Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals

Postoperative rehabilitation exercise experiences of geriatric patients with femoral neck fractures based on the perspective of medical staff: a qualitative study

BACKGROUND

The incidence of femoral neck fractures in older adults is increasing each year. Active and reasonable postoperative rehabilitation exercises can restore the activity of geriatric patients with femoral neck fractures to a great extent, while also avoiding bedridden complications and re-fractures. This study explores the perspectives, experiences, and recommendations of medical staff regarding the implementation status, existing problems, promoting factors, and hindering factors of post-surgical rehabilitation exercises for geriatric patients with femoral neck fractures. The ultimate goal is to further optimize rehabilitation exercise programs and to expedite this process for patients.

METHODS

A qualitative, descriptive phenomenological study was conducted. A total of 21 clinical medical staff were selected using the purposive sampling method for semi-structured interviews. A content analysis method was used to collate and analyze the collected interview data.

RESULTS

A total of 2 themes and 6 sub-themes were defined. The themes consisted of multiple obstacles occurring during the implementation of rehabilitation exercises and the scientific cognition of medical staff on these exercises. Respondents found that patient initiative during rehabilitation exercises was insufficient, that the comprehensiveness and continuity of exercises could not be guaranteed, and that unification between textbook theory and clinical practice was incomplete. Moreover, respondents believed that their professional quality should be excellent, but that staffing and organizational management required optimization, and that support was required for the implementation of rehabilitation exercises.

CONCLUSION

This study investigated the opinions and experiences of medical staff during postoperative rehabilitation exercises in geriatric patients with femoral neck fractures. Collaborative efforts should fully engage hospitals, communities, and families, enhance the alignment of health education with patient needs, advance the scientific development of an integrated medical model by refining the curriculum and teaching system, and significantly elevate the level of medical science and technology. This study will serve as a valuable reference for the establishment of future professional, and personalized rehabilitation programs tailored for geriatric patients with femoral neck fractures.

Comparison of a Supervised Home-Based Tele-Rehabilitation with Center-Based Pulmonary Rehabilitation: Protocol for a Randomized Non-Inferiority Multicenter Study in Ningxia

Background

Pulmonary rehabilitation (PR) is an effective intervention for people with chronic obstructive pulmonary disease (COPD). However, fewer than 5% of eligible individuals receive pulmonary rehabilitation, largely due to limited by the accessibility of rehabilitation and difficulties associated with travel and transport. Supervised home-based tele-rehabilitation (SHTR) is an alternative model to center-based pulmonary rehabilitation. We will determine whether supervised home-based tele-rehabilitation is non-inferior to center-based pulmonary rehabilitation.

Methods

The participants will undergo an 8-week rehabilitation program. Pulmonary rehabilitation comprises four main modules: exercise training, education, nutritional support, and psychological and behavioral interventions. We mainly focus on the module of exercise training and education. The education module includes information on exercise training, nutrition, and psychology, which are presented in an educational booklet provided to each participant. Blinded assessors will evaluate the outcomes at baseline, post-intervention, and 6 months after the intervention. The primary outcome is the change in the 6-minute walking distance. Secondary outcomes will assess changes in the patients' 1-minute sit-to-stand test, maximal inspiratory pressure (MIP), scales (CAT, mMRC, HAD), diaphragm ultrasound (TD, DE, DIF), changes in extrathoracic muscle volume and mass, completion rate of patient exercise prescriptions, occurrence of adverse events, as well as disease exacerbation and rehospitalization rates after rehabilitation and during the 6-month follow-up.

Discussion

In order to improve the accessibility of pulmonary rehabilitation and patient-related outcomes, it is necessary to propose an alternative model of pulmonary rehabilitation. This trial will establish whether a supervised home-based tele-rehabilitation is not inferior to traditional center-based pulmonary rehabilitation.

Trial Registration

Chinese Clinical Trial Registry ChiCTR2300076969. Registered on October 25, 2023.

The Long-Term Benefit of Exercise With and Without Manual Therapy for Mild Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

PURPOSE

Chronic obstructive pulmonary disease (COPD) is characterized by decreasing exercise capacity and deteriorating quality of life (QoL). Recent evidence indicates that combining exercise with manual therapy (MT) delivers greater improvements in exercise capacity than exercise alone in moderate COPD. The aim of this study was to investigate whether this combination delivers similar results in mild COPD.

METHODS

A total of 71 participants aged 50-65 yr with mild COPD were randomly allocated to two groups: exercise only (Ex) or MT plus exercise (MT + Ex). Both groups received 16 wk of exercise with the MT + Ex group also receiving 8 MT sessions. Lung function (forced vital capacity [FVC] and forced expiratory volume in the 1 st sec [FEV 1 ]), exercise capacity (6-min walk test [6MWT]), and QoL (St George's Respiratory Questionnaire [SGRQ] and Hospital Anxiety and Depression Scale [HADS]) were measured at baseline, 4, 8, 16, 24, 32, and 48 wk.

RESULTS

Although there was no difference in the mean effect over time between groups for lung function (FEV 1 , P = .97; FVC, P = .98), exercise capacity (6MWT, P = .98), and QoL (SGRQ, P = .41; HADS anxiety, P = .52; and HADS depression, P = .06), there were clinically meaningful improvements at 48 wk for 6MWT (30 m; 95% CI, 10-51 m; P < .001), SGRQ (6.3 units; 95% CI, 2.5-10.0; P < .001), and HADS anxiety (1.5 units; 95% CI, 0.3-2.8 units; P = .006) across the entire cohort.

CONCLUSIONS

While adding MT to Ex did not produce any additional benefits, exercise alone did deliver sustained modest improvements in exercise capacity and QoL in mild COPD.

Fostering the discussion of planetary health in occupational therapy and physiotherapy

INTRODUCTION

Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals.

METHODS

This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH.

RESULTS

The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field.

CONCLUSIONS

Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.

A mixed methods study of Aboriginal health workers' and exercise physiologists' experiences of co-designing chronic lung disease 'yarning' education resources

BACKGROUND

Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management.

AIM

To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management.

METHODS

AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework '8 Ways of learning', which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise is important; Managing breathlessness; Healthy eating; Managing anxiety and depression. After each session, AHWs with support from EPs, co-designed education 'yarning' resources using Aboriginal ways of learning to ensure topics were culturally safe for the local Aboriginal community and practiced delivering this at the following session. At the end of the program participants completed an anonymous online survey (5-point Likert scale) to assess satisfaction, and a semi-structured interview about their experience of the online education.

RESULTS

Of the 12 participants, 11 completed the survey (7 AHWs, 4 EPs). Most (90%) participants strongly agreed or agreed that the online sessions increased knowledge and skills they needed to support Aboriginal patients with COPD. All (100%) participants felt: their cultural perspectives and opinions were valued and that they were encouraged to include cultural knowledge. Most (91%) reported that delivering their own co-designed yarning scripts during the online sessions improved their understanding of the topics. Eleven participants completed semi-structured interviews about participating in online education to co-design Aboriginal 'yarning' resources. Themes identified were: revealing the Aboriginal lung health landscape; participating in online learning; structuring the online education sessions; co-designing with the facilitators.

CONCLUSIONS

Online education using co-design and 8 Ways of learning was rated highly by AHWs and EPs for improving COPD knowledge and valuing cultural perspectives. The use of co-design principles supported the cultural adaptation of COPD resources for Aboriginal people with COPD.

TRIAL REGISTRATION

PROSPERO (registration number: CRD42019111405).

Exploration of village health centres in Northern and Central China: A qualitative study

OBJECTIVE

China faces issues associated with urban-rural health inequities. This study explores functions of village health centres through a community perspective. Four research questions were asked, including: (a) What are the functions of village health centres? (b) How is medication administered in village health centres? (c) What are the roles of village doctors? (d) What are the evaluation mechanisms of village health centres?

DESIGN

In-depth interviews and field observations are used in the study.

SETTING

Nine rural villages in two provinces in Northern and Central China.

PARTICIPANTS

A total of 93 people across were interviewed.

RESULTS

Village health centres are primarily responsible for providing public health services and essential medical care. In addition, village health centres also function as a social venue of a rural community. A centralised medication scheme augments these processes through supplying health centres with affordable medications. Village doctors are expected to take the needs and preferences of their patients into consideration when creating care plans, and must establish trusting rapport with patients by upholding their unique values. This results in care that is convenient, accessible, and person-centred. Village health centres are evaluated through a 2-step process which has direct effects on the amount of government subsidy received.

CONCLUSION

Village health centres have multi-faceted functions in rural Chinese communities. Overall, the benefits of village health centres include convenient and timely access to care for rural residents. Improvements can be made in certain areas, such as streamlining provincial medication schemes and adopting a strengths-based model of evaluation.

Healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis

Purpose: To establish literature regarding healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease.Method: A critical interpretive synthesis was conducted; CINAHL, PsychINFO and MEDLINE were searched between 1988 and August 2019, using MeSH headings and key terms. Reference lists of accepted papers were also searched. Qualitative, quantitative and mixed methods studies, written in English, including healthcare professionals' perceptions of pulmonary rehabilitation were included. The search yielded 133 papers which were assessed for eligibility; 20 met the inclusion criteria.Results: Two themes were identified, the first explored "Barriers to Pulmonary Rehabilitation" from a healthcare professional's perspective. This incorporated a lack of knowledge, a lack of resources, practical barriers, patient barriers, and healthcare professional's being unsure it is their role to refer. The second entitled "General Perceptions of Pulmonary Rehabilitation", highlighted ways in which the programme could be improved, the perceived positives and negatives, facilitators to referral, and perceptions of patients referred.Conclusions: This is the first systematic review to encompass the perceptions of healthcare professionals with ability to refer and those who deliver pulmonary rehabilitation. Referral was low, highlighting potential influencing factors such as a lack of programme knowledge, pulmonary rehabilitation beliefs, and communication skills. Given inclusion of studies from multiple geographical locations, the findings provide implications for any healthcare system that develops and delivers pulmonary rehabilitation. With respect of a lack of referrals to the programme, further research should highlight healthcare professionals' perceptions of the referral process, and the views of those in Secondary Care.Implications for rehabilitationChronic obstructive pulmonary disease:•Pulmonary rehabilitation is a proven cost-effective management strategy for patients with chronic obstructive pulmonary disease, which reduces associated hospital admissions and increases quality of life.•Due to a lack of knowledge and negative perceptions surrounding pulmonary rehabilitation, further training and education is required for healthcare professionals surrounding non-pharmacological management strategies.•Pulmonary rehabilitation programmes should consider ways to increase awareness of the service amongst those with chronic obstructive pulmonary disease.•Those delivering pulmonary rehabilitation should consider ways to support healthcare professionals referring to the programme.

What do indigenous communities want from their surgeons and surgical services: A systematic review

BACKGROUND

This investigation was undertaken to define the factors determining the optimal and most productive relationship among indigenous communities, surgeons, and providers of surgical services.

METHODS

A systematic literature review was conducted to identify studies reporting on the experience of indigenous communities with surgeons, medical practitioners, and the providers of surgical and other health services. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, including all literature available until the search date of April 3, 2019. The reference lists of all included articles and related review articles were searched manually to identify further relevant studies. An inductive approach was used to identify common themes.

RESULTS

Thirty-three publications discussed the experiences of New Zealand Māori (n = 2), Aboriginal and Torres Strait Islanders (n = 20), North American First Nation (n = 10), and Indigenous Latin Americans (n = 1). Across all indigenous peoples, 6 themes emerged: accessible health services, community participation and community governance, continuous quality improvement, a culturally appropriate and clinically skilled workforce, a flexible approach to care, and holistic healthcare.

CONCLUSION

To provide medical and surgical services in indigenous communities successfully requires a diverse range of skills and core technical and academic competencies. Many skills lie within the definition of professionalism and advocacy as well as the ability to undertake and operationalize community consultation and empowerment. If surgical services serving Indigenous communities are to be successful in addressing health disparity, specific training in these skills will need to be developed and made available.

Smart Vest for Respiratory Rate Monitoring of COPD Patients Based on Non-Contact Capacitive Sensing

In this paper, a first approach to the design of a portable device for non-contact monitoring of respiratory rate by capacitive sensing is presented. The sensing system is integrated into a smart vest for an untethered, low-cost and comfortable breathing monitoring of Chronic Obstructive Pulmonary Disease (COPD) patients during the rest period between respiratory rehabilitation exercises at home. To provide an extensible solution to the remote monitoring using this sensor and other devices, the design and preliminary development of an e-Health platform based on the Internet of Medical Things (IoMT) paradigm is also presented. In order to validate the proposed solution, two quasi-experimental studies have been developed, comparing the estimations with respect to the golden standard. In a first study with healthy subjects, the mean value of the respiratory rate error, the standard deviation of the error and the correlation coefficient were 0.01 breaths per minute (bpm), 0.97 bpm and 0.995 (p < 0.00001), respectively. In a second study with COPD patients, the values were −0.14 bpm, 0.28 bpm and 0.9988 (p < 0.0000001), respectively. The results for the rest period show the technical and functional feasibility of the prototype and serve as a preliminary validation of the device for respiratory rate monitoring of patients with COPD.

Telerehabilitation versus traditional centre-based pulmonary rehabilitation for people with chronic respiratory disease: protocol for a randomised controlled trial

BACKGROUND

Pulmonary rehabilitation is an effective therapeutic intervention for people with chronic respiratory disease. However, fewer than 5% of eligible individuals receive pulmonary rehabilitation on an annual basis, largely due to limited availability of services and difficulties associated with travel and transport. The Rehabilitation Exercise At Home (REAcH) study is an assessor-blinded, multi-centre, randomised controlled equivalence trial designed to compare the efficacy of home-based telerehabilitation and traditional centre-based pulmonary rehabilitation in people with chronic respiratory disease.

METHODS

Participants will undertake an 8-week group-based pulmonary rehabilitation program of twice-weekly supervised exercise training, either in-person at a centre-based pulmonary rehabilitation program or remotely from their home via the Internet. Supervised exercise training sessions will include 30 min of aerobic exercise (cycle and/or walking training). Individualised education and self-management training will be delivered. All participants will be prescribed a home exercise program of walking and strengthening activities. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and 12-months post intervention. The primary outcome is change in dyspnea score as measured by the Chronic Respiratory Questionnaire - dyspnea domain (CRQ-D). Secondary outcomes will evaluate the efficacy of telerehabilitation on 6-min walk distance, endurance cycle time during a constant work rate test, physical activity and quality of life. Adherence to pulmonary rehabilitation between the two models will be compared. A full economic analysis from a societal perspective will be undertaken to determine the cost-effectiveness of telerehabilitation compared to centre-based pulmonary rehabilitation.

DISCUSSION

Alternative models of pulmonary rehabilitation are required to improve both equity of access and patient-related outcomes. This trial will establish whether telerehabilitation can achieve equivalent improvement in outcomes compared to traditional centre-based pulmonary rehabilitation. If efficacious and cost-effective, the proposed telerehabilitation model is designed to be rapidly deployed into clinical practice.

TRIAL REGISTRATION

Clinical trial registered with the Australian and New Zealand Clinical Trials Register at ( ACTRN12616000360415 ). Registered 21 March 2016.

Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework

QUESTION

What are the barriers and enablers of referral, uptake, attendance and completion of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD)?

DESIGN

Systematic review of qualitative or quantitative studies reporting data relating to referral, uptake, attendance and/or completion in pulmonary rehabilitation.

PARTICIPANTS

People aged >18years with a diagnosis of COPD and/or their healthcare professionals.

DATA EXTRACTION AND ANALYSIS

Data were extracted regarding the nature of barriers and enablers of pulmonary rehabilitation referral and participation. Extracted data items were mapped to the Theoretical Domains Framework (TDF).

RESULTS

A total of 6969 references were screened, with 48 studies included and 369 relevant items mapped to the TDF. The most frequently represented domain was 'Environment' (33/48 included studies, 37% of mapped items), which included items such as waiting time, burden of illness, travel, transport and health system resources. Other frequently represented domains were 'Knowledge' (18/48 studies, including items such as clinician knowledge of referral processes, patient understanding of rehabilitation content) and 'Beliefs about consequences' (15/48 studies, including items such as beliefs regarding role and safety of exercise, expectations of rehabilitation outcomes). Barriers to referral, uptake, attendance or completion represented 71% (n=183) of items mapped to the TDF. All domains of the TDF were represented; however, items were least frequently coded to the domains of 'Optimism' and 'Memory'. The methodological quality of included studies was fair (mean quality score 9/12, SD 2).

CONCLUSION

Many factors - particularly those related to environment, knowledge, attitudes and behaviours - interact to influence referral, uptake, attendance and completion of pulmonary rehabilitation. Overcoming the challenges associated with the personal and/or healthcare system environment will be imperative to improving access and uptake of pulmonary rehabilitation.

TRIAL REGISTRATION

PROSPERO CRD42015015976. [Cox NS, Oliveira CC, Lahham A, Holland AE (2017) Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy 63: 84-93].