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Uche-Okoye D, Ajemba MN, Amy B, Arene EC, Ugo CH, Eze NP, Anyadike IK, Onuorah UM, Chiwenite CM. Is telerehabilitation an effective maintenance strategy for patients with chronic obstructive pulmonary diseases: a systematic review. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2023; 47:13. [PMID: 36743313 PMCID: PMC9890431 DOI: 10.1186/s42269-023-00980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has proven to improve the physical and psychosocial function in patients with chronic obstructive pulmonary disease (COPD). However, the gains achieved during pulmonary rehabilitation diminish over time without an effective maintenance strategy. With several factors affecting access to pulmonary rehabilitation, calls for innovative models were made, which saw the emergence of studies exploring telerehabilitation (TR) as an alternative to traditional pulmonary rehabilitation models. Although there are current reviews exploring the effectiveness of telerehabilitation as an alternative for conventional PR, no review has considered telerehabilitation effectiveness in the long term. Hence, this review aims at examining the effectiveness of telerehabilitation following to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. MAIN BODY A systematic review of the literature using CINAHL, MEDLINE, SCOPUS, Web of science PEDRO, AMED and EMBASE databases was conducted to assess the effectiveness of telerehabilitation following PR in patients with COPD. Health-related quality of life (HRQoL) and exercise capacity was maintained within 6-12 months of a TR maintenance programme. However, there was no significant increase in HRQoL and exercise capacity between the intervention and control groups in 6-12 months. CONCLUSIONS This review suggests that a TR maintenance strategy effectively maintains benefits gained and may improve HRQoL and exercise capacity within 6-12 months for patients with COPD. Nonetheless, it is impossible to extrapolate the findings to the general population due to the paucity of included studies. Further high quality randomised controlled trials examining TR in the long-term is required in the future. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s42269-023-00980-8.
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Maglakelidze M, Kurua I, Maglakelidze N, Maglakelidze T, Chkhaidze I, Gogvadze K, Chkhaidze N, Beadle H, Redden-Rowley K, Adab P, Adams R, Chi C, Cheng KK, Cooper B, Correia-de-Sousa J, Dickens AP, Enocson A, Farley A, Gale NK, Jowett S, Martins S, Rai K, Sitch AJ, Stavrikj K, Stelmach R, Turner AM, Williams S, Jordan RE, Jolly K. Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single-site, randomised controlled trial from the Breathe Well Group. BMJ Open 2022; 12:e056902. [PMID: 36153030 PMCID: PMC9511586 DOI: 10.1136/bmjopen-2021-056902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT). DESIGN A two-arm, randomised feasibility trial with a mixed-methods process evaluation. SETTING Secondary care setting in Georgia, Europe. PARTICIPANTS People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care. INTERVENTIONS Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews. RESULTS The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of ≤50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George's Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was -24.9 (95% CI -40.3 to -9.6) at programme end and -4.4 (95% CI -12.3 to 3.4) at 6 months follow-up for the intervention group and -0.5 (95% CI -8.1 to 7.0) and -8.1 (95% CI -16.5 to 0.3) for the usual care group at programme end and 6 months, respectively. CONCLUSIONS It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research. TRIAL REGISTRATION NUMBER ISRCTN16184185.
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Affiliation(s)
- Mariam Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Ia Kurua
- Georgian Respiratory Association, Tbilisi, Georgia
| | | | - Tamaz Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University Faculty of Medicine, Tbilisi, Georgia
| | - Ivane Chkhaidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Tbilisi State Medical University Faculty of Medicine, Tbilisi, Georgia
| | | | | | - Helen Beadle
- Department of Physiotherapy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kelly Redden-Rowley
- iCares Directorate, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Rachel Adams
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Brendan Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
- International Primary Care Respiratory Group, Edinburgh, Scotland
| | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicola K Gale
- Health Services Management Centre, University of Birmingham College of Arts and Law, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sonia Martins
- Family Medicine, ABC Medical School, São Paulo, Brazil
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Katarina Stavrikj
- Centre for Family Medicine, Medical Faculty, Skopje, North Macedonia
| | - Rafael Stelmach
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sian Williams
- International Primary Care Respiratory Group, Edinburgh, Scotland
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Cheng KC, Lai CC, Wang CY, Wang CM, Ho CH, Sung MI, Hsing SC, Liao KM, Ko SC. The Impact of the Pay-for-Performance Program on the Outcome of COPD Patients in Taiwan After One Year. Int J Chron Obstruct Pulmon Dis 2022; 17:883-891. [PMID: 35480556 PMCID: PMC9037731 DOI: 10.2147/copd.s349468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the impact of a multidisciplinary intervention on the clinical outcomes of patients with COPD. Methods This study retrospectively extracted the data of patients enrolled in the national pay-for-performance (P4P) program for COPD in four hospitals. Only COPD patients who received regular follow-up for at least one year in the P4P program between September 2018 and December 2020 were included. Results A total of 1081 patients were included in this study. Among them, 424 (39.2%), 287 (26.5%), 179 (16.6%), and 191 (17.7%) patients were classified as COPD Groups A, B, C, and D, respectively. Dual therapy with long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) was the most used inhaled bronchodilator at baseline (n = 477, 44.1%) patients, followed by LAMA monotherapy (n = 195, 18.0%), triple therapy with inhaled corticosteroid (ICS)/LABA/LAMA (n = 184, 17.0%), and ICS/LABA combination (n = 165, 15.3%). After one year of intervention, 374 (34.6%) and 323 (29.9%) patients had their pre- and post-bronchodilator-forced expiratory volume in one second (FEV1) increase of more than 100 mL. Both the COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) scores had a mean change of −2.2 ± 5.5 and −0.3 ± 0.9, respectively. The improvement in pulmonary function and symptom score were observed across four groups. The decreased number of exacerbations was only observed in Groups C and D, and not in Groups A and B. Conclusion This real-world study demonstrated that the intervention in the P4P program could help improve the clinical outcome of COPD patients. It also showed us a different view on the use of dual therapy, which has a lower cost in Taiwan.
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Affiliation(s)
- Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Ching-Min Wang
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, 11695, Taiwan.,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Mei-I Sung
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Chen Hsing
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Shian-Chin Ko
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Doucet JR, Fournier TA, Bishop CM, Gaudet DJ, Nagel DA. Pilot of a community-based interprofessional "student-infused" pulmonary rehabilitation program in Saint John, New Brunswick. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2022; 57:26-31. [PMID: 35295955 PMCID: PMC8919708 DOI: 10.29390/cjrt-2020-053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background With the increasing prevalence of chronic pulmonary conditions in New Brunswick and Canada it is necessary to consider innovative interventions to improve access to rehabilitation and supportive care for affected clients. In Fall 2018 we piloted a pulmonary rehabilitation (PR) program for persons with moderate to severe chronic obstructive pulmonary disease (COPD) to demonstrate a novel approach of bridging interprofessional education of students in health care fields with provision of care in a community setting. Methods An 8-week PR program was implemented and evaluated using a quasi-experimental design with pre- and post-testing to measure the effects of the program’s exercise and educational interventions on persons with COPD. Participants were assessed using the 6-Minute Walk Test (6MWT), the St. George’s Respiratory Questionnaire (SGRQ), and a custom questionnaire that rated the participants’ activities of daily living and the PR program. Results Seven participants completed our PR program. Following the intervention, participants’ self-reported health demonstrated a statistically significant improvement. Even though changes on the 6MWT and SGRQ were not shown to be statistically significant, there was evidence of clinically meaningful improvements in those measures. On average, participants walked 25 m further postintervention and showed clinically meaningful improvements on the SGRQ. Conclusions This pilot project demonstrated that a community-based PR program with active involvement of students from multiple health care programs can have positive outcomes for clients with COPD. It also illustrated how educational programs can provide an innovative means for increasing access to rehabilitation and supportive care for clients in the community.
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Affiliation(s)
- John R Doucet
- Allied Health Department, School of Health, New Brunswick Community College, Saint John, Canada
| | - Tammie A Fournier
- Allied Health Department, School of Health, New Brunswick Community College, Saint John, Canada
| | - Christy M Bishop
- Allied Health Department, School of Health, New Brunswick Community College, Saint John, Canada
| | - Derek J Gaudet
- Department of Psychology, University of New Brunswick, Saint John, Canada
| | - Daniel A Nagel
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Akylbekov A, Orme MW, Jones AV, Mademilov M, Muratbekova A, Aidaralieva S, Mirzalieva G, Oleinik A, Magdieva K, Taalaibekova A, Rysbek Kyzy A, Yusuf ZK, Rupert J, Barton A, Miah RB, Manise A, Matheson JA, Malcolm D, Free RC, Steiner MC, Sooronbaev T, Singh SJ. Culturally adapted pulmonary rehabilitation for adults living with post-tuberculosis lung disease in Kyrgyzstan: protocol for a randomised controlled trial with blinded outcome measures. BMJ Open 2022; 12:e048664. [PMID: 35190411 PMCID: PMC8860058 DOI: 10.1136/bmjopen-2021-048664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is a programme of individually prescribed physical exercise, education and self-management activities. PR is recommended in international guidelines for managing chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases. PR is still under-recognised in tuberculosis (TB) guidelines and PR is not available in many low and middle-income countries and for people with post-TB lung disease (PTBLD). The main aims of the study are to adapt and define a culturally appropriate PR programme in Kyrgyzstan for people living with PTBLD and to test, in a fully powered randomised controlled trial (RCT), the effectiveness of PR in improving exercise capacity for people living with PTBLD. METHODS AND ANALYSIS The study will be divided into three stages: stage 1: focus group discussions with patients living with PTBLD and interviews with PR referrers will be conducted to explore initial perceptions and inform the cultural adaptation, structure and content of PR. Stage 2a: a single-blind RCT evaluating the effectiveness of a culturally adapted 6-week PR programme on maximal exercise capacity, assessed by the incremental shuttle walking test, before and after PR. Participants will be additionally followed-up 12 weeks postbaseline. Additional outcomes will include health-related quality of life, respiratory symptoms, psychological well-being and physical function. Stage 2b: participants' experience of PR will be collected through interviews and using a log book and a patient evaluation form. Staff delivering PR will be interviewed to explore their experience of delivering the intervention and refining the delivery for future implementation. ETHICS AND DISSEMINATION The study was approved 22/07/2019 by Ethics Committee National Center for Cardiology and Internal Medicine (reference number 17) and by University of Leicester ethics committee (reference number 22293). Study results will be disseminated through appropriate peer-reviewed journals, national and international respiratory/physiotherapy conferences, social media, and through patient and public involvement events in Kyrgyzstan and in the UK. TRIAL REGISTRATION NUMBER ISRCTN11122503.
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Affiliation(s)
- Azamat Akylbekov
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Amy V Jones
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Maamed Mademilov
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Aibermet Muratbekova
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Shoira Aidaralieva
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Gulzada Mirzalieva
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Alena Oleinik
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Kamila Magdieva
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Aijan Taalaibekova
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Aidai Rysbek Kyzy
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
| | - Zainab K Yusuf
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jones Rupert
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Andy Barton
- South West Research Design Service, Plymouth, UK
| | - Ruhme B Miah
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Adrian Manise
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Robert C Free
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Michael C Steiner
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Talant Sooronbaev
- Department of Pulmonology, National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
- Republican Research Center of Pulmonology and Rehabilitation, Bishkek, Kyrgyzstan
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
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Wang JM, Han MK, Labaki WW. Understanding lung health beliefs in low-resource settings. THE LANCET GLOBAL HEALTH 2022; 10:e6-e7. [DOI: 10.1016/s2214-109x(21)00511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022] Open
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Brakema EA, van der Kleij RMJJ, Poot CC, An PL, Anastasaki M, Crone MR, Hong LHTC, Kirenga B, Lionis C, Mademilov M, Numans ME, Oanh LTT, Tsiligianni I, Sooronbaev T, Walusimbi S, Williams S, Chavannes NH, Reis R. Mapping low-resource contexts to prepare for lung health interventions in four countries (FRESH AIR): a mixed-method study. THE LANCET GLOBAL HEALTH 2022; 10:e63-e76. [DOI: 10.1016/s2214-109x(21)00456-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023] Open
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Tabyshova A, Estebesova B, Beishenbekova A, Sooronbaev T, Brakema EA, Chavannes NH, Postma MJ, van Boven JFM. Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2833-2843. [PMID: 34703219 PMCID: PMC8523360 DOI: 10.2147/copd.s322778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings. AIM We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan. METHODS A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses. RESULTS A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost. CONCLUSION The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.
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Affiliation(s)
- Aizhamal Tabyshova
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bermet Estebesova
- Kyrgyz-Russian Slavic University (KRSU), Bishkek, Kyrgyzstan
- Primary Care Center of the Ministry of Internal Affairs, Bishkek, Kyrgyzstan
| | | | - Talant Sooronbaev
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
- Department of Pharmacology & Therapy, Airlangga University, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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Targeting exertional breathlessness to improve physical activity: the role of primary care. NPJ Prim Care Respir Med 2021; 31:41. [PMID: 34504091 PMCID: PMC8429707 DOI: 10.1038/s41533-021-00254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
Primary care physicians (PCPs) play a crucial role in the diagnosis and management of chronic obstructive pulmonary disease (COPD). By working together with patients to target exertional breathlessness and increase physical activity, PCPs have an important role to play, early in the disease course, in improving patient outcomes in both the short and long term. In this article, we consider how physical activity affects disease progression from the PCP perspective. We discuss the role of pharmacological therapy, the importance of an holistic approach and the role of PCPs in assessing and promoting physical activity. The complexity and heterogeneity of COPD make it a challenging disease to treat. Patients' avoidance of activity, and subsequent decline in capacity to perform it, further impacts the management of the disease. Improving patient tolerance of physical activity, increasing participation in daily activities and helping patients to remain active are clear goals of COPD management. These may require an holistic approach to management, including pulmonary rehabilitation and psychological programmes in parallel with bronchodilation therapy, in order to address both physiological and behavioural factors. PCPs have an important role to optimise therapy, set goals and communicate the importance of maintaining physical activity to their patients. In addition, optimal treatment that addresses activity-related breathlessness can help prevent the downward spiral of inactivity and get patients moving again, to improve their overall health and long-term prognosis.
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10
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Orme MW, Free RC, Manise A, Jones AV, Akylbekov A, Barton A, Emilov B, Girase B, Jayamaha AR, Jones R, Katagira W, Kirenga B, Matheson J, Miah R, Perrera C, Sahasrabudhe S, Salvi S, Sekibira R, Sooronbaev T, Steiner MC, Wimalasekera S, Singh SJ. Global RECHARGE: Establishing a standard international data set for pulmonary rehabilitation in low- and middle-income countries. J Glob Health 2021; 10:020316. [PMID: 33282213 PMCID: PMC7688060 DOI: 10.7189/jogh.10.020316] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mark W Orme
- Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Robert C Free
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Adrian Manise
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Amy V Jones
- Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Azamat Akylbekov
- Department of Respiratory, National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Andy Barton
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Berik Emilov
- Department of Respiratory, National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | | | - Akila R Jayamaha
- Department of Health Sciences, Kaatsu International University, Battaramulla, Sri Lanka
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Winceslaus Katagira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Jesse Matheson
- Department of Economics, University of Sheffield, Sheffield, UK
| | - Ruhme Miah
- Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Chamilya Perrera
- Department of Health Sciences, Kaatsu International University, Battaramulla, Sri Lanka
| | | | | | - Rogers Sekibira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Talant Sooronbaev
- Department of Respiratory, National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Michael C Steiner
- Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
| | - Savi Wimalasekera
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sally J Singh
- Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicester, UK
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11
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Brakema EA, van der Kleij RM, Poot CC, Chavannes NH, Tsiligianni I, Walusimbi S, An PL, Sooronbaev T, Numans ME, Crone MR, Reis RR. A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries. BMJ Glob Health 2021; 6:bmjgh-2020-003221. [PMID: 33436446 PMCID: PMC7805378 DOI: 10.1136/bmjgh-2020-003221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/06/2020] [Accepted: 11/27/2020] [Indexed: 01/18/2023] Open
Abstract
Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.
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Affiliation(s)
- Evelyn A Brakema
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Charlotte C Poot
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraclion, Crete, Greece
| | - Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Pham Le An
- Center of Training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Talant Sooronbaev
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Matty R Crone
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria R Reis
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,The Children's Institute, University of Cape Town, Cape Town, South Africa
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12
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Sandelowsky H, Krakau I, Modin S, Ställberg B, Johansson SE, Nager A. Patient outcomes following GPs' educations about COPD: a cluster randomized controlled trial. NPJ Prim Care Respir Med 2020; 30:44. [PMID: 33060615 PMCID: PMC7566632 DOI: 10.1038/s41533-020-00204-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
This study aimed to compare patient outcomes following case method learning and traditional lectures as methods for continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) in Sweden. In a pragmatic cluster randomized controlled trial, COPD patients (n = 425; case method group n = 209, traditional lectures group n = 216) from 24 primary health care centers replied to questionnaires prior to and 18 months after a 2 × 2-h CME was given to GPs (n = 255). We measured changes in the scores of the Clinical COPD Questionnaire (CCQ), symptoms, needs for disease information, exacerbations, smoking, and use of pulmonary rehabilitation. The changes over time were similar for both CME methods. Patients who had used pulmonary rehabilitation increased from 13.2 to 17.8% (P = 0.04), and prevalence of smoking decreased from 28.9 to 25.1% (P = 0.003). In conclusion, neither of the used CME methods was superior than the other regarding patient outcomes. CME's primary value may lay in improving GPs' adherence to guidelines, which should lead to long-term positive changes in patient health.
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Affiliation(s)
- Hanna Sandelowsky
- Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, SE-171 76, Stockholm, Sweden.
- Academic Primary Health Care Centre, Stockholm County Council, Box 45436, SE-104 31, Stockholm, Sweden.
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden.
| | - Ingvar Krakau
- Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, SE-171 76, Stockholm, Sweden
| | - Sonja Modin
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden
| | - Björn Ställberg
- Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Box 564, SE-751 22, Uppsala, Sweden
| | - Sven-Erik Johansson
- Lund University, Center for Primary Health Care Research, Department of Clinical Sciences, SE-205 02, Malmö, Sweden
| | - Anna Nager
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden
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