(12)70037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zainuldin R, Mackey MG, Alison JA. Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 2011:CD008008. [PMID: 22071841 PMCID: PMC8939846 DOI: 10.1002/14651858.cd008008.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intensity of exercise is considered a key determinant of training response, however, no systematic review has investigated the effects of different levels of training intensity on exercise capacity, functional exercise capacity and health-related quality of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). As type of training (continuous or interval) may also affect training response, the effects of the type of training in COPD also require investigation. OBJECTIVES To determine the effects of training intensity (higher versus lower) or type (continuous versus interval training) on primary outcomes in exercise capacity and secondary outcomes in symptoms and HRQoL for people with COPD. SEARCH METHODS We searched for studies in any language from the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and PubMed. Searches were current as of June 2011. SELECTION CRITERIA We included randomised controlled trials comparing higher training intensity to lower training intensity or comparing continuous training to interval training in people with COPD. We excluded studies that compared exercise training with no exercise training. DATA COLLECTION AND ANALYSIS We pooled results of comparable groups of studies and calculated the treatment effect and 95% confidence intervals (CI) using a random-effects model. We made two separate comparisons of effects between: 1) higher and lower training intensity; 2) continuous and interval training. We contacted authors of missing data. MAIN RESULTS We analysed three included studies (231 participants) for comparisons between higher and lower-intensity training and eight included studies (367 participants) for comparisons between continuous and interval training. Primary outcomes were outcomes at peak exercise (peak work rate, peak oxygen consumption, peak minute ventilation and lactate threshold), at isowork or isotime, endurance time on a constant work rate test and functional exercise capacity (six-minute walk distance). When comparing higher versus lower-intensity training, the pooled primary outcomes were endurance time and six-minute walk distance. There were no significant differences in endurance time improvement (mean difference (MD) 1.07 minutes; 95% CI -1.53 to 3.67) and six-minute walk distance improvement (MD 2.8 metres; 95% CI -10.1 to 15.6) following higher or lower-intensity training. However, heterogeneity of the endurance time results between studies was significant. When comparing continuous and interval training, there were no significant differences in any of the primary outcomes, except for oxygen consumption at isotime (MD 0.08; 95% CI 0.01 to 0.16) but the treatment effect was not considered clinically important. According to the GRADE system, studies were of low to moderate quality. AUTHORS' CONCLUSIONS Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.
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Affiliation(s)
- Rahizan Zainuldin
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.
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Use of the Functional Independence Measure in people for whom weaning from mechanical ventilation is difficult. Phys Ther 2011; 91:1109-15. [PMID: 21596958 DOI: 10.2522/ptj.20100369] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Functional Independence Measure (FIM) has been proposed as an outcome measure for people receiving pulmonary rehabilitation after an acute exacerbation of chronic obstructive pulmonary disease. Objective The purpose of this study was to examine the clinical utility of the FIM after a weaning program in people for whom weaning from mechanical ventilation is difficult. Design This was a retrospective observational study. METHODS People who had had a tracheostomy, for whom weaning from mechanical ventilation was difficult, and who were participating in a weaning program (WP group) were retrospectively evaluated. People receiving pulmonary rehabilitation after an acute exacerbation of chronic obstructive pulmonary disease (PR group) were included as a validated control group. The scores on the FIM questionnaire and the Medical Research Council dyspnea scores were assessed at admission to and at discharge from the programs. RESULTS Admission and discharge data from 56 participants in the WP group and 63 participants in the PR group were compared. At admission, according to the FIM, 5 participants in the WP group (7.7%) were defined as functionally independent, 34 (52.3%) were defined as partially dependent, and 26 (40.0%) were defined as completely dependent. At discharge, the mean FIM global score was significantly improved, from 47.9 (SD=22.8) to 62.6 (SD=30.0). For participants in the WP group, changes in the FIM score were significantly inversely related to the admission Acute Physiology and Chronic Health Evaluation (R=-.286) and Simplified Acute Physiology (R=-.293) scores and directly related to the admission FIM score (R=.355). At admission, 46 participants in the PR group (67.7%) were defined as functionally independent, 19 (27.9%) were defined as partially dependent, and 3 (4.4%) were defined as completely dependent. After pulmonary rehabilitation, the mean FIM global score was significantly improved, from 97.4 (SD=27.5) to 102.5 (SD=25.7). Limitations The study was not randomized and involved a relatively small sample size. CONCLUSIONS The FIM can be used as a functional status outcome measure in people for whom weaning from mechanical ventilation is difficult.
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Effects of pulmonary rehabilitation on quality of life in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med 2011; 17:62-71. [PMID: 21206273 DOI: 10.1097/mcp.0b013e328343521c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Pulmonary rehabilitation plays a key role in the management of chronic obstructive pulmonary disease (COPD). Although the American Thoracic Society recently provided a grade of 1A for evidence of health-related quality of life (HRQoL) benefits related to pulmonary rehabilitation, knowledge about the psychological and behavioral processes explaining the impact of pulmonary rehabilitation on HRQoL in COPD patients remains limited. This review describes the state of knowledge over the past year concerning HRQoL benefits after pulmonary rehabilitation and suggests avenues for future research. RECENT FINDINGS HRQoL outcomes related to pulmonary rehabilitation explores five themes: optimizing pulmonary rehabilitation components to improve HRQoL; characterization of a responder phenotype; suitability of pulmonary rehabilitation following acute exacerbations; exploration of psychological and behavioral mechanisms explaining pulmonary rehabilitation benefits; and long-term maintenance of HRQoL benefits after pulmonary rehabilitation. SUMMARY Evidence supports the use of pulmonary rehabilitation to improve HRQoL in patients with moderate-to-severe COPD. However, it is unclear how pulmonary rehabilitation improves HRQoL and which characteristics confer the greatest HRQoL benefits. Moreover, most studies failed to provide a compelling theoretical rationale for the intervention employed. Future research should focus on improving the understanding of the psychological mechanisms implicated in the adoption and maintenance of healthy behavior.
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KO FANNYW, DAI DAVIDL, NGAI JENNY, TUNG ALVIN, NG SUSANNA, LAI KENNETH, FONG RICKY, LAU HERMAN, TAM WILSON, HUI DAVIDS. Effect of early pulmonary rehabilitation on health care utilization and health status in patients hospitalized with acute exacerbations of COPD. Respirology 2011; 16:617-24. [DOI: 10.1111/j.1440-1843.2010.01921.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sgambato F, Clini E. Complessità del paziente con insufficienza respiratoria cronica associata a BPCO. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Clini E, Roversi P, Crisafulli E. Early rehabilitation: much better than nothing. Am J Respir Crit Care Med 2010; 181:1016-7. [PMID: 20460544 DOI: 10.1164/rccm.201001-0054ed] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:111-20. [DOI: 10.1097/spc.0b013e32833a1dfc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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