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Sheill G, Hennessy M, Neill LO, Reynolds S, Towns J, Gill M, Guinan E. Exercise and chronic health conditions in the community: A qualitative Study of Patients and Fitness instructors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1025-1034. [PMID: 33704862 DOI: 10.1111/hsc.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 11/14/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Further information is needed on how community exercise facilities can be effectively utilised to engage people living with chronic health conditions in exercise. The aim of this study was to identify the exercise barriers, facilitators and needs of patients with chronic disease in the community; and to provide recommendations to support the transition from hospital-based to community-based exercise. Using a qualitative approach, four focus groups were conducted with patients who had completed hospital-based exercise programmes (n = 11) and fitness instructors (n = 10). Data were audio recorded, member checked and transcribed verbatim for thematic analysis using NVivo. The side effects of chronic health conditions, the gym environment and a need for support when joining/attending a gym were perceived as barriers to exercising in the community. In contrast, the presence of supportive staff was perceived by patients as a facilitator to engaging in exercise in the community. A total of three themes emerged from participants views on exercise needs in the community; the referral and induction process in community gyms, fitness instructor training and experience and creating a supportive exercise environment. Themes informed eight key recommendations to support patients to exercise in the community, including supportive gym referral and induction processes for patients with chronic conditions, increased professional training for fitness instructors in the area of chronic disease management and exercise prescription, and exercise support at regular intervals for those with chronic conditions attending community gyms. This study found that there is potential for community gyms to play a key role in promoting health among people with chronic conditions. However, more can be done to foster an inclusive atmosphere in this space. Patients living with chronic conditions need information and advice on exercising in their communities. Community gyms require further support to ensure that facilities meet the exercise needs of people with chronic conditions.
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Affiliation(s)
- Gráinne Sheill
- Wellcome HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
| | - Martina Hennessy
- Wellcome HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Linda O Neill
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Jeremy Towns
- Wellcome HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
| | - Michael Gill
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry & Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Occupational therapy in pulmonary rehabilitation programs: A scoping review. Respir Med 2022; 199:106881. [DOI: 10.1016/j.rmed.2022.106881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/17/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022]
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Roberts NJ, Kidd L, Kirkwood K, Cross J, Partridge MR. How is the education component of pulmonary rehabilitation delivered in practice--Is it patient-centred? CLINICAL RESPIRATORY JOURNAL 2021; 15:835-842. [PMID: 33825323 DOI: 10.1111/crj.13371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pulmonary rehabilitation (PR) involves a significant component of education, but little has been published on what educational content is covered or how it is delivered. This survey study set out to investigate how PR education is delivered in practice. METHODS A survey was designed to investigate the current educational delivery and which topics respondents reported should be included in a PR programme. The survey was sent to 11 Scottish PR Action group regional leads. RESULTS Nine completed the questionnaire (81.8%). Education was reported to be predominately group-based and face-to-face (n = 9, 100%) consisting of between 6 and 12 sessions. Most educational topics lasted 15 min or less, some topic areas were not consistently covered. The educational content was variable and not personalised to individual needs. Three health areas undertook informal literacy assessment at baseline assessment and when tailoring COPD plans. Often attendance at educational sessions was not needed to 'complete' PR. CONCLUSIONS Content and delivery of educational topics were varied, and no consistent outcome measure to assess the effectiveness of education was used. PRACTICE IMPLICATIONS Education needs to be delivered in a patient-centred way tailoring for literacy skills using a range of different teaching approaches and aids.
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Affiliation(s)
- Nicola J Roberts
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lisa Kidd
- Nursing & Health Care School, University of Glasgow, Glasgow, UK
| | - Kim Kirkwood
- Pulmonary Rehabilitation, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jane Cross
- School of Health Life Sciences, University of East Anglia, Norwich, UK
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Roberts NJ, Kidd L, Kirkwood K, Cross J, Partridge MR. A systematic review of the content and delivery of education in pulmonary rehabilitation programmes. Respir Med 2018; 145:161-181. [PMID: 30509706 DOI: 10.1016/j.rmed.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is a core component of Chronic Obstructive Pulmonary Disease (COPD) management with well recognized benefits. While suggestions for educational content within pulmonary rehabilitation have been detailed in clinical guidance, it is unclear what educational content is delivered as part of pulmonary rehabilitation, who delivers it, and how it is delivered. METHODS A systematic review was conducted to identify what educational content is delivered as part of pulmonary rehabilitation, how is this delivered and who delivers it. Databases were searched from 1981 to 2017 using multiple search terms related to "pulmonary rehabilitation" and "education". RESULTS Fourteen studies were identified. This included 6 survey studies, 5 quasi-experimental studies and 3 RCTs. Five key topics that were consistently included within PR programmes were identified as: 1) Anxiety/depression and stress management. 2) Early recognition of signs of infection. 3) Dyspnea and symptom management. 4) Nutrition. 5) Techniques using inhalers and nebulizers. Broader topics such as welfare/benefits, sexuality, and advance care directives did not frequently feature. Only four studies used tools to measure knowledge or learning pre and post rehabilitation in an attempt to evaluate the effectiveness of the education delivered as part of PR. CONCLUSIONS The delivery of education in PR programmes is variable and does not follow suggested educational topics. Education needs to take a patient centered motivational approach to ensure effective delivery. Further research into appropriate educational outcome measures are needed, in order to evaluate the changes in behaviour associated with education.
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Affiliation(s)
- N J Roberts
- School of Health and Life Sciences, Glasgow Caledonian University, United kingdom.
| | - L Kidd
- School of Medicine, Dentistry and Nursing, University of Glasgow, United kingdom
| | - K Kirkwood
- Pulmonary Rehabilitation, NHS Greater Glasgow and Clyde, United kingdom
| | - J Cross
- School of Health Sciences, University of East Anglia, United kingdom
| | - M R Partridge
- National Heart and Lung Institute, Imperial College London, United kingdom
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Vodanovich DA, Bicknell TJ, Holland AE, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Thompson P, Stirling RG, Lee AL. Validity and Reliability of the Chronic Respiratory Disease Questionnaire in Elderly Individuals with Mild to Moderate Non-Cystic Fibrosis Bronchiectasis. Respiration 2015; 90:89-96. [PMID: 26088151 DOI: 10.1159/000430992] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The chronic respiratory disease questionnaire (CRDQ) is designed to assess health-related quality of life (HRQOL) in chronic respiratory conditions, but its reliability, validity and responsiveness in individuals with mild to moderate non-cystic fibrosis (CF) bronchiectasis are unclear. OBJECTIVES This study aimed to determine measurement properties of the CRDQ in non-CF bronchiectasis. METHODS Participants with non-CF bronchiectasis involved in a randomised controlled trial of exercise training were recruited. Internal consistency was assessed using Cronbach's α. Over 8 weeks, reliability was evaluated using intra-class correlation coefficients and Bland-Altman analysis for measures of agreement. Convergent and divergent validity was assessed by correlations with the other HRQOL questionnaires and the Hospital Anxiety and Depression Scale (HADS). The responsiveness to exercise training was assessed using effect sizes and standardised response means. RESULTS Eighty-five participants were included (mean age ± SD, 64 ± 13 years). Internal consistency was adequate (>0.7) for all CRDQ domains and the total score. Test-retest reliability ranged from 0.69 to 0.85 for each CRDQ domain and was 0.82 for the total score. Dyspnoea (CRDQ) was related to St George's respiratory questionnaire (SGRQ) symptoms only (r = 0.38), with no relationship to the Leicester cough questionnaire (LCQ) or HADS. Moderate correlations were found between the total score of the CRDQ, the SGRQ (rs = -0.49) and the LCQ score (rs = 0.51). Lower CRDQ scores were associated with higher anxiety and depression (rs = -0.46 to -0.56). The responsiveness of the CRDQ was small (effect size 0.1-0.24). CONCLUSIONS The CRDQ is a valid and reliable measure of HRQOL in mild to moderate non-CF bronchiectasis, but responsiveness was limited.
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Wilson JJ, O’Neill B, Collins EG, Bradley J. Interventions to Increase Physical Activity in Patients with COPD: A Comprehensive Review. COPD 2014; 12:332-43. [DOI: 10.3109/15412555.2014.948992] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Desveaux L, Janaudis-Ferreira T, Goldstein R, Brooks D. An International Comparison of Pulmonary Rehabilitation: A Systematic Review. COPD 2014; 12:144-53. [DOI: 10.3109/15412555.2014.922066] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura Desveaux
- 1Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- 2Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Tania Janaudis-Ferreira
- 2Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- 3St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Roger Goldstein
- 1Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- 2Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- 4Departments of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- 5Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- 1Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- 2Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- 4Departments of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- 5Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Cosgrove D, MacMahon J, Bourbeau J, Bradley JM, O’Neill B. Facilitating education in pulmonary rehabilitation using the living well with COPD programme for pulmonary rehabilitation: a process evaluation. BMC Pulm Med 2013; 13:50. [PMID: 23915179 PMCID: PMC3751129 DOI: 10.1186/1471-2466-13-50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 07/31/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Standardised evidenced-based materials and mechanisms to facilitate the delivery of the education component of pulmonary rehabilitation are not widely available. The aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in pulmonary rehabilitation; and, 2) to conduct a process evaluation of the adapted programme. METHODS The adaptations to the LWWCOPD programme were informed by focus groups, current practice, relevant research and guideline documents. Pulmonary rehabilitation sites used the adapted programme, the LWWCOPD programme for pulmonary rehabilitation, to deliver the education component of pulmonary rehabilitation. A process evaluation was conducted: elements included reach (patients' attendance rates), dose delivered (amount of programme delivered), dose received (health professional and patient satisfaction) and fidelity (impact on patients' knowledge, understanding and self-efficacy on the Understanding COPD questionnaire). Descriptive statistics (mean, SD) were used to summarise demographics and key data from the feedback questionnaires. Qualitative feedback on the programme was collated and categorised. Changes in the Understanding COPD questionnaire were examined using paired t-tests. RESULTS The LWWCOPD programme for pulmonary rehabilitation was delivered in eleven hospital- and community-based programmes (n=25 health professionals, n=57 patients with COPD). It consisted of six weekly 30-45 minute sessions. The process evaluation showed positive results: 62.3% of patients attended ≥ 4 education sessions (reach); mean (SD) 90 (10)% of the session content were delivered (dose delivered); the majority of sessions were rated as excellent or good by health professionals and patients. Patients' satisfaction was high: mean (SD) Section B of the Understanding COPD questionnaire: 91.67 (9.55)% (dose received). Knowledge, understanding and self-efficacy improved significantly: mean change (95% CI): Section A of the Understanding COPD questionnaire: 26.75 (21.74 to 31.76)%, BCKQ 10.64 (6.92 to 14.37)% (fidelity). CONCLUSION This rigorous process evaluation has demonstrated that the LWWCOPD programme for pulmonary rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based pulmonary rehabilitation. This programme is now available worldwide (http://www.livingwellwithcopd.com/living-well-and-pulmonary-rehabilitation.html). TRIAL REGISTRATION This study was registered with clinicaltrials.gov (reference number: NCT01226836).
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Affiliation(s)
- Denise Cosgrove
- Centre of Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health research, School of Health Sciences, University of Ulster, Newtownabbey, BT37 OQB, Northern Ireland
- (Current affiliation) Northern Ireland Clinical Research Network (Respiratory Health), Belfast City Hospital, Belfast, BT9 7AB, Northern Ireland
| | - Joseph MacMahon
- Department of Respiratory Medicine, Belfast City Hospital, Belfast, BT9 7AB, Northern Ireland
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, H2X 2P4, Canada
| | - Judy M Bradley
- Centre of Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health research, School of Health Sciences, University of Ulster, Newtownabbey, BT37 OQB, Northern Ireland
- Department of Respiratory Medicine, Belfast City Hospital, Belfast, BT9 7AB, Northern Ireland
| | - Brenda O’Neill
- Centre of Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health research, School of Health Sciences, University of Ulster, Newtownabbey, BT37 OQB, Northern Ireland
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O'Neill B, Cosgrove D, MacMahon J, McCrum-Gardner E, Bradley JM. Assessing Education in Pulmonary Rehabilitation: The Understanding COPD (UCOPD) Questionnaire. COPD 2012; 9:166-74. [DOI: 10.3109/15412555.2011.644601] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pulmonary rehabilitation in Australia: a national survey. Physiotherapy 2011; 97:284-90. [DOI: 10.1016/j.physio.2010.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 12/31/2010] [Indexed: 11/22/2022]
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Jenkins S, Hill K, Cecins NM. State of the art: how to set up a pulmonary rehabilitation program. Respirology 2011; 15:1157-73. [PMID: 20920127 DOI: 10.1111/j.1440-1843.2010.01849.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health-related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost-effective. Although most of the evidence for pulmonary rehabilitation has been obtained in patients with COPD, symptomatic individuals with other respiratory diseases have been shown to benefit. In this review we outline a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program (PRP) that would be feasible in most settings. Throughout the review we have specified the minimum requirements for a PRP to facilitate the establishment of programs using limited resources. Recommendations for staffing and other resources required for a PRP are presented in the first section. Exercise training is a focus of the section on program delivery as this is the component of rehabilitation that has the strongest level of evidence for benefit. Program considerations for patients with respiratory conditions other than COPD are described. Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and individual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.
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Affiliation(s)
- Sue Jenkins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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KOZU R, JENKINS S, SENJYU H, MUKAE H, SAKAMOTO N, KOHNO S. Peak power estimated from 6-minute walk distance in Asian patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Respirology 2010; 15:706-13. [DOI: 10.1111/j.1440-1843.2010.01744.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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