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Child CE, Kelly ML, Sizelove H, Garvin M, Guilliams J, Kim P, Cai HD, Luo S, McQuade KJ, Swenson ER, Wise AT, Lynch YT, Ho LA, Brown MB. A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation. Respir Med 2023; 218:107397. [PMID: 37640274 DOI: 10.1016/j.rmed.2023.107397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
RATIONALE Alternatives to center-based pulmonary rehabilitation are needed to improve patient access to this important therapy. A critical challenge to overcome is how to maximize safety of unsupervised exercise for at-risk patients. We investigated if a novel remote monitoring-enabled mobile health (mHealth) program is safe, feasible, and effective for patients who experience exercise-induced hemoglobin desaturation. METHODS An interstitial lung disease (ILD) commonly associated with pronounced exercise desaturation was investigated - the rare, female-predominant ILD lymphangioleiomyomatosis (LAM). Over a 12-week program, hemoglobin saturation (SpO2) was continuously recorded during all home exercise sessions. Intervention effects were assessed with 6-min walk test (6MWT), maximal cardiopulmonary exercise test (CPET), lower extremity computerized dynamometry, pulmonary function tests, and health-related quality of life (QoL) surveys. Safety was assessed by blood biomarkers of systemic inflammation and cardiac wall stress, and incidence of adverse events. RESULTS Fifteen LAM patients enrolled and 14 completed the intervention, with high adherence to aerobic (87 ± 15%) and strength (87 ± 12%) training components. An innovative characterization of exercise training SpO2 revealed that while mild-to-moderate desaturation was common during home workouts, participants were able to self-adjust exercise intensity and supplemental oxygen levels to maintain recommended exercise parameters. Significant improvements included 6MWT distance (+36 ± 34 m, p = 0.003), CPET time (p = 0.04), muscular endurance (p = 0.008), QoL (p = 0.009 to 0.03), and fatigue (p = 0.001 to 0.03). Patient acceptability and satisfaction indicators were high, blood biomarkers remained stable (p > 0.05), and no study-related adverse events occurred. CONCLUSION A remote monitoring-enabled home exercise program is a safe, feasible, and effective approach even for patients who experience exercise desaturation.
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Affiliation(s)
- Claire E Child
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Morgan L Kelly
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Haley Sizelove
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Marissa Garvin
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Julia Guilliams
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Paul Kim
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Haotian D Cai
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - SiWei Luo
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Kevin J McQuade
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Erik R Swenson
- Medical Service, VA Puget Sound Health Care System, USA; University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
| | - Amanda T Wise
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Ylinne T Lynch
- University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
| | - Lawrence A Ho
- University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
| | - Mary Beth Brown
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
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Kato M, Kanehiro Y, Yoshimi K, Kodama Y, Sekiya M, Sato T, Takahashi K, Seyama K. COPD assessment test as a possible tool for evaluating health-related quality of life in lymphangioleiomyomatosis. Respir Investig 2018; 56:480-488. [PMID: 30143460 DOI: 10.1016/j.resinv.2018.07.004] [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: 02/21/2018] [Revised: 07/02/2018] [Accepted: 07/17/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) is a progressive, cystic lung disease that causes an obstructive ventilatory impairment similar to chronic obstructive pulmonary disease (COPD) and impairs the health-related quality of life (HRQoL). Here, we extended the use of the COPD assessment test (CAT) to patients with chronic respiratory diseases other than COPD. Specifically, the CAT was administered to patients with LAM for the first time. METHODS Using data from 25 patients with LAM at Juntendo University who participated in the Multicenter Lymphangioleiomyomatosis Sirolimus Trial for Safety (MLSTS), we evaluated changes in pulmonary function, responses to HRQoL questionnaires (the CAT, St. George׳s Respiratory Questionnaire [SGRQ], EuroQOL Visual Analogue Scale [EuroQOL-VAS], and Functional Performance Inventory [FPI]), and the association between pulmonary function and HRQoL during a 24-month period of sirolimus treatment. RESULTS Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and CAT total scores improved over the 24 months of sirolimus treatment (5.33 ± 1.20 ml/month, 2.61 ± 1.16 ml/month, and -0.127 ± 0.022 score/month, respectively), whereas SGRQ total score, EuroQOL-VAS score, and FPI score did not. Most pulmonary functions at baseline were associated with the CAT breathlessness score during the first year. Longitudinal changes in FEV1, FEV1%predicted, or FEV1/FVC correlated significantly with the scores of CAT total, CAT breathlessness, and SGRQ activity. When analyzed by stepwise multivariate regression within a linear mixed-effects model, CAT breathlessness and confidence scores were significantly associated with a change in FEV1 from the baseline value (P = 0.0011, and P = 0.0441). CONCLUSION Our results suggest that the CAT is a useful instrument for assessing HRQoL in sirolimus-treated patients with LAM.
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Affiliation(s)
- Miharu Kato
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Yumiko Kanehiro
- Clinical Research Center, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Kaku Yoshimi
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Yuzo Kodama
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Mitsuaki Sekiya
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Tadashi Sato
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Kazuhisa Takahashi
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
| | - Kuniaki Seyama
- Divisions of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan.
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Smith KA, Bosch JD, Pelletier G, MacKenzie M, Hoy MY. The Development of a Tracheostomy-Specific Quality of Life Questionnaire. Ann Otol Rhinol Laryngol 2016; 125:667-71. [DOI: 10.1177/0003489416644619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A long-term tracheostomy can be a life-altering event and can have significant effects on patients’ quality of life (QOL). There is currently no instrument available to evaluate tracheostomy-specific QOL. To address this deficiency, the objective of this study was to create and preliminarily validate a pilot tracheostomy-specific QOL questionnaire to assess its feasibility. Methods: A multidisciplinary team developed the pilot tracheostomy-specific QOL questionnaire (TQOL) in 3 phases: item generation, item review, and scale construction. The survey was administered at 0 and 2 weeks to a pilot group of tracheostomy patients with concurrent administration of a validated general QOL questionnaire at week 0. Convergence validity, test-retest reliability, and internal consistency were the primary outcome measures. Results: A total of 37 patients completed the study (mean tracheostomy duration = 90 weeks). The convergence validity of the TQOL was moderately strong ( r = 0.72), and the test-retest reliability was strong ( r = 0.75). The TQOL also demonstrated good internal consistency (Cronbach’s alpha = 0.82). Conclusion: The TQOL has moderately strong internal consistency, convergence validity, and test-retest reliability. While additional refinement and validation may improve the questionnaire, these initial results are promising and support further development of this tool.
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Affiliation(s)
- Kristine A. Smith
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, AB, Canada
| | - John Douglas Bosch
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, AB, Canada
| | - Guy Pelletier
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Marianne MacKenzie
- Department of Respiratory Technology, Alberta Health Services, Calgary, AB, Canada
| | - Monica Y. Hoy
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, AB, Canada
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