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de Graaf D, de Vries NM, van de Zande T, Schimmel JJP, Shin S, Kowahl N, Barman P, Kapur R, Marks WJ, van 't Hul A, Bloem B. Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e55452. [PMID: 38713508 PMCID: PMC11109858 DOI: 10.2196/55452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life. OBJECTIVE We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test. METHODS This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ≥18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT. RESULTS In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024. CONCLUSIONS The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options. TRIAL REGISTRATION ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55452.
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Affiliation(s)
- Debbie de Graaf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Nienke M de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Tessa van de Zande
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Janneke J P Schimmel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Sooyoon Shin
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Nathan Kowahl
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Poulami Barman
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Ritu Kapur
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
- Verily Life Sciences, South San Fransisco, CA, United States
| | - William J Marks
- Verily Life Sciences, South San Fransisco, CA, United States
| | - Alex van 't Hul
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, Nijmegen, Netherlands
| | - Bastiaan Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
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O'Shea O, Murphy G, Fox L, O'Reilly KMA. Changes in physical activity in people with idiopathic pulmonary fibrosis before and after virtual pulmonary rehabilitation: a feasibility study. BMC Pulm Med 2024; 24:215. [PMID: 38698361 PMCID: PMC11064383 DOI: 10.1186/s12890-024-03030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is recommended for the treatment of people with idiopathic pulmonary fibrosis (IPF). Physical activity is an important health behaviour, closely linked to survival in people with IPF. Little is known about the impact of virtual (V) PR on physical activity in people with IPF. OBJECTIVE To explore the feasibility of conducting a trial to explore effect of virtual PR on objectively measured physical activity in people with IPF. METHODS All patients with a diagnosis of IPF in a stable phase of the disease were invited to participate in VPR: a 10 week exercise programme delivered twice-weekly for one hour. Data were collected at baseline (BL) and post VPR (10 weeks): Kings Brief Interstitial Lung Disease (K-BILD), Exercise capacity (6-minute walk test (6MWT) or 1-minute sit-to-stand (STS)) and Physical Activity. Physical activity was measured with a triaxial accelerometer for seven days. Screening, recruitment, adherence and safety data were collected. RESULTS 68 people were screened for this study. N = 16 participants were recruited to the study. There was one dropout. N = 15 completed VPR. All results reported in mean (standard deviation) (SD). Participants attended 18.1(2.0) of the 20 sessions. No adverse events were detected. The mean age of participants was 71.5(11.5) years, range: 47-95 years; 7 M:9 F. Mean (SD) FEV1 2.3(0.3)L, FVC 2.8(0.7)L. No statistically significant changes were observed in outcome measures apart from exercise capacity. Light physical activity increased from 152(69.4) minutes per day (n = 16) to 161.9(88.7) minutes per day (n = 14), mean change (SD) (CI) p-value: 9.9 (39.8) [-12.3 to 30.9] p = 0.4. Moderate-to-vigorous physical activity increased from 19.1(18.6) minutes per day (n = 16) to 25.7(28.3) minutes per day (n = 14), mean change (SD) (CI) p-value: 6.7 (15.5) [-2.1 to 15.1] p = 0.1. Step count increased from 3838(2847) steps per day (n = 16) to 4537(3748) steps per day (n = 14), mean change (SD) (CI) p-value: 738 (1916) [-419.3 to 1734.6] p = 0.2. K-BILD (n = 15) increased from 55.1(7.4) at BL to 55.7(7.9) post VPR mean change (SD) [95% confidence interval] (CI) p-value: 1.7(6.5) [-1.7 to 5.3], p = 0.3. 6MWT (n = 5) increased from 361.5(127.1) to 452.2(136.1) meters, mean change (SD) (CI) p-value: 63.7 (48.2) [-3.8 to 123.6], p = 0.04 and 1-minute STS increased from 17.6(3.0) (n = 11) to 23.7(6.3) (n = 10), mean change (SD) (CI) p-value 5.8 (4.6) [2.6 to 9.1], p = 0.003. CONCLUSION VPR can improve physical activity in people with IPF. A number of important feasibility issues included recruitment, retention, adherence and safety have been reported which are crucial for future research in this area. A fully powered trial is needed to determine the response of people with IPF to PR with regard to physical activity.
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Affiliation(s)
- Orlagh O'Shea
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Grainne Murphy
- Department of Physiotherapy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lynn Fox
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Katherine M A O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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3
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Schertzer K, Belitzky J, Conboy C, Joshi H, Harvey K, Hondal GS, Miller E, Mathur S, Wickerson L. Physiotherapists' Adoption and Perceptions of Tele-Rehabilitation for Cardiorespiratory Care in Response to COVID-19. Physiother Can 2024; 76:211-217. [PMID: 38725596 PMCID: PMC11078246 DOI: 10.3138/ptc-2021-0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 05/12/2024]
Abstract
Purpose The use of tele-rehabilitation as a mode for physiotherapy services was widely implemented following the onset of the coronavirus disease 2019 (COVID-19) pandemic. This study explored the perceived value and experiences of physiotherapists relating to tele-rehabilitation for cardiorespiratory care. Method Semi-structured interviews were conducted with physiotherapists who provided tele-rehabilitation to adults with cardiorespiratory conditions between March 11 and December 31, 2020. Interviews were analyzed using conventional content analysis. Results Seven participants were interviewed; six practising solely in pulmonary rehabilitation and one practising in both pulmonary and cardiac rehabilitation. Three major themes emerged: (1) the pandemic presented unique challenges to implementing tele-rehabilitation while exacerbating previous challenges inherent with virtual care, (2) tele-rehabilitation use during the pandemic was deemed as equally effective in quality of care and patient adherence when compared to in-person services, and (3) tele-rehabilitation had significant value during the pandemic and has potential as an alternative delivery model post pandemic. Conclusion Despite the inherent challenges, tele-rehabilitation was endorsed by participants as a suitable and effective alternative to care delivery and holds promise as a post-pandemic delivery model. Further evaluation is needed to support and optimize tele-rehabilitation use in physiotherapy practice.
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Affiliation(s)
- Katarina Schertzer
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Belitzky
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cassandra Conboy
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hitesh Joshi
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Harvey
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gabriela Suarez Hondal
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erin Miller
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Lisa Wickerson
- From the:
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
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Singh P. Commentary on Schertzer et al. 1. Physiother Can 2024; 76:218-219. [PMID: 38725593 PMCID: PMC11078253 DOI: 10.3138/ptc-2021-0135-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Prashna Singh
- Certified Respiratory Educator Pulmonary Rehabilitation Coordinator, Trillium Health Partners, Mississauga, Ontario, Canada;
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Verweel L, Packham T, Goldstein R, Brooks D, MacKay C. Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers. Respir Med 2024; 225:107588. [PMID: 38460709 DOI: 10.1016/j.rmed.2024.107588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Pulmonary rehabilitation (PR) plays an important role in the management of symptomatic patients with chronic respiratory diseases (CRD). While studies have investigated the feasibility and efficacy of virtual PR (VPR), it is important to understand the experiences of patients and healthcare providers (HCPs) during the rapid digital health transformation that occurred in the COVID-19 pandemic. OBJECTIVES To explore the experiences and perspectives of patients and HCPs who participated in VPR during the pandemic. METHODS Semi-structured interviews were conducted with CRD patients and HCPs. This study used a qualitative descriptive approach and a team-based inductive thematic analysis. RESULTS Participants included 11 HCPs (7 female; 29-55 years) and 19 CRD patients (11 male; 62-83 years; 15 COPD, 4 COPD/ILD). Three major themes and 10 subthemes were identified: i) the pandemic response: a 'trial by fire' (navigating uncertainty, emotional impact of change, shifting practice amid complexity); ii) beyond the emergency: navigating a 'new normal' (eligibility and assessment for VPR, virtual exercise, virtual education and resources, clinical supervision and patient safety); and iii) care beyond boundaries: the implications of using technology for PR (benefits and limitations of technology, psychosocial implications, VPR in the future). CONCLUSION The pivot to VPR was acknowledged as positive by both patients and HCPs although both groups were mindful of the implementation challenges. These findings provide insight into the experience of HCPs and patients in introducing VPR in response to the pandemic and will inform future implementation of VPR for individuals with CRD.
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Affiliation(s)
- L Verweel
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada.
| | - T Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - R Goldstein
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada; Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
| | - D Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
| | - C MacKay
- West Park Healthcare Centre, Toronto, Canada; Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
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Jacinto T, Smith E, Diciolla NS, van Herck M, Silva L, Granados Santiago M, Volpato E, Grønhaug LM, Verkleij M, Peters JB, Sylvester K, Inal-Ince D, Padilha JM, Langer D, Demeyer H, Cruz J. ERS International Congress 2023: highlights from the Allied Respiratory Professionals Assembly. ERJ Open Res 2024; 10:00889-2023. [PMID: 38529350 PMCID: PMC10962454 DOI: 10.1183/23120541.00889-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 03/27/2024] Open
Abstract
This article summarises some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2023 European Respiratory Society International Congress. Two sessions from each Assembly group are outlined, covering the following topics: Group 9.01 focuses on respiratory physiology techniques, specifically on predicted values and reference equations, device development and novel applications of cardiopulmonary exercise tests; Group 9.02 presents an overview of the talks given at the mini-symposium on exercise training, physical activity and self-management at home and outlines some of the best abstracts in respiratory physiotherapy; Group 9.03 highlights the nursing role in global respiratory health and presents nursing interventions and outcomes; and Group 9.04 provides an overview of the best abstracts and recent advances in behavioural science and health psychology. This Highlights article provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.
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Affiliation(s)
- Tiago Jacinto
- Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Centre for Health Technology and Services Research, Porto, Portugal
- These authors contributed equally to writing
| | - Elizabeth Smith
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
- Respiratory Medicine Department, Royal Perth Hospital, Perth, Australia
- These authors contributed equally to writing
| | - Nicola S Diciolla
- Physiotherapy in Women's Health Research Group - FPSM, Department of Nursing and Physiotherapy, University of Alcalá, Alcalá de Henares, Spain
- Respiratory Research and Rehabilitation Laboratory - Lab3R, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
- These authors contributed equally to writing
| | - Maarten van Herck
- Department of Research and Education, Ciro, Horn, The Netherlands
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- These authors contributed equally to writing
| | - Liliana Silva
- CINTESIS@RISE - Centre for Health Technology and Services Research, Porto, Portugal
- Matosinhos Local Health Unit, Matosinhos, Portugal
- These authors contributed equally to writing
| | - Maria Granados Santiago
- Department of Nursing, Faculty of Health Science, University of Granada, Granada, Spain
- These authors contributed equally to writing
| | - Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- These authors contributed equally to writing
| | - Louise Muxoll Grønhaug
- Department of Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- These authors contributed equally to writing
| | - Marieke Verkleij
- Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jeannette B Peters
- Department of Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Karl Sylvester
- Cambridge Respiratory Physiology, Royal Papworth and Cambridge University Hospitals, Cambridge, UK
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - José Miguel Padilha
- CINTESIS@RISE - Centre for Health Technology and Services Research, Porto, Portugal
- Escola Superior de Enfermagem do Porto (Nursing School of Porto), Porto, Portugal
| | - Daniel Langer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- These authors contributed equally to conceptualisation, writing, review and editing
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic Institute of Leiria, Leiria, Portugal
- These authors contributed equally to conceptualisation, writing, review and editing
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7
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Liu Y, Liu Z, Zhang L, Zhang Y, Zhang N, Han Y, Shen L. Preoperative 6-minute walk distance is associated with postoperative complications in patients undergoing laparoscopic gastrointestinal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107139. [PMID: 37948791 DOI: 10.1016/j.ejso.2023.107139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/30/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The 6-min walk test (6MWT) is a simple and valid method to evaluate cardiopulmonary function. We performed this prospective study in patients undergoing laparoscopic gastrointestinal cancer surgery to explore the association between preoperative 6MWT performance and overall postoperative complications. METHODS This study was registered at clinicaltrials.gov (NCT03711526). The study consecutively enrolled patients receiving laparoscopic gastrointestinal cancer surgery in our institution. All patients performed the 6MWT upon recruitment and received 30 days of postoperative follow-up. The primary outcome was overall complications, defined by ≥ grade I Clavien-Dindo (CD) classification (2004) complications. Multivariable logistic regression was used to test the association of 6-min walk distance (6MWD) with the outcome. RESULTS A total of 184 patients were included in the final analyses. In the 37 (20.1 %) patients with overall complications, the mean (standard deviation) preoperative 6MWD was 469.1 (86.8) m. In patients with no complications, the 6MWD was 502.6 (90.2) m. The mean difference was 33.5 m (95 % confidence interval, 1.3, 65.7; P = 0.042). A longer preoperative 6MWD was associated with a lower odds of developing postoperative complications (odds ratio, 0.994 per meter increase; 95 % confidence interval, 0.989, 0.999; p = 0.023). CONCLUSION This study indicated an association between the preoperative 6MWD and postoperative complications in patients undergoing laparoscopic gastrointestinal cancer surgery.
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Affiliation(s)
- Yuchao Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zijia Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Liangyan Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ningchen Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Han
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peroy-Badal R, Sevillano-Castaño A, Torres-Castro R, García-Fernández P, Maté-Muñoz JL, Dumitrana C, Sánchez Rodriguez E, de Frutos Lobo MJ, Vilaró J. Comparison of different field tests to assess the physical capacity of post-COVID-19 patients. Pulmonology 2024; 30:17-23. [PMID: 36117103 PMCID: PMC9339971 DOI: 10.1016/j.pulmoe.2022.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/01/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In coronavirus disease (COVID-19), physical capacity is one of the most impaired sequelae. Due to their simplicity and low cost, field tests such as the six-minute walk test (6MWT) are widely used However, in many places it is difficult to perform them and alternatives can be used such as the 1 min sit-to-stand test (1min-STST) or the Chester step test (CST). Therefore, our objective was to compare the 6MWT, 1min-STST and the CST in post-COVID-19 patients. METHODS We conducted a cross-sectional analysis in post-COVID-19 patients, compared with matched controls (CG). Demographic characteristics and comorbidities were collected. We analysed oxygen saturation (SpO2), heart rate (HR), and the modified Borg scale in the 6MWT, 1min-STST, and CST. Additionally, the correlations between tests were analysed. RESULTS We recruited 27 post-COVID-19 patients and 27 matched controls. The median age was 48 (IQR 43-59) years old (44% female). The median distance walked in 6MWT was 461 (IQR 415-506) m in post-COVID-patients and 517 (IQR 461-560) m in CG (p = 0.001). In 1min-STST, the repetitions were 21.9 ± 6.7 and 28.3 ± 7.1 in the post-COVID-19 group and CG, respectively (p = 0.001). In the CST, the post-COVID-19 group performed 150 (86-204) steps vs the CG with 250 (250-250) steps (p < 0.001). We found correlations between the 6MWT with the 1min-STST in COVID-19 patients (r = 0.681, p < 0.001) and CG (r = 0.668, p < 0.001), and between the 6MWT and the CST in COVID-19 patients (r = 0.692, p < 0.001). CONCLUSION The 1min-STST and the CST correlated significantly with the 6MWT in patients post-COVID-19 being alternatives if the 6MWT cannot be performed.
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Affiliation(s)
- R Peroy-Badal
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain; Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - A Sevillano-Castaño
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain; Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - R Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain.
| | - P García-Fernández
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - J L Maté-Muñoz
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - C Dumitrana
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain
| | - E Sánchez Rodriguez
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M J de Frutos Lobo
- Hospital Virgen de La Torre - Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J Vilaró
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain; Facultad de Ciencias de la Salud Blanquerna, Global Research on Wellbeing (GRoW), Universidad Ramon Llull, Barcelona, Spain
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9
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Althobiani MA, Ranjan Y, Jacob J, Orini M, Dobson RJB, Porter JC, Hurst JR, Folarin AA. Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study. JMIR Form Res 2023; 7:e51507. [PMID: 37999935 DOI: 10.2196/51507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. OBJECTIVE This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. METHODS In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post-COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses-base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. RESULTS Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8% of the day), 123.91 (SD 33.73) hours weekly (72.6% of the week), and 463.82 (SD 156.70) hours monthly (64.4% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59%) were performed. Of these, 90.3% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. CONCLUSIONS Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/28873.
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Affiliation(s)
- Malik A Althobiani
- Respiratory Medicine, University College London, London, United Kingdom
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yatharth Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Joseph Jacob
- Respiratory Medicine, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Richard James Butler Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, London, United Kingdom
| | - Joanna C Porter
- Respiratory Medicine, University College London, London, United Kingdom
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
| | - John R Hurst
- Respiratory Medicine, University College London, London, United Kingdom
| | - Amos A Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre at University College London Hospitals, National Institute for Health Foundation Trust, London, United Kingdom
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10
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Volpato E, Banfi P, Pagnini F. The Interaction Between Asthma, Emotions, and Expectations in the Time of COVID-19. J Asthma Allergy 2023; 16:1157-1175. [PMID: 37881179 PMCID: PMC10596046 DOI: 10.2147/jaa.s418840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction The main aim was to gain insight into the experience of adult people with a diagnosis of at least 6-months of mild or moderate persistent asthma according to the Global Initiative for Asthma (GINA), and their emotions, beliefs, and expectations during the first wave of COVID-19. Methods Qualitative semi-structured interviews using the Interpretative Phenomenological Analysis (IPA) were carried out by phone involving 31 people (mean age=58.2; SD=16.2). Interviews were audio recording, transcribed verbatim and analysed through thematic analysis. Results Five superordinate themes and themes were dedicated to illness (symptoms of asthma; difficulties related to COVID-19), experienced emotions (lockdown period; medical changes; emotions COVID-19 related), beliefs (about asthma; about COVID-19), expectations (related to asthma; related to COVID-19) and behaviours (to protect; risk taken; adherence; contacts with General Practitioners; support). The prevalence of emotions such as fear, worry and anxiety emerged in the participants' narratives. All are accompanied by a preference for action and problem solving. A sense of protection, connection to self and other, and commitment to life were revealed as central concepts for enhancing well-being even at a time of deterring. Discussion The common threads of the presence of uncertainty and vulnerability open the outlook of a treatment that ensures greater continuity and ownership of care in the patient, preserving the sense of self-efficacy even in times of greater instability.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Universita’ Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Universita’ Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
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11
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Man W, Chaplin E, Daynes E, Drummond A, Evans RA, Greening NJ, Nolan C, Pavitt MJ, Roberts NJ, Vogiatzis I, Singh SJ. British Thoracic Society Clinical Statement on pulmonary rehabilitation. Thorax 2023; 78:s2-s15. [PMID: 37770084 DOI: 10.1136/thorax-2023-220439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- William Man
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Enya Daynes
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Alistair Drummond
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Rachael A Evans
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claire Nolan
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Matthew J Pavitt
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Nicola J Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumberland University Newcastle, Newcastle Upon Tyne, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
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12
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da Silva MMC, Viana DR, Colucci MG, Gonzaga LA, Arcuri JF, Frade MCM, de Facio CA, Zopelari LMP, de Figueiredo TEN, Franco FJBZ, Catai AM, Di Lorenzo VAP. Effects of a cardiopulmonary telerehabilitation using functional exercises in individuals after COVID-19 hospital discharge: A randomized controlled trial. J Telemed Telecare 2023:1357633X231188394. [PMID: 37559399 DOI: 10.1177/1357633x231188394] [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: 08/11/2023]
Abstract
INTRODUCTION Individuals with severe coronavirus disease 2019 (COVID-19) may present respiratory and motor complications, requiring rehabilitation programs (RP) for long periods. However, access to cardiopulmonary rehabilitation is poor. Cardiopulmonary telerehabilitation is an alternative for cardiopulmonary dysfunction, improving functional capacity, dyspnea, and quality of life. Moreover, few clinical trials verified the effectiveness of telerehabilitation using functional exercise for post-COVID symptoms. Thus, the present study aimed to verify the effects of cardiopulmonary telerehabilitation using functional and accessible exercises in individuals after COVID-19 hospital discharge. METHODS This blinded, randomized, and controlled clinical trial and included 67 adult individuals after COVID-19 hospital discharge. Participants were randomized into the groups of telerehabilitation (TG; n = 33) and control (CG; n = 34). TG underwent an individualized exercise program (functional and accessible exercises) supervised by a physical therapist (videoconference), and CG received guidance on general care and self-monitoring of vital signs (videoconference). The primary outcome was performance and physiological responses on the 6-minute step test (6MST). Secondary outcomes were performance on the 2-minute stationary walk test (2MSWT), 30-second chair stand test (30CST), and quality of life using the 36-Item Short Form Health Survey (SF-36) questionnaire physical functioning concept (PF). RESULTS Functional capacity (6MST) improved by 28 ± 17 steps in TG and 15 ± 26 in CG (p = 0.04). For secondary outcomes, performance on 2MSWT increased by 39 ± 6 steps in TG and 10 ± 6 in CG (p = 0.00); 30CST by 3 ± 1 repetitions in TG and 1.5 ± 0.5 in CG (p = 0.05); and PF (SF-36) by 17 ± 4 points in TG and 12 ± 4 in CG (p = 0.00). Also, peak oxygen uptake VO2peak (6MST) improved by 3.8 ± 1 mL min-1 kg-1 in TG and 4.1 ± 1 in CG (p = 0.6), and heart rate demand (6MST) by 11 ± 37% in TG and -4 ± 19% in CG (p = 0.04). CONCLUSIONS Cardiopulmonary telerehabilitation using functional exercises improved the exercise and functional capacity assessed using 6MST, 30CST, and 2MSWT and the quality of life of individuals after COVID-19 hospital discharge.
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Affiliation(s)
- Marcela M C da Silva
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
- Physical Therapy Department, Santo Amaro University - Santo Amaro, São Paulo, Brazil
| | - Daiane R Viana
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Maria G Colucci
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Luana A Gonzaga
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Juliano F Arcuri
- University Center Nossa Senhora do Patrocínio (CEUNSP) - Itu, São Paulo, Brazil
| | - Maria C M Frade
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | - Carina A de Facio
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
| | | | | | | | - Aparecida M Catai
- Physical Therapy Department (UFSCar) - São Carlos, São Paulo, Brazil
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13
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Larrateguy S, Vinagre J, Londero F, Dabin J, Ricciardi E, Jeanpaul S, Torres-Castro R, Núñez-Cortés R, Sánchez-Ramírez D, Gimeno-Santos E, Blanco I. Clinical Variables Related to Functional Capacity and Exertional Desaturation in Patients with COVID-19. Biomedicines 2023; 11:2051. [PMID: 37509690 PMCID: PMC10377716 DOI: 10.3390/biomedicines11072051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Impaired functional capacity is one of the most commonly reported consequences among post-COVID-19 patients. This study aimed to analyse the clinical variables related to functional capacity and exertional desaturation in post-COVID-19 patients at the time of hospital discharge. A cross-sectional study was conducted on patients recovering from COVID-19 pneumonia. The main outcomes measures were functional capacity, assessed using the 1 min sit-to-stand test (1 min STST), and exertional desaturation, defined as a drop of ≥4% in the arterial oxygen saturation. Factors used to characterise the participant outcomes included the use of a high-flow nasal cannula (HFNC), prolonged hospitalisation, occurrence of pulmonary embolism during hospitalisation, and underlying comorbidities. A total of 381 participants (mean age = 53.7 ± 13.2 years, 65.6% men) were included. Participants completed a mean of 16.9 ± 6.2 repetitions in the 1 min STST. Exertional desaturation was observed in 51% of the patients. Higher odds of exertional desaturation were found in the participants who used a HFNC (OR = 3.6; 95%CI: 1.6 to 7.8), were admitted in the hospital >10 days (OR = 4.2; 95%CI: 2.6 to 6.8), and had a pulmonary embolism (OR = 3.5; 95%CI: 2.2. to 5.3). Use of a HFNC (β = -3.4; 95%CI: -5.3 to -1.44), a hospital stay >10 days (β = -2.2; 95%CI: -3.4 to -0.9), and a history of pulmonary embolism (β = -1.4; 95%CI: -2.6 to -0.2) were also negatively associated with the 1 min STST. Most post-COVID-19 patients exhibited reduced functional capacity at the time of hospital discharge, and approximately half had exertional desaturation after the 1 min STST. The use of a HFNC, prolonged hospitalisation and pulmonary embolism were the main clinical variables associated with worse a 1 min STST performance and a higher likelihood of exertional desaturation.
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Affiliation(s)
- Santiago Larrateguy
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
- Facultad de Ciencias de la Salud, Universidad Adventista del Plata, Libertador San Martin 3103, Argentina
| | - Julian Vinagre
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Federico Londero
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Johana Dabin
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Evangelina Ricciardi
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Santiago Jeanpaul
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina; (S.L.); (J.V.); (F.L.); (J.D.); (E.R.); (S.J.)
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (R.T.-C.); (R.N.-C.)
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (R.T.-C.); (R.N.-C.)
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46003 Valencia, Spain
| | - Diana Sánchez-Ramírez
- Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 30627 Madrid, Spain
- Barcelona Institute for Global Health (ISGlobal), 08036 Barcelona, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 30627 Madrid, Spain
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Pinnock H, Hui CY, van Boven JF. Implementation of digital home monitoring and management of respiratory disease. Curr Opin Pulm Med 2023; 29:302-312. [PMID: 37132298 PMCID: PMC10241431 DOI: 10.1097/mcp.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE OF REVIEW Digital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the over-arching societal themes of equity, trust and communication. RECENT FINDINGS Technological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data. SUMMARY Understanding and addressing the implementation challenges posed by gaps in policy, regulatory, financial, and technical infrastructure is essential to support delivery of equitable respiratory care that is acceptable to patients and professionals.
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Affiliation(s)
| | - Chi Yan Hui
- Usher Institute, The University of Edinburgh, UK
| | - Job F.M. van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, The Netherlands
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15
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Lavín-Pérez AM, León-Llamas JL, Salas Costilla FJ, Collado-Mateo D, López de las Heras R, Gasque Celma P, Villafaina S. Validity of On-Line Supervised Fitness Tests in People with Low Back Pain. Healthcare (Basel) 2023; 11:healthcare11071019. [PMID: 37046945 PMCID: PMC10094436 DOI: 10.3390/healthcare11071019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
This study aimed to investigate the concurrent validity between online evaluations (OEs) and face-to-face evaluations (IPEs) of a Senior Fitness Test and two balance tests in people with low back pain (LBP). Forty participants of 58.48 (9.87) years were included. The 30 s chair stand-up, arm curl, 2 min step, chair-sit and reach, back scratch, 8 foot up-and-go, sharpened Romberg, and one-legged stance tests were administrated using both OE and IPE methods. The results indicated no significant differences (p > 0.05) between the two methods except in the 8-foot up-and-go test (p = 0.007). Considering the ICC values and Bland-Altman plots, excellent agreement was found for the chair-sit and reach test, moderate agreement for the arm-curl and 8-foot up-and-go tests, and good agreement for the other tests. Strong correlations (p < 0.001) were observed in all variables except for the arm-curl and 8-foot up-and-go tests, where moderate correlations were found (p < 0.05). These results support the validity of OEs and IPEs in all tests, except for the arm-curl and 8-foot up-and-go tests, where lower ICC values and moderate correlations were found. However, it is important to consider the range of fluctuation of the ICC and the significant values obtained through correlations.
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- Centre for Sport Studies, Rey Juan Carlos University, 28943 Fuenlabrada, Spain
- GO fitLAB, Ingesport, 28003 Madrid, Spain
| | - Juan Luis León-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain
| | | | | | | | - Pablo Gasque Celma
- Sports Medicine Service, Alcobendas City Council, 28100 Alcobendas, Spain
- Department of Physical Education, Sport and Human Motricity, Autónoma Univesity, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
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16
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207:819-837. [PMID: 36856433 PMCID: PMC10111975 DOI: 10.1164/rccm.202301-0106pp] [Citation(s) in RCA: 104] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas Health, San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J. Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital, New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D. Sin
- St. Paul’s Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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17
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Pimenta S, Hansen H, Demeyer H, Slevin P, Cruz J. Role of digital health in pulmonary rehabilitation and beyond: shaping the future. ERJ Open Res 2023; 9:00212-2022. [PMID: 36923569 PMCID: PMC10009701 DOI: 10.1183/23120541.00212-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Pulmonary rehabilitation (PR) is a cost-effective intervention with well-known benefits to exercise capacity, symptoms and quality of life in patients with chronic respiratory diseases. Despite the compelling evidence of its benefits, PR implementation is still suboptimal, and maintenance of PR benefits is challenging. To overcome these pitfalls, there has been a growing interest in developing novel models for PR delivery. Digital health is a promising solution, as it has the potential to address some of the most reported barriers to PR uptake and adherence (such as accessibility issues), help maintain the positive results following a PR programme and promote patients' adherence to a more active lifestyle through physical activity (tele)coaching. Despite the accelerated use of digital health to deliver PR during the coronavirus disease 2019 pandemic, there are still several factors that contribute to the resistance to the adoption of digital health, such as the lack of evidence on its effectiveness, low acceptability by patients and healthcare professionals, concerns about implementation and maintenance costs, inequalities in access to the internet and technological devices, and data protection issues. Nevertheless, the trend towards reducing technology costs and the higher availability of digital devices, as well as the greater ease and simplicity of use of devices, enhance the opportunities for future development of digitally enabled PR interventions. This narrative review aims to examine the current evidence on the role of digital health in the context of PR, including strengths and weaknesses, and to determine possible threats and opportunities, as well as areas for future work.
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Affiliation(s)
- Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
| | - Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Respiratory Division, University Hospitals Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Dublin
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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18
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Arch Bronconeumol 2023; 59:232-248. [PMID: 36933949 DOI: 10.1016/j.arbres.2023.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain.
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK; School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | - Jadwiga A Wedzicha
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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19
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, de Oca MM, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, Varela MVL, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Respirology 2023; 28:316-338. [PMID: 36856440 DOI: 10.1111/resp.14486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute Imperial College London, UK
| | - Jean Bourbeau
- McGill University Health Centre McGill University Montreal, Canada
| | - MeiLan K Han
- University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando J Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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20
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Torres-Castro R, Núñez-Cortés R, Larrateguy S, Alsina-Restoy X, Barberà JA, Gimeno-Santos E, García AR, Sibila O, Blanco I. Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen? Life (Basel) 2023; 13:life13030621. [PMID: 36983777 PMCID: PMC10054514 DOI: 10.3390/life13030621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.
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Affiliation(s)
- Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46003 Valencia, Spain
| | - Santiago Larrateguy
- Servicio de Kinesiología y Fisioterapia, Hospital de la Baxada “Dra. Teresa Ratto”, Paraná 3100, Argentina
- Facultad de Ciencias de la Salud, Universidad Adventista del Plata, Libertador San Martin 3103, Argentina
| | - Xavier Alsina-Restoy
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Joan Albert Barberà
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
- Barcelona Institute for Global Health (ISGlobal), 08036 Barcelona, Spain
- Correspondence:
| | - Agustin Roberto García
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
| | - Oriol Sibila
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 30627 Madrid, Spain
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21
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Wickerson L. Clinician's Commentary on Malik et al. 1. Physiother Can 2023; 75:10-11. [PMID: 37250736 PMCID: PMC10211384 DOI: 10.3138/ptc-2021-0051-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Affiliation(s)
- Lisa Wickerson
- Assistant Professor, Department of Physical Therapy, University of Toronto; Affiliate Scientist, TGHRI & Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada;
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22
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Keen C, Smith I, Hashmi-Greenwood M, Sage K, Kiely DG. Pulmonary Hypertension and Measurement of Exercise Capacity Remotely: Evaluation of the 1-min Sit-to-Stand Test (PERSPIRE) - a cohort study. ERJ Open Res 2023; 9:00295-2022. [PMID: 36699650 PMCID: PMC9868966 DOI: 10.1183/23120541.00295-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background Multiparameter risk assessment is recommended to aid treatment decisions in patients with pulmonary arterial hypertension. The 1-min sit-to-stand test (1MSTS) has been validated for use in other respiratory illnesses. The aim of this study was to evaluate its safety in the hospital setting and potential utility in remote assessment in patients with pulmonary hypertension. Methods In a prospective cohort study design patients performed the 1MSTS and incremental shuttle walk test (ISWT) on the same day. The primary aim of the study was to assess safety signals and correlations with other metrics used in risk assessment. Results 60 patients with pulmonary arterial hypertension and 15 with chronic thromboembolic pulmonary hypertension were enrolled. No adverse events were recorded. Post-test change in physiological parameters was lower for the 1MSTS than for the ISWT in heart rate (mean±sd change +9.4±8.0 versus +38.3±25.9 beats per min, p<0.001), oxygen saturation (-3.8±4.0% versus -8.9±7.3%, p<0.01) and systolic blood pressure (+10.1±10.5 versus +17.7±19 mmHg, p<0.001). There were significant correlations between the 1MSTS and ISWT (r=0.702, p<0.01), World Health Organization functional class (r= -0.449, p<0.01), emPHAsis-10 (-0.436, p<0.001) and N-terminal pro-b-type natriuretic peptide (r= -0.270, p=0.022). 97% of patients were willing to perform the test at home. Conclusion This study has demonstrated the safety, sub-maximal characteristics of the 1MSTS in pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the hospital setting, its positive correlation with the ISWT and potential role in remote risk assessment. Further evaluation of this exercise test is now warranted.
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Affiliation(s)
- Carol Keen
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Ian Smith
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Karen Sage
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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23
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Wijsenbeek MS, Moor CC, Johannson KA, Jackson PD, Khor YH, Kondoh Y, Rajan SK, Tabaj GC, Varela BE, van der Wal P, van Zyl-Smit RN, Kreuter M, Maher TM. Home monitoring in interstitial lung diseases. THE LANCET. RESPIRATORY MEDICINE 2023; 11:97-110. [PMID: 36206780 DOI: 10.1016/s2213-2600(22)00228-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
The widespread use of smartphones and the internet has enabled self-monitoring and more hybrid-care models. The COVID-19 pandemic has further accelerated remote monitoring, including in the heterogenous and often vulnerable group of patients with interstitial lung diseases (ILDs). Home monitoring in ILD has the potential to improve access to specialist care, reduce the burden on health-care systems, improve quality of life for patients, identify acute and chronic disease worsening, guide treatment decisions, and simplify clinical trials. Home spirometry has been used in ILD for several years and studies with other devices (such as pulse oximeters, activity trackers, and cough monitors) have emerged. At the same time, challenges have surfaced, including technical, analytical, and implementational issues. In this Series paper, we provide an overview of experiences with home monitoring in ILD, address the challenges and limitations for both care and research, and provide future perspectives. VIDEO ABSTRACT.
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Affiliation(s)
- Marlies S Wijsenbeek
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
| | - Catharina C Moor
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Kerri A Johannson
- Department of Medicine and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Peter D Jackson
- Department of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Yet H Khor
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Sujeet K Rajan
- Department of Chest Medicine, Bombay Hospital Institute of Medical Sciences, Bhatia Hospital, Mumbai, India
| | - Gabriela C Tabaj
- Department of Respiratory Medicine, Cetrángolo Hospital, Buenos Aires, Argentina
| | - Brenda E Varela
- Department of Respiratory Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Pieter van der Wal
- Patient expert, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases and Interdisciplinary Center for Sarcoidosis, Thoraxklinik, University Hospital Heidelberg, Germany; German Center for Lung Research, Heidelberg, Germany; Department of Pneumology, RKH Clinics Ludwigsburg, Ludwigsburg, Germany
| | - Toby M Maher
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; National Heart and Lung Institute, Imperial College London, London, UK
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24
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Early Change in Lower Limb Strength and Function in Lung Transplant Patients After Center-Based and Telerehabilitation. J Cardiopulm Rehabil Prev 2023; 43:55-60. [PMID: 35961370 DOI: 10.1097/hcr.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this study was to examine the change and relationship among quadriceps torque (QT) and physical function in adult lung transplant (LTx) patients undergoing rehabilitation. METHODS A prospective study assessed 6-min walk test (6MWT) distance, QT, and Short Physical Performance Battery (SPPB) at the start of pre-habilitation and 10-12 wk post-LTx. Functional outcomes were examined for within-group differences for participants who completed center-based rehabilitation between September 2019 and March 2020 and participants who completed telerehabilitation ("telerehab") between March 2020 and June 2021 during COVID-19. Relationships between QT, SPPB, and 6MWT were examined pre- and post-LTx. RESULTS A total of 49 LTx recipients were included (30 men, 61 [56-67] yr, 26 center-based rehab, and 23 telerehab). The 6MWT increased (median 75 m: 95% CI, 35 - 117, P < .0001), and the telerehab group showed an LTx decrease in QT (-9.6 Nm: 95% CI, -29 to -2.3, P = .02) and an increased gait speed (0.21 m/sec: 95% CI, 0.11 - 0.47, P < .0001). Pre-LTx QT showed a moderate correlation to pre-LTx SPPB ( r = 0.41, P = .004) and weak correlations to gait speed and 6MWT ( r ranging from 0.21 to 0.35, P < .05). Post-LTx QT showed moderate correlations to post-LTx SPPB ( r = 0.43, P = .002), gait speed ( r = 0.54, P < .001), five-time sit-to-stand ( r =-0.57, P < .0001), and 6MWT ( r = 0.62, P < .0001). CONCLUSIONS Early post-LTx 6MWT and gait speed increased with no improvement in QT or other SPPB components. Correlations between QT and measures of exercise capacity and lower limb function were stronger post-LTx. Serial measurements may further inform functional trajectories and rehabilitation models.
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25
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Bowman A, Denehy L, Benjemaa A, Crowe J, Bruns E, Hall T, Traill A, Edbrooke L. Feasibility and safety of the 30-second sit-to-stand test delivered via telehealth: An observational study. PM R 2023; 15:31-40. [PMID: 35138036 DOI: 10.1002/pmrj.12783] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Exercise testing is essential to determine the safety and efficacy of prescribing exercise. Limited evidence exists to support remotely supervised exercise testing in oncology literature. OBJECTIVE To determine the feasibility, safety, and convergent validity of the 30-second sit-to-stand test (30STS) delivered via telehealth in an oncology population. Exploratory analyses informed remote test feasibility according to participant and treatment characteristics. DESIGN Cross-sectional, observational study. SETTING Telehealth outpatient clinic, tertiary metropolitan oncology hospital. PARTICIPANTS Thirty-two consecutive outpatients attending telehealth exercise appointments were screened for inclusion. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A pre-test safety screening questionnaire included the Australia-modified Karnofsky Performance Status (AKPS) and Clinical Frailty Scale (CFS). Following one practice, one 30STS test was completed using a standardized protocol modified for telehealth assessment. Secondary measures: International Physical Activity Questionnaire-Short Form (IPAQ-SF) and pre/post-test Borg Rating of Perceived Exertion (RPE). RESULTS Thirty participants were deemed as being safe using the screening questionnaire and completed the remote 30STS. Participants were a median (interquartile range [IQR]) 62.5 (51.8 to 66.5) years old, 59% male, 72% undergoing cancer treatment, 34% with metastatic disease, and 56% met current exercise guidelines. Moderate correlation was found between 30STS and IPAQ-SF (rho = 0.49, p = .006), providing evidence of convergent validity. Correlations between 30STS and AKPS (rho = 0.26, p = .161), and CFS (rho = -0.23, p = .214), were fair. Chair-height standardization was poor (range 43 to 60 cm). The clinician could visualize the participant's whole body in 2 of 30 tests. No significant difference in test performance was found for participants with metastatic disease, higher age, or body mass index. No adverse events occurred. CONCLUSION With screening, the 30STS, performed by telehealth, is a safe and feasible measure of function and lower limb strength. Telehealth exercise testing presents challenges in standardizing the environment and ensuring participant safety. Minimal space and equipment requirements and moderate convergent validity with physical activity provide good clinical utility in this setting.
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Affiliation(s)
- Amy Bowman
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Health Services Research, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aisha Benjemaa
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Jess Crowe
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Emma Bruns
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Travis Hall
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Anya Traill
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Lara Edbrooke
- Department of Health Services Research, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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26
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Núñez-Cortés R, Flor-Rufino C, Martínez-Arnau FM, Arnal-Gómez A, Espinoza-Bravo C, Hernández-Guillén D, Cortés-Amador S. Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID. Diagnostics (Basel) 2022; 13:24. [PMID: 36611316 PMCID: PMC9818883 DOI: 10.3390/diagnostics13010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0−10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0−10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8240000, Chile
| | - Cristina Flor-Rufino
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Francisco Miguel Martínez-Arnau
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Anna Arnal-Gómez
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | - David Hernández-Guillén
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Group of Physiotherapy in the Aging Process: Social and Health Care Strategies (PT_AGE), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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27
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Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review. Transplant Direct 2022; 8:e1385. [PMID: 36246000 PMCID: PMC9553387 DOI: 10.1097/txd.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Measures of exercise capacity, frailty, and physical function are commonly used in lung transplant candidates and recipients to evaluate their physical limitations and the effects of exercise training and to select candidates for transplantation. It is unclear how these measures are related to clinical outcomes and healthcare utilization before and after lung transplantation. The purpose of this scoping review was to describe how measures of exercise capacity, physical function, and frailty are related to pre- and posttransplant outcomes.
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28
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Stubbs H, Brewis M, Church C, Johnson M. Towards telemedicine in pulmonary hypertension: Assessing the feasibility of remote quality of life and exercise capacity assessment. Pulm Circ 2022; 12:e12144. [PMID: 36381292 PMCID: PMC9647124 DOI: 10.1002/pul2.12144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/25/2022] [Accepted: 09/26/2022] [Indexed: 01/22/2024] Open
Abstract
Patients with pulmonary hypertension (PH) are happy to perform simple exercise capacity tests at home and believe this is feasible. A proportion of patients are able to use an electronic form to complete quality of life questionnaires. These findings are being used to build a telemedicine strategy for PH patients.
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Affiliation(s)
- Harrison Stubbs
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Melanie Brewis
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Colin Church
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Martin Johnson
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
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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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Psychometric properties of performance-based measures of physical function administered via telehealth among people with chronic conditions: A systematic review. PLoS One 2022; 17:e0274349. [PMID: 36083879 PMCID: PMC9462578 DOI: 10.1371/journal.pone.0274349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Telehealth could enhance rehabilitation for people with chronic health conditions. This review examined the psychometric properties of performance-based measures of physical function administered via telehealth among people with chronic health conditions using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) approach. Methods This systematic review was registered with Prospero (Registration number: CRD42021262547). Four electronic databases were searched up to June 2022. Study quality was evaluated by two independent reviewers using the COSMIN risk of bias checklist. Measurement properties were rated by two independent reviewers in accordance with COSMIN guidance. Results were summarised according to the COSMIN approach and the modified GRADE approach was used to grade quality of the summarised evidence. Results Five articles met the eligibility criteria. These included patients with Parkinson’s Disease (n = 2), stroke (n = 1), cystic fibrosis (n = 1) and chronic heart failure (n = 1). Fifteen performance-based measures of physical function administered via videoconferencing were investigated, spanning measures of functional balance (n = 7), other measures of general functional capacity (n = 4), exercise capacity (n = 2), and functional strength (n = 2). Studies were conducted in Australia (n = 4) and the United States (n = 1). Reliability was reported for twelve measures, with all twelve demonstrating sufficient inter-rater and intra-rater reliability. Criterion validity for all fifteen measures was reported, with eight demonstrating sufficient validity and the remaining seven demonstrating indeterminate validity. No studies reported data on measurement error or responsiveness. Conclusions Several performance-based measures of physical function across the domains of exercise capacity, strength, balance and general functional capacity may have sufficient reliability and criterion validity when administered via telehealth. However, the evidence is of low-very low quality, reflecting the small number of studies conducted and the small sample sizes included in the studies. Future research is needed to explore the measurement error, responsiveness, interpretability and feasibility of these measures administered via telehealth.
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Salles Albuquerque1 V, Dal Corso2 S, Pereira do Amaral2 D, Medina Dutra de Oliveira1 T, Fonseca Souza3 G, Naara Silva de Souza3 R, Karolyn Menezes Nogueira3 A, Dal Lago4 P, Luísa Rocha Dadalt4 M, Faraco Correa4 I, França Bernardelli Cipriano5 G, Maria Ferreira Silva5 F, Rodrigues Britto6 R, José1 A, Malaguti1 C. Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study. J Bras Pneumol 2022. [PMCID: PMC9496468 DOI: 10.36416/1806-3756/e20210511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To establish normative values and a reference equation for the number of steps climbed during the six-minute step test (6MST) in healthy adults, and to assess the reliability of the test and of the equation. Methods: This was a multicenter cross-sectional study involving 468 healthy volunteers (age range: 18-79 years) recruited from the general community in six research laboratories across different regions of Brazil, which is a country with continental dimensions. The 6MST was performed twice (30-min interval), and clinical, demographic, and functional variables were evaluated. An independent sample of 24 volunteers was evaluated to test the reference equation a posteriori. Results: The number of steps had excellent test-retest reliability (intraclass correlation coefficient = 0.96 [95%CI: 0.95-0.97]), and the mean number of steps was 175 ± 45, the number being 14% greater in males than in females. The best performance on the test was correlated with age (r = -0.60), sex (r = 0.28), weight (r = 0.13), height (r = 0.41), BMI (r = -0.22), waist circumference (r = -0.22), thigh circumference (r = 0.15), FVC (r = 0.54), and physical activity level (r = 0.17; p < 0.05 for all). In the regression analysis, age, sex, height, and weight explained 42% of the variability of the 6MST. Normative values were established for the 6MST according to age and sex. There was no difference between the 6MST values from the independent sample and its predicted values (157 ± 29 steps vs. 161 ± 25 steps; p = 0.47; 97% of predicted values). Conclusions: The normative values and the reference equation for the 6MST in this study seem adequate to accurately predict the physical functional performance in adults in Brazil.
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Affiliation(s)
- Vanessa Salles Albuquerque1
- 1. Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Universidade Federal de Juiz de Fora – UFJF – Juiz de Fora (MG) Brasil
| | | | - Daniel Pereira do Amaral2
- 2. Programa de Pós-Graduação em Ciências de Reabilitação, Universidade Nove de Julho – UNINOVE – São Paulo (SP) Brasil
| | - Túlio Medina Dutra de Oliveira1
- 1. Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Universidade Federal de Juiz de Fora – UFJF – Juiz de Fora (MG) Brasil
| | - Gerson Fonseca Souza3
- 3. Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte – UFRN – Natal (RN) Brasil
| | | | | | - Pedro Dal Lago4
- 4. Programa de Pós-Graduação em Ciências de Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA – Porto Alegre (RS) Brasil
| | - Maria Luísa Rocha Dadalt4
- 4. Programa de Pós-Graduação em Ciências de Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA – Porto Alegre (RS) Brasil
| | - Isadora Faraco Correa4
- 4. Programa de Pós-Graduação em Ciências de Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA – Porto Alegre (RS) Brasil
| | | | - Fabíola Maria Ferreira Silva5
- 5. Programa de Pós-Graduação em Ciências e Tecnologias em Saúde. Universidade de Brasília – UnB – Brasília (DF) Brasil
| | - Raquel Rodrigues Britto6
- 6. Programa de Pós-Graduação em Ciências de Reabilitação, Universidade Federal de Minas Gerais –UFMG – Belo Horizonte (MG) Brasil
| | - Anderson José1
- 1. Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Universidade Federal de Juiz de Fora – UFJF – Juiz de Fora (MG) Brasil
| | - Carla Malaguti1
- 1. Programa de Pós-Graduação em Ciências de Reabilitação e Desempenho Físico-Funcional, Universidade Federal de Juiz de Fora – UFJF – Juiz de Fora (MG) Brasil
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Carpallo-Porcar B, Romo-Calvo L, Pérez-Palomares S, Jiménez-Sánchez C, Herrero P, Brandín-de la Cruz N, Calvo S. Efficacy of an asynchronous telerehabilitation program in post-COVID-19 patients: A protocol for a pilot randomized controlled trial. PLoS One 2022; 17:e0270766. [PMID: 35853037 PMCID: PMC9295945 DOI: 10.1371/journal.pone.0270766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background
About 40% of patients who have had COVID-19 still have symptoms three months later whereas a 10% may experience physical and/or psychological consequences two years later. Therefore, it is necessary to perform preventive interventions when patients are discharged from the hospital to decrease the aforementioned sequelae. The purpose of this pilot-controlled trial will be to determine the efficacy of a rehabilitation program on functional status and psychosocial factors for post-COVID-19 patients when it is delivered through a tele-care platform versus a booklet-based rehabilitation.
Methods
The estimated sample size will be of 50 participants who have been discharged after COVID-19 and have a level of fatigue equal or greater than 4 on the Fatigue Severity Scale. The primary outcome will be the severity of fatigue. Participants will be randomly allocated to an “asynchronous telerehabilitation group” or to a “booklet-based rehabilitation group”. Treatment in both groups will be the same and will consist of a combination of therapeutic exercise and an educative program. Treatment outcomes will be evaluated the last day of the intervention and at three- and six-months follow-up.
Discussion
The telerehabilitation intervention appears to be a viable and efficacy option in decreasing severe fatigue and other fitness variables such as strength and aerobic capacity, similar to other traditional rehabilitation formats such as through an explanatory booklet.
Clinical trial registration
This trial has been prospectively registered at clinialtrials.gov identifier: NCT04794036.
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Affiliation(s)
- Beatriz Carpallo-Porcar
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Laura Romo-Calvo
- Hospital Real y Provincial Nuestra Señora de Gracia, Zaragoza, Spain
| | - Sara Pérez-Palomares
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
| | - Carolina Jiménez-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- * E-mail:
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
| | - Natalia Brandín-de la Cruz
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Sandra Calvo
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
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Exercise oncology during and beyond the COVID-19 pandemic: Are virtually supervised exercise interventions a sustainable alternative? Crit Rev Oncol Hematol 2022; 174:103699. [PMID: 35526668 PMCID: PMC9069989 DOI: 10.1016/j.critrevonc.2022.103699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/08/2023] Open
Abstract
During the COVID-19 pandemic, new challenges are presented in clinical research settings to increase exercise levels, particularly in vulnerable populations such as cancer survivors. While in-person supervised exercise is an effective format to improve patient-reported outcomes and physical function for cancer survivors, the COVID-19 pandemic limited this form of exercise as a feasible option within research and cancer care. As such, exercise oncology interventions were adapted to home-based instruction. In this review, we examine the current evidence of exercise interventions in cancer populations during and beyond the COVID-19 pandemic. We identified that group-based virtually supervised home-based exercise was the most used format among exercise oncology interventions during the pandemic. Preliminary results support feasibility and effectiveness of this emerging exercise setting in cancer survivors; however, it needs to be further investigated in adequately designed larger trials. Additionally, we provide recommendations and perspective for the implementation of virtually supervised home-based exercise.
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Home-based and remote functional exercise testing in cardiac conditions, during the covid-19 pandemic and beyond: a systematic review. Physiotherapy 2022; 115:27-35. [PMID: 35180642 PMCID: PMC8694378 DOI: 10.1016/j.physio.2021.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/29/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the change in healthcare to one that adopts a greater reliance on remote delivery, guidance regarding functional exercise testing, either in-person in the home or performed remotely, is urgently needed for people with cardiac conditions. OBJECTIVES To identify functional exercise tests that have been conducted in the home or remotely in patients with cardiac conditions. DATA SOURCES A search was undertaken across four electronic databases and grey literature for English language publications without time restrictions. STUDY ELIGIBILITY CRITERIA Studies of any designs were selected if they reported an exercise test conducted at home or remotely in patients with cardiac conditions. STUDY APPRAISAL AND SYNTHESIS Studies were independently screened and graded by two reviewers according to the Downs and Black checklist. A narrative synthesis of the included studies was undertaken. RESULTS Five studies (six articles) were included, with a total of 438 patients with cardiac conditions. Tests used at home or remotely were the 6-minute walk test (6MWT, five studies) and the timed up and go test (one study). No studies reported the use of step tests in the home or remotely. The 6MWTs were administered via a smartphone application, rope, videoconferencing and accelerometer and proved to be feasible, valid and reliable. CONCLUSIONS Despite a marked demand for home-based exercise programs, the 6MWT remains the most commonly administered functional exercise test for people with cardiac conditions. Surprisingly few studies have explored alternative tests for this patient population that may be more suitable for home or remote performance. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42020219512.
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Amir NH, Dorobantu DM, Wadey CA, Caputo M, Stuart AG, Pieles GE, Williams CA. Exercise training in paediatric congenital heart disease: fit for purpose? Arch Dis Child 2022; 107:525-534. [PMID: 34535443 DOI: 10.1136/archdischild-2020-321390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/30/2021] [Indexed: 11/03/2022]
Abstract
Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.
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Affiliation(s)
- Nurul Hidayah Amir
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA Cawangan Perlis, Kampus Arau, Arau, Perlis, Malaysia
| | - Dan M Dorobantu
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
| | - Massimo Caputo
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
| | - A Graham Stuart
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
| | - Guido E Pieles
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK .,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
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Michaelchuk W, Oliveira A, Marzolini S, Nonoyama M, Maybank A, Goldstein R, Brooks D. Design and delivery of home-based telehealth pulmonary rehabilitation programs in COPD: A systematic review and meta-analysis. Int J Med Inform 2022; 162:104754. [PMID: 35395474 DOI: 10.1016/j.ijmedinf.2022.104754] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 12/11/2022]
Abstract
RATIONALE Home-based telehealth pulmonary rehabilitation (HTPR) for chronic obstructive pulmonary disease (COPD) is increasingly common partly due to the COVID-19 pandemic. However, optimal HTPR programming has not been described. This review provides a comprehensive overview of the design, delivery, and effects of HTPR for people with COPD. METHODS Relevant databases were searched to July 2021 for studies on adults with COPD utilizing information or communication technology to monitor or deliver HTPR. A meta-analysis was performed on a subset of randomized controlled trials. RESULTS Of 3124 records retrieved, 38 studies evaluating 1993 individuals with stable COPD (age 54-75 and FEV1 31-92% predicted) were included. Program components included exercise and education (n = 17) or exercise alone (n = 15) with in-clinic baseline assessments commonly conducted (n = 26). Few trials (n = 7) featured synchronous virtual exercise supervision. Aerobic exercise commonly involved walking (n = 14) and cycling (n = 11) and most programs included resistance training (n = 25). Exercise progressions and emergency action plans were inconsistently reported. Meta-analysis demonstrated HTPR was comparable to outpatient PR and had a greater effect than usual care for the modified Medical Research Council dyspnea scale (mean difference [95 %CI]: -0.49 [-0.77, -0.22], p < 0.01) and COPD Assessment Test score (-4.90 [-7.13, -2.67], p < 0.01). Neither HTPR nor outpatient PR impacted sedentary time or step count. Only 6% of studies reported race and no studies reported participant ethnicity. CONCLUSION This review revealed the heterogeneity of HTPR program designs in COPD. HTPR programs had similar effects to outpatient PR programs and greater effects than usual care for people with COPD.
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Affiliation(s)
- Wade Michaelchuk
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Canada; Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada
| | - Ana Oliveira
- Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada; Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; IBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Susan Marzolini
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Canada; KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Mika Nonoyama
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Canada; Faculty of Health Sciences, Ontario Tech University, Canada
| | - Aline Maybank
- Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; Medical Sciences, Dalhousie University, Halifax, Canada
| | - Roger Goldstein
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Canada; Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Dina Brooks
- Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Canada.
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Chen H, Shi H, Liu X, Sun T, Wu J, Liu Z. Effect of Pulmonary Rehabilitation for Patients With Post-COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:837420. [PMID: 35265644 PMCID: PMC8899076 DOI: 10.3389/fmed.2022.837420] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 01/03/2023] Open
Abstract
Background Evidence increasingly suggested that impaired respiratory function remained in about 40% of patients with coronavirus disease 2019 (COVID-19) after discharge, jeopardizing their activities of daily living and quality of life (QoL) in a long term. Pulmonary rehabilitation (PR) can improve exercise capacity and QoL in individuals with chronic lung disease; however, evidence on the effect of PR for patients with post-COIVD-19 was scarce. This study aimed to conduct a systematic review and meta-analysis to evaluate the effect of PR on lung impairment for patients with post-COVID-19. Methods Five databases were searched for all the published trials of PR for patients with post-COVID-19 from 2019 to October 2021. Data were extracted using a standardized form. The risks of bias of included studies were assessed using the Cochrane risk of the bias assessment tool. Data were synthesized where possible; otherwise, qualitative analysis was done. Results Among 6,000 retrieved studies, 3 studies with 233 patients after COVID-19 were included. The pooled estimate of PR effect on 6-min walk test (6-MWT) (50.41, 95% CI 34.34 to 66.48; p < 0.0001) was in favor of the experiment group with clinical importance. It is found that PR could improve the symptom of dyspnea and QoL; however, its effect on pulmonary function test was inconsistent across studies. The risk of bias of included studies varied, with major concerns on the risk of blinding of participants and interventions performers. Conclusion The review showed that PR could improve exercise capacity measured by 6-MWT among patients with mild-to-moderate lung impairment after COVID-19. The interpretation of effects on lung function, dyspnea, and QoL should be cautious due to inadequate and conflicting data reported across studies. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289562, identifier: CRD42021289562.
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Affiliation(s)
- Huan Chen
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hangyu Shi
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Xitong Liu
- Department of Respiratory Disease, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Tianheng Sun
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Jiani Wu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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38
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Guidarelli C, Lipps C, Stoyles S, Dieckmann NF, Winters-Stone KM. Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment. J Geriatr Oncol 2022; 13:691-697. [PMID: 35177378 DOI: 10.1016/j.jgo.2022.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 02/03/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the reliability of using videoconference technology to remotely administer the Short Physical Performance Battery (SPPB), including the 5-time sit-to-stand (5XSTS) and usual 4-m walk (4mWT), and the Timed Up and Go (TUG) tests and agreement with in-person administration among adults with and without cancer. METHODS Participants from two ongoing clinical exercise trials in cancer survivors, one that included partners without cancer, comprised the available sample (n = 176; mean age 62.5 ± 11.5 years.). Remote tests were administered on two separate days by either the same or a different assessor to determine intra-rater and inter-rater reliability, respectively. We also compared tests conducted remotely and in-person using the same assessor and the same participant. Intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI) were used for all comparisons, except for the SPPB score, which used Cohen's kappa and Krippendorf's alpha for intra- and inter-rater reliability, respectively. RESULTS Remote assessment of the TUG test had excellent intra-rater reliability (0.98, 95% CI 0.93-0.99), inter-rater reliability (ICC = 0.96, 95% CI 0.90-0.99), and good agreement with in-person tests (ICC = 0.88, 95% CI 0.74-0.94). The 5XSTS and 4mWT showed excellent (ICC = 0.92, 95% CI 0.84-0.96) and good (ICC = 0.87, 95% CI 0.71-0.94) intra-rater reliability, respectively, but somewhat lower inter-rater reliability (5XSTS: ICC = 0.65, 95% CI 0.34-0.83 and 4mWT: ICC = 0.62, 95% CI 0.30-0.81). Remote 5XSTS had moderate agreement (ICC = 0.72, 95% CI 0.62-0.80) and 4mWT had poor agreement (ICC = 0.48, 95% CI -0.07-0.76) with in-person tests. CONCLUSIONS Remote assessment of common physical function tests in older adults, including those who have cancer, is feasible and highly reliable when using the same assessor. TUG may be the most methodologically robust measure for remote assessment because it is also highly reliable when using different assessors and correlates strongly with in-person testing. Adapting administration of objective measures of physical function for the remote environment could significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.
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Affiliation(s)
- Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Colin Lipps
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, USA; Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kerri M Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; School of Nursing, Oregon Health & Science University, Portland, OR, USA.
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39
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Zeren M, Karci M, Demir R, Gurses HN, Oktay V, Uzunhasan I, Yigit Z. Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation. Ir J Med Sci 2022; 191:2587-2595. [PMID: 35066793 PMCID: PMC8783771 DOI: 10.1007/s11845-021-02901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
Background Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fibrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed. Aims We aimed to provide cut-off values for two frequently used field tests to be able to objectively interpret symptom burden in atrial fibrillation. Methods One hundred twenty-five patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classified as “asymptomatic”, and those with EHRA 2–4 as “symptomatic”. Cut-off values of 6MWT and 30 s-STST for discriminating between these patients were calculated. Results The optimal cut-off value was “450 m” for 6MWT (sensitivity: 0.71; specificity of 0.79) and “11 repetitions” for 30 s-STST (sensitivity 0.77; specificity of 0.70). Area under ROC curve was 0.75 for both tests (p < 0.001). Discriminative properties of the two tests were similar, and they were significantly correlated (r = 0.58; p < 0.001). Subgroup analysis revealed patients below cut-off values also had worse outcomes in SF-36, IPAQ-SF, and spirometry. Conclusions In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-off values may help identifying patients who may require adjustments in their routine treatment or who may benefit from additional rehabilitative approaches.
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Affiliation(s)
- Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Kaynaklar St, 35665, Izmir, Turkey.
| | - Makbule Karci
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Istanbul Arel University, Istanbul, Turkey
| | - Rengin Demir
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Veysel Oktay
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Isil Uzunhasan
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zerrin Yigit
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
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40
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Telemedicine as a Means to an End, Not an End in Itself. Life (Basel) 2022; 12:life12010122. [PMID: 35054515 PMCID: PMC8777880 DOI: 10.3390/life12010122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.
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41
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Núñez-Cortés R, Cruz-Montecinos C, Martinez-Arnau F, Torres-Castro R, Zamora-Risco E, Pérez-Alenda S, Andersen LL, Calatayud J, Arana E. 30 s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors. Chron Respir Dis 2022; 19:14799731221114263. [PMID: 35957593 PMCID: PMC9379968 DOI: 10.1177/14799731221114263] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction After hospitalization, early detection of musculoskeletal sequelae might help
healthcare professionals to improve and individualize treatment,
accelerating recovery after COVID-19. The objective was to determine the
association between the 30s sit-to-stand muscle power (30s-STS) and
cross-sectional area of the chest muscles (pectoralis) in COVID-19
survivors. Method This cross-sectional study collected routine data from COVID-19 survivors
one month after hospitalization: 1) a chest computed tomography (CT) scan
and 2) a functional capacity test (30s-STS). The pectoralis muscle area
(PMA) was measured from axial CT images. For each gender, patients were
categorized into tertiles based on PMA. The 30s-STS was performed to
determine the leg extension power. The allometric and relative STS power
were calculated as absolute 30s-STS power normalized to height squared and
body mass. The two-way ANOVA was used to compare the gender-stratified
tertiles of 30s-STS power variants. Results Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years,
30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant
differences between the PMA tertiles in absolute STS power
(p = .002) and allometric STS power (p
= .001). There were no significant gender x PMA tertile interactions (all
variables p > .05). The high tertile of PMA showed a
higher allometric STS power compared to the low and middle tertile,
p = .002 and p = .004, respectively.
Absolute STS power and allometric STS power had a moderate correlation with
the PMA, r = 0.519 (p < .001) and r = 0.458
(p < .001) respectively. Conclusion The 30s-STS power is associated with pectoralis muscle thickness in both male
and female COVID-19 survivors. Thus, this test may indicate global
muscle-wasting and may be used as a screening tool for lower extremity
functional capacity in the early stages of rehabilitation planning in
COVID-19 survivors.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Day Hospital Unit, Hospital Clínico Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Francisco Martinez-Arnau
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | | | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Lars L Andersen
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joaquín Calatayud
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, 16781University of Valencia, Valencia, Spain
| | - Estanislao Arana
- Department of Radiology, 16829Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Goyal D, Inada-Kim M, Mansab F, Iqbal A, McKinstry B, Naasan AP, Millar C, Thomas S, Bhatti S, Lasserson D, Burke D. Improving the early identification of COVID-19 pneumonia: a narrative review. BMJ Open Respir Res 2021; 8:8/1/e000911. [PMID: 34740942 PMCID: PMC8573292 DOI: 10.1136/bmjresp-2021-000911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO2)) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO2 carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy.
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Affiliation(s)
- Daniel Goyal
- Department of Acute Internal Medicine, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Matthew Inada-Kim
- Department of Infection, Antimicrobial Resistance and Deterioration, NHS England, Redditch, Worcestershire, UK.,Department of Acute Medicine, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
| | - Fatam Mansab
- Department of Public Health, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Amir Iqbal
- Department of Covid-19 Remote Monitoring of Patients During Response & Recovery, NHS Grampian, Aberdeen, Aberdeen, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Adeeb P Naasan
- Department of General Medicine, Islands Hospital, Oban, UK
| | - Colin Millar
- Department of General Medicine, Islands Hospital, Oban, UK
| | - Stephen Thomas
- Department of Respiratory Medicine, Raigmore Hospital, Inverness, Highland, UK
| | - Sohail Bhatti
- Department of Public Health, Gibraltar Health Authority, Gibraltar, Gibraltar
| | - Daniel Lasserson
- Hospital at Home, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK.,Department of Ambulatory Medicine, University of Warwick, Coventry, West Midlands, UK
| | - Derek Burke
- Department of Clinical Governance, Gibraltar Health Authority, Gibraltar, Gibraltar
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Cox NS, McDonald CF, Mahal A, Alison JA, Wootton R, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Corbett M, Handley E, Burge AT, Holland AE. Telerehabilitation for chronic respiratory disease: a randomised controlled equivalence trial. Thorax 2021; 77:643-651. [PMID: 34650004 DOI: 10.1136/thoraxjnl-2021-216934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. This study investigated whether home-based telerehabilitation was equivalent to centre-based pulmonary rehabilitation in people with chronic respiratory disease. METHODS A multicentre randomised controlled trial with assessor blinding, powered for equivalence was undertaken. Individuals with a chronic respiratory disease referred to pulmonary rehabilitation at four participating sites (one rural) were eligible and randomised using concealed allocation to pulmonary rehabilitation or telerehabilitation. Both programmes were two times per week for 8 weeks. The primary outcome was change in Chronic Respiratory Disease Questionnaire Dyspnoea (CRQ-D) domain at end-rehabilitation, with a prespecified equivalence margin of 2.5 points. Follow-up was at 12 months. Secondary outcomes included exercise capacity, health-related quality of life, symptoms, self-efficacy and psychological well-being. RESULTS 142 participants were randomised to pulmonary rehabilitation or telerehabilitation with 96% and 97% included in the intention-to-treat analysis, respectively. There were no significant differences between groups for any outcome at either time point. Both groups achieved meaningful improvement in dyspnoea and exercise capacity at end-rehabilitation. However, we were unable to confirm equivalence of telerehabilitation for the primary outcome ΔCRQ-D at end-rehabilitation (mean difference (MD) (95% CI) -1 point (-3 to 1)), and inferiority of telerehabilitation could not be excluded at either time point (12-month follow-up: MD -1 point (95% CI -4 to 1)). At end-rehabilitation, telerehabilitation demonstrated equivalence for 6-minute walk distance (MD -6 m, 95% CI -26 to 15) with possibly superiority of telerehabilitation at 12 months (MD 14 m, 95% CI -10 to 38). CONCLUSION telerehabilitation may not be equivalent to centre-based pulmonary rehabilitation for all outcomes, but is safe and achieves clinically meaningful benefits. When centre-based pulmonary rehabilitation is not available, telerehabilitation may provide an alternative programme model. TRIAL REGISTRATION NUMBER ACtelerehabilitationN12616000360415.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia .,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer A Alison
- School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Allied Health Research and Education Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Richard Wootton
- Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromso, Norway
| | | | - Paolo Zanaboni
- Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromso, Norway.,Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | | | - Kathryn Barker
- Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Bruna Wageck
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Pawel Czupryn
- West Wimmera Health Service, Nhill, Victoria, Australia
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Emma Handley
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
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Uzzaman MN, Chan SC, Shunmugam RH, Engkasan JP, Agarwal D, Habib GMM, Hanafi NS, Jackson T, Jebaraj P, Khoo EM, Liew SM, Mirza FT, Pinnock H, Rabinovich RA. Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases: a systematic review protocol. BMJ Open 2021; 11:e050362. [PMID: 34642195 PMCID: PMC8513265 DOI: 10.1136/bmjopen-2021-050362] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Chronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care. METHODS AND ANALYSIS We will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for 'Chronic Respiratory Disease' AND 'Pulmonary Rehabilitation' AND 'Home-PR', and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR? ETHICS AND DISSEMINATION Research ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences. PROSPERO REGISTRATION NUMBER CRD42020220137.
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Affiliation(s)
- Md Nazim Uzzaman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Soo Chin Chan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - G M Monsur Habib
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
- Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | | | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Ee Ming Khoo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Roberto A Rabinovich
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Inflammation Research, QMRI, The University of Edinburgh, Edinburgh, UK
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45
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Dalbosco-Salas M, Torres-Castro R, Rojas Leyton A, Morales Zapata F, Henríquez Salazar E, Espinoza Bastías G, Beltrán Díaz ME, Tapia Allers K, Mornhinweg Fonseca D, Vilaró J. Effectiveness of a Primary Care Telerehabilitation Program for Post-COVID-19 Patients: A Feasibility Study. J Clin Med 2021; 10:jcm10194428. [PMID: 34640447 PMCID: PMC8509356 DOI: 10.3390/jcm10194428] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 12/31/2022] Open
Abstract
In many health systems, it is difficult to carry out traditional rehabilitation programs as the systems are stressed. We evaluate the effectiveness of a telerehabilitation program conducted in primary care in post-COVID-19 patients. An observational, prospective study was conducted in seven primary care centers in Chile. We included adult patients (>18 years) with a previous SARS-CoV-2 infection. The telerehabilitation program consisted of 24 sessions of supervised home-based exercise training. The efficacy was measured by the 1-min sit-to-stand test (1-min STST), the 36-Item Short Form Health Survey (SF-36), fatigue, and dyspnea symptoms before and after intervention. We included 115 patients (55.4% female) with a mean age of 55.6 ± 12.7 years. Fifty-seven patients (50%) had antecedents of hospitalization, and 35 (30.4%) were admitted to the ICU. The 1-min STST was improved after the intervention from 20.5 ± 10.2 (53.1 ± 25.0%predicted) to 29.4 ± 11.9 (78.2 ± 28.0%predicted) repetitions (p < 0.001). The SF-36 global score improved significantly from 39.6 ± 17.6 to 58.9 ± 20.5. Fatigue and dyspnea improved significantly after the intervention. Although limited by the absence of a control group, this report showed that a telerehabilitation program applied in primary health care is feasible and was effective in improving physical capacity, quality of life and symptoms in adult survivors of COVID-19.
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Affiliation(s)
- Marcelo Dalbosco-Salas
- Dirección de Salud de San Bernardo, Santiago 8070894, Chile;
- Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad de las Américas, Santiago 7500975, Chile
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
- International Physiotherapy Research Network (PhysioEvidence), 08025 Barcelona, Spain;
- Correspondence:
| | | | | | | | | | | | | | | | - Jordi Vilaró
- International Physiotherapy Research Network (PhysioEvidence), 08025 Barcelona, Spain;
- Blanquerna School of Health Sciences, Global Research on Wellbeing (GRoW), Universitat Ramon Llull, 08025 Barcelona, Spain
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46
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Bairapareddy KC, Alaparthi GK, Jitendra RS, Prathiksha, Rao PP, Shetty V, Chandrasekaran B. "We are so close; yet too far": perceived barriers to smartphone-based telerehabilitation among healthcare providers and patients with Chronic Obstructive Pulmonary Disease in India. Heliyon 2021; 7:e07857. [PMID: 34485736 PMCID: PMC8403547 DOI: 10.1016/j.heliyon.2021.e07857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Telerehabilitation is imperative and impending in the management of chronic obstructive pulmonary disease patients. However, its feasibility in low- and middle-income nations such as India remained unclear. Objective To assess the feasibility of administering a smartphone-based telerehabilitation program for chronic obstructive pulmonary disease patients in India. Material and method An online cross-sectional survey was administered to stakeholders of the telerehabilitation program: chronic obstructive pulmonary disease patients, health care professionals including pulmonary care physicians, rehabilitation nurses and physiotherapists. The survey sought to ascertain the causes, barriers, and facilitators associated with the implementation of smartphone-based telerehabilitation, as well as strategies for practice improvement. Results While 71% (n = 37/52) of the 52 healthcare professionals surveyed were aware of smartphone-based telerehabilitation, implementation was found to be extremely low (n = 4/37; 10%). The majority of patients with chronic obstructive pulmonary disease (n = 21/30; 70%) agreed to accept smartphone-based telerehabilitation as one of their treatment options. In India, challenges to efficient telerehabilitation implementation included a lack of infrastructure, perceived time consumption, a lack of expertise and training, organizational support, and perceived inefficacy. Conclusion While knowledge of smartphone-based telerehabilitation is high among healthcare professionals and chronic obstructive pulmonary disease patients, implementation of this novel intervention measure has been limited due to perceived constraints associated with smartphone-based telerehabilitation. Adapting national and organizational policies to support smartphone-based telerehabilitation services is critical during this decade of social isolation.
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Affiliation(s)
| | | | - Romika Sawant Jitendra
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Prathiksha
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Priyanka Prasad Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Vanitha Shetty
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Baskaran Chandrasekaran
- Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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47
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Li J, Xia W, Zhan C, Liu S, Yin Z, Wang J, Chong Y, Zheng C, Fang X, Cheng W, Reinhardt JD. A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): a randomised controlled trial. Thorax 2021; 77:697-706. [PMID: 34312316 PMCID: PMC8318721 DOI: 10.1136/thoraxjnl-2021-217382] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/28/2021] [Indexed: 01/23/2023]
Abstract
Objectives To investigate superiority of a telerehabilitation programme for COVID-19 (TERECO) over no rehabilitation with regard to exercise capacity, lower limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL) and dyspnoea. Design Parallel-group randomised controlled trial with 1:1 block randomisation. Setting Three major hospitals from Jiangsu and Hubei provinces, China. Participants 120 formerly hospitalised COVID-19 survivors with remaining dyspnoea complaints were randomised with 61 allocated to control and 59 to TERECO. Intervention Unsupervised home-based 6-week exercise programme comprising breathing control and thoracic expansion, aerobic exercise and LMS exercise, delivered via smartphone, and remotely monitored with heart rate telemetry. Outcomes Primary outcome was 6 min walking distance (6MWD) in metres. Secondary outcomes were squat time in seconds; pulmonary function assessed by spirometry; HRQOL measured with Short Form Health Survey-12 (SF-12) and mMRC-dyspnoea. Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up). Results Adjusted between-group difference in change in 6MWD was 65.45 m (95% CI 43.8 to 87.1; p<0.001) at post-treatment and 68.62 m (95% CI 46.39 to 90.85; p<0.001) at follow-up. Treatment effects for LMS were 20.12 s (95% CI 12.34 to 27.9; p<0.001) post-treatment and 22.23 s (95% CI 14.24 to 30.21; p<0.001) at follow-up. No group differences were found for lung function except post-treatment maximum voluntary ventilation. Increase in SF-12 physical component was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24 to 6.35; p=0.004) at post-treatment and 2.69 (95% CI 0.06 to 5.32; p=0.045) at follow-up. Conclusions This trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and physical HRQOL. Trial registration number ChiCTR2000031834.
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Affiliation(s)
- Jian'an Li
- Center for Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, People's Republic of China.,School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Wenguang Xia
- Department of Rehabilitation Medicine, Hubei Province Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, People's Republic of China
| | - Chao Zhan
- Department of Rehabilitation Medicine, Huangshi Traditional Chinese Medicine Hospital, Huangshi, Hubei, People's Republic of China
| | - Shouguo Liu
- Center for Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, People's Republic of China.,School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Zhifei Yin
- Center for Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, People's Republic of China
| | - Jiayue Wang
- Center for Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, People's Republic of China.,School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yufei Chong
- Department of Rehabilitation Medicine, Hubei Province Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, People's Republic of China
| | - Chanjuan Zheng
- Department of Rehabilitation Medicine, Hubei Province Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, People's Republic of China
| | - Xiaoming Fang
- Department of Rehabilitation Medicine, Huangshi Traditional Chinese Medicine Hospital, Huangshi, Hubei, People's Republic of China
| | - Wei Cheng
- Department of Rehabilitation Medicine, Huangshi Traditional Chinese Medicine Hospital, Huangshi, Hubei, People's Republic of China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, Sichuan, People's Republic of China .,Swiss Paraplegic Research, Nottwil, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,XD Group Hospital, Xi'an, Shaanxi, People's Republic of China
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48
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Short-Term Effects of a Conditioning Telerehabilitation Program in Confined Patients Affected by COVID-19 in the Acute Phase. A Pilot Randomized Controlled Trial. ACTA ACUST UNITED AC 2021; 57:medicina57070684. [PMID: 34356965 PMCID: PMC8305888 DOI: 10.3390/medicina57070684] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives: The COVID-19 pandemic has become a challenge for health systems and, specifically, to physical therapists obligated to adapt their job and stop face-to-face consultations. In this situation, therapeutic exercise has been implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel therapeutic exercise program through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Materials and Methods: A total of 40 subjects were randomized an experimental group, based on muscle conditioning, and in a control group, who did not perform physical activity. Thirty-six subjects, 18 in each group, completed the one-week intervention. We measured the six-minute walking test, multidimensional dyspnoea-12, thirty seconds sit-to-stand test, and Borg Scale. Results: Both groups were comparable at baseline. Statistically significant improvement between groups (p < 0.05) in favor of the experimental group was obtained. No differences between gender were found (p > 0.05). Ninety percent adherence was found in our program. Conclusion: A one-week telerehabilitation program based on muscle toning exercise is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage.
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49
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Wickerson L, Helm D, Gottesman C, Rozenberg D, Singer LG, Keshavjee S, Sidhu A. Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation. JMIR Mhealth Uhealth 2021; 9:e28708. [PMID: 34048354 PMCID: PMC8213059 DOI: 10.2196/28708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/30/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. OBJECTIVE The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. METHODS This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. RESULTS In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ≥10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ≥4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). CONCLUSIONS We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic.
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Affiliation(s)
- Lisa Wickerson
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Denise Helm
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Chaya Gottesman
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Aman Sidhu
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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50
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Benzo RP, Ridgeway J, Hoult JP, Novotny P, Thomas BE, Lam NM, V Benzo M, Kramer K, Seifert S. Feasibility of a Health Coaching and Home-Based Rehabilitation Intervention With Remote Monitoring for COPD. Respir Care 2021; 66:960-971. [PMID: 33906954 PMCID: PMC10027177 DOI: 10.4187/respcare.08580] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary rehabilitation is an effective treatment for patients with COPD, but patient uptake and adherence to the current offering of center-based pulmonary rehabilitation is modest due to transportation, access, poverty, and frailty, and even more so in the context of the COVID pandemic. Home-based options have been proposed and were found noninferior to center-based rehabilitation; however, there is a lack of home-based programs, and more understanding is needed. We aimed to test the feasibility, uptake, and adherence to a home-based program for COPD rehabilitation with health coaching. METHODS We conducted a randomized trial with a wait-list controlled design to evaluate the effects of a home-based program with health coaching on breathlessness in subjects with moderate to severe COPD unable to attend the regular pulmonary rehabilitation program. The 8-week intervention consisted of video-guided exercises to be done 6 times a week and captured with a computer tablet. Health coaching was done weekly over the telephone to review subject activity and symptoms and to provide an opportunity for the subject to define their weekly goals. The primary outcomes were uptake, adherence, and Chronic Respiratory Questionnaire (CRQ) Dyspnea Domain. Secondary outcomes were self-management abilities and CRQ Emotions-Mastery-Fatigue. RESULTS 154 subjects with moderate to severe COPD were randomized. Subject adherence was 86% to the proposed 6-times a week exercise routine. There (P = .062) was no significant difference in breathlessness (CRQ dyspnea). There was a significant improvement in self-management abilities (P < .001). The results of the qualitative interviews showed high levels of acceptability of the program. CONCLUSIONS The tested home-based rehabilitation program with health coaching was feasible, highly acceptable, showed a high degree of adherence, and improved self-management abilities. This study offers seminal information for home-based rehabilitation programs to design alternative options of rehabilitation to individuals with COPD that cannot attend to the well-established center-based pulmonary rehabilitation. (ClinicalTrials.gov registration NCT02557178.).
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Affiliation(s)
- Roberto P Benzo
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota.
| | | | - Johanna P Hoult
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Paul Novotny
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Benjamin E Thomas
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Nyanjok M Lam
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Maria V Benzo
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Kevin Kramer
- Minnesota Health Solutions, Minneapolis, Minnesota
| | - Sara Seifert
- Minnesota Health Solutions, Minneapolis, Minnesota
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