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Alexandre F, Molinier V, Hognon L, Charbonnel L, Calvat A, Castanyer A, Henry T, Marcenac A, Jollive M, Vernet A, Oliver N, Heraud N. Time-Course of Changes in Multidimensional Fatigue and Functional Exercise Capacity and Their Associations during a Short Inpatient Pulmonary Rehabilitation Program. COPD 2023; 20:55-63. [PMID: 36655947 DOI: 10.1080/15412555.2022.2164261] [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: 01/20/2023]
Abstract
This study aimed to assess the time-course of changes in multidimensional fatigue and functional exercise capacity and their associations during an inpatient pulmonary rehabilitation (PR) program. Seventy COPD patients from three centres were enrolled for a four-week PR program and were evaluated before (T0) and at the end of each week (T1, T2, T3, and T4). Weekly change in multidimensional fatigue was assessed by the multidimensional inventory questionnaire (MFI-20) and functional exercise capacity by the 6-minute walking distance (6MWD). Reaction time (RT) and heart rate variability (HRV) were also assessed as complementary markers of fatigue. HRV did not change during the study (all p > 0.05). MFI-20 score and RT decreased during the first part of the program (p < 0.001) and levelled off at T2 (all p > 0.05 compared with each preceding time). While 6MWD improved by almost 70% during the first part of the PR, it continued to increase, albeit at a greatly reduced pace, between T2 and T4 (p < 0.05). In parallel, a negative association was found between MFI-20 score and 6MWD at each evaluation time (r ranged from 0.43 to 0.71), with a significantly stronger T3 correlation compared with the other time periods (all p < 0.05). The strengthening of the association between fatigue and functional exercise capacity at T3, which occurred concomitantly with the slowdown of functional exercise capacity improvement, is consistent with a role for fatigue in the limitation of performance changes during PR. The limitation of fatigue during PR is thus an interesting aspect to improve the magnitude of performance changes.
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Affiliation(s)
- François Alexandre
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France
| | - Virginie Molinier
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France
| | - Louis Hognon
- Euromov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | | | | | | | - Thomas Henry
- Clinique du Souffle Les Clarines, Korian, Riom-ès-montagne, France
| | | | | | | | - Nicolas Oliver
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France.,Clinique du Souffle La Vallonie, Korian, Lodève, France
| | - Nelly Heraud
- Direction de la recherche clinique et de l'innovation en Santé, Korian, Lodève, France
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Bishop JA, Spencer LM, Dwyer TJ, McKeough ZJ, McAnulty A, Alison JA. Changes in Exercise Capacity and Health-Related Quality of Life at Four and Eight Weeks of a Pulmonary Rehabilitation Program in People with COPD. COPD 2021; 18:612-620. [PMID: 34927525 DOI: 10.1080/15412555.2021.2013793] [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: 10/19/2022]
Abstract
Pulmonary Rehabilitation (PR) is a key intervention in the management of people with chronic obstructive pulmonary disease (COPD), though few studies have assessed where changes in outcomes occur during a PR program. The aim of this study was to determine the changes in exercise capacity and health-related quality of life at four and eight weeks during a twice-weekly supervised PR program in people with COPD. Fifty participants with COPD were recruited and attended PR twice-weekly for eight weeks. The outcome measures were the endurance shuttle walk test (ESWT), six-minute walk distance (6MWD), St George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and the Hospital Anxiety and Depression Scale (HADS) which were measured at baseline, four and eight weeks. Compared to baseline, at week four there were significant improvements in ESWT (mean difference [95%CI] 197 [89 to 305] seconds), 6MWD (22 [8 to 36] metres), SGRQ symptom score (-6 [-12 to -1] points) and SGRQ total score (-4 [-7 to -1] points). Between week four and eight there were further significant improvements in ESWT (94 [8 to 181] seconds) only. By week eight, ESWT, 6MWD, SGRQ symptoms and total score, and CAT had all improved significantly compared to baseline measures. This study demonstrated that participants with moderate to very severe COPD who participated in a twice weekly, eight-week PR program (16 sessions) had significant improvement in ESWT, 6MWD, SGRQ, and CAT score with the greatest improvements occurring in the first four weeks of the program.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2013793 .
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Affiliation(s)
- Joshua A Bishop
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Physiotherapy, Balmain Hospital, Balmain, Australia
| | - Lissa M Spencer
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Tiffany J Dwyer
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Zoe J McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Amanda McAnulty
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Allied Health, Sydney Local Health District, Sydney, Australia
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Souto-Miranda S, Rodrigues G, Spruit MA, Marques A. Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review. Ann Phys Rehabil Med 2021; 65:101564. [PMID: 34329794 DOI: 10.1016/j.rehab.2021.101564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures. OBJECTIVES This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD). METHODS The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel. RESULTS We included 267 studies (43153 individuals with COPD). A broad range of domains (n=22), outcomes (n=163) and measures (n=217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n=218) assessed with the 6-min walk test (n=140), health-related quality of life (n=204) assessed with the Saint George's respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified Medical Research Council dyspnea scale (n=56). The least reported outcomes were comorbidities, adverse events and knowledge. CONCLUSIONS This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders. PROSPERO ID CRD42017079935.
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Affiliation(s)
- Sara Souto-Miranda
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Guilherme Rodrigues
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Research and Development, CIRO, Horn, Netherlands
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
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Machado A, Quadflieg K, Oliveira A, Keytsman C, Marques A, Hansen D, Burtin C. Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review. J Clin Med 2019; 8:E1458. [PMID: 31540240 PMCID: PMC6780679 DOI: 10.3390/jcm8091458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.
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Affiliation(s)
- Ana Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
| | - Kirsten Quadflieg
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Charly Keytsman
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810 Aveiro, Portugal
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Jessa hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium.
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Catalfo G, Crea L, Lo Castro T, Magnano San Lio F, Minutolo G, Siscaro G, Vaccino N, Crimi N, Aguglia E. Depression, body mass index, and chronic obstructive pulmonary disease - a holistic approach. Int J Chron Obstruct Pulmon Dis 2016; 11:239-49. [PMID: 26929612 PMCID: PMC4755693 DOI: 10.2147/copd.s84347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Several clinical studies suggest common underlying pathogenetic mechanisms of COPD and depressive/anxiety disorders. We aim to evaluate psychopathological and physical effects of aerobic exercise, proposed in the context of pulmonary rehabilitation, in a sample of COPD patients, through the correlation of some psychopathological variables and physical/pneumological parameters. Methods Fifty-two consecutive subjects were enrolled. At baseline, the sample was divided into two subgroups consisting of 38 depression-positive and 14 depression-negative subjects according to the Hamilton Depression Rating Scale (HAM-D). After the rehabilitation treatment, we compared psychometric and physical examinations between the two groups. Results The differences after the rehabilitation program in all assessed parameters demonstrated a significant improvement in psychiatric and pneumological conditions. The reduction of BMI was significantly correlated with fat mass but only in the depression-positive patients. Conclusion Our results suggest that pulmonary rehabilitation improves depressive and anxiety symptoms in COPD. This improvement is significantly related to the reduction of fat mass and BMI only in depressed COPD patients, in whom these parameters were related at baseline. These findings suggest that depressed COPD patients could benefit from a rehabilitation program in the context of a multidisciplinary approach.
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Affiliation(s)
- Giuseppe Catalfo
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Luciana Crea
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Tiziana Lo Castro
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Francesca Magnano San Lio
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Giuseppe Minutolo
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Gherardo Siscaro
- Operative Unit Neurorehabilitation, IRCCS Fondazione Salvatore Maugeri, Sciacca, Italy
| | - Noemi Vaccino
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Nunzio Crimi
- Department of Pneumology, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Psychiatry, Policlinico "G. Rodolico" University Hospital, University of Catania, Catania, Italy
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Abstract
A comprehensive assessment is the foundation of a successful pulmonary rehabilitation programme. There is a broad selection of outcome measures that tend to be categorized into measures of exercise performance (including measures of strength) quality of life (health status), psychological well-being, nutritional status and more recently knowledge and self-efficacy. There is a growing interest in the measurement of physical activity too, although this is a current line of research activity. A sophisticated suite of outcomes allows the rehabilitation program to be personalised to the individual and deliver effective rehabilitation.
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Affiliation(s)
- Sally Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Groby Road, Leicester LE3 9QP, UK.
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7
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Metabolic Disease and Participant Age Are Independent Predictors of Response to Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2013; 33:249-56. [DOI: 10.1097/hcr.0b013e31829501b7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Seto W, Turner BS, Champagne MT, Liu L. Utilizing a diabetic registry to manage diabetes in a low-income Asian American population. Popul Health Manag 2011; 15:207-15. [PMID: 22192058 DOI: 10.1089/pop.2011.0052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Racial and income disparities persist in diabetes management in America. One third of African and Hispanic Americans with diabetes receive the recommended diabetes services (hemoglobin A1c [A1c] testing, retinal and foot examinations) shown to reduce diabetes complications and mortality, compared to half of whites with diabetes. National data for Asian Americans are limited, but studies suggest that those with language and cultural barriers have difficulty accessing health services. A diabetic registry has been shown to improve process and clinical outcomes in a population with diabetes. This study examined whether a community center that serves primarily low-income Asian American immigrants in Santa Clara County, California, could improve diabetes care and outcomes by implementing a diabetic registry. The registry was built using the Access 2007 software program. A total of 580 patients with diabetes were identified by reviewing charts, the appointment database, and reimbursement records from Medicaid, Medicare, and private insurance companies. Utilizing the registry, medical assistants contacted patients for follow-up appointments, and medical providers checked and tracked the patients' A1c results. Among the 431 patients who returned for treatment, the mean A1c was reduced from 7.27% to 6.97% over 8 months (P<0.001). Although 10.8% of the patients changed from controlled to uncontrolled diabetes post intervention, 32.6% of patients with uncontrolled diabetes converted to controlled diabetes (P<0.001). The diabetes control rate improved from 47% to 59% at the end of the study. This study demonstrated that a diabetic registry is an effective tool to manage an underserved population with diabetes, thereby reducing disparities in diabetes management.
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Affiliation(s)
- Winnie Seto
- Kaiser Permanente, Santa Clara, California, USA.
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Janaudis-Ferreira T, Beauchamp MK, Goldstein RS, Brooks D. How should we measure arm exercise capacity in patients with COPD? A systematic review. Chest 2011; 141:111-120. [PMID: 21659430 DOI: 10.1378/chest.11-0475] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There are no recommendations on how to measure arm exercise capacity in individuals with COPD. The objectives of this study were (1) to synthesize the literature on measures of arm exercise capacity in individuals with COPD, (2) to describe the psychometric properties and the target construct of each measure, and (3) to make recommendations for clinical practice and research. METHODS Studies conducted in patients with COPD that included a measure of arm exercise capacity were identified after searches of five electronic databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library) and reference lists of pertinent articles. One reviewer performed data extraction, and two assessed the quality of the studies that described measurement properties, using the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. RESULTS Of 654 reports, 41 met the study criteria. Five types of arm exercise tests were identified: arm ergometry, ring shifts, dowel lifts, proprioceptive neuromuscular facilitation, and activities of daily living. Four studies assessed the measurement properties of the unsupported upper-limb exercise test (UULEX), the 6-min pegboard and ring test (6PBRT), a test involving weight shifts, and the grocery-shelving task (GST). Validity studies were of fair to good quality, whereas reliability studies were of poor quality. CONCLUSIONS Arm ergometry may be the best method for measuring peak supported arm exercise capacity and endurance. The UULEX, 6PBRT, and GST may better reflect activities of daily living and should be the tests of choice to measure peak unsupported arm exercise capacity (UULEX) and arm function (6PBRT and GST).
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Affiliation(s)
- Tania Janaudis-Ferreira
- Department of Respiratory Medicine West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Marla K Beauchamp
- Department of Respiratory Medicine West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Department of Respiratory Medicine West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
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Jenkins S, Hill K, Cecins NM. State of the art: how to set up a pulmonary rehabilitation program. Respirology 2011; 15:1157-73. [PMID: 20920127 DOI: 10.1111/j.1440-1843.2010.01849.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health-related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost-effective. Although most of the evidence for pulmonary rehabilitation has been obtained in patients with COPD, symptomatic individuals with other respiratory diseases have been shown to benefit. In this review we outline a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program (PRP) that would be feasible in most settings. Throughout the review we have specified the minimum requirements for a PRP to facilitate the establishment of programs using limited resources. Recommendations for staffing and other resources required for a PRP are presented in the first section. Exercise training is a focus of the section on program delivery as this is the component of rehabilitation that has the strongest level of evidence for benefit. Program considerations for patients with respiratory conditions other than COPD are described. Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and individual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.
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Affiliation(s)
- Sue Jenkins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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11
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Duration of pulmonary rehabilitation to achieve a plateau in quality of life and walk test in COPD. Respir Med 2008; 103:722-8. [PMID: 19117744 DOI: 10.1016/j.rmed.2008.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 11/16/2008] [Accepted: 11/24/2008] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To address the minimum duration of pulmonary rehabilitation necessary for patients with chronic obstructive pulmonary disease (COPD) to achieve a plateau in Health-Related Quality of Life (HRQL) and exercise tolerance. METHODS COPD patients with a dyspnea rating of at least 2 on the Medical Research Council scale participated in an outpatient rehabilitation program of 3 weekly sessions for 12 weeks. Measurements included HRQL and exercise tolerance 2 weeks before the program started and every 2 weeks thereafter. Patients were considered to have reached a plateau if they showed no improvement beyond 20% of the minimal important difference between 2 consecutive evaluations on HRQL score or walk tests. RESULTS Twenty-eight patients participated. The number of patients achieving stability after 8 weeks, showing continued improvement after 8 weeks, and demonstrating an erratic pattern of change was as follows: for physical function 16 (56%), 10 (37%) and 2 (7%) patients; for emotional function 22 (79%), 5 (18%) and 1 (4%); and for 6-min walk test 21 (75%), 5 (18%) and 2 (7%). More severe patients demonstrated a greater likelihood (76%) of achieving stability in physical function at 12 weeks than did less severe patients (27%; p on difference=0.003). The likelihood of stability at 12 weeks in emotional function and the 6-min walk test did not differ by severity. CONCLUSIONS A program of 3 weekly 3-h sessions of outpatient pulmonary rehabilitation program should last at least 8 weeks in order to achieve optimal HRQL and exercise tolerance for most patients.
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12
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Di Meo F, Pedone C, Lubich S, Pizzoli C, Traballesi M, Incalzi RA. Age does not hamper the response to pulmonary rehabilitation of COPD patients. Age Ageing 2008; 37:530-5. [PMID: 18565981 DOI: 10.1093/ageing/afn126] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND pulmonary rehabilitation (PR) improves health status and exercise tolerance, but not respiratory function in patients with chronic obstructive pulmonary disease (COPD). Our objective was to identify predictors of improvement in the 6-min walked distance (6'WD) in elderly COPD patients after PR. METHODS this was a prospective observational study performed in an ambulatory rehabilitation setting. We enrolled 74 patients aged 65-83 years (mean: 74.2, SD: 4.4) with stable COPD in GOLD stage 3-4. About half (45.6%) of them had a basal O(2) saturation of 90% or less. After a baseline multi-dimensional assessment, patients underwent a 20-session rehabilitation cycle including training of the upper and lower extremities, and respiratory exercises, along with education sessions. The difference between final and basal 6'WD was expressed as a per cent of the basal value (6'WD gain). Patients were divided into two groups according to whether the 6'WD gain was above or under the 75th percentile, corresponding to 33% gain. RESULTS patients whose 6'WD improved more had lower baseline forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (46.0 versus 52.2%, P = 0.03) and baseline 6'WD, both as an absolute value (329.5 versus 408.9 m, P = 0.01) and as a per cent of the predicted (71.1 versus 93.5%, P = 0.002). After correction for potential confounders, baseline 6'WD was the only variable associated with the outcome (OR for 5% increments: 0.79; 95% CI 0.65-0.95). CONCLUSIONS among elderly patients with COPD, a comprehensive rehabilitation programme can significantly improve the 6'WD even in the presence of chronic hypoxemia. The most physically impaired patients achieve the greatest benefit from rehabilitation, but we could not develop a model accurately predicting the response to rehabilitation.
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Affiliation(s)
- Francesco Di Meo
- Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
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ZuWallack R, Hedges H. Primary care of the patient with chronic obstructive pulmonary disease-part 3: pulmonary rehabilitation and comprehensive care for the patient with chronic obstructive pulmonary disease. Am J Med 2008; 121:S25-32. [PMID: 18558104 DOI: 10.1016/j.amjmed.2008.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article reviews the rationale for and the benefits from a pulmonary rehabilitation approach to the treatment of chronic obstructive pulmonary disease (COPD). Key clinical trials, meta-analyses, and national guidelines or statements on pulmonary rehabilitation were identified. After formal presentations to a panel of pulmonary specialists and primary care physicians, key messages to assist in the implementation of guideline-based care in the primary care setting were developed and integrated into this article, the third in a 4-part mini-symposium. The main points of the roundtable consensus were as follows: (1) Comprehensive pulmonary rehabilitation includes patient education, exercise training, psychosocial support, and nutritional intervention; the evaluation for oxygen supplementation is also conveniently done in this setting. (2) These important components of care are often best delivered in an integrated fashion in a hospital-based pulmonary rehabilitation program; when pulmonary rehabilitation is a not feasible option, clinicians can provide elements of this care to individual patients. (3) Pulmonary rehabilitation has erroneously been considered a "last-ditch" intervention for patients with advanced respiratory disease; however, referral should be considered for any patient with chronic respiratory disease who remains symptomatic or has decreased functional status despite otherwise optimal medical therapy. (4) Pulmonary rehabilitation increases exercise capacity, reduces breathlessness, improves health-related quality of life, and decreases health care utilization; this improvement may be of greater magnitude than that achieved with pharmacologic therapy. (5) Pulmonary rehabilitation has no direct effect on usual pulmonary function tests. It works, in part, through reducing nonpulmonary comorbidity. We conclude that patients with COPD-who are commonly managed in primary care settings-may benefit from multiple components of pulmonary rehabilitation.
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Affiliation(s)
- Richard ZuWallack
- Pulmonary and Critical Care, St. Francis Hospital, Hartford, Connecticut 06105, USA.
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14
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Orr PM, McGinnis MA, Hudson LR, Coberley SS, Crawford A, Clarke JL, Goldfarb NI. A focused telephonic nursing intervention delivers improved adherence to A1c testing. ACTA ACUST UNITED AC 2008; 9:277-83. [PMID: 17044761 DOI: 10.1089/dis.2006.9.277] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Compliance with hemoglobin A1c (A1c) testing is suboptimal despite the clear national recommendations and guidelines established for care of patients with diabetes. Recent studies have demonstrated a relationship between participation in a diabetes disease management (DM) program and improved adherence to A1c testing. A focused intervention study was initiated to investigate the ability of a DM program to drive improvement in A1c testing. A cohort of 36,327 members experienced a statistically significant increase (29%) in A1c testing while participating in the 6-month focused intervention. This finding demonstrated that a focused DM intervention is able to deliver improvement in a clinical process metric critical for managing patients with diabetes, thereby reducing their risk of disease exacerbation.
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Affiliation(s)
- Patty M Orr
- Healthways, Inc., Nashville, Tennessee 37215, USA.
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