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Wong JJ, Wang D, Hogg-Johnson S, Mior SA, Côté P. Prevalence and characteristics of healthcare utilization with different providers among Canadians with chronic back problems: A population-based study. BRAIN & SPINE 2024; 4:102812. [PMID: 38698804 PMCID: PMC11063586 DOI: 10.1016/j.bas.2024.102812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024]
Abstract
Introduction Understanding healthcare utilization by Canadians with back problems informs healthcare planning nationally. Research question What is the prevalence of utilization of healthcare providers (medical doctors, chiropractors, physiotherapists, nurses), and associated characteristics among Canadians with chronic back problems (2001-2016)? Material and methods This population-based study used Canadian Community Health Survey data (2001-2016) restricted to respondents with chronic back problems (aged ≥12 years). We used self-reported consultation with healthcare providers (medical doctors, chiropractors, physiotherapists, nurses) from 2001-2010, and self-reported regular healthcare provider from 2015-2016. We calculated the 12-month prevalence of utilization with providers, and used modified Poisson regression to assess sociodemographic, health-related and behavioural factors associated with utilization of different providers. Results From 2001 to 2010 and 2015/2016, respectively, prevalence of utilization of medical doctors was 87.9% (95% CI 87.6-88.2) and 86.7% (95% CI 85.9-87.5); chiropractors 24.0% (95% CI 23.6-24.4) and 14.5% (95% CI 13.8-15.3); physiotherapists 17.2% (95% CI 16.9-17.6) and 10.7% (95% CI 10.0-11.4); nurses 14.0% (95% CI 13.7-14.2) and 6.6% (95% CI 6.1-7.0). Females were more likely to see any provider than males. Persons of lower socioeconomic status were less likely to consult chiropractors or physiotherapists (2001-2016), or nurses (2001-2010). Immigrants were less likely to consult chiropractors or nurses. Persons aged >65 years were less likely to consult chiropractors or physiotherapists, and those with fair/poor general health were less likely to consult chiropractors, but more likely to consult other providers. Discussion and conclusion Medical doctors were most commonly consulted by Canadians with back problems, then chiropractors and physiotherapists. Characteristics of healthcare utilization varied by provider. Findings inform the need to strengthen healthcare delivery for Canadians with back problems.
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Affiliation(s)
- Jessica J. Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Dan Wang
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada
| | - Silvano A. Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1G 0C5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada
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Capecci M, Cima R, Barbini FA, Mantoan A, Sernissi F, Lai S, Fava R, Tagliapietra L, Ascari L, Izzo RN, Leombruni ME, Casoli P, Hibel M, Ceravolo MG. Telerehabilitation with ARC Intellicare to Cope with Motor and Respiratory Disabilities: Results about the Process, Usability, and Clinical Effect of the "Ricominciare" Pilot Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:7238. [PMID: 37631774 PMCID: PMC10459854 DOI: 10.3390/s23167238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND "Ricominciare" is a single-center, prospective, pre-/post-intervention pilot study aimed at verifying the feasibility and safety of the ARC Intellicare (ARC) system (an artificial intelligence-powered and inertial motion unit-based mobile platform) in the home rehabilitation of people with disabilities due to respiratory or neurological diseases. METHODS People with Parkinson's disease (pwPD) or post-COVID-19 condition (COV19) and an indication for exercise or home rehabilitation to optimize motor and respiratory function were enrolled. They underwent training for ARC usage and received an ARC unit to be used independently at home for 4 weeks, for 45 min 5 days/week sessions of respiratory and motor patient-tailored rehabilitation. ARC allows for exercise monitoring thanks to data from five IMU sensors, processed by an AI proprietary library to provide (i) patients with real-time feedback and (ii) therapists with information on patient adherence to the prescribed therapy. Usability (System Usability Scale, SUS), adherence, and adverse events were primary study outcomes. Modified Barthel Index (mBI), Barthel Dyspnea Index (BaDI), 2-Minute Walking Test (2MWT), Brief Fatigue Inventory (BFI), Beck Depression or Anxiety Inventory (BDI, BAI), and quality of life (EQ-5D) were also monitored pre- and post-treatment. RESULTS A total of 21 out of 23 eligible patients were enrolled and completed the study: 11 COV19 and 10 pwPD. The mean total SUS score was 77/100. The median patients' adherence to exercise prescriptions was 80%. Clinical outcome measures (BaDI, 2MWT distance, BFI; BAI, BDI, and EQ-5D) improved significantly; no side effects were reported. CONCLUSION ARC is usable and safe for home rehabilitation. Preliminary data suggest promising results on the effectiveness in subjects with post-COVID condition or Parkinson's disease.
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Affiliation(s)
- Marianna Capecci
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Rossella Cima
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Filippo A. Barbini
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Alice Mantoan
- Henesis Division, Camlin Italy Srl, 43123 Parma, Italy; (A.M.); (F.S.); (S.L.); (R.F.); (L.T.); (L.A.)
| | - Francesca Sernissi
- Henesis Division, Camlin Italy Srl, 43123 Parma, Italy; (A.M.); (F.S.); (S.L.); (R.F.); (L.T.); (L.A.)
| | - Stefano Lai
- Henesis Division, Camlin Italy Srl, 43123 Parma, Italy; (A.M.); (F.S.); (S.L.); (R.F.); (L.T.); (L.A.)
| | - Riccardo Fava
- Henesis Division, Camlin Italy Srl, 43123 Parma, Italy; (A.M.); (F.S.); (S.L.); (R.F.); (L.T.); (L.A.)
| | - Luca Tagliapietra
- Henesis Division, Camlin Italy Srl, 43123 Parma, Italy; (A.M.); (F.S.); (S.L.); (R.F.); (L.T.); (L.A.)
| | - Luca Ascari
- Henesis Division, Camlin Italy Srl, 43123 Parma, Italy; (A.M.); (F.S.); (S.L.); (R.F.); (L.T.); (L.A.)
| | - Roberto N. Izzo
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Maria Eleonora Leombruni
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Paola Casoli
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Margherita Hibel
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy; (R.C.); (F.A.B.); (R.N.I.); (M.E.L.); (P.C.); (M.H.); (M.G.C.)
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Geraghty TJ, Foster MM, Burridge LH. Moving from Interest to Engagement-Understanding the Research Capacity Building Needs of Rehabilitation Doctors. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:112-119. [PMID: 37493439 DOI: 10.1097/ceh.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Doctors working in rehabilitation settings have specialized clinical skills and experience, but research activity may be constrained by time pressures and inadequate current skills. This means missed opportunities to contribute to the evidence-base for better clinical practice and outcomes for people living with disabling, chronic complex conditions. This research aimed to understand rehabilitation doctors' research needs, experience, and aspirations to enable future training initiatives that are tailored to their practice context. METHODS This exploratory sequential mixed-method study comprised a survey followed by focus groups. Rehabilitation doctors from three health services in south-east Queensland, Australia completed an online survey incorporating the Research Spider to explore their research experience, confidence, interest, opportunity, and intent. Focus groups explored the survey results and participants' views regarding strategies to build research capacity. RESULTS The major findings were the gap between high research interest and low experience, confidence and opportunity; and fundamental research skills were identified as priority training topics. These findings support previous research. However, rehabilitation doctors may also have a self-expectation that, as competent clinicians, they should necessarily also be research-competent, and hold misperceptions regarding the shared nature of health services research. DISCUSSION Protected time and funding may enhance engagement with research to generate specialty-relevant evidence for practice. To this end, a research capacity building initiative in the form of a series of self-directed learning packages has been developed and implemented. A tailored workshop to strengthen rehabilitation doctors' research skills and engagement has also been developed for implementation.
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Affiliation(s)
- Timothy J Geraghty
- Prof. Geraghty: Co-Director, The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia, and Medical Chair, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Brisbane, Australia. Prof. Foster: Adjunct Professor, Policy Innovation Hub, Griffith Business School, Griffith University, Nathan, Queensland, Australia, The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia, and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia. Dr. Burridge: Research Fellow, The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia, and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021; 396:2006-2017. [PMID: 33275908 PMCID: PMC7811204 DOI: 10.1016/s0140-6736(20)32340-0] [Citation(s) in RCA: 830] [Impact Index Per Article: 276.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/04/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury. METHODS To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific). FINDINGS Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed. INTERPRETATION To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Alarcos Cieza
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kaloyan Kamenov
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Somnath Chatterji
- Data and Analytics Department, World Health Organization, Geneva, Switzerland
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Alharbi MG, Kalra HS, Suri M, Soni N, Okpaleke N, Yadav S, Shah S, Iqbal Z, Hamid P. Pulmonary Rehabilitation in Management of Chronic Obstructive Pulmonary Disease. Cureus 2021; 13:e18414. [PMID: 34646587 PMCID: PMC8486403 DOI: 10.7759/cureus.18414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an obstructive and progressive airway disorder that is linked with a significant loss in daily physical activity as well as psychological issues that contribute to the patient's impairment and poor health-related quality of life. Over the last two decades, however, the research and application of nonpharmacologic therapies such as lung rehabilitation have been expedited with increasing evidence of systemic events in COPD patient groups and their nugatory impact on their functioning pulmonary rehabilitation (PR). It is a key part of integrated treatment for COPD and other chronic breathing disorders and is helpful in supporting the recovery of patients following COPD hospitalization. In this paper, we summarize current evidence regarding the effectiveness of PR in the management of chronic COPD. A systematic review was carried out during June 2021, searching databases PubMed, Google Scholar, and EBSCO. The authors extracted qualitative data, and then the author's names, year, study type, methodology, and the result were reported. The search of the aforementioned databases returned a total of 127 studies that were included for title, abstract, and full-text screening, and nine studies were enrolled for final data extraction. PR alleviates tiredness and dyspnea, improves emotional function, and increases the ability to do daily activities. These benefits are relatively extensive and substantial clinically. Rehabilitation acts as an important component of COPD management and helps to improve the quality of life and training linked to health.
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Affiliation(s)
- Mohammed G Alharbi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Prince Mohammed Bin Abdulaziz Medical City, Aljouf, SAU
| | - Harjeevan S Kalra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Firefield, USA
| | - Megha Suri
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nitin Soni
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nkiruka Okpaleke
- Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shikha Yadav
- Internal Medicine, Kathmandu University, Kathmandu, NPL
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Suchitra Shah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zafar Iqbal
- Emergency Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Emergency Medicine, The Kidney Centre, Karachi, PAK
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Hoogendoorn M, Corro Ramos I, Soulard S, Cook J, Soini E, Paulsson E, Rutten-van Mölken M. Cost-effectiveness of the fixed-dose combination tiotropium/olodaterol versus tiotropium monotherapy or a fixed-dose combination of long-acting β2-agonist/inhaled corticosteroid for COPD in Finland, Sweden and the Netherlands: a model-based study. BMJ Open 2021; 11:e049675. [PMID: 34348953 PMCID: PMC8340281 DOI: 10.1136/bmjopen-2021-049675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for patients with COPD who have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-utility of the fixed dose combination of the bronchodilators tiotropium and olodaterol versus two comparators, tiotropium monotherapy and long-acting β2 agonist/inhaled corticosteroid (LABA/ICS) combinations, in three European countries: Finland, Sweden and the Netherlands. METHODS A previously published COPD patient-level discrete event simulation model was updated with most recent evidence to estimate lifetime quality-adjusted life years (QALYs) and costs for COPD patients receiving either tiotropium/olodaterol, tiotropium monotherapy or LABA/ICS. Treatment efficacy covered impact on trough forced expiratory volume in 1 s (FEV1), total and severe exacerbations and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained for each country. The country-specific analyses adhered to the Finnish, Swedish and Dutch pharmacoeconomic guidelines, respectively. RESULTS Treatment with tiotropium/olodaterol gained QALYs ranging from 0.09 (Finland and Sweden) to 0.11 (the Netherlands) versus tiotropium and 0.23 (Finland and Sweden) to 0.28 (the Netherlands) versus LABA/ICS. The Finnish payer's incremental cost-effectiveness ratio (ICER) of tiotropium/olodaterol was €11 000/QALY versus tiotropium and dominant versus LABA/ICS. The Swedish ICERs were €6200/QALY and dominant, respectively (societal perspective). The Dutch ICERs were €14 400 and €9200, respectively (societal perspective). The probability that tiotropium/olodaterol was cost-effective compared with tiotropium at the country-specific (unofficial) threshold values for the maximum willingness to pay for a QALY was 84% for Finland, 98% for Sweden and 99% for the Netherlands. Compared with LABA/ICS, this probability was 100% for all three countries. CONCLUSIONS Based on the simulations, tiotropium/olodaterol is a cost-effective treatment option versus tiotropium or LABA/ICS in all three countries. In both Finland and Sweden, tiotropium/olodaterol is more effective and cost saving (ie, dominant) in comparison with LABA/ICS.
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Affiliation(s)
- Martine Hoogendoorn
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Isaac Corro Ramos
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Stéphane Soulard
- Boehringer Ingelheim The Netherlands, Amsterdam, The Netherlands
| | - Jennifer Cook
- Boehringer Ingelheim International GmbH, Ingelheim, Rheinland-Pfalz, Germany
| | | | | | - Maureen Rutten-van Mölken
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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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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Al Imam MH, Jahan I, Das MC, Muhit M, Akbar D, Badawi N, Khandaker G. Situation analysis of rehabilitation services for persons with disabilities in Bangladesh: identifying service gaps and scopes for improvement. Disabil Rehabil 2021; 44:5571-5584. [PMID: 34176400 DOI: 10.1080/09638288.2021.1939799] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Rehabilitation needs are rising globally; however, the rate is strikingly higher in low- and middle-income countries (LMICs). Like many LMICs, the situation of rehabilitation services for persons with disabilities (PwDs) in Bangladesh is mostly unknown. We assessed the current situation of rehabilitation services for PwDs in Bangladesh. MATERIALS AND METHODS This mixed-method study incorporated an online survey of rehabilitation service providers and a scoping review of documents published on rehabilitation services for PwDs in Bangladesh. Descriptive and thematic analyses were completed. RESULTS A total of 1102 rehabilitation service providers were interviewed, and 36 documents were reviewed. Rehabilitation services for PwDs were found not integrated into the mainstream health services, financing mechanisms, information systems, and health policies in Bangladesh. There are 6.8 rehabilitation units for 1 million people, and 6.2% of them are located in rural areas. In terms of the rehabilitation workforce, there are 9.4 physiotherapists, 1.3 occupational therapists, 0.9 speech and language therapists, and 0.2 prosthetist and orthotists for 1 million people in Bangladesh. Majority (66.3%) of rehabilitation services require an out-of-pocket payment. CONCLUSIONS A critical shortage and uneven distribution of the rehabilitation workforce are evident, indicating a likelihood of very high unmet rehabilitation needs in Bangladesh. To strengthen the rehabilitation capacity of Bangladesh, rehabilitation services should be integrated into mainstream health policies and programs with a special focus on the rehabilitation workforce training, recruitment and distribution, and allocation of resources.Implications for rehabilitationRehabilitation services in Bangladesh are mostly provided by the private sector, although the government of Bangladesh operates a small number of rehabilitation services outside of the mainstream public health service delivery system.Rehabilitation services are lacking in the primary and secondary health facilities, while services at tertiary level public hospitals are mainly provided by medical technologists in the absence of a qualified rehabilitation workforce.A severe shortage of rehabilitation workforce coupled with an uneven distribution of the existing limited number of rehabilitation services and out-of-pocket expenditures might result in inadequate access and poor rehabilitation service uptake amongst persons with disabilities (PwDs) in Bangladesh.Robust governance and leadership are needed to monitor the implementation of existing legislations and policies and develop strategies to improve the situation of rehabilitation services for PwDs in Bangladesh.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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9
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Neo HY, Yap CW, Teo LM, Lee LT, Tan HW, Xu HY, Hum A, Abisheganaden JA. Palliative Rehabilitation Improves Health Care Utilization and Function in Frail Older Adults with Chronic Lung Diseases. J Am Med Dir Assoc 2021; 22:2478-2485.e1. [PMID: 34153233 DOI: 10.1016/j.jamda.2021.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/14/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Integrated Care for Advanced REspiratory Disorders (ICARE) service is a stay-in, post-acute care program for hospitalized patients with chronic, nonmalignant lung diseases. It provides palliative rehabilitation-a novel model integrating functional rehabilitation with early palliative care. We compare reduction of health care utilization among ICARE participants vs matched controls receiving usual care. DESIGN This is a prospective, propensity score-matched study. Primary outcomes were reduction in hospital readmissions and length of stay and emergency department (ED) visits, comparing the period 6 months before and after ICARE, or 6 months before and after hospital discharge (for controls). Secondary outcomes included 6-minute walking distance (6MWD) and Modified Barthel Index (MBI). SETTING Participants were matched 1:1 to controls by age, respiratory diagnosis, socioeconomic strata, index hospitalization length of stay, frailty, and recent admissions into intensive care unit or noninvasive ventilation units. METHODS Multidisciplinary interventions focused on symptom relief, functional rehabilitation, targeted comorbidity management, and postdischarge care coordination. RESULTS One hundred pairs of patients were matched. Participants were older adults (mean age 73.9 ± 8.2 years) with prolonged index hospitalization (median 12.0 days; interquartile range 7-18). Overall, 57% had high Hospital Frailty Risk Scores and 71% had overlapping respiratory diagnoses, the most common commonest being COPD (89%), followed by interstitial lung disease (54%) and bronchiectasis (28%). Small reductions in health care utilization were observed among controls. ICARE was associated with a further 9.1 ± 19.9 days' reduction in hospitalization length of stay (P < .001), 0.8 ± 1.9 lesser admission (P < .001), and 0.6 ± 2.2 fewer ED visits (P < .02). Participants with longest index hospitalization were observed to have greatest reduction in length of stay. 6MWD and MBI scores improved by 41.0 ± 60.2 m and 12.3 ± 11.6 points, respectively (both P < .001). Greater improvement was observed in patients with lower baseline 6MWD and MBI scores. Prescription of slow-release opioids rose from 9% to 49%. Treatment for anxiety and depression rose from 5% to 19%. CONCLUSIONS AND IMPLICATIONS Integrating palliative care with postexacerbation functional rehabilitation was associated with short-term reduction in health care utilization, improved functional capacity, and increased treatment of dyspnea, anxiety, and depression.
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Affiliation(s)
- Han-Yee Neo
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore.
| | - Chun-Wei Yap
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Liang-Ming Teo
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
| | | | | | - Hui-Ying Xu
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
| | - John A Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
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10
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Li M, Cheng K, Ku K, Li J, Hu H, Ung COL. Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record. Int J Chron Obstruct Pulmon Dis 2021; 16:1677-1685. [PMID: 34135579 PMCID: PMC8200153 DOI: 10.2147/copd.s307164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aims to identify the effects of patient and clinical therapy factors on the length of hospital stay (LOS) for admission due to chronic obstructive pulmonary disease (COPD) in Macao. Patients and Methods Health record of patients with COPD admitted to Kiang Wu Hospital from January 2017 to December 2019 was retrospectively analyzed. Demographic information, blood test results, clinical therapies, and LOS were described and analyzed by multivariable regression. Results A total of 1116 admissions were included with the average LOS being 12.28 (±9.23) days. Among them, 735 (66.6%) were male with mean age 79.42 (±10.35) years old, 697 were current or previous smokers (62.5%), and 360 (32.2%) had 3 or more comorbidities. During hospitalization, the most common treatments received were oxygen therapy (n=991,88.8%), antibiotics (n=828,74.2%), and systemic steroids (n=596,53.4%); only 120 (10.8%) had pulmonary rehabilitation (PR) and 128 (11.5%) received noninvasive ventilation (NIV). Inhaled medications were used during nearly 95% of hospitalization cases, while 2 and 3 types of inhaled medications were used during 230 (20.6%) and 582 (52.2%) hospitalization cases, respectively. Patient factors including age (B=0.178, 95% CI:0.535–1.072), being female (B=−1.147, 95% CI:-0.138–0.056), being current (B=−0.086, 95% CI:-0.124–0.018) or previous smoker (B=0.072, 95% CI:0.004–0.087), having 1, 2, 3 and over 3 comorbidities (B=0.126, 95% CI:0.034–0.147; B=0.125, 95% CI:0.031–0.144; B=0.116, 95% CI:0.028–0.146, B=0.090, 95% CI:0.021–0.166) and having low hemoglobin level (B=−0.118, 95% CI:-0.629- −0.214) exhibited significant associations with LOS. The use of NIV (B=0.080, 95% CI:0.022–0.138), pulmonary rehabilitation (B=0.269, 95% CI:0.212–0.327), two and three types of inhaled medications (B=0.109, 95% CI:0.003–0.166, B=0.255, 95% CI:0.083–0.237) were significantly associated with longer LOS (P<0.05). Conclusion NIV, PR and combined inhaled medications, which are often used for AECOPD, are the main clinical therapies associated with longer LOS in Macao. Smoking cessation, early treatments of comorbidities may be crucial to avoiding AECOPD and reducing LOS and disease burden.
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Affiliation(s)
- Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Kun Cheng
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Keisun Ku
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Junlei Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
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11
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Hasanpour Dehkordi A, Ebrahimi-Dehkordi S, Banitalebi-Dehkordi F, Salehi Tali S, Kheiri S, Soleimani Babadi A. The effect of teach-back training intervention of breathing exercise on the level of dyspnea, six-minutes walking test and FEV1/FVC ratio in patients with chronic obstructive pulmonary disease; a randomized controlled trial. Expert Rev Respir Med 2020; 15:161-169. [PMID: 32921199 DOI: 10.1080/17476348.2020.1822740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an irreversible pulmonary obstruction. Respiratory exercise training by a feedback-based model besides the routine managements have been considered to perform. RESEARCH DESIGN AND METHODS Eighty exacerbated COPD patients with informed consent were divided to the control group (n = 40) received the routine approach and the intervention group (n = 40) received a teach-back training method (TBTM) of respiratory exercise including diaphragmatic breathing (DB), pursed-lip breathing (PLB), and effective coughing (EC) plus routine approach. The clinical outcomes were evaluated by measurement of the FEV1/FVC ratio, the Borg scale of dyspnea (BSD), and the 6-minute walking test (6MWT) results at the baseline, just after TBTM, and next 3 months. RESULTS FEV1/FVC ratio has been indicated the significant improvement followed by TBTM compare to the baseline (p < 0.001). Moreover, the BSD scores in 3-month follow-up after TBTM were significantly lower compared to the baseline (6 ± 1.3 vs. 3.8 ± 0.78, p < 0.001). Although a significant difference was reported in 6MWT distance between two groups after 3-month follow-up (p < 0.001), there was no significant difference immediately after the TBTM (p = 0.992) that suggested a long-term effect of educational intervention on physical activity. CONCLUSION Significant enhancement in the clinical variables can demonstrate the efficacy of the TBTM program in reducing COPD patients' symptoms. TRIAL REGISTRATION http//www.irct.ir.Unique identifier: IRCT20181024041449N5.
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Affiliation(s)
- Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Sepehr Ebrahimi-Dehkordi
- Student Research Committee, Shahrekord University of Medical Sciences , Shahrekord, Iran.,Medical Faculty, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Fatemeh Banitalebi-Dehkordi
- Nursing Department, School of Nursing & Midwifery, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Shahriar Salehi Tali
- Nursing Department, School of Nursing & Midwifery, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Soleiman Kheiri
- Modeling in Health Research Center, Shahrekord University of Medical Sciences , Shahrekord, Iran
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12
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Freedman N. Reducing COPD Readmissions: Strategies for the Pulmonologist to Improve Outcomes. Chest 2020; 156:802-807. [PMID: 31590710 DOI: 10.1016/j.chest.2019.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/02/2019] [Accepted: 06/10/2019] [Indexed: 11/17/2022] Open
Abstract
Hospitalizations for patients with acute exacerbations of COPD are associated with several adverse patient outcomes as well as with significant health-care costs. Despite many interventions targeted at reducing readmissions following an initial hospitalization, there are few strategies that have been consistently associated with reductions in this outcome. Despite the lack of consensus as to the best strategies to deploy to reduce readmissions related to acute exacerbations of COPD, efforts must continue to focus on determining the best approaches for this population. These tactics will need to be cost-effective for payers while not being cost-prohibitive for providers. In addition, these interventions will need to be relatively easy to institute while not being overbearing for patients or providers. Larger systems with their greater financial resources will likely find success with technology and data-driven comprehensive programs; independent hospitals and practices are more likely to succeed with less resource-intensive interventions such as early postdischarge follow-up, coaching, action plans, self-management education, and pulmonary rehabilitation. Choosing the right interventions that will utilize financial and human resources in a cost-effective manner, while tailoring the approaches to meet the needs of a specific patient group, will be of key importance.
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Affiliation(s)
- Neil Freedman
- Division of Pulmonary, Critical Care, Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL.
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13
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Cascone R, Sica A, Sagnelli C, Carlucci A, Calogero A, Santini M, Fiorelli A. Endoscopic Treatment and Pulmonary Rehabilitation for Management of Lung Abscess in Elderly Lymphoma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030997. [PMID: 32033391 PMCID: PMC7038113 DOI: 10.3390/ijerph17030997] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 12/17/2022]
Abstract
Background: The management of lung abscess may be a challenge in elderly patients undergoing chemotherapy and/or radiotherapy for previous malignancy. Herein, we reported a case series of elderly patients with previous lymphoma undergoing endoscopic treatment followed by pulmonary rehabilitation for lung abscess. Methods: Our study population included a consecutive series of elderly patients with previous lymphoma and lung abscess. Suppurative infection was refractory with specific antibiotic therapy. In all cases, drainage was endoscopically inserted in lung abscess via video-bronchoscopy. This strategy allowed performing daily therapy with the installation of gentamicin directly into the abscess cavity. All patients underwent a respiratory rehabilitation program to speed up convalescence and allow early discharge. Results: After positioning the catheter through a bronchoscopic route and subsequent washing with gentamicin, all the patients in our study showed an improvement in clinical conditions with resolution of fever within a few days of starting the procedure with normalization of blood tests (mean hospital length 7 ± 0.73 days). A follow-up chest computed tomography scan showed a resolution of lung abscess within a mean of 27 ± 1.53 days. Conclusions: Endoscopic treatment with a rehabilitation program may be a valuable strategy for the management of lung abscess that is refractory to standard antibiotic therapy. Further and larger studiesshould be done to confirm our results.
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Affiliation(s)
- Roberto Cascone
- Department of Translation Medicine, Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (A.C.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Annalisa Carlucci
- Department of Translation Medicine, Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (A.C.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Mario Santini
- Department of Translation Medicine, Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (A.C.)
| | - Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (A.C.)
- Correspondence: ; Tel.: +39-0815665228
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14
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Weinreich UM. Domiciliary high-flow treatment in patients with COPD and chronic hypoxic failure: In whom can we reduce exacerbations and hospitalizations? PLoS One 2019; 14:e0227221. [PMID: 31887206 PMCID: PMC6937157 DOI: 10.1371/journal.pone.0227221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Domiciliary High-flow, humidified, nasal cannula (HFNC) is a possible add-on in patients with chronic respiratory diseases. This post-hoc study investigates benefit of HFNC in subgroups of advanced COPD patients with chronic hypoxic failure on reduction of exacerbations and hospitalizations. METHODS One hundred patients were randomized to HFNC in a previous trial. Subgroups with 0-1 (N = 32) respectively two or more (2+) (N = 68) exacerbations 12 months pre-study were investigated. Changes in number of exacerbations and hospitalizations pre- and in study were analyzed, corrected for HFNC days with HFNC. RESULTS Patients were comparable at baseline. Exacerbations increased in subgroup 0-1 (p = 0.01) and decreased in subgroup 2+ (p = 0.03). Correcting for HFNC days no correlation was seen in subgroup 0-1 (p = 0.08), but in subgroup 2+ (p<0.001). Number of hospitalizations increased in subgroup 0-1 (p = 0.01) with no change in days of hospitalization (p = 0.08). Number and days of hospitalization decreased in subgroup 2+ (p = 0.002 resp. 0.025). Correcting for HFNC days no correlation was found in number or days of hospitalization in subgroup 0-1 (p = 0.48 and p = 0.65). Positive correlation was found in subgroup 2+ (both p<0.001). CONCLUSION In patients with advanced COPD, chronic hypoxic failure and two or more exacerbations per year, HFNC significantly reduced exacerbations and hospitalizations.
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Affiliation(s)
- Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, and The Clinical Institute, Aalborg University, Aalborg, Denmark
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15
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Polastri M, Comellini V, Pacilli AMG, Nava S. Magnetic Stimulation Therapy in Patients with COPD: A Systematic Review. COPD 2018; 15:165-170. [PMID: 29558200 DOI: 10.1080/15412555.2018.1439910] [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: 10/17/2022]
Abstract
Magnetotherapy (MT) is a therapeutic treatment based on the use of magnetic fields (MF) that can have an anti-inflammatory and analgesic effect. MT represents a possible treatment or an ancillary therapeutic intervention for a wide range of diseases and it is often used in the field of physiotherapeutic practices. A crucial point in the treatment of chronic obstructive pulmonary disease (COPD) patients, to counteract muscular depletion and respiratory symptoms, is represented by physiotherapy. Nevertheless, the knowledge about the application of MF as a therapeutic option in COPD patients is very limited. The purpose of the present study was to define what is currently known about the use of MF in patients with COPD. A systematic review of the literature was conducted during the month of October 2017, searching three main databases. Only those citations providing detailed informations about the use of MF to treat COPD symptoms either during an acute or a chronic phase of the disease, were selected. Following the selection process three articles were included in the final analysis. The present review focused on a total of thirty-six patients with COPD, and on the effects of the application of MF. In the majority of cases, the treatment sessions with MF were carried-out in an outpatient setting, and they differed with regard to the duration; frequency of application; dosage; intensity of the applied MF. Basing on the available informations, it seems that MF is a feasible, well tolerated, safe therapeutic option, for the treatment of motor-related COPD symptoms.
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Affiliation(s)
- Massimiliano Polastri
- a Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation , University Hospital St. Orsola-Malpighi , Bologna , Italy
| | - Vittoria Comellini
- b Respiratory and Critical Care Unit , University Hospital St. Orsola-Malpighi , Bologna , Italy
| | - Angela Maria Grazia Pacilli
- c Department of Specialistic, Diagnostic and Experimental Medicine (DIMES) , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | - Stefano Nava
- b Respiratory and Critical Care Unit , University Hospital St. Orsola-Malpighi , Bologna , Italy.,c Department of Specialistic, Diagnostic and Experimental Medicine (DIMES) , Alma Mater Studiorum University of Bologna , Bologna , Italy
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