1
|
Bains KK, Jennings S, Bull C, Tilley L, Montgomery L, Lee AL. A systematic review of change in symptoms, well-being and quality of life with group singing in people with cancer and their caregivers. Support Care Cancer 2024; 32:246. [PMID: 38520544 DOI: 10.1007/s00520-024-08449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This systematic review aimed to assess the impact of group singing on physical function, cancer-related symptoms, well-being (emotional, physical, social, spiritual), and health-related quality of life in individuals with cancer and their caregivers. METHODS A search was performed using Ovid MEDLINE, Embase, Scopus and Web of Science from inception to April 2023; key words included cancer, choir, and group singing. Observational cohort, prospective or retrospective studies, randomized controlled studies, and crossover studies were included. Two teams of independent reviewers extracted data and assessed the risk of bias using the Downs and Black Tool. RESULTS A total of 6 studies (6 reports) met the inclusion criteria for this review, with a mix of study designs. The overall quality of the studies was poor. Group singing significantly reduced anxiety levels in those with cancer and their caregivers, while the effects on depression were variable and there was no impact on fatigue. Caregivers reported improved well-being, self-efficacy and self-esteem. Both those with cancer and their caregivers had reductions in fear, anger, confusion; and reported improvement in energy, relaxation and connectedness at longer term follow-up compared to no treatment. Those with cancer reported improvements in health-related quality of life domains of bodily pain, vitality and mental health with group singing, though the effects on caregivers were mixed. CONCLUSIONS Group singing may have favourable effects on selected symptoms, aspects of well-being, and domains of health-related quality of life specific to vitality, bodily pain, and mental health in individuals with cancer and their caregivers.
Collapse
Affiliation(s)
- Kuljit Kaur Bains
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
- Department of Integrated Community Health Services, Western Health, 29 - 35 Grant Street, Bacchus Marsh, VIC, 3340, Australia
| | - Sophie Jennings
- Allied Health and Ambulatory Services, Cabrini Health, 181 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Caitlin Bull
- Palliative and Supportive Care Services, Cabrini Health, 181 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Louise Tilley
- Allied Health and Ambulatory Services, Cabrini Health, 181 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Laura Montgomery
- Department of Physiotherapy, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
| |
Collapse
|
2
|
Watson KE, Lee AL, Dwyer TJ, McKeough ZJ. Applying the treatable traits approach in bronchiectasis-A scoping review of traits, measurements and treatments implemented by allied health professionals and nurses. Respir Med 2024; 222:107503. [PMID: 38141863 DOI: 10.1016/j.rmed.2023.107503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Using treatable traits as a management approach in bronchiectasis involves determining identifiable, clinically relevant, measurable and treatable problems to develop a management strategy in collaboration with the patient. OBJECTIVE To identify new treatable traits not previously reported in the literature and treatment strategies for new and existing traits that could be implemented in an outpatient clinic or community setting by an allied health professional or nurse in adults with bronchiectasis. METHODS A scoping review was conducted with searches of MEDLINE, CINAHL, AMED, Embase, Cochrane Central Register of Controlled Trials and PsycInfo. The search yielded 9963 articles with 255 articles proceeding to full text review and 114 articles included for data extraction. RESULTS Sixteen new traits were identified, including fatigue (number of studies with new trait (n) = 13), physical inactivity (n = 13), reduced peripheral muscle power and/or strength (n = 12), respiratory muscle weakness (n = 9) and sedentarism (n = 6). The main treatment strategies for new and existing traits were airway clearance therapy (number of citations (n) = 86), pulmonary rehabilitation (n = 58), inspiratory muscle training (n = 20) and nebulised saline (n = 12). CONCLUSION This review identifies several new traits in bronchiectasis and highlights the common treatments for new and existing traits that can be implemented in a treatable traits approach in an outpatient clinic or community setting by an allied health professional or nurse.
Collapse
Affiliation(s)
- Kirsty E Watson
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia; Department of Allied Health, Central Queensland Hospital and Health Service, Rockhampton, Australia.
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, Australia
| | - Tiffany J Dwyer
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Zoe J McKeough
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
3
|
Lee AL, Burge AT. Adding Up the Value of Pulmonary Rehabilitation in COPD: Money, Morbidity, and Mortality. Chest 2024; 165:231-232. [PMID: 38336430 DOI: 10.1016/j.chest.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia.
| | - Angela T Burge
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Brusco NK, Walpole B, Kugler H, Tilley L, Thwaites C, Devlin A, Dorward E, Dulfer F, Lee AL, Morris ME, Taylor NF, Dawes H, Whittaker SL, Ekegren CL. Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings. Aust Occup Ther J 2023; 70:617-626. [PMID: 37291993 DOI: 10.1111/1440-1630.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Self-directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self-directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self-directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings. METHODS My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open-ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free-text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model). RESULTS Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self-directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self-directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme. CONCLUSION Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale-up the implementation of the My Therapy programme and evaluate its effectiveness.
Collapse
Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Brianna Walpole
- Safer Care Victoria, Victorian Government, Melbourne, Australia
| | - Helen Kugler
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Louise Tilley
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Claire Thwaites
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Fiona Dulfer
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Helen Dawes
- Clinical Rehabilitation, University of Exeter, Exeter, UK
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| |
Collapse
|
5
|
Herrero-Cortina B, Spinou A, Oliveira A, O'Neill B, Jácome C, Dal Corso S, Poncin W, Muñoz G, Inal-Ince D, Alcaraz-Serrano V, Reychler G, Bellofiore A, Posthumus A, Chalmers JD, Lee AL. Airway clearance techniques and exercise in people with bronchiectasis: two different coins. Eur Respir J 2023; 62:2300741. [PMID: 37827549 DOI: 10.1183/13993003.00741-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Beatriz Herrero-Cortina
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Universidad San Jorge, Zaragoza, Spain
| | - Arietta Spinou
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Centre for Lung Health, King's College London, London, UK
| | - Ana Oliveira
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Brenda O'Neill
- School of Health Sciences, Ulster University, Coleraine, UK
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Simone Dal Corso
- Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - William Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gerard Muñoz
- Department of Pneumology, Dr Josep Trueta University Hospital, Bronchiectasis Group, Girona Biomedical Research Institute, Girona, Spain
- Department of Physical Therapy, EUSES & ENTI, University of Girona and University of Barcelona, Girona, Spain
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Victoria Alcaraz-Serrano
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain
| | - Gregory Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Angela Bellofiore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Healthcare Professions Department, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Centre, Milan, Italy
| | | | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| |
Collapse
|
6
|
Bhat A, Lee AL, Maiya GA, Vaishali K. Measurement properties of physical activity in adults with bronchiectasis: A systematic review protocol. F1000Res 2023; 12:801. [PMID: 37600906 PMCID: PMC10439356 DOI: 10.12688/f1000research.138593.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/22/2023] Open
Abstract
People with bronchiectasis reduce their physical activity (PA) due to muscle weakness, dyspnea, fatigue, reduced exercise capacity and frequent cough with expectoration. Patient-reported and objective physical assessment methods have been used to evaluate PA in people with bronchiectasis. In the literature, significant differences in the PA measured using patient-reported outcome measures when compared with the objective methods. Given the availability of many PA assessment tools, it is tedious for the clinician or researcher to choose an outcome measure for clinical practice or research. The evidence on validity and reliability in bronchiectasis are unclear. Objectives: To identify the PA assessment tools, describe and evaluate the literature on psychometric properties of instruments measuring and analyzing PA. Methods: The search will be conducted in PubMed/Medline, Cochrane Central Register of Controlled Studies, Scopus and EMBASE databases. The keywords, index terms and synonyms of the following words will be used: bronchiectasis, physical activity, and outcome measures. Published studies of adult with clinical and/ or radiologically diagnosed bronchiectasis, aged >18 years, any gender and studies that assessed PA and/or if there are reports on measurement properties of PA will be included in the review. Studies using qualitative research methods, narrative reviews, letters to editors and editorials will be excluded. The quality of the study will be assessed and data will be extracted. Any disagreement will be resolved in the presence of an author not involved in the screening or selecting studies. Discussion: By assessing the quality of studies on measurement properties, this review will help researchers choose the outcome measure to evaluate the effects of interventions on PA. This review will identify the suite of outcome measures of PA for people with bronchiectasis that can be used for research and clinical purpose.
Collapse
Affiliation(s)
- Anup Bhat
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Clayton, Frankston, Victoria, 3199, Australia
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
7
|
Maddocks M, Brighton LJ, Alison JA, Ter Beek L, Bhatt SP, Brummel NE, Burtin C, Cesari M, Evans RA, Ferrante LE, Flores-Flores O, Franssen FME, Garvey C, Harrison SL, Iyer AS, Lahouse L, Lareau S, Lee AL, Man WDC, Marengoni A, McAuley HJC, Rozenberg D, Singer JP, Spruit MA, Osadnik CR. Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:767-780. [PMID: 37261787 PMCID: PMC10257033 DOI: 10.1513/annalsats.202302-129st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a "frailty rehabilitation paradox" whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.
Collapse
|
8
|
Herrero-Cortina B, Lee AL, Oliveira A, O'Neill B, Jácome C, Dal Corso S, Poncin W, Muñoz G, Inal-Ince D, Alcaraz-Serrano V, Reychler G, Bellofiore A, Tonia T, Chalmers JD, Spinou A. European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis. Eur Respir J 2023:13993003.02053-2022. [PMID: 37142337 DOI: 10.1183/13993003.02053-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/15/2023] [Indexed: 05/06/2023]
Abstract
Airway clearance techniques (ACTs) are part of the main management strategy for patients with bronchiectasis. Despite being a priority for patients, accessibility, implementation, and reporting of ACTs are variable in clinical settings and research studies. This European Respiratory Society statement summarises current knowledge about the ACTs in adults with bronchiectasis and makes recommendations to improve future evidence base. A task force of 14 experts and two patient representatives (10 countries) determined the scope of this statement through consensus and defined six questions. The questions were answered based on systematic searches of the literature.The statement provides a comprehensive review of the physiological rationale for ACTs in adults with bronchiectasis, and the mechanisms of action along with the advantages and disadvantages of each ACT. Evidence on the ACTs in clinical practice indicates that active cycle of breathing techniques, positive expiratory pressure devices and gravity assisted drainage technique are the most frequently used techniques, although there is limited evidence on the type of ACTs used in specific countries. A review of 30 randomised trials for the effectiveness of the ACTs shows that these interventions increase sputum clearance during or after treatment, reduce the impact of cough and the risk of exacerbations, and improve health-related quality of life. Furthermore, strategies for reducing the risk of bias in future studies are proposed. Finally, an exploration of patientś perceptions, barriers and enablers related to this treatment is also included to facilitate implementation and adherence to ACTs.
Collapse
Affiliation(s)
- Beatriz Herrero-Cortina
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Universidad San Jorge, Zaragoza, Spain
| | - Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Ana Oliveira
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | | | - Cristina Jácome
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto Faculty of Medicine, Porto, Portugal
| | - Simone Dal Corso
- Graduate Program in Rehabilitation Sciences. Universidade Nove de Julho. São Paulo/SP, Brazil
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - William Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gerard Muñoz
- Department of Pneumology, Dr. JosepTrueta University Hospital. Bronchiectasis Group, Girona Biomedical Research InstituteSalt, Girona
- Department of Physical Therapy, EUSES & ENTI. University of Girona and University of Barcelona. Carrer del President Francesc Macià, Salt, Girona
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Samanpazari, Ankara, Turkey
| | - Victoria Alcaraz-Serrano
- Barcelona Institute for Global Health (ISGlobal)
- Blanquerna School of Health Science, Ramon Llull University, Barcelona
| | - Gregory Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Angela Bellofiore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Centre, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Health and Care Professions Department, Milan, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Arietta Spinou
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- King's Centre for Lung Health, King's College London, London, UK
| |
Collapse
|
9
|
Wright JM, Lee AL, Rappazzo KM, Ru H, Radke EG, Bateson TF. Systematic review and meta-analysis of birth weight and PFNA exposures. Environ Res 2023; 222:115357. [PMID: 36706898 DOI: 10.1016/j.envres.2023.115357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
We used a systematic review that included risk of bias and study sensitivity analysis to identify 34 studies examining changes in birth weight (BWT) in relation to PFNA biomarker measures (e.g., maternal serum/plasma or umbilical cord samples). We fit a random effects model of the overall pooled estimate and stratified estimates based on sample timing and overall study confidence. We conducted a meta-regression to further examine the impact of gestational age at biomarker sample timing. We detected a -32.9 g (95%CI: -47.0, -18.7) mean BWT deficit per each ln PFNA increase from 27 included studies. We did not detect evidence of publication bias (pE = 0.30) or between-study heterogeneity in the summary estimate (pQ = 0.05; I2 = 36%). The twelve high confidence studies yielded a smaller pooled effect estimate (β = -28.0 g; 95%CI: -49.0, -6.9) than the ten medium (β = -39.0 g; 95%CI: -61.8, -16.3) or four low (β = -36.9 g; 95%CI: -82.9, 9.1) confidence studies. The stratum-specific results based on earlier pregnancy sampling periods in 11 studies showed smaller deficits (β = -22.0 g; 95%CI: -40.1, -4.0) compared to 10 mid- and late-pregnancy (β = -44.2 g; 95%CI: -64.8, -23.5) studies and six post-partum studies (β = -42.9 g; 95%CI: -88.0, 2.2). Using estimates of the specific gestational week of sampling, the meta-regression showed results consistent with the categorical sample analysis, in that as gestational age at sampling time increases across these studies, the summary effect estimate of a mean BWT deficit got larger. Overall, we detected mean BWT deficits for PFNA that were larger and more consistent across studies than previous PFAS meta-analyses. Compared to studies with later sampling, BWT deficits were smaller but remained sizeable for even the earliest sampling periods. Contrary to earlier meta-analyses for PFOA and PFOS, BWT deficits that were detected across all strata did not appear to be fully explained by potential bias due to pregnancy hemodynamics from sampling timing differences.
Collapse
Affiliation(s)
- J M Wright
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Chemical and Pollutant Assessment Division, USA.
| | - A L Lee
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Chemical and Pollutant Assessment Division, USA
| | - K M Rappazzo
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Public Health and Environmental Systems Division, USA
| | - H Ru
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Chemical and Pollutant Assessment Division, USA
| | - E G Radke
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Chemical and Pollutant Assessment Division, USA
| | - T F Bateson
- US EPA, Office of Research and Development, Center for Public Health & Environmental Assessment, Chemical and Pollutant Assessment Division, USA
| |
Collapse
|
10
|
Barker K, Holland AE, Skinner EH, Lee AL. Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review. J Rehabil Med 2023; 55:jrm00377. [PMID: 36876460 PMCID: PMC10015470 DOI: 10.2340/jrm.v55.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 01/13/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outcomes, and adverse events. DATA SOURCES A search was conducted in MEDLINE, CINHAL, EMBASE, and Cochrane Central Register of Controlled Trials databases. STUDY SELECTION AND EXTRACTION Randomized and non-randomized controlled trials and cohort studies of exercise rehabilitation vs any comparison in people with multimorbidity. DATA SYNTHESIS Forty-four reports (38 studies) were included. Rehabilitation ranged from 8 weeks to 4 years, with 1-7 sessions of rehabilitation weekly. Exercise included aerobic and resistance, limb training, aquatic exercises and tai chi. Compared with usual care, exercise rehabilitation improved 6-min walk distance (weighted mean difference (WMD) 64 m, 95% CI 45-82) and peak oxygen consumption (WMD 2.74 mL/kg/min, 95% CI -3.32 to 8.79). Effects on cardiometabolic outcomes and health-related quality of life also favoured rehabilitation; however; few data were available for other secondary outcomes. CONCLUSION In people with multimorbidity, exercise rehabilitation improved exercise capacity, health-related quality of life, and cardiometabolic outcomes.
Collapse
Affiliation(s)
- Kathryn Barker
- Department of Chronic and Complex Care, Western Health, St Albans; Discipline of Physiotherapy, La Trobe University, Bundoora
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora; Central Clinical School, Monash University, Melbourne; Alfred Health, Melbourne; Institute for Breathing and Sleep, Austin Health, Heidelberg
| | - Elizabeth H Skinner
- Alfred Health, Melbourne; Department of Physiotherapy, Monash University, Frankston; Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Austin Health, Heidelberg; Department of Physiotherapy, Monash University, Frankston.
| |
Collapse
|
11
|
Phillips J, Hing W, Pope R, Canov A, Harley N, Lee AL. Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: a randomised, controlled trial protocol. BMC Pulm Med 2023; 23:36. [PMID: 36698169 PMCID: PMC9875756 DOI: 10.1186/s12890-023-02324-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Airway clearance techniques (ACTs) for individuals with bronchiectasis are routinely prescribed in clinical practice and recommended by international guidelines, especially during an acute exacerbation. However, there is limited evidence of the efficacy of these techniques during an exacerbation to improve sputum expectoration, health-related quality-of-life (HRQOL) or exercise tolerance. The primary aim of this study is to compare the effects of the active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (O-PEP) therapy, and walking with huffing on sputum expectoration for adults hospitalised with an acute exacerbation of bronchiectasis. Secondary aims are to compare the effects of these interventions on HRQOL, health status, exacerbation rates and hospital admissions in a six-month period following hospital discharge. METHODS This multi-centre randomised controlled trial will recruit adults with an acute exacerbation of bronchiectasis requiring hospital admission. Participants will be randomised to receive one of three interventions: ACBT, O-PEP therapy, and walking with huffing. Outcome measures including sputum volume during and 1-h post ACT session, and 24-h sputum, as well as health status, HRQOL and exercise capacity will be completed during inpatient stay on day 2 and day 6 of admission, and within 24 h of hospital discharge. Time to first exacerbation, and time to first hospitalisation will be monitored via monthly phone calls for six months post hospital discharge. Health status and HRQOL will be assessed after discharge at two and six months, and exercise capacity will be assessed at six months post hospital discharge. DISCUSSION Despite recommendations regarding the importance of ACT for individuals with bronchiectasis during an acute exacerbation, there is a gap in the literature regarding effectiveness of ACT when undertaken by individuals in this clinical state. This study will add to the evidence base regarding the effectiveness of commonly implemented ACTs during a hospital admission with an exacerbation of bronchiectasis. Additionally, it will contribute to knowledge of the long term effects on important and patient-centred outcomes, including incidence of future exacerbations, and HRQOL, which has not been previously established. Trial registration Registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864).
Collapse
Affiliation(s)
- Jennifer Phillips
- grid.1033.10000 0004 0405 3820Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226 Australia ,grid.417021.10000 0004 0627 7561Allied Health Department, The Wesley Hospital, Uniting Care Health, 451 Coronation Drive, Auchenflower, QLD 4066 Australia
| | - Wayne Hing
- grid.1033.10000 0004 0405 3820Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226 Australia
| | - Rodney Pope
- grid.1033.10000 0004 0405 3820Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226 Australia ,grid.1037.50000 0004 0368 0777School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, PO Box 789, Albury, NSW 2640 Australia
| | - Ashleigh Canov
- grid.417021.10000 0004 0627 7561Allied Health Department, The Wesley Hospital, Uniting Care Health, 451 Coronation Drive, Auchenflower, QLD 4066 Australia
| | - Nicole Harley
- grid.477917.bAllied Health Department, St Andrews Hospital, Uniting Care Health, 457 Wickham Terrace, Spring Hill, QLD 4000 Australia
| | - Annemarie L. Lee
- grid.1002.30000 0004 1936 7857Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Hwy, Frankston, VIC 3199 Australia ,grid.434977.a0000 0004 8512 0836Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, VIC Australia
| |
Collapse
|
12
|
Lee AL, Smith R, Burr L, Chang AB, Holmes‐Liew C, King P, Middleton P, Morgan L, Smith D, Thomson R, Waterer G, Wong C, McAleer R. 'Teach me how to look after myself': What people with bronchiectasis want from education in a pulmonary rehabilitation setting. Clin Respir J 2022; 17:59-69. [PMID: 36404576 PMCID: PMC9829624 DOI: 10.1111/crj.13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Pulmonary rehabilitation is recommended for people with bronchiectasis. Various education topics are included in these programmes, but the content is largely guided by the needs of people with other respiratory conditions. OBJECTIVES With the education topics applicable to people with bronchiectasis unclear, we aimed to explore the perspective of adults with this condition on relevant educational topics in a pulmonary rehabilitation context. METHODS Participants from the Australian Bronchiectasis Registry were invited to undertake a semi-structured interview. Interview transcripts were coded independently, with themes established by consensus (two researchers). RESULTS Twenty-one people participated. The major themes were greater clarity on the underlying cause of bronchiectasis and prognosis. Most sought knowledge about self-management strategies and treatments to address extra-pulmonary symptoms. Participants requested more information on physiotherapy options and the role of exercise and physical activity outside of pulmonary rehabilitation. Preferences were mixed for the education delivery model. CONCLUSIONS We have identified unmet educational topics of interest for people with bronchiectasis. Our study provides a framework for education topics desired by adults with bronchiectasis within a pulmonary rehabilitation setting. The topics identified will guide development of an education curriculum for pulmonary rehabilitation that is more fit-for-purpose for people with bronchiectasis.
Collapse
Affiliation(s)
- Annemarie L. Lee
- Department of PhysiotherapyMonash UniversityFrankstonVictoriaAustralia,Monash Lung and SleepMonash HealthClaytonVictoriaAustralia,Institute for Breathing and SleepAustin HealthHeidelbergVictoriaAustralia,Department of Allied Health ResearchCabrini HealthMalvernVictoriaAustralia
| | - Rebecca Smith
- Department of PhysiotherapyMonash UniversityFrankstonVictoriaAustralia,Physiotheraphy DepartmentLaunceston General HospitalLauncestonTasmaniaAustralia
| | - Lucy Burr
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia,Department of Respiratory and Sleep MedicineMater Hospital BrisbaneBrisbaneQueenslandAustralia,University of QueenslandBrisbaneQueenslandAustralia
| | - Anne B. Chang
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Australian Centre for Health Services Innovation, Queensland University of Technology, and Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Chien‐Li Holmes‐Liew
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia
| | - Paul King
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia
| | - Peter Middleton
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia
| | - Lucy Morgan
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia,Department of Respiratory MedicineConcord Repatriation General HospitalConcordNew South WalesAustralia,Sydney School of MedicineThe University of SydneyCamperdownNew South WalesAustralia
| | - Daniel Smith
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia
| | - Rachel Thomson
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia,University of QueenslandBrisbaneQueenslandAustralia,Gallipoli Medical Research InstituteGreenslopes Private HospitalGreenslopesQueenslandAustralia
| | - Grant Waterer
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia
| | - Conroy Wong
- Australian Bronchiectasis RegistryLung Foundation AustraliaMiltonQueenslandAustralia,Middlemore HospitalUniversity of AucklandAucklandNew Zealand
| | - Rachael McAleer
- La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
| |
Collapse
|
13
|
Lee AL, Cheng S, McKeough ZJ. Two steps forward following an acute exacerbation of
COPD. Respirology 2022; 28:305-306. [PMID: 36394127 DOI: 10.1111/resp.14415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Annemarie L. Lee
- Department of Physiotherapy School of Primary and Allied Health Care, Monash University Melbourne Victoria Australia
- Institute for Breathing and Sleep Melbourne Victoria Australia
| | - Sonia Cheng
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Zoe J. McKeough
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| |
Collapse
|
14
|
Jesus LA, Malaguti C, Evangelista DG, Azevedo FM, França BP, Santos LT, Reboredo MM, Lee AL, Cabral LA, Cabral LF, José A, Oliveira CC. Caregiver Burden Is Associated With the Physical Function of Individuals on Long-Term Oxygen Therapy. Respir Care 2022; 67:1413-1419. [PMID: 35764347 PMCID: PMC9993965 DOI: 10.4187/respcare.09619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The influence of physical function of individuals on long-term oxygen therapy (LTOT) on caregiver burden is underexplored. This study investigated the association of caregiver burden with physical function of individuals on LTOT and the association between caregiver's burden and quality of life. METHODS This was a cross-sectional study. Informal caregivers were assessed for burden using the Caregiver Burden Inventory (CBI), the European Quality of Life 5 Dimension questionnaire index (EQ-5D index) and its Visual Analog Scale (EQ-VAS). Physical function of subjects on LTOT was assessed by dyspnea, activities of daily living (ADLs), and mobility. Univariate and multivariate linear regression models were explored. RESULTS Fifty-four caregivers (54.7 ± 16.1 y, 74.1% female) were included. CBI total score was correlated with subject's dyspnea (r = 0.369, P = .006) and ADLs (r = 0.300, P = .03). In the multivariate regression models, subject's physical function limitation due to dyspnea explained 26.4% of the CBI total score variance (P = .005). In the CBI dimension analysis, the time-dependence caregiver burden was correlated with subject's dyspnea (r = 0.335, P = .01), ADLs (r = 0.436, P = .001), and mobility (r = -0.415, P = .002). CBI developmental and physical caregiver burden were correlated with dyspnea (r = 0.309, P = .02; r = 0.363, P = .007) and ADLs (r = 0.274, P = .045; r = 0.299, P = .03). Emotional caregiver burden was correlated with dyspnea (r = 0.333, P = .01). Higher CBI total score was correlated with worse quality of life on EQ-5D index (rs= -0.374, P = .005) and EQ-VAS (rs= -0.494, P = .001) in caregivers. CONCLUSIONS Increased caregiver burden was associated with higher physical limitation due to dyspnea and dependence in ADLs of individuals on LTOT. The increased burden was associated with a worse caregiver's quality of life.
Collapse
Affiliation(s)
- Luciana As Jesus
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Carla Malaguti
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Deborah G Evangelista
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Felipe M Azevedo
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Brena P França
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | | | - Maycon M Reboredo
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia; and Centre for Allied Health Research and Education, Cabrini Health, Malvern, Victoria, Australia
| | - Laura A Cabral
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Leandro F Cabral
- School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson José
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Cristino C Oliveira
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil.
| |
Collapse
|
15
|
Holland AE, Wageck B, Hoffman M, Lee AL, Jones AW. Does pulmonary rehabilitation address treatable traits? A systematic review. Eur Respir Rev 2022; 31:31/165/220042. [PMID: 36002168 DOI: 10.1183/16000617.0042-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is growing interest in a "treatable traits" approach to pulmonary rehabilitation in chronic airways disease. The frequency with which pulmonary rehabilitation programmes address treatable traits is unknown. METHODS Randomised controlled trials of pulmonary rehabilitation compared to usual care in patients with stable chronic airways disease were included. The components of pulmonary rehabilitation delivered were extracted and mapped to treatable traits in pulmonary, extrapulmonary and behavioural/lifestyle domains. Meta-analysis was used to evaluate the impact of addressing >1 treatable trait on exercise capacity and health-related quality of life (HRQoL). RESULTS 116 trials were included (6893 participants). Almost all pulmonary rehabilitation programmes addressed deconditioning (97% of trials). The most commonly addressed extrapulmonary traits were nutritional status (obesity and cachexia, 18% each) and mood disturbance (anxiety and depression, 10% each). Behavioural/lifestyle traits most frequently addressed were nonadherence (46%), poor inhalation technique (24%) and poor family/social support (19%). Exercise capacity and HRQoL outcomes did not differ between studies that addressed deconditioning alone and those that targeted additional traits, but heterogeneity was high. CONCLUSION Aside from deconditioning, treatable traits are infrequently addressed in existing trials of pulmonary rehabilitation. The potential of the treatable traits approach to improve pulmonary rehabilitation outcomes remains to be explored.
Collapse
Affiliation(s)
- Anne E Holland
- Central Clinical School, Monash University, Melbourne, Australia .,Dept of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Bruna Wageck
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Mariana Hoffman
- Central Clinical School, Monash University, Melbourne, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Melbourne, Australia.,Dept of Physiotherapy, Monash University, Melbourne, Australia.,Dept of Allied Health Research, Cabrini Health, Malvern, Australia
| | - Arwel W Jones
- Central Clinical School, Monash University, Melbourne, Australia
| |
Collapse
|
16
|
Alsubheen SA, Beauchamp MK, Ellerton C, Goldstein R, Alison JA, Dechman G, Haines KJ, Harrison SL, Holland AE, Lee AL, Marques A, Spencer L, Stickland M, Skinner EH, Brooks D. Validity of the Activities-specific Balance Confidence Scale in individuals with chronic obstructive pulmonary disease. Expert Rev Respir Med 2022; 16:689-696. [DOI: 10.1080/17476348.2022.2099378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sanaa A. Alsubheen
- School of Rehabilitation Science, Faculty of Health Science, McMaster University,Hamilton, ON, Canada
| | - Marla K. Beauchamp
- School of Rehabilitation Science, Faculty of Health Science, McMaster University,Hamilton, ON, Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto ON, Canada
| | - Jennifer A. Alison
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Allied Health, Sydney Local Health District, Sydney, Australia
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax NS, Canada
- Department of Medicine, Respirology, Dalhousie University and Nova Scotia Health Authority, Halifax NS, Canada
| | | | - Samantha L. Harrison
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Anne E. Holland
- Department of Physiotherapy, Alfred Health, Melbourne VIC, Australia
- Respiratory Research, Monash University, Melbourne VIC, Australia
- Institute for Breathing and Sleep, Melbourne VIC, Australia
| | - Annemarie L. Lee
- Institute for Breathing and Sleep, Melbourne VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne VIC, Australia
- Department of Allied Health Research, Cabrini Health, Malvern VIC, Australia
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, ESSUA) and Institute of Biomedicine, iBiMED), University of Aveiro, Aveiro, Portugal
| | - Lissa Spencer
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown NSW, Australia
| | - Michael Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton AB, Canada
- G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Elizabeth H. Skinner
- Physiotherapy Department, Western Health, Melbourne VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne VIC, Australia
| | - Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Respiratory Research, Monash University, Melbourne VIC, Australia
| |
Collapse
|
17
|
Alcaraz-Serrano V, Lee AL, Gimeno-Santos E. Respiratory Physiotherapy and Bronchiectasis. Arch Bronconeumol 2022; 58:377-378. [PMID: 35312580 DOI: 10.1016/j.arbres.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Victoria Alcaraz-Serrano
- Clinic Foundation for Biomedical Research, Clinic Hospital of Barcelona, Spain; Barcelona Institute for Global Health (ISGlobal), Spain; Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain.
| | - Annemarie L Lee
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia; Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Elena Gimeno-Santos
- Barcelona Institute for Global Health (ISGlobal), Spain; Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain; Clinic Hospital of Barcelona, Spain
| |
Collapse
|
18
|
Brusco NK, Kugler H, Dufler F, Lee AL, Walpole B, Morris ME, Hill KD, Ekegren CL, Whittaker SL, Taylor NF. Including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment. JRM-CC 2022; 5:1000076. [PMID: 35154583 PMCID: PMC8771766 DOI: 10.2340/20030711-1000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
Objective To test the feasibility, safety and effectiveness of the My Therapy programme for inpatients with mild-moderate cognitive impairment. Design Observational pilot study. Patients Rehabilitation inpatients with mild-moderate cognitive impairment. Methods During their inpatient admission, participants received My Therapy, a programme that can increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy. Outcomes included My Therapy participation, falls, Functional Independence Measure (FIM) and 10-m walk test. Outcomes were compared with those of participants without cognitive impairment from the original My Therapy study (n = 116) using χ2 and independent t-tests. Results Eight participants with mild-moderate cognitive impairment (mean (standard deviation (SD)) age 89.6 years (4.8); 3 women) were included. All participants completed the My Therapy programme on at least one day of their admission, with no associated falls. Participants had an 8.4 s (SD 5.1) reduction in their 10-m walk test and a 21.5 point (SD 11.1) improvement on FIM scores from admission to discharge. There were no significant between-group differences in feasibility, safety or effectiveness for participants with and without cognitive impairment. Conclusion This pilot study has shown that including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment.
Collapse
Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- La Trobe University Centre for Sport and Exercise Medicine Research, Bundoora, Australia
- Cabrini Health, Malvern, Frankston, Australia
| | | | | | - Annemarie L Lee
- Cabrini Health, Malvern, Frankston, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | | | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Bundoora, Australia
- Healthscope, La Trobe University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Cabrini Health, Malvern, Frankston, Australia
- Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Eastern Health, Melbourne, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Bundoora, Australia
- Eastern Health, Melbourne, Australia
| |
Collapse
|
19
|
Lee AL, Nicolson CHH, Bondarenko J, Button BM, Ellis S, Stirling RG, Hew M. The clinical impact of self-reported symptoms of chronic rhinosinusitis in people with bronchiectasis. Immun Inflamm Dis 2022; 10:101-110. [PMID: 34647432 PMCID: PMC8669700 DOI: 10.1002/iid3.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis affects 62% of adults with bronchiectasis and is linked to greater bronchiectasis severity. However, the impact of symptoms of chronic rhinosinusitis on disease-specific and cough-related quality of life is unknown. METHODS In this cross-sectional study, adults with stable bronchiectasis and chronic rhinosinusitis symptoms completed the sinonasal outcome test-22 (SNOT-22), quality of life-bronchiectasis questionnaire, and Leicester cough questionnaire. Bronchiectasis severity was assessed using the bronchiectasis severity index (BSI) and chest high-resolution computed tomography (HRCT). RESULTS Sixty participants with bronchiectasis (mean [SD] forced expiratory volume in 1 s of 73.2 [25.5] %predicted) were included. Greater severity of chronic rhinosinusitis symptoms (based on SNOT-22) was moderately associated with impaired cough-related quality of life (according to the Leicester cough questionnaire; all r > -.60) and impaired bronchiectasis-specific quality of life (based on the quality of life-bronchiectasis questionnaire), with impaired physical function (r = -.518), less vitality (r = -.631), reduced social function (r = -.546), greater treatment burden (r = -.411), and increased severity of respiratory symptoms (r = -.534). Chronic rhinosinusitis symptoms were unrelated to disease severity according to the BSI (r = .135) and HRCT scoring (all r < .200). The severity of chronic rhinosinusitis symptoms was not affected by sputum color (p = .417) or the presence of Pseudomonas aeruginosa colonization (p = .73). CONCLUSIONS In adults with bronchiectasis, chronic rhinosinusitis has a consistent and negative impact on both cough-related and bronchiectasis-specific quality of life.
Collapse
Affiliation(s)
- Annemarie L. Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health CareMonash UniversityFrankstonAustralia
- Institute for Breathing and SleepAustin HealthHeidelbergAustralia
- Centre for Allied Health Research and EducationCabrini HealthMalvernAustralia
| | | | - Janet Bondarenko
- Department of Allergy, Asthma and Clinical ImmunologyAlfred HealthMelbourneAustralia
- Department of PhysiotherapyAlfred HealthMelbourneAustralia
| | - Brenda M. Button
- Department of Allergy, Asthma and Clinical ImmunologyAlfred HealthMelbourneAustralia
- Department of PhysiotherapyAlfred HealthMelbourneAustralia
- Department of Medicine, Faculty of Medicine, Nursing and Health SciencesMonash UniversityFrankstonAustralia
| | | | - Robert G. Stirling
- Department of Allergy, Asthma and Clinical ImmunologyAlfred HealthMelbourneAustralia
- Department of Medicine, Faculty of Medicine, Nursing and Health SciencesMonash UniversityFrankstonAustralia
| | - Mark Hew
- Department of Allergy, Asthma and Clinical ImmunologyAlfred HealthMelbourneAustralia
- Sub‐Faculty of Translational Medicine and Public HealthMonash UniversityFrankstonAustralia
| |
Collapse
|
20
|
Clarke SY, Williams MT, Johnston KN, Lee AL. The prevalence and assessment of pain and dyspnoea in acute exacerbations of COPD: A systematic review. Chron Respir Dis 2022; 19:14799731221105518. [PMID: 35698999 PMCID: PMC9201350 DOI: 10.1177/14799731221105518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dyspnoea and pain are symptoms of chronic obstructive pulmonary disease (COPD). This review focused upon pain and dyspnoea during hospital admissions for acute exacerbations of COPD (AECOPD), with the aim of examining prevalence, assessment, clinical associations, and researcher-reported implications of these symptoms. METHODS Four electronic databases were searched from inception to 31 May 2021. Full text versions of studies were assessed for methodological quality and data were extracted independently by two reviewers. Where data permitted, pooled prevalence of pain and dyspnoea were calculated by meta-analysis. RESULTS Four studies were included. The pooled prevalence of pain and dyspnoea was 44% (95% confidence interval (CI) 35%-52%) and 91% (95% CI 87%-94%) respectively. An array of instruments with varying focal periods were reported (pain: six tools, dyspnoea: four tools). Associations and clinical implications between the two symptoms at the time of hospital admission were rarely reported. CONCLUSIONS Few studies reported prevalence of pain and dyspnoea during an AECOPD. A greater understanding into the prevalence, intensity and associations of these symptoms during AECOPD could be furthered by use of standardised assessment tools with clearly defined focal periods.
Collapse
Affiliation(s)
- Stephanie Y Clarke
- Department of Physiotherapy, School
of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Frankston, Victoria, Australia
- Physiotherapy Department, Eastern Health, Victoria, Australia
| | - Marie T Williams
- IMPlementation And Clinical
Translation in Health (IIMPACT), Allied Health and Human Performance, University of South
Australia, Adelaide, South Australia, Australia
| | - Kylie N Johnston
- IMPlementation And Clinical
Translation in Health (IIMPACT), Allied Health and Human Performance, University of South
Australia, Adelaide, South Australia, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School
of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Frankston, Victoria, Australia
- Centre for Allied Health Research
and Education, Cabrini Health, Victoria, Australia
- Institute for Breathing and
Sleep, Victoria, Australia
| |
Collapse
|
21
|
Brusco NK, Ekegren CL, Taylor NF, Hill KD, Lee AL, Somerville L, Lannin NA, Wade D, Abdelmotaleb R, Callaway L, Whittaker SL, Morris ME. Correction to: Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21:977. [PMID: 34535151 PMCID: PMC8447696 DOI: 10.1186/s12913-021-07002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia. .,La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.,Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Eastern Health, 5 Arnold St, Box Hill, 3128, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Annemarie L Lee
- Cabrini Health, 154 Wattletree Rd, Malvern, 3144, Australia.,School of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Lisa Somerville
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Natasha A Lannin
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia.,Department of Neuroscience, Monash University, Central Clinical School, 99 Commercial Rd, Melbourne, 3004, Australia
| | - Derick Wade
- Physiotherapy and Rehabilitation, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.,School of Occupational Therapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Healthscope ARCH, The Victorian Rehabilitation Centre, 499 Springvale Road, Glen Waverley, 3150, Australia
| |
Collapse
|
22
|
Brusco NK, Ekegren CL, Taylor NF, Hill KD, Lee AL, Somerville L, Lannin NA, Wade D, Abdelmotaleb R, Callaway L, Whittaker SL, Morris ME. Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21:811. [PMID: 34384427 PMCID: PMC8361638 DOI: 10.1186/s12913-021-06462-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions. METHODS This implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios. DISCUSSION The My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs. TRIAL REGISTRATION This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).
Collapse
Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia.
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Eastern Health, 5 Arnold St, 3128, Box Hill, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Annemarie L Lee
- Cabrini Health, 154 Wattletree Rd, 3144, Malvern, Australia
- School of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Lisa Somerville
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Natasha A Lannin
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
- Department of Neuroscience, Monash University, Central Clinical School, 99 Commercial Rd, 3004, Melbourne, Australia
| | - Derick Wade
- Physiotherapy and Rehabilitation, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, OX3 0BP, Oxford, United Kingdom
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- School of Occupational Therapy, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Healthscope ARCH, The Victorian Rehabilitation Centre, 499 Springvale Road, 3150, Glen Waverley, Australia
| |
Collapse
|
23
|
Giacchi M, Nguyen MT, Gaudin J, Bergin M, Collicoat O, Armstrong B, Jennings S, El-ansary D, Lee AL. The relationship between cardiorespiratory parameters, mobilisation and physical function following cardiac surgery. European Journal of Physiotherapy 2021. [DOI: 10.1080/21679169.2021.1942195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Matthew Giacchi
- Department of Medicine, Monash University, Clayton, Australia
| | - My-Thao Nguyen
- Department of Medicine, Monash University, Clayton, Australia
| | - James Gaudin
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Miles Bergin
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Olivia Collicoat
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Bronte Armstrong
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Sophie Jennings
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Doa El-ansary
- Physiotherapy, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
- Department of Surgery, Royal Melbourne Hospital, School of Medicine, University of Melbourne, Parkville, Australia
| | - Annemarie L. Lee
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
- Department of Physiotherapy, Monash University, Frankston, Australia
| |
Collapse
|
24
|
Lee AL, Baenziger S, Louey A, Jennings S, Solin P, Hoy R. A review of physiotherapy practice for people with bronchiectasis. ERJ Open Res 2021; 7:00569-2020. [PMID: 34109238 PMCID: PMC8181622 DOI: 10.1183/23120541.00569-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/01/2020] [Indexed: 01/12/2023] Open
Abstract
People with bronchiectasis experience chronic productive cough and acute exacerbations, which are linked to poorer quality of life and a higher rate of disease progression. The clinical guidelines for bronchiectasis management recommend physiotherapy [1, 2]. These guidelines advise the prescription of airway clearance techniques (ACTs) to improve sputum clearance and reduce symptoms [1, 2]. Mucoactive agents may be cautiously considered when required [1, 2]. Individuals with reduced exercise tolerance are recommended to engage in pulmonary rehabilitation or undertake exercise or physical activity [1, 2]. Surveys of physiotherapy management for people with bronchiectasis have described commonly applied ACTs [3, 4] but have not alluded to technique combinations, a strategy considered a key approach towards personalising therapy [3–5]. Other audits have highlighted that ACTs were applied in only 49% and 52% of people with bronchiectasis in Europe and Australia respectively, reflecting a potential underuse of this therapeutic approach [6, 7]. Low referral rates to pulmonary rehabilitation have been noted [3, 7], and the prescription of exercise and physical activity beyond pulmonary rehabilitation is unknown [3]. A combination of airway clearance techniques are applied for people with bronchiectasis, together with recommendations for exercise and suggestions for management of common comorbiditieshttps://bit.ly/2U3c99H
Collapse
Affiliation(s)
- Annemarie L Lee
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia.,Dept of Physiotherapy, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | | | | | - Sophie Jennings
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia.,Cabrini Health, Malvern, Australia
| | | | - Ryan Hoy
- Cabrini Health, Malvern, Australia.,Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia
| |
Collapse
|
25
|
Burge AT, Holland AE, McDonald CF, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahhama A, Gillies R, Mahald A. "Willingness to Pay": The Value Attributed to Program Location by Pulmonary Rehabilitation Participants. COPD 2021; 18:281-287. [PMID: 34060968 DOI: 10.1080/15412555.2021.1924127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The "contingent valuation" method is used to quantify the value of services not available in traditional markets, by assessing the monetary value an individual ascribes to the benefit provided by an intervention. The aim of this study was to determine preferences for home or center-based pulmonary rehabilitation for participants with chronic obstructive pulmonary disease (COPD) using the "willingness to pay" (WTP) approach, the most widely used technique to elicit strengths of individual preferences. This is a secondary analysis of a randomized controlled equivalence trial comparing center-based and home-based pulmonary rehabilitation. At their final session, participants were asked to nominate the maximum that they would be willing to pay to undertake home-based pulmonary rehabilitation in preference to a center-based program. Regression analyses were used to investigate relationships between participant features and WTP values. Data were available for 141/163 eligible study participants (mean age 69 [SD 10] years, n = 82 female). In order to undertake home-based pulmonary rehabilitation in preference to a conventional center-based program, participants were willing to pay was mean $AUD176 (SD 255) (median $83 [IQR 0 to 244]). No significant difference for WTP values was observed between groups (p = 0.98). A WTP value above zero was related to home ownership (odds ratio [OR] 2.95, p = 0.02) and worse baseline SF-36 physical component score (OR 0.94, p = 0.02). This preliminary evidence for WTP in the context of pulmonary rehabilitation indicated the need for further exploration of preferences for treatment location in people with COPD to inform new models of service delivery.
Collapse
Affiliation(s)
- Angela T Burge
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Narelle S Cox
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
| | | | - Caroline Nicolson
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Aroub Lahhama
- Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Rebecca Gillies
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Ajay Mahald
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
26
|
Abstract
BACKGROUND Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which reduce exercise tolerance and impair quality of life. Exercise training in isolation or in conjunction with other interventions is beneficial for people with other respiratory diseases, but its effects in bronchiectasis have not been well established. OBJECTIVES To determine effects of exercise training compared to usual care on exercise tolerance (primary outcome), quality of life (primary outcome), incidence of acute exacerbation and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis. SEARCH METHODS We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, and the World Health Organization trials portal, from their inception to October 2020. We reviewed respiratory conference abstracts and reference lists of all primary studies and review articles for additional references. SELECTION CRITERIA We included randomised controlled trials in which exercise training of at least four weeks' duration (or eight sessions) was compared to usual care for people with stable bronchiectasis or experiencing an acute exacerbation. Co-interventions with exercise training including education, respiratory muscle training, and airway clearance therapy were permitted if also applied as part of usual care. DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors for missing data. We calculated mean differences (MDs) using a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included six studies, two of which were published as abstracts, with a total of 275 participants. Five studies were undertaken with people with clinically stable bronchiectasis, and one pilot study was undertaken post acute exacerbation. All studies included co-interventions such as instructions for airway clearance therapy and/or breathing strategies, provision of an educational booklet, and delivery of educational sessions. The duration of training ranged from six to eight weeks, with a mix of supervised and unsupervised sessions conducted in the outpatient or home setting. No studies of children were included in the review; however we identified two studies as currently ongoing. No data were available regarding physical activity levels or adverse events. For people with stable bronchiectasis, evidence suggests that exercise training compared to usual care improves functional exercise tolerance as measured by the incremental shuttle walk distance, with a mean difference (MD) between groups of 87 metres (95% confidence interval (CI) 43 to 132 metres; 4 studies, 161 participants; low-certainty evidence). Evidence also suggests that exercise training improves six-minute walk distance (6MWD) (MD between groups of 42 metres, 95% CI 22 to 62; 1 study, 76 participants; low-certainty evidence). The magnitude of these observed mean changes appears clinically relevant as they exceed minimal clinically important difference (MCID) thresholds for people with chronic lung disease. Evidence suggests that quality of life improves following exercise training according to St George's Respiratory Questionnaire (SGRQ) total score (MD -9.62 points, 95% CI -15.67 to -3.56 points; 3 studies, 160 participants; low-certainty evidence), which exceeds the MCID of 4 points for this outcome. A reduction in dyspnoea (MD 1.0 points, 95% CI 0.47 to 1.53; 1 study, 76 participants) and fatigue (MD 1.51 points, 95% CI 0.80 to 2.22 points; 1 study, 76 participants) was observed following exercise training according to these domains of the Chronic Respiratory Disease Questionnaire. However, there was no change in cough-related quality of life as measured by the Leicester Cough Questionnaire (LCQ) (MD -0.09 points, 95% CI -0.98 to 0.80 points; 2 studies, 103 participants; moderate-certainty evidence), nor in anxiety or depression. Two studies reported longer-term outcomes up to 12 months after intervention completion; however exercise training did not appear to improve exercise capacity or quality of life more than usual care. Exercise training reduced the number of acute exacerbations of bronchiectasis over 12 months in people with stable bronchiectasis (odds ratio 0.26, 95% CI 0.08 to 0.81; 1 study, 55 participants). After an acute exacerbation of bronchiectasis, data from a single study (N = 27) suggest that exercise training compared to usual care confers little to no effect on exercise capacity (MD 11 metres, 95% CI -27 to 49 metres; low-certainty evidence), SGRQ total score (MD 6.34 points, 95%CI -17.08 to 29.76 points), or LCQ score (MD -0.08 points, 95% CI -0.94 to 0.78 points; low-certainty evidence) and does not reduce the time to first exacerbation (hazard ratio 0.83, 95% CI 0.31 to 2.22). AUTHORS' CONCLUSIONS This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.
Collapse
Affiliation(s)
- Annemarie L Lee
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
| | - Carla S Gordon
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| |
Collapse
|
27
|
Wageck B, Cox NS, McDonald CF, Burge AT, Mahal A, Hill CJ, Lee AL, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, Holland AE. The Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial. Int J Chron Obstruct Pulmon Dis 2021; 15:3423-3431. [PMID: 33408472 PMCID: PMC7781036 DOI: 10.2147/copd.s271094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months. Methods This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA). Results A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV1) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEV1%predicted (0.98, 95% CI 0.96 to 0.99). Conclusion Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management.
Collapse
Affiliation(s)
| | - Narelle S Cox
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Angela T Burge
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Ajay Mahal
- The Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Caroline Nicolson
- Department of Pulmonary Hypertension, Alfred Health, Melbourne, Australia.,Physiotherapy Department, Monash University, Melbourne, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Aroub Lahham
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Rebecca Gillies
- La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Anne E Holland
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| |
Collapse
|
28
|
Oliveira CC, Annoni R, Lee AL, McGinley J, Irving LB, Denehy L. Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: A systematic review. Respir Med 2020; 176:106284. [PMID: 33338874 DOI: 10.1016/j.rmed.2020.106284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Falls are frequent in people with chronic obstructive pulmonary disease (COPD) and related to increased morbidity, mortality, and health care costs in older adults. This systematic review aims to synthesise the falls outcomes and to examine risk factors for falls in the COPD literature. METHODS The protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42015017257). Searches were updated and operated in five electronic databases in December 2019 for studies reporting falls outcomes and risk factors in people with COPD. Meta-analyses were conducted on the prevalence of fallers and frequent fallers. Quality assessment appraised the risk of bias of included articles. RESULTS Twenty-three studies met the eligibility criteria and were retained after the full-text review. In the meta-analyses, the pooled prevalence of COPD fallers was 30% (95%CI 19%-42%), and the pooled prevalence of frequent fallers (≥2 falls in the analysed period of occurrence) was 24% (95%CI 2%-56%). The falls incidence rate in stable COPD varied from 1.17 to 1.49 falls/person-year. Different study methodologies were identified. Age, female gender, falls history, the number of medications, comorbidities, coronary heart disease, use of supplemental oxygen, impaired balance performance and smoking history were risk factors for falls identified in stable COPD. CONCLUSION Prevalence of fallers, frequent fallers, and falls incidence rate have been reported in the COPD literature using a varying methodology. People with stable COPD present with ageing and disease-related risk factors for falls. Further research using the recommended prospective recording is needed in COPD.
Collapse
Affiliation(s)
- Cristino C Oliveira
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, MG, Brazil.
| | - Raquel Annoni
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Department of Applied Physiotherapy, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil.
| | - Annemarie L Lee
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia; Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia.
| | - Jennifer McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|
29
|
Grimwood CL, Holland AE, McDonald CF, Mahal A, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, Burge AT. Comparison of self-report and administrative data sources to capture health care resource use in people with chronic obstructive pulmonary disease following pulmonary rehabilitation. BMC Health Serv Res 2020; 20:1061. [PMID: 33228654 PMCID: PMC7682690 DOI: 10.1186/s12913-020-05920-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background The optimal method to collect accurate healthcare utilisation data in people with chronic obstructive pulmonary disease (COPD) is not well established. The aim of this study was to determine feasibility and compare self-report and administrative data sources to capture health care resource use in people with COPD for 12 months following pulmonary rehabilitation. Methods This is a secondary analysis of a randomised controlled equivalence trial comparing centre-based and home-based pulmonary rehabilitation. Healthcare utilisation data were collected for 12 months following pulmonary rehabilitation from self-report (monthly telephone questionnaires and diaries) and administrative sources (Medicare Benefits Schedule, medical records). Feasibility was assessed by the proportion of self-reports completed and accuracy was established using month-by-month and per participant comparison of self-reports with administrative data. Results Data were available for 145/163 eligible study participants (89%, mean age 69 (SD 9) years, mean forced expiratory volume in 1 s 51 (SD 19) % predicted; n = 83 male). For 1725 months where data collection was possible, 1160 (67%) telephone questionnaires and 331 (19%) diaries were completed. Accuracy of recall varied according to type of health care encounter and self-report method, being higher for telephone questionnaire report of emergency department presentation (Kappa 0.656, p < 0.001; specificity 99%, sensitivity 59%) and hospital admission (Kappa 0.669, p < 0.001; specificity 97%, sensitivity 68%) and lower for general practitioner (Kappa 0.400, p < 0.001; specificity 62%, sensitivity 78%) and medical specialist appointments (Kappa 0.458, p < 0.001; specificity 88%, sensitivity 58%). A wide variety of non-medical encounters were reported (allied health and nursing) which were not captured in administrative data. Conclusion For self-reported methods of healthcare utilisation in people with COPD following pulmonary rehabilitation, monthly telephone questionnaires were more frequently completed and more accurate than diaries. Compared to administrative records, self-reports of emergency department presentations and inpatient admissions were more accurate than for general practitioner and medical specialist appointments. Trial registration NCT01423227 at clinicaltrials.gov Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05920-0.
Collapse
Affiliation(s)
- Chantal L Grimwood
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Anne E Holland
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Physiotherapy, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Annemarie L Lee
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Physiotherapy, Monash University, Building B, McMahons Rd, Frankston, VIC, 3199, Australia
| | - Narelle S Cox
- La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Caroline Nicolson
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Paul O'Halloran
- Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Aroub Lahham
- La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Rebecca Gillies
- La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Angela T Burge
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia. .,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia. .,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.
| |
Collapse
|
30
|
Butler SJ, Desveaux L, Lee AL, Beauchamp MK, Brusco NK, Wang W, Goldstein RS, Brooks D. Randomized controlled trial of community-based, post-rehabilitation exercise in COPD. Respir Med 2020; 174:106195. [PMID: 33171390 DOI: 10.1016/j.rmed.2020.106195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Although pulmonary rehabilitation (PR) improves function in people with chronic obstructive pulmonary disease (COPD), a community-based exercise program may be necessary to maintain functional capacity. We aimed to determine the effectiveness of a post-rehabilitation, community-based maintenance program on exercise tolerance, functional capacity and quality of life. METHODS Patients with COPD who completed PR were randomized to receive a community-based maintenance program (intervention) or usual care (control). The primary outcome was 6-min walk distance (6MWD), measured immediately post-PR, 6 months and 12 months later. Secondary outcomes included self-reported functional capacity, health-related quality of life, self-efficacy, program cost, and lower extremity muscle strength. RESULTS Ninety-seven patients (69 ± 9 years) were enrolled. There was a non-significant trend of an intervention effect on 6MWD over time (β = 42, 95% CI: 0.06 to 83.93, p = 0.053). There was no significant impact of group on any of the secondary outcomes. Restricting the analysis to those who attended ≥50% of the exercise sessions showed a significant intervention effect for 6MWD (β = 69.19, 95% CI = 10.16 to 128.22, p = 0.03). The cost of participating in the community maintenance program for the intervention group was $374.77 (SD 142.12) and membership renewal was highest at community centres offering twice weekly, supervised exercise classes. CONCLUSIONS A post rehabilitation, community-based exercise program, will maintain exercise capacity in people with COPD who attend at least 50% of available sessions over one year. An increased focus on factors that determine adherence would help inform improvements in maintenance program design.
Collapse
Affiliation(s)
- Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Desveaux
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Marla K Beauchamp
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Wei Wang
- Cabrini Health, Malvern, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
31
|
Smith R, Osadnik CR, Lee AL. Educational topics and their rationale for inclusion within pulmonary rehabilitation - a systematic review. Patient Educ Couns 2020; 103:1997-2008. [PMID: 32376143 DOI: 10.1016/j.pec.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify the scope of educational topics within pulmonary rehabilitation (PR) for people with chronic respiratory diseases and determine their rationale for inclusion. METHODS Four electronic databases were searched, with data extracted and assessed for quality by two reviewers using the Downs and Black tool or the Critical Appraisal Skills Programme checklist. RESULTS Twenty-one studies of variable quality were included. In chronic obstructive pulmonary disease (COPD), common education topics included disease pathophysiology, medications, psychological support, strategies for breathlessness, role of exercise and recognition of acute exacerbations, while less frequent topics included end-of-life planning, disease impact on sexual relationships and comorbidities. In interstitial lung disease (ILD), topics focused upon disease pathophysiology, approaches to limit disease progression, symptom management and end-of-life care. Evidence of a rationale for including education topics in PR were often lacking, but focused on recommended guidelines and information to improve self-management. CONCLUSION A core range of educational topics based broadly upon clinical presentation and management strategies appear to be incorporated into PR for people with COPD. Topics for people with ILD appear to be selected according to patient need. PRACTICE IMPLICATIONS The topics identified in this review may help clinicians seeking to develop educational resources for PR.
Collapse
Affiliation(s)
- Rebecca Smith
- Department of Physiotherapy, Monash University, Frankston, Australia
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Frankston, Australia; Monash Lung and Sleep, Monash Health, Clayton, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Monash University, Frankston, Australia; Monash Lung and Sleep, Monash Health, Clayton, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia; Cabrini Health, Malvern, Australia.
| |
Collapse
|
32
|
Abstract
Chronic pain affects up to 88% of people with chronic obstructive pulmonary disease (COPD) and has been associated with comorbidities. However, with pain not evaluated during pulmonary rehabilitation (PR) assessments, it is unclear whether PR impacts pain intensity and coping ability. This study aimed to 1) determine the effect of PR on pain qualities, coping behavior and psychological symptoms in those with COPD and chronic pain; and 2) assess the impact of PR on exercise capacity and quality of life in individuals with COPD and chronic pain compared to those without pain. Patients with COPD and comorbidities enrolling in outpatient PR were assessed for chronic pain. Those with chronic pain completed the Brief Pain Inventory, Coping Strategies Questionnaire-24, Fear Avoidance Behavior Questionnaire and measures of anxiety and depression. Changes in HRQOL and 6-minute walk distance (6MWD) following PR were compared between participants with and without chronic pain. Thirty-four participants with chronic pain and 34 participants without pain were included (mean ± SD, FEV1 47 ± 19% predicted). In those with chronic pain, PR did not affect pain intensity (median[IQR] pre/post PR 3[2-5] vs. 4[2-6] points, p = 0.21), anxiety (7[2-9] vs. 5[3-8] points, p = 0.82) or depression (4[2-8] vs. 3[1-6] points, p = 0.38) and did not change pain coping strategies. Both groups improved in 6MWD (mean difference [95% CI] 17[-39 to 72] m), and those without pain had greater improvement in mastery (p = 0.013). PR was effective in patients with moderate to severe COPD whether or not they reported chronic pain at the time of their initial assessment.
Collapse
Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia.,Cabrini Health, Malvern, Victoria, Australia
| | - Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Robert G Varadi
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
33
|
Holland AE, Liacos A, McDonald CF, Mahal A, Hill CJ, Lee AL, Burge AT, Moore R, Nicolson C, O’Halloran P, Cox NS, Lahham A, Gillies R. Response to letter to the Editor re ‘Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD)’. Physiotherapy 2020; 106:217-218. [DOI: 10.1016/j.physio.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 10/25/2022]
|
34
|
Nakazawa A, Dowman LM, Cox NS, McDonald CF, Hill CJ, Lee AL, Holland AE. Factors predicting progression of exercise training loads in people with interstitial lung disease. ERJ Open Res 2019; 5:00245-2018. [PMID: 31832427 PMCID: PMC6899336 DOI: 10.1183/23120541.00245-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/03/2019] [Indexed: 11/05/2022] Open
Abstract
In ILD, adherence to the training sessions in pulmonary rehabilitation predicts progression of exercise training loads; declining lung function is an independent predictor of failure to progress training loads http://bit.ly/2Z4x9Nw.
Collapse
Affiliation(s)
- Atsuhito Nakazawa
- Discipline of Physiotherapy, La Trobe University, Alfred Centre, Melbourne, Australia
| | - Leona M Dowman
- Discipline of Physiotherapy, La Trobe University, Alfred Centre, Melbourne, Australia.,Dept of Physiotherapy, Austin Health, Heidelberg, Australia.,Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Narelle S Cox
- Discipline of Physiotherapy, La Trobe University, Alfred Centre, Melbourne, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Christine F McDonald
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Dept of Medicine, University of Melbourne, Parkville, Australia
| | - Catherine J Hill
- Dept of Physiotherapy, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Heidelberg, Australia.,Dept of Physiotherapy, Monash University, Frankston, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Alfred Centre, Melbourne, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Dept of Physiotherapy, Alfred Health, Melbourne, Australia
| |
Collapse
|
35
|
Alison JA, McKeough ZJ, Leung RW, Holland AE, Hill K, Morris NR, Jenkins S, Spencer LM, Hill CJ, Lee AL, Seale H, Cecins N, McDonald CF. Exercise training in COPD with exercise-induced desaturation does improve exercise capacity, irrespective of whether supplemental oxygen or air is provided during training. Eur Respir J 2019; 54:54/5/1901725. [DOI: 10.1183/13993003.01725-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 11/05/2022]
|
36
|
Cox NS, Wilson CJ, Bennett KA, Johnston K, Potter A, Chang AB, Lee AL. Health-related quality of life and psychological wellbeing are poor in children with bronchiectasis and their parents. ERJ Open Res 2019; 5:00063-2019. [PMID: 31528635 PMCID: PMC6734007 DOI: 10.1183/23120541.00063-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
Bronchiectasis is characterised by chronic wet cough, a cycle of inflammation, impaired mucociliary clearance, bacterial colonisation and infection [1]. People with bronchiectasis experience substantial disease burden, including recurrent hospitalisations and impaired quality of life (QoL) [2]. The prevalence and burden of bronchiectasis is increasingly appreciated worldwide [3]. Children with bronchiectasis in a stable state have poor HRQoL and their parents report higher levels of anxiety and depression. Parental perception of HRQoL is associated with poorer parental psychological wellbeing.http://bit.ly/2lcf3uB
Collapse
Affiliation(s)
- Narelle S Cox
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | | | | | - Kylie Johnston
- School of Health Sciences, University of SA, Adelaide, Australia
| | - Angela Potter
- Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Annemarie L Lee
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia.,Dept of Physiotherapy, Monash University, Melbourne, Australia
| |
Collapse
|
37
|
Burge AT, Holland AE, McDonald CF, Abramson MJ, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, Mahal A. Home‐based pulmonary rehabilitation for COPD using minimal resources: An economic analysis. Respirology 2019; 25:183-190. [DOI: 10.1111/resp.13667] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/03/2019] [Accepted: 07/16/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Angela T. Burge
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Department of PhysiotherapyAlfred Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Anne E. Holland
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Department of PhysiotherapyAlfred Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Christine F. McDonald
- Institute for Breathing and Sleep Melbourne VIC Australia
- Department of Respiratory and Sleep MedicineAustin Health Melbourne VIC Australia
- Department of MedicineThe University of Melbourne Melbourne VIC Australia
| | - Michael J. Abramson
- Department of Epidemiology and Preventive MedicineMonash University Melbourne VIC Australia
| | - Catherine J. Hill
- Department of PhysiotherapyAlfred Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Annemarie L. Lee
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Department of PhysiotherapyAlfred Health Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Narelle S. Cox
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Caroline Nicolson
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Department of PhysiotherapyAlfred Health Melbourne VIC Australia
| | - Paul O'Halloran
- Department of Public HealthLa Trobe University Melbourne VIC Australia
| | - Aroub Lahham
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Institute for Breathing and Sleep Melbourne VIC Australia
| | - Rebecca Gillies
- Discipline of PhysiotherapyLa Trobe University Melbourne VIC Australia
- Department of PhysiotherapyAlfred Health Melbourne VIC Australia
| | - Ajay Mahal
- The Nossal Institute for Global HealthThe University of Melbourne Melbourne VIC Australia
| |
Collapse
|
38
|
Alison JA, McKeough ZJ, Leung RWM, Holland AE, Hill K, Morris NR, Jenkins S, Spencer LM, Hill CJ, Lee AL, Seale H, Cecins N, McDonald CF. Oxygen compared to air during exercise training in COPD with exercise-induced desaturation. Eur Respir J 2019; 53:13993003.02429-2018. [PMID: 30880289 DOI: 10.1183/13993003.02429-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/06/2019] [Indexed: 11/05/2022]
Abstract
Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD) desaturate during exercise. Although oxygen supplementation may ameliorate oxygen desaturation, the effects on outcomes of exercise training have not been rigorously evaluated. This study aimed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life (HRQoL) in people with COPD.People with COPD who demonstrated oxygen desaturation <90% during the 6-min walk test were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an Oxygen group or Air group, blinding (participants, exercise trainers and European Respiratory Journal assessors) and intention-to-treat analysis. Both groups received the respective gas from concentrators via nasal prongs at 5 L·min-1 during exercise training consisting of treadmill and cycle exercise, three times per week for 8 weeks. Primary outcomes were the endurance shuttle walk test (ESWT) time and Chronic Respiratory Disease Questionnaire (CRQ)-Total score.111 participants (60 males), mean±sd age 69±7 years, with moderate to severe COPD were recruited and 97 completed (Oxygen group n=52; Air group n=45). At the end of the 8-week training programme there were no between-group differences in change in ESWT (mean difference 15 s (95% CI -106-136 s) or change in CRQ-Total (0.0 points (95% CI -0.3-0.3 points)). Within-group changes at end-training were significant for ESWT and CRQ-Total (all p<0.01).Exercise capacity and HRQoL improved in both groups, with no greater benefit from training with supplemental oxygen than medical air.
Collapse
Affiliation(s)
- Jennifer A Alison
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Zoe J McKeough
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Regina W M Leung
- Dept of Physiotherapy, Concord Repatriation General Hospital, Sydney, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, School of Allied Health, LaTrobe University, Melbourne, Australia.,Dept of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia.,Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia
| | - Norman R Morris
- School of Allied Health Sciences, Griffith University, Southport, Australia.,Metro North Hospital and Health Service, The Prince Charles Hospital, Allied Health Research Collaborative, Brisbane, Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia.,Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia.,Dept of Physiotherapy, Sir Charles Gardiner Hospital, Perth, Australia
| | - Lissa M Spencer
- Dept of Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Dept of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Dept of Physiotherapy, Monash University, Melbourne, Australia
| | - Helen Seale
- Dept of Physiotherapy, Prince Charles Hospital, Queensland, Australia
| | - Nola Cecins
- Dept of Physiotherapy, Sir Charles Gardiner Hospital, Perth, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Dept of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| |
Collapse
|
39
|
Cox NS, Pepin V, Burge AT, Hill CJ, Lee AL, Bondarenko J, Moore R, Nicolson C, Lahham A, Parwanta Z, McDonald CF, Holland AE. Pulmonary Rehabilitation does not Improve Objective Measures of Sleep Quality in People with Chronic Obstructive Pulmonary Disease. COPD 2019; 16:25-29. [PMID: 30884984 DOI: 10.1080/15412555.2019.1567701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abnormal sleep duration is associated with poor health. Upwards of 50% of people with chronic obstructive pulmonary disease (COPD) report poor sleep quality. The effect of pulmonary rehabilitation on self-reported sleep quality is variable. The aim of this study was to assess the effect of pulmonary rehabilitation on objectively measured sleep quality (via actigraphy) in people with COPD. Sleep quality was assessed objectively using the SenseWear Armband (SWA, BodyMedia, Pittsburgh, PA), worn for ≥4 days before and immediately after completing an 8-week pulmonary rehabilitation program. Sleep characteristics were derived from accelerometer positional data and registration of sleep state by the SWA, determined from energy expenditure. Forty-eight participants (n = 21 male) with COPD (mean (SD), age 70 (10) years, mean FEV1 55 (20) % predicted, mean 45 (24) pack year smoking history) contributed pre and post pulmonary rehabilitation sleep data to this analysis. No significant differences were seen in any sleep parameters after pulmonary rehabilitation (p = 0.07-0.70). There were no associations between sleep parameters and measures of quality of life or function (all p > 0.30). Sleep quality, measured objectively using actigraphy, did not improve after an 8-week pulmonary rehabilitation program in individuals with COPD. Whether on-going participation in regular exercise training beyond the duration of pulmonary rehabilitation may influence sleep quality, or whether improving sleep quality could enhance rehabilitation outcomes, is yet to be determined.
Collapse
Affiliation(s)
- Narelle S Cox
- a Discipline of Physiotherapy , La Trobe University and Institute for Breathing and Sleep , Melbourne , Australia
| | - Véronique Pepin
- b Department of Health, Kinesiology, and Applied Physiology, Axe Maladies Chroniques, Centre de Recherche de l'Hopital du Sacre-Coeur de Montreal , Concordia University , Montreal , Canada
| | - Angela T Burge
- c Discipline of Physiotherapy, Department of Physiotherapy, Alfred Health, Institute for Breathing and Sleep , La Trobe University , Melbourne , Australia
| | - Catherine J Hill
- d Department of Physiotherapy , Austin Health, and Institute for Breathing and Sleep , Melbourne , Australia
| | - Annemarie L Lee
- e Department of Physiotherapy, Alfred Health, and Institute for Breathing and Sleep , Monash University , Frankston , Australia
| | - Janet Bondarenko
- f Department of Physiotherapy , Alfred Health , Melbourne , Australia
| | - Rosemary Moore
- g Institute for Breathing and Sleep , Melbourne , Australia
| | - Caroline Nicolson
- h Discipline of Physiotherapy , La Trobe University and Department of Physiotherapy, Alfred Health , Melbourne , Australia
| | - Aroub Lahham
- a Discipline of Physiotherapy , La Trobe University and Institute for Breathing and Sleep , Melbourne , Australia
| | - Zohra Parwanta
- b Department of Health, Kinesiology, and Applied Physiology, Axe Maladies Chroniques, Centre de Recherche de l'Hopital du Sacre-Coeur de Montreal , Concordia University , Montreal , Canada
| | - Christine F McDonald
- i Department of Respiratory Medicine, Austin Health, Institute for Breathing and Sleep, and School of Medicine , University of Melbourne , Melbourne , Australia
| | - Anne E Holland
- c Discipline of Physiotherapy, Department of Physiotherapy, Alfred Health, Institute for Breathing and Sleep , La Trobe University , Melbourne , Australia
| |
Collapse
|
40
|
Handley E, Nicolson CH, Hew M, Lee AL. Prevalence and Clinical Implications of Chronic Rhinosinusitis in People with Bronchiectasis: A Systematic Review. J Allergy Clin Immunol Pract 2019; 7:2004-2012.e1. [PMID: 30836230 DOI: 10.1016/j.jaip.2019.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is an extrapulmonary manifestation in some individuals with bronchiectasis, but the prevalence of CRS in this population and its clinical impact has not been systematically reviewed. OBJECTIVE To systematically review the prevalence of CRS in bronchiectasis and identify its clinical implications. METHODS Four databases were searched from inception to August 2018 for studies reporting the prevalence and/or clinical impact of CRS in individuals with bronchiectasis. Clinical outcomes included health-related quality of life (HRQOL), severity of bronchiectasis, lung function, clinical and psychological symptoms, exacerbation frequency, and health care utilization. Two independent reviewers rated the quality of evidence using the risk of bias for prevalence trials tool. RESULTS Of 80 studies identified, 8 studies with 797 participants (all adults) were included. Mean FEV1 % predicted was 77.7%. Overall, 5 studies were classed as low risk of bias and 3 were of moderate risk of bias. The pooled prevalence of clinical and/or radiological CRS was 62% (95% CI, 50%-74%). CRS was associated with a greater degree of bronchiectasis severity, poorer HRQOL, reduction in smell detection, elevated levels of inflammatory markers, and reduced time to first exacerbation. However, the association with airflow obstruction was inconsistent and there was no impact on anxiety or depression. CONCLUSIONS CRS is present in 62% of adults with bronchiectasis. Its presence is associated with poorer HRQOL, greater degree of disease severity, and more extensive radiological bronchiectasis.
Collapse
Affiliation(s)
- Emma Handley
- Alfred Health Hospital Admission Risk Program - Pulmonary Rehabilitation, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Caroline H Nicolson
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Hew
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Physiotherapy, Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia.
| |
Collapse
|
41
|
Liacos A, McDonald CF, Mahal A, Hill CJ, Lee AL, Burge AT, Moore R, Nicolson C, O’Halloran P, Cox NS, Lahham A, Gillies R, Holland AE. The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with chronic obstructive pulmonary disease (COPD). Physiotherapy 2019; 105:90-97. [DOI: 10.1016/j.physio.2018.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/29/2018] [Indexed: 12/20/2022]
|
42
|
Lee AL, Goldstein RS, Rhim M, Chan C, Brooks D, Zabjek K. Reliability and validity of non-radiological measures of thoracic kyphosis in chronic obstructive pulmonary disease. International Journal of Therapy and Rehabilitation 2018. [DOI: 10.12968/ijtr.2018.25.12.648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Thoracic kyphosis in people with chronic obstructive pulmonary disease can be measured from digital photogrammetry or three-dimensional motion capture. This study aimed to determine the reliability, validity and agreement for non-radiological measures of thoracic kyphosis in chronic obstructive pulmonary disease. Methods: A total of 19 participants with chronic obstructive pulmonary disease were included. Cobb angles from chest radiographs and spinous process landmarks using photogrammetry and three-dimensional motion capture were evaluated. Findings: The mean kyphosis (± standard deviation) was 48.8 ± 10.9 degrees by radiograph; 49.6 ± 12.9 degrees by three-dimensional motion capture and 52.2 ± 11.1 degrees by photogrammetry. Radiographic Cobb angle and photogrammetry measurements demonstrated excellent intra- and inter-rater reliability. Correlation between non-radiological kyphosis measurements and chest radiographs was strong (Pearson's r2 >0.75 for both). Limits of agreement between radiographs and 3D motion capture were –9 degrees to 7 degrees, and –12 to 8 degrees between radiographs and photogrammetry. Conclusions: Non-radiological measures of thoracic kyphosis are reliable and valid in chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Annemarie L Lee
- Postdoctoral research fellow, Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Professor and respiratory physician, Department of Respiratory Medicine, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Rhim
- Research assistant, Department of Respiratory Medicine, Toronto, Ontario, Canada
| | - Christen Chan
- Research assistant, Department of Respiratory Medicine, Toronto, Ontario, Canada
| | - Dina Brooks
- Professor and senior scientist, Department of Respiratory Medicine, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Karl Zabjek
- Associate professor, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
43
|
Barker K, Holland AE, Lee AL, Haines T, Ritchie K, Boote C, Saliba J, Lowe S, Pazsa F, Thomas L, Turczyniak M, Skinner EH. Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases: a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:181. [PMID: 30519483 PMCID: PMC6267787 DOI: 10.1186/s40814-018-0369-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 11/13/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials. METHODS A pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization. RESULTS Sixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval - 16 to 60) compared to 22 (57) meters (95% confidence interval - 69 to 114) (control). CONCLUSIONS It was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.
Collapse
Affiliation(s)
- Kathryn Barker
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Anne E. Holland
- La Trobe University, Plenty Rd and Kingsbury Drive, Bundoora, Victoria 3086 Australia
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004 Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - Annemarie L. Lee
- La Trobe University, Plenty Rd and Kingsbury Drive, Bundoora, Victoria 3086 Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Victoria 3000 Australia
| | - Terry Haines
- Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria 3199 Australia
| | - Kathryn Ritchie
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Claire Boote
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004 Australia
| | - Joanne Saliba
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050 Australia
| | - Stephanie Lowe
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Fiona Pazsa
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Lee Thomas
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Monica Turczyniak
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Australian Institute of Musculoskeletal Science, Western Centre for Health Research and Education, Western Health, St Albans, Victoria 3021 Australia
- Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria 3199 Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Victoria 3000 Australia
| |
Collapse
|
44
|
Affiliation(s)
- Annemarie L Lee
- Monash University; Department of Physiotherapy; Melbourne Australia
- Institute for Breathing and Sleep; Commercial Road Melbourne Australia
- La Trobe University; Department of Rehabilitation, Nutrition and Sport; Melbourne Australia
| | - Carla S Gordon
- Monash University; Department of Physiotherapy; Melbourne Australia
- Monash Health; Department of Physiotherapy; Melbourne Australia
| | - Christian R Osadnik
- Monash University; Department of Physiotherapy; Melbourne Australia
- Monash Health; Monash Lung and Sleep; Melbourne Australia
| |
Collapse
|
45
|
Afzal S, Burge AT, Lee AL, Bondarenko J, Holland AE. Should the 6-Minute Walk Test Be Stopped If Oxyhemoglobin Saturation Falls Below 80%? Arch Phys Med Rehabil 2018; 99:2370-2372. [PMID: 30130517 DOI: 10.1016/j.apmr.2018.07.426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the occurrence of adverse events in patients undergoing assessment for pulmonary rehabilitation when a 6-minute walk test (6MWT) continues despite desaturation below 80%. DESIGN Retrospective audit following REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. SETTING Large teaching hospital. PARTICIPANTS All patients (N=549) (55% men, mean age 69±11y) assessed for pulmonary rehabilitation (September 2005 to January 2016). INTERVENTIONS The standardized tests were conducted by experienced cardiorespiratory physiotherapists. Oxyhemoglobin saturation was monitored continuously using a pulse oximeter (lowest value used for analysis). Medical records were reviewed, and adverse events defined as tachycardia, bradycardia, chest pain, or other sign/symptom necessitating cessation. MAIN OUTCOME MEASURE 6MWT. RESULTS Data from 672 walk tests were included with mean distance 369 (124) meters. The main diagnoses were chronic obstructive pulmonary disease (70%), interstitial lung disease (14%), and bronchiectasis (8%). Sixty individuals (11%) recorded desaturation below 80% without adverse events. Two adverse events were recorded during tests without desaturation; in 1 instance, chest pain with no evidence of cardiorespiratory compromise and in another, the patient stopped due to concern regarding blood sugar levels (11.5 mmol/L when tested). Independent predictors of desaturation to less than 80% were resting oxyhemoglobin saturation <95% (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.06-7.08) and a diagnosis of interstitial lung disease or pulmonary arterial hypertension (OR 5.24, 95% CI 2.59-10.58). CONCLUSIONS This study found that desaturation to less than 80% during a 6MWT was not associated with adverse events in a large cohort of patients referred to pulmonary rehabilitation and assessed by experienced physiotherapists, suggesting that test cessation due to desaturation in stable patients may be unwarranted.
Collapse
Affiliation(s)
| | - Angela T Burge
- Alfred Health, Melbourne, Australia; La Trobe University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
| | - Annemarie L Lee
- La Trobe University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
| | | | - Anne E Holland
- Alfred Health, Melbourne, Australia; La Trobe University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| |
Collapse
|
46
|
Barker K, Holland AE, Lee AL, Ritchie K, Boote C, Lowe S, Pazsa F, Thomas L, Turczyniak M, Skinner EH. A rehabilitation programme for people with multimorbidity versus usual care: A pilot randomized controlled trial. J Comorb 2018; 8:2235042X18783918. [PMID: 30057892 PMCID: PMC6060614 DOI: 10.1177/2235042x18783918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multimorbidity, the coexistence of two or more chronic conditions, is common in clinical practice. Rehabilitation for people with multimorbidity may provide access to a rehabilitation programme that can address common symptoms and risk factors for multiple chronic diseases. OBJECTIVE The aims of this study were to (1) evaluate the feasibility of a rehabilitation programme compared to usual medical care (UMC) in people with multimorbidity and (2) gather preliminary data regarding clinical effects and impact on functional exercise capacity, activities of daily living, health-related quality of life and resource utilization. DESIGN A pilot feasibility parallel randomized controlled trial was undertaken. Adults with multimorbidity were randomized to the rehabilitation programme (intervention) or UMC (control). The duration of the rehabilitation programme was 8 weeks and comprised exercise (1 h, twice weekly) and education (1 h, once weekly). The UMC group did not participate in a structured exercise programme. RESULTS One hundred people were screened to recruit 16 participants, with a 71% completion rate for the intervention group. The rehabilitation group achieved a mean (standard deviation) improvement in 6-minute walk distance of 44 (41) m and the UMC group of 23 (29) m. CONCLUSIONS This study suggests that it would be feasible to conduct a larger randomized control trial investigating a rehabilitation programme for people with multimorbidity. Low uptake of the study suggests that refinement of the inclusion criteria, recruitment sources and programme model will be needed to achieve the number of participants required.
Collapse
Affiliation(s)
- Kathryn Barker
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora,
Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria,
Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health,
Heidelberg, Victoria, Australia
| | - Annemarie L Lee
- Discipline of Physiotherapy, La Trobe University, Bundoora,
Victoria, Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health,
Heidelberg, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health
Science, School of Primary and Allied Health Care, Monash University, Frankston,
Victoria, Australia
| | - Kathryn Ritchie
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Claire Boote
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria,
Australia
| | - Stephanie Lowe
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Fiona Pazsa
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Lee Thomas
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Monica Turczyniak
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
- Australian Institute of Musculoskeletal Science, Western Centre for
Health Research and Education, Western Health, Victoria, Australia
- Allied Health Research Unit, Faculty of Medicine, Nursing and Health
Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health
Sciences, Melbourne School of Health Sciences, The University of Melbourne,
Victoria, Australia
| |
Collapse
|
47
|
Holland AE, Hill CJ, Dowman L, Glaspole I, Goh N, Lee AL, McDonald CF. Short- and Long-Term Reliability of the 6-Minute Walk Test in People With Idiopathic Pulmonary Fibrosis. Respir Care 2018; 63:994-1001. [DOI: 10.4187/respcare.05875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
48
|
Lee AL, Goldstein RS, Chan C, Rhim M, Zabjek K, Brooks D. Postural deviations in individuals with chronic obstructive pulmonary disease (COPD). Canadian Journal of Respiratory, Critical Care, and Sleep Medicine 2018. [DOI: 10.1080/24745332.2017.1409091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Annemarie L. Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Ontario, Canada
- Department of Physical Therapy, Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Roger S. Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Ontario, Canada
- Department of Physical Therapy, Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christen Chan
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Ontario, Canada
| | - Matthew Rhim
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Ontario, Canada
| | - Karl Zabjek
- Department of Physical Therapy, Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Ontario, Canada
- Department of Physical Therapy, Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
49
|
Lahham A, McDonald CF, Mahal A, Lee AL, Hill CJ, Burge AT, Cox NS, Moore R, Nicolson C, O'halloran P, Gillies R, Holland AE. Acceptability and validity of a home exercise diary used in home-based pulmonary rehabilitation: A secondary analysis of a randomised controlled trial. Clin Respir J 2018; 12:2057-2064. [PMID: 29392881 DOI: 10.1111/crj.12773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/09/2018] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Evaluating adherence to home-based pulmonary rehabilitation (PR) could be challenging due to lack of direct supervision and the complex nature of the rehabilitation model. To measure adherence to home-based PR in the HomeBase trial, participants were encouraged to work towards a goal of at least 30 min of whole-body exercise on most days of the week and report their participation using a home exercise diary. OBJECTIVE This project aimed to evaluate the acceptability and validity of the home exercise diary. METHODS Diary return and completion rates assessed acceptability of the home exercise diary. Home participants underwent physical activity (PA) monitoring using the Sensewear armband during the final week of an 8-week PR. The correlation between self-documented and objective daily exercise minutes was calculated. Objective exercise minutes were defined as bouts of ≥10 min spent in ≥ moderate PA. Differences in self-documented weekly exercise minutes between sufficiently active (≥7000 daily steps) and inactive participants were computed. RESULTS Diaries were returned by 92% of programme completers. Of those who returned diaries, 72% have completed exercise documentation. Fifteen programme completers underwent PA monitoring [mean age 69 (9) (SD) years, FEV1 55 (19) %predicted]. A moderate correlation was observed between self-documented and objective mean daily exercise minutes (r = .59, P = .02). Active participants [n = 6, 10 253 (1521) daily steps] documented more exercise (111 min) during week eight compared with inactive participants [n = 9, 2705 (1772) daily steps, P = .002]. CONCLUSION The self-documented home exercise diary is an acceptable and valid method to reflect exercise participation during home-based PR.
Collapse
Affiliation(s)
- Aroub Lahham
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Nossal Institute of Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Angela T Burge
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Narelle S Cox
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Caroline Nicolson
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Paul O'halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Rebecca Gillies
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
50
|
Lee AL, Harrison SL, Goldstein RS, Brooks D. An exploration of pain experiences and their meaning in people with chronic obstructive pulmonary disease. Physiother Theory Pract 2018; 34:765-772. [DOI: 10.1080/09593985.2018.1425512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Samantha L Harrison
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|