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Duncan R, Berlowitz DJ, Mullen S, Bondarenko J, Winton-Brown TT, O'Brien TJ, Zaloumis S, Braat S, Oliver G, Kanaan RA. Breathing control training for functional seizures: A multi-site, open-label pilot study. Epilepsy Behav 2024; 154:109745. [PMID: 38521027 DOI: 10.1016/j.yebeh.2024.109745] [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: 11/22/2023] [Revised: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
There are no well-validated treatments for functional seizures. While specialist psychotherapy is usually recommended, the evidence for its benefit is qualified, and it can be difficult to obtain. Given the association between hyperventilation and functional seizures we explored an alternative modality, breathing control training, in a multi-site open label pilot trial. Participants with functional seizures over the age of 16 received an hour of breathing training from a respiratory physiotherapist, with a half-hour booster session a month later. Seizure frequency and Nijmegen scores (a measure of hyperventilation) were reported at baseline and follow-up, 3-4 months later. Eighteen subjects were recruited, and 10 completed follow-up. Seven of these 10 had improved seizure frequency, and 3 did not (Wilcoxon signed rank test, p = 0.09), with seizure frequency correlating with Nijmegen score (Spearman's rank correlation = 0.75, p = 0.034). The intervention was well tolerated, with no adverse events reported. These preliminary results support a potentially new approach to treating functional seizures that should prove cost-effective and acceptable, though require confirmation by a randomised controlled trial.
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Affiliation(s)
- Roderick Duncan
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - David J Berlowitz
- Department of Physiotherapy, The University of Melbourne, Melbourne Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Saul Mullen
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Janet Bondarenko
- Physiotherapy, Alfred Health, Melbourne, Australia; Respiratory Research@Alfred, Monash University, Melbourne, Australia
| | - Toby T Winton-Brown
- Department of Neuroscience, Central Clinical School, Monash University, Prahran 3004, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Prahran 3004, Australia
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne Australia
| | - Georgina Oliver
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Richard A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia.
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Holland AE, Fineberg D, Marceau T, Chong M, Beaman J, Wilson L, Buchanan JA, Uren J, Dal Corso S, Lannin NA, Hoffman M, Mellerick CR, Fernando K, Bondarenko J. The Alfred Health post-COVID-19 service, Melbourne, 2020-2022: an observational cohort study. Med J Aust 2024; 220:91-96. [PMID: 38130117 DOI: 10.5694/mja2.52192] [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: 05/22/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To determine the uptake of the Alfred Health Post-COVID service among people hospitalised with coronavirus disease 2019 (COVID-19) or referred by general practitioners; to describe their characteristics and symptoms at eight weeks and the clinical services they required. STUDY DESIGN Observational cohort study. SETTING Outpatient post-COVID-19 follow-up service in a tertiary Melbourne hospital. PARTICIPANTS All people admitted to Alfred Health (inpatients, hospital-in-the-home) with COVID-19, 19 March 2020 - 28 December 2022; people with persistent symptoms referred by general practitioners in the Alfred Health catchment area during 2022. INTERVENTION Questionnaire-based symptom assessment eight weeks after onset of COVID-19. Dyspnoea, fatigue, depression, anxiety, and post-traumatic stress disorder were assessed with standardised tools, as were health status and health-related quality of life; return to work or study, weight loss, and altered cognition and memory were also assessed. Screening was followed by physical assessment and management at the service (specialist general medicine review, physiotherapist, allied health assistant, neuropsychologist) and referral to other specialist medical services as required. MAIN OUTCOME MEASURES Proportion of eligible people who used the service for follow-up at eight weeks; proportions of service users who reported symptoms and return to pre-COVID-19 employment or study; clinical services required by service users. RESULTS Of 6712 people invited for screening, 726 completed questionnaires (11%). At least one persistent symptom was reported by 385 of 642 respondents (60% of respondents, 5.7% of invitees), most frequently memory (371 of 656, 57%) or concentration problems (431 of 656, 66%), dyspnoea (197 of 703, 28%), and extreme fatigue (189 of 673, 28%). Sixty-seven of 453 respondents had not returned to pre-COVID-19 work or study (15%). People were referred to a variety of medical and non-medical services for management, including specialist medical clinics, allied health, and rehabilitation. Among 71 people who also completed questionnaires at twelve months, the proportions who reported fatigue, anxiety, and memory and concentration changes were similar at both assessments. CONCLUSIONS After acute COVID-19 that required hospital admission or was followed by persistent symptoms in community care, a small proportion of people (5.7%) reported symptoms that required medical and allied health specialist assessment and management. Our findings may assist planning services for people with long COVID.
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Affiliation(s)
- Anne E Holland
- Monash University, Melbourne, VIC
- Alfred Health, Melbourne, VIC
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Mellerick CR, Burge AT, Hill CJ, Cox NS, Bondarenko J, Holland AE. Impact of Test Instructions on 6-min Walk Distance in Adults With Chronic Respiratory Disease: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2024; 44:49-54. [PMID: 37941096 DOI: 10.1097/hcr.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
PURPOSE The 6-min walk test (6MWT) is commonly used to assess functional exercise capacity in people with chronic respiratory disease in both clinical and research settings. However, two tests are required to achieve accurate results, due to a well-documented learning effect for the 6-min walk distance (6MWD). Whether it is possible to reduce or eliminate the learning effect by optimizing 6MWT instructions is not known. METHODS People with chronic respiratory disease referred to pulmonary rehabilitation undertook two 6MWT with random allocation to modified instructions ( fast -walk as fast as possible; n = 46) or usual instructions ( far -walk as far as possible; n = 49). The primary outcome was the learning effect, defined as the difference in the 6MWD between test one and test two. Subgroup analyses investigated whether effects varied in those who were naïve to the 6MWT or according to diagnosis (chronic obstructive pulmonary disease, interstitial lung disease, and bronchiectasis). RESULTS A learning effect was present in both groups, with a mean improvement in the 6MWD on the second test of 14 m in the fast (modified) group (95% CI, 6-22) and 11 m in the far (usual) group (95% CI, 4-19). There was no statistically or clinically significant difference between groups in the magnitude of the learning effect (between-group difference -3 m, 95% CI, -14 to 8). There was no significant effect of naivety to the 6MWT or diagnosis. CONCLUSION The current recommended procedures for the 6MWT, including standardized instructions and performance of two tests on each occasion, should be retained.
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Affiliation(s)
- Christie R Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia (Mss Mellerick and Bondarenko and Drs Burge, Cox, and Holland); Institute for Breathing and Sleep, Melbourne, Victoria, Australia (Ms Mellerick and Drs Burge, Hill, Cox, and Holland); Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia (Mss Mellerick and Bondarenko and Drs Burge and Holland); and Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia (Dr Hill)
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Cox NS, Bondarenko J, Chong M, Marceu T, Perryman J, Holland AE. Rapid real-world implementation of pulmonary telerehabilitation: good fortune or COVID-19 luck? ERJ Open Res 2024; 10:00820-2023. [PMID: 38375426 PMCID: PMC10875453 DOI: 10.1183/23120541.00820-2023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024] Open
Abstract
"Real-world" telerehabilitation achieves clinically meaningful outcomes for patients and may improve access to pulmonary rehabilitation, but implementation into practice may have been aided by COVID-19-related support for telehealth https://bit.ly/3NqYdCC.
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Affiliation(s)
- Narelle S. Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Melissa Chong
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Tunya Marceu
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Jaycie Perryman
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Anne E. Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
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Lin T, Pham J, Denton E, Lee J, Hore-Lacy F, Sverrild A, Stojanovic S, Tay TR, Murthee KG, Radhakrishna N, Dols M, Bondarenko J, Mahoney J, O'Hehir RE, Dabscheck E, Hew M. Trait profiles in difficult-to-treat asthma: Clinical impact and response to systematic assessment. Allergy 2023; 78:2418-2427. [PMID: 36940306 DOI: 10.1111/all.15719] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND Multidisciplinary systematic assessment improves outcomes in difficult-to-treat asthma, but without clear response predictors. Using a treatable-traits framework, we stratified patients by trait profile, examining clinical impact and treatment responsiveness to systematic assessment. METHODS We performed latent class analysis using 12 traits on difficult-to-treat asthma patients undergoing systematic assessment at our institution. We examined Asthma Control Questionnaire (ACQ-6) and Asthma Quality of Life Questionnaire (AQLQ) scores, FEV1 , exacerbation frequency, and maintenance oral corticosteroid (mOCS) dose, at baseline and following systematic assessment. RESULTS Among 241 patients, two airway-centric profiles were characterized by early-onset with allergic rhinitis (n = 46) and adult onset with eosinophilia/chronic rhinosinusitis (n = 60), respectively, with minimal comorbid or psychosocial traits; three non-airway-centric profiles exhibited either comorbid (obesity, vocal cord dysfunction, dysfunctional breathing) dominance (n = 51), psychosocial (anxiety, depression, smoking, unemployment) dominance (n = 72), or multi-domain impairment (n = 12). Compared to airway-centric profiles, non-airway-centric profiles had worse baseline ACQ-6 (2.7 vs. 2.2, p < .001) and AQLQ (3.8 vs. 4.5, p < .001) scores. Following systematic assessment, the cohort showed overall improvements across all outcomes. However, airway-centric profiles had more FEV1 improvement (5.6% vs. 2.2% predicted, p < .05) while non-airway-centric profiles trended to greater exacerbation reduction (1.7 vs. 1.0, p = .07); mOCS dose reduction was similar (3.1 mg vs. 3.5 mg, p = .782). CONCLUSION Distinct trait profiles in difficult-to-treat asthma are associated with different clinical outcomes and treatment responsiveness to systematic assessment. These findings yield clinical and mechanistic insights into difficult-to-treat asthma, offer a conceptual framework to address disease heterogeneity, and highlight areas responsive to targeted intervention.
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Affiliation(s)
- Tiffany Lin
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Jonathan Pham
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joy Lee
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Asger Sverrild
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Stephanie Stojanovic
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore City, Singapore
| | | | - Naghmeh Radhakrishna
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Monique Dols
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Janine Mahoney
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Robyn E O'Hehir
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Eli Dabscheck
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Zanaboni P, Dinesen B, Hoaas H, Wootton R, Burge AT, Philp R, Oliveira CC, Bondarenko J, Tranborg Jensen T, Miller BR, Holland AE. Long-term Telerehabilitation or Unsupervised Training at Home for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Am J Respir Crit Care Med 2023; 207:865-875. [PMID: 36480957 PMCID: PMC10111997 DOI: 10.1164/rccm.202204-0643oc] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Rationale: Despite the benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), many patients do not access or complete pulmonary rehabilitation, and long-term maintenance of exercise is difficult. Objectives: To compare long-term telerehabilitation or unsupervised treadmill training at home with standard care. Methods: In an international randomized controlled trial, patients with COPD were assigned to three groups (telerehabilitation, unsupervised training, or control) and followed up for 2 years. Telerehabilitation consisted of individualized treadmill training at home supervised by a physiotherapist and self-management. The unsupervised training group performed unsupervised treadmill exercise at home. The control group received standard care. The primary outcome was the combined number of hospitalizations and emergency department presentations. Secondary outcomes included time free from the first event; exercise capacity; dyspnea; health status; quality of life; anxiety; depression; self-efficacy; and subjective impression of change. Measurements and Main Results: A total of 120 participants were randomized. The incidence rate of hospitalizations and emergency department presentations was lower in telerehabilitation (1.18 events per person-year; 95% confidence interval [CI], 0.94-1.46) and unsupervised training group (1.14; 95% CI, 0.92-1.41) than in the control group (1.88; 95% CI, 1.58-2.21; P < 0.001 compared with intervention groups). Telerehabilitation and unsupervised training groups experienced better health status for 1 year. Intervention participants reached and maintained clinically significant improvements in exercise capacity. Conclusions: Long-term telerehabilitation and unsupervised training at home in COPD are both successful in reducing hospital readmissions and can broaden the availability of pulmonary rehabilitation and maintenance strategies.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Birthe Dinesen
- Laboratory of Welfare Technologies-Digital Health & Rehabilitation, Sports Science, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hanne Hoaas
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Angela T. Burge
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Physiotherapy Department and
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | | | | | - Janet Bondarenko
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Physiotherapy Department and
| | | | | | - Anne E. Holland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Physiotherapy Department and
- Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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Cox NS, Lee JYT, McDonald CF, Mahal A, Alison JA, Wootton R, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Corbett M, Handley E, Burge AT, Holland AE. Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study. Chest 2022:S0012-3692(22)04344-6. [PMID: 36574926 DOI: 10.1016/j.chest.2022.12.023] [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: 08/19/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging. RESEARCH QUESTION To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program? STUDY DESIGN AND METHODS Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes. RESULTS One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss. INTERPRETATION Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear. TRIAL REGISTRY ClinicalTrials.gov; No.: ACTRN12616000360415; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne.
| | - Joanna Y T Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne; Respiratory and Sleep Medicine Clinic, Melbourne; Faculty of Medicine, Melbourne
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne; Melbourne
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia; Allied Health Research and Education Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Austin Health, Melbourne
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne
| | | | | | - Kathryn Barker
- Community Based Rehabilitation Service, Western Health, Melbourne
| | - Hayley Crute
- Physiotherapy Service, Wimmera Health Care Group, Horsham
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Bruna Wageck
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Pawel Czupryn
- Physiotherapy Service, West Wimmera Health Service, Nhill, VIC
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
| | - Emma Handley
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
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Bondarenko J, Holland AE. Clinimetrics: The Breathing Pattern Assessment Tool. J Physiother 2022; 69:127. [PMID: 36526557 DOI: 10.1016/j.jphys.2022.11.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Janet Bondarenko
- Physiotherapy Department, Alfred Health, Melbourne, Australia; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
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9
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Holland AE, Bondarenko J. Breathlessness: Remembering the worst of it. Respirology 2022; 27:806-807. [PMID: 35821602 DOI: 10.1111/resp.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Anne E Holland
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
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10
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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.
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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
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11
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Dowman LM, May AK, Hill CJ, Bondarenko J, Spencer L, Morris NR, Alison JA, Walsh J, Goh NSL, Corte T, Glaspole I, Chambers DC, McDonald CF, Holland AE. High intensity interval training versus moderate intensity continuous training for people with interstitial lung disease: protocol for a randomised controlled trial. BMC Pulm Med 2021; 21:361. [PMID: 34758808 PMCID: PMC8582173 DOI: 10.1186/s12890-021-01704-2] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Interstitial lung disease is a debilitating condition associated with significant dyspnoea, fatigue, and poor exercise tolerance. Pulmonary rehabilitation is an effective and key intervention in people with interstitial lung disease. However, despite the best efforts of patients and clinicians, many of those who participate are not achieving clinically meaningful benefits. This assessor-blinded, multi-centre, randomised controlled trial aims to compare the clinical benefits of high intensity interval exercise training versus the standard pulmonary rehabilitation method of continuous training at moderate intensity in people with fibrotic interstitial lung disease. Methods Eligible participants will be randomised to either a standard pulmonary rehabilitation group using moderate intensity continuous exercise training or high intensity interval exercise training. Participants in both groups will undertake an 8-week pulmonary rehabilitation program of twice-weekly supervised exercise training including aerobic (cycling) and strengthening exercises. In addition, participants in both groups will be prescribed a home exercise program. Outcomes will be assessed at baseline, upon completion of the intervention and at six months following the intervention by a blinded assessor. The primary outcome is endurance time on a constant work rate test. Secondary outcomes are functional capacity (6-min walk distance), health-related quality of life (Chronic Respiratory Disease Questionnaire (CRQ), St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis specific version (SGRQ-I), breathlessness (Dyspnoea 12, Modified Medical Research Council Dyspnoea Scale), fatigue (fatigue severity scale), anxiety (Hospital Anxiety and Depression Scale), physical activity level (GeneActiv), skeletal muscle changes (ultrasonography) and completion and adherence to pulmonary rehabilitation. Discussion The standard exercise training strategies used in pulmonary rehabilitation may not provide an optimal exercise training stimulus for people with interstitial lung disease. This study will determine whether high intensity interval training can produce equivalent or even superior changes in exercise performance and symptoms. If high intensity interval training proves effective, it will provide an exercise training strategy that can readily be implemented into clinical practice for people with interstitial lung disease. Trial registration ClinicalTrials.gov Registry (NCT03800914). Registered 11 January 2019, https://clinicaltrials.gov/ct2/show/NCT03800914 Australian New Zealand Clinical Trials Registry ACTRN12619000019101. Registered 9 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376050&isReview=true
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Affiliation(s)
- Leona M Dowman
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia. .,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia. .,Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia. .,Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - Anthony K May
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Catherine J Hill
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Janet Bondarenko
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Lissa Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Metro North Hospital and Health Service, The Prince Charles Hospital, Allied Health Research Collaborative, Chermside, QLD, Australia
| | - Jennifer A Alison
- Allied Health Professorial Unit, Sydney Local Health District, Sydney, NSW, Australia.,Faculty of Medicine and Health Science, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - James Walsh
- School of Health Sciences and Social Work, The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Metro North Hospital and Health Service, The Prince Charles Hospital, Allied Health Research Collaborative, Chermside, QLD, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Tamera Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Ian Glaspole
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Holland
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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12
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Cox NS, Lahham A, McDonald CF, Mahal A, O'Halloran P, Hepworth G, Spencer L, McNamara RJ, Bondarenko J, Macdonald H, Gavin S, Burge AT, Le Maitre C, Ringin C, Webb E, Nichols A, Tsai LL, Luxton N, van Hilten S, Santos M, Crute H, Byrne M, Boursinos H, Broe J, Corbett M, Marceau T, Warrick B, Boote C, Melinz J, Holland AE. Home-based pulmonary rehabilitation early after hospitalisation in COPD (early HomeBase): protocol for a randomised controlled trial. BMJ Open Respir Res 2021; 8:e001107. [PMID: 34819323 PMCID: PMC8614151 DOI: 10.1136/bmjresp-2021-001107] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations of respiratory disease, frequently requiring hospital admission. Pulmonary rehabilitation can reduce the likelihood of future hospitalisation, but programme uptake is poor. This study aims to compare hospital readmission rates, clinical outcomes and costs between people with COPD who undertake a home-based programme of pulmonary rehabilitation commenced early (within 2 weeks) of hospital discharge with usual care. METHODS A multisite randomised controlled trial, powered for superiority, will be conducted in Australia. Eligible patients admitted to one of the participating sites for an exacerbation of COPD will be invited to participate. Participants will be randomised 1:1. Intervention group participants will undertake an 8-week programme of home-based pulmonary rehabilitation commencing within 2 weeks of hospital discharge. Control group participants will receive usual care and a weekly phone call for attention control. Outcomes will be measured by a blinded assessor at baseline, after the intervention (week 9-10 posthospital discharge), and at 12 months follow-up. The primary outcome is hospital readmission at 12 months follow-up. ETHICS AND DISSEMINATION Human Research Ethics approval for all sites provided by Alfred Health (Project 51216). Findings will be published in peer-reviewed journals, conferences and lay publications. TRIAL REGISTRATION NUMBER ACTRN12619001122145.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Lissa Spencer
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Janet Bondarenko
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Samantha Gavin
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Cade Ringin
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Elizabeth Webb
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Ling-Ling Tsai
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nia Luxton
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Stephanie van Hilten
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Mary Santos
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Megan Byrne
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Broe
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tunya Marceau
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Brooke Warrick
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | | | - Joanna Melinz
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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13
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Cox NS, McDonald CF, Mahal A, Alison JA, Wootton R, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Corbett M, Handley E, Burge AT, Holland AE. Telerehabilitation for chronic respiratory disease: a randomised controlled equivalence trial. Thorax 2021; 77:643-651. [PMID: 34650004 DOI: 10.1136/thoraxjnl-2021-216934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. This study investigated whether home-based telerehabilitation was equivalent to centre-based pulmonary rehabilitation in people with chronic respiratory disease. METHODS A multicentre randomised controlled trial with assessor blinding, powered for equivalence was undertaken. Individuals with a chronic respiratory disease referred to pulmonary rehabilitation at four participating sites (one rural) were eligible and randomised using concealed allocation to pulmonary rehabilitation or telerehabilitation. Both programmes were two times per week for 8 weeks. The primary outcome was change in Chronic Respiratory Disease Questionnaire Dyspnoea (CRQ-D) domain at end-rehabilitation, with a prespecified equivalence margin of 2.5 points. Follow-up was at 12 months. Secondary outcomes included exercise capacity, health-related quality of life, symptoms, self-efficacy and psychological well-being. RESULTS 142 participants were randomised to pulmonary rehabilitation or telerehabilitation with 96% and 97% included in the intention-to-treat analysis, respectively. There were no significant differences between groups for any outcome at either time point. Both groups achieved meaningful improvement in dyspnoea and exercise capacity at end-rehabilitation. However, we were unable to confirm equivalence of telerehabilitation for the primary outcome ΔCRQ-D at end-rehabilitation (mean difference (MD) (95% CI) -1 point (-3 to 1)), and inferiority of telerehabilitation could not be excluded at either time point (12-month follow-up: MD -1 point (95% CI -4 to 1)). At end-rehabilitation, telerehabilitation demonstrated equivalence for 6-minute walk distance (MD -6 m, 95% CI -26 to 15) with possibly superiority of telerehabilitation at 12 months (MD 14 m, 95% CI -10 to 38). CONCLUSION telerehabilitation may not be equivalent to centre-based pulmonary rehabilitation for all outcomes, but is safe and achieves clinically meaningful benefits. When centre-based pulmonary rehabilitation is not available, telerehabilitation may provide an alternative programme model. TRIAL REGISTRATION NUMBER ACtelerehabilitationN12616000360415.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia .,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer A Alison
- School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Allied Health Research and Education Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Richard Wootton
- Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromso, Norway
| | | | - Paolo Zanaboni
- Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromso, Norway.,Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | | | - Kathryn Barker
- Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Bruna Wageck
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Pawel Czupryn
- West Wimmera Health Service, Nhill, Victoria, Australia
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Emma Handley
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
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14
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Dowman LM, May AK, Cox NS, Morris NR, Nakazawa A, Parker L, Bondarenko J, Holland AE. Attenuation of exertional desaturation and preference for interval exercise compared to continuous exercise in people with interstitial lung disease. Respirology 2021; 26:1076-1079. [PMID: 34596934 DOI: 10.1111/resp.14159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/02/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Leona M Dowman
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Anthony K May
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Narelle S Cox
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Norman R Morris
- School of Allied Health Sciences and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Metro North Hospital and Health Service, The Prince Charles Hospital, Allied Health Research Collaborative, Chermside, Queensland, Australia
| | - Atsuhito Nakazawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Centre, Yokohama, Japan
| | - Lewan Parker
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Janet Bondarenko
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
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15
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Guler SA, Hur SA, Stickland MK, Brun P, Bovet L, Holland AE, Bondarenko J, Hambly N, Wald J, Makhdami N, Kreuter M, Gloeckl R, Jarosch I, Tan B, Johannson KA, McBride SA, De Boer K, Sandoz JS, Sun K, Assayag D, Bhatt SP, Morisset J, Ferraro V, Garvey C, Camp PG, Ryerson CJ. Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study. Thorax 2021; 77:589-595. [PMID: 34462346 DOI: 10.1136/thoraxjnl-2021-217361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/27/2021] [Accepted: 08/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival. METHODS This retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders. RESULTS 701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%). CONCLUSIONS Patients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.
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Affiliation(s)
- Sabina Anna Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seo Am Hur
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Brun
- Bern Rehabilitation Center, Heiligenschwendi, Bern, Switzerland
| | - Luc Bovet
- Bern Rehabilitation Center, Heiligenschwendi, Bern, Switzerland
| | - Anne E Holland
- Department of Physiotherapy, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Nathan Hambly
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada
| | - Joshua Wald
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada
| | - Nima Makhdami
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Benjamin Tan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Ainslie McBride
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaissa De Boer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Kelly Sun
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama At Birmingham, Birmingham, Alabama, USA
| | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Vincent Ferraro
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Chris Garvey
- Pulmonary Rehabilitation and Sleep Disorders Center, University of California San Francisco, San Francisco, California, USA
| | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Malaguti C, Holland AE, McDonald CF, Mahal A, Alison JA, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Burge AT, Cox NS. Community Participation by People with Chronic Obstructive Pulmonary Disease. COPD 2021; 18:533-540. [PMID: 34424802 DOI: 10.1080/15412555.2021.1966761] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Little is known regarding community participation in individuals with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore community participation in individuals with COPD and to determine whether there is an association between community participation and activity-related outcome variables commonly collected during pulmonary rehabilitation assessment. We also sought to investigate which of these variables might influence community participation in people with COPD. Ninety-nine individuals with COPD were enrolled (67 ± 9 years, FEV1: 55 ± 22% predicted). We assessed community participation (Community Participation Indicator (CPI) and European Social Survey (ESS) for formal and informal community participation), daily physical activity levels (activity monitor), exercise capacity (6-minute walk test), breathlessness (Modified Medical Research Council, MMRC scale), self-efficacy (Pulmonary Rehabilitation Adapted Index of Self-Efficacy) and anxiety and depression (Hospital Anxiety and Depression Scale). Higher levels of community participation on the CPI were associated with older age and greater levels of physical activity (total, light and moderate-to-vigorous) (all rs = 0.30, p < 0.05). Older age and more moderate-to-vigorous physical activity independently predicted greater community participation measured by CPI. Higher levels of depression symptoms were associated with less formal and informal community participation on ESS (rs = -0.25). More formal community participation on ESS was weakly (rs = 0.2-0.3) associated with older age, better lung function, exercise capacity and self-efficacy, and less breathlessness. Self-efficacy, exercise capacity, and age independently predicted formal community participation in individuals with COPD. Strategies to optimize self-efficacy and improve exercise capacity may be useful to enhance community participation in people with COPD.
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Affiliation(s)
- Carla Malaguti
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Anne E Holland
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Allied Health Research and Education Unit, Sydney Local Health District, Sydney, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Heather Macdonald
- Community Rehabilitation, Wimmera Health Care Group, Horsham Victoria, Australia
| | - Kathryn Barker
- Community Based Rehabilitation, Western Health, Melbourne, Australia
| | - Hayley Crute
- Physiotherapy, Wimmera Health Care Group, Horsham Victoria, Australia
| | - Christie Mellerick
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Bruna Wageck
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Helen Boursinos
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Aroub Lahham
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Amanda Nichols
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | | | - Angela T Burge
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Narelle S Cox
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
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Bondarenko J, Babic C, Burge AT, Holland AE. Home-based pulmonary rehabilitation: an implementation study using the RE-AIM framework. ERJ Open Res 2021; 7:00469-2020. [PMID: 33981764 PMCID: PMC8107349 DOI: 10.1183/23120541.00469-2020] [Citation(s) in RCA: 3] [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: 07/06/2020] [Accepted: 09/08/2020] [Indexed: 11/05/2022] Open
Abstract
Pulmonary rehabilitation is an effective intervention for people with chronic lung disease, with evidence for improvements in exercise capacity, breathlessness and health-related quality of life [1]. It is strongly recommended in clinical guidelines for the management of people with chronic obstructive pulmonary disease [2] and there is growing evidence for its effectiveness in other respiratory conditions [3–5]. The majority of pulmonary rehabilitation programmes are centre based, requiring participants to attend an outpatient centre for every session of supervised exercise and education related to self-management [6]. Home-based pulmonary rehabilitation is a clinically effective alternative for people who cannot attend centre-based programmeshttps://bit.ly/33qPx7A
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Affiliation(s)
- Janet Bondarenko
- Dept of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Chloe Babic
- Hospital Admissions Risk Program, Alfred Health, Melbourne, Victoria, Australia
| | - Angela T Burge
- Dept of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Anne E Holland
- Dept of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
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18
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Burge AT, Rodrigues JC, Abramson MJ, Cox NS, Bondarenko J, Webb E, Marceau T, Handley E, Macdonald H, Askin A, Calasans GASA, do Amaral DP, Dreger J, Dal Corso S, Holland AE. Application of the Modified Incremental Step Test for Pulmonary Rehabilitation. Phys Ther 2021; 101:6124134. [PMID: 33528020 DOI: 10.1093/ptj/pzab044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/11/2020] [Revised: 09/23/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A Modified Incremental Step Test (MIST) performed in the home may facilitate entirely home-based pulmonary rehabilitation programs. The aims of this study were to investigate the reliability and responsiveness, and the utility of the MIST for exercise prescription in people with stable chronic lung disease. METHODS The MIST was undertaken at the center and home in random order, before and after pulmonary rehabilitation, with 2 tests at each time point. Reliability was assessed using intraclass correlation coefficient. Responsiveness was evaluated as effect size. The minimal important difference was appraised using distribution and anchor-based methods. In a substudy, physiological responses to MIST were measured by a portable metabolic system, followed by a constant step rate test at 60% of peak oxygen uptake (VO2peak), to evaluate utility for exercise prescription. RESULTS Forty-six participants were recruited (29% of eligible candidates). There was excellent reliability for number of steps recorded in home- and center-based settings (intraclass correlation coefficient = 0.954, 95% CI = 0.915-0.976). A small-moderate effect size was demonstrated following pulmonary rehabilitation (0.34), and the minimal detectable change was 7 steps. All participants in the substudy achieved 60% of VO2peak and achieved steady state by the fourth minute, with 60% of VO2peak corresponding to a mean 37% (95% CI = 29-44) of the MIST final level. CONCLUSIONS The MIST is reliable and responsive to pulmonary rehabilitation in people with stable chronic respiratory disease. It provides new opportunities to assess exercise capacity, prescribe exercise training, and reassess exercise program outcomes in environments where established field walking tests are not feasible. IMPACT Pulmonary rehabilitation is a highly effective treatment that is underutilized worldwide. Home-based pulmonary rehabilitation may improve access for patients and deliver equivalent clinical outcomes but is limited by the availability of a robust exercise test that can be used at home to assess exercise capacity and prescribe training intensity. This study tested the clinimetric properties of the MIST and demonstrated a new way to assess exercise capacity, prescribe exercise training of an appropriate intensity, and reassess exercise capacity in environments where established field walking tests are not feasible.
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Affiliation(s)
- Angela T Burge
- Physiotherapy, Alfred Health, Melbourne, Australia.,Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | | | | | - Narelle S Cox
- Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Janet Bondarenko
- Physiotherapy, Alfred Health, Melbourne, Australia.,Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Hospital Admission Risk Program, Alfred Health, Melbourne, Australia
| | - Elizabeth Webb
- School of Public Health and Preventive Medicine, Monash University
| | - Tunya Marceau
- Hospital Admission Risk Program, Alfred Health, Melbourne, Australia
| | - Emma Handley
- Hospital Admission Risk Program, Alfred Health, Melbourne, Australia
| | | | | | | | | | - Julianna Dreger
- Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | | | - Anne E Holland
- Physiotherapy, Alfred Health, Melbourne, Australia.,Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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19
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Bondarenko J, Hew M, Button B, Webb E, Jackson V, Clark R, Holland AE. Reliability of the breathing pattern assessment tool for in-person or remote assessment in people with asthma. Clin Exp Allergy 2021; 51:1218-1220. [PMID: 33638261 DOI: 10.1111/cea.13856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Janet Bondarenko
- Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Mark Hew
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Vic., Australia
| | - Brenda Button
- Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Vic., Australia
| | - Elizabeth Webb
- Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Victoria Jackson
- Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia
| | - Rebecca Clark
- Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic., Australia
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20
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Cox NS, McDonald CF, Gleeson M, Wood L, Hall S, Hill C, Bondarenko J, Holland AE. Challenges of evaluating the effect of exercise training on salivary IgA in people with COPD. Clin Respir J 2021; 15:699-701. [PMID: 33548086 DOI: 10.1111/crj.13337] [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] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Narelle S Cox
- Faculty Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,School of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maree Gleeson
- School of Biomedical Science and Pharmacy, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Lisa Wood
- School of Biomedical Science and Pharmacy, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Sharron Hall
- School of Biomedical Science and Pharmacy, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Catherine Hill
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia
| | - Anne E Holland
- Faculty Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia
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21
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Holland AE, Malaguti C, Hoffman M, Lahham A, Burge AT, Dowman L, May AK, Bondarenko J, Graco M, Tikellis G, Lee JY, Cox NS. Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review. Chron Respir Dis 2020; 17:1479973120952418. [PMID: 32840385 PMCID: PMC7450293 DOI: 10.1177/1479973120952418] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To identify exercise tests that are suitable for home-based or remote
administration in people with chronic lung disease. Methods: Rapid review of studies that reported home-based or remote administration of
an exercise test in people with chronic lung disease, and studies reporting
their clinimetric (measurement) properties. Results: 84 studies were included. Tests used at home were the 6-minute walk test
(6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go
(TUG, 4 studies) and step tests (two studies). Exercise tests administered
remotely were the 6MWT (two studies) and step test (one study). Compared to
centre-based testing the 6MWT distance was similar when performed outdoors
but shorter when performed at home (two studies). The STS, TUG and step
tests were feasible, reliable (intra-class correlation coefficients
>0.80), valid (concurrent and known groups validity) and moderately
responsive to pulmonary rehabilitation (medium effect sizes). These tests
elicited less desaturation than the 6MWT, and validated methods to prescribe
exercise were not reported. Discussion: The STS, step and TUG tests can be performed at home, but do not accurately
document desaturation with walking or allow exercise prescription. Patients
at risk of desaturation should be prioritised for centre-based exercise
testing when this is available.
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Affiliation(s)
- Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Carla Malaguti
- Department of Cardiorespiratory and Skeletal muscle, 28113Federal University of Juiz de Fora, São Pedro, Juiz de Fora, Brazil
| | - Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Aroub Lahham
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Angela T Burge
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Leona Dowman
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Anthony K May
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Australia.,Allied Health, 5392Alfred Health, Melbourne, Victoria, Australia
| | - Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Joanna Yt Lee
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Narelle S Cox
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Institute for Breathing and Sleep, Australia
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Wageck B, Cox NS, Bondarenko J, Corbett M, Nichols A, Moore R, Holland AE. Early home-based pulmonary rehabilitation following acute exacerbation of COPD: A feasibility study using an action research approach. Chron Respir Dis 2020; 17:1479973120949207. [PMID: 32815732 PMCID: PMC7444104 DOI: 10.1177/1479973120949207] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: Pulmonary rehabilitation (PR) improves function, reduces symptoms and decreases healthcare usage in people with chronic obstructive pulmonary disease (COPD) following an acute exacerbation (AECOPD). However, rehabilitation uptake rates are low. This study aimed to address barriers to uptake and completion of PR following AECOPD. Methods: An action research approach was used to reflect on study feasibility, and to plan and implement an improved protocol. Phase I tested the feasibility of home-based PR started early after AECOPD. Phase II used qualitative interviews to identified potential barriers to program uptake. Phase III re-tested the program with changes to recruitment and assessment strategies. Results: Phase I: From 97 screened patients, 26 were eligible and 10 (38%) started home-based PR. Eight participants undertook ≥70% of PR sessions, achieving clinically meaningful improvement in 6-minute walk distance (mean (SD) change 76 (60) m) and chronic respiratory disease questionnaire total score (15 (21) units). Phase II: Potential barriers to uptake of home-based PR included access issues, confidence to exercise, and lack of information about PR benefits. Phase III: From 77 screened patients, 23 were eligible and 5 (22%) started the program. Discussion: Home-based PR improved clinical outcomes, but program eligibility and uptake remain challenging. Efforts should be made to ensure PR program eligibility criteria are broad enough to accommodate patient needs, and new ways of engaging patients are needed to improve PR uptake after AECOPD.
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Affiliation(s)
- Bruna Wageck
- Discipline of Physiotherapy, 2080La Trobe University, Melbourne, Australia
| | - Narelle S Cox
- Discipline of Physiotherapy, 2080La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Central Clinical School, 161666Monash University, Melbourne, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, 5392Alfred Hospital, Melbourne, Australia
| | - Monique Corbett
- Department of Physiotherapy, 5392Alfred Hospital, Melbourne, Australia
| | - Amanda Nichols
- Central Clinical School, 161666Monash University, Melbourne, Australia.,Department of Physiotherapy, Monash Health, Melbourne, Australia
| | | | - Anne E Holland
- Discipline of Physiotherapy, 2080La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Central Clinical School, 161666Monash University, Melbourne, Australia.,Department of Physiotherapy, 5392Alfred Hospital, Melbourne, Australia
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23
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Lee J, Denton E, Hoy R, Tay TR, Bondarenko J, Hore-Lacy F, Radhakrishna N, O'Hehir RE, Dabscheck E, Abramson MJ, Hew M. Paradoxical Vocal Fold Motion in Difficult Asthma Is Associated with Dysfunctional Breathing and Preserved Lung Function. J Allergy Clin Immunol Pract 2020; 8:2256-2262. [PMID: 32173506 DOI: 10.1016/j.jaip.2020.02.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/13/2020] [Accepted: 02/23/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many patients with difficult asthma also have coexisting vocal cord dysfunction (VCD), evident by paradoxical vocal fold motion (PVFM) on laryngoscopy. OBJECTIVE Among patients with difficult asthma, we sought to identify clinical features associated with laryngoscopy-diagnosed PVFM. METHODS Consecutive patients with "difficult asthma" referred by respiratory specialists underwent systematic assessment in this observational study. Those with a high clinical suspicion for VCD were referred for laryngoscopy, either at rest or after mannitol provocation. Statistical analyses were performed to identify clinical factors associated with PVFM, and a multivariate logistic regression model was fitted to control for confounders. RESULTS Of 169 patients with difficult asthma, 63 (37.3%) had a high clinical probability of VCD. Of 42 who underwent laryngoscopy, 32 had PVFM confirmed. Patients with PVFM more likely had preserved lung function (prebronchodilator forced expiratory ratio 74% ± 11 vs 62% ± 16, P < .001); physiotherapist-confirmed dysfunctional breathing (odds ratio [OR] = 5.52, 95% confidence interval [CI]: 2.4-12.7, P < .001), gastro-oesophageal reflux (OR = 2.6, 95% CI: 1.16-5.8, P = .02), and a lower peripheral eosinophil count (0.09 vs 0.23, P = .004). On multivariate logistic regression, independent predictors for PVFM were dysfunctional breathing (OR = 4.93, 95% CI: 2-12, P < .001) and preserved lung function (OR = 1.07, 95% CI: 1.028-1.106, P < .001). CONCLUSION Among specialist-referred patients with difficult asthma, VCD pathogenesis may overlap with dysfunctional breathing but is not associated with severe airflow obstruction. Dysfunctional breathing and preserved lung function may serve as clinical clues for the presence of VCD.
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Affiliation(s)
- Joy Lee
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ryan Hoy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tunn Ren Tay
- Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore
| | - Janet Bondarenko
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Robyn E O'Hehir
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Respiratory Medicine, Allergy and Clinical Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Eli Dabscheck
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael J Abramson
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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24
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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.
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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
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25
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Denton E, Bondarenko J, O'Hehir RE, Hew M. Breathing pattern disorder in difficult asthma: Characteristics and improvement in asthma control and quality of life after breathing re-training. Allergy 2019; 74:201-203. [PMID: 30243028 DOI: 10.1111/all.13611] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eve Denton
- Allergy, Asthma & Clinical Immunology The Alfred Hospital Melbourne Victoria Australia
- Public Health & Preventive Medicine Monash University Melbourne Victoria Australia
| | - Janet Bondarenko
- Physiotherapy Department The Alfred Hospital Melbourne Victoria Australia
| | - Robyn E. O'Hehir
- Allergy, Asthma & Clinical Immunology The Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology The Alfred Hospital Melbourne Victoria Australia
- Public Health & Preventive Medicine Monash University Melbourne Victoria Australia
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26
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Denton E, Bondarenko J, Tay T, Lee J, Radhakrishna N, Hore-Lacy F, Martin C, Hoy R, O'Hehir R, Dabscheck E, Hew M. Factors Associated with Dysfunctional Breathing in Patients with Difficult to Treat Asthma. J Allergy Clin Immunol Pract 2018; 7:1471-1476. [PMID: 30529061 DOI: 10.1016/j.jaip.2018.11.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/01/2018] [Accepted: 11/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Understanding of dysfunctional breathing in patients with difficult asthma who remain symptomatic despite maximal inhaler therapy is limited. OBJECTIVE We characterized the pattern of dysfunctional breathing in patients with difficult asthma and identified possible contributory factors. METHODS Dysfunctional breathing was identified in patients with difficult asthma using the Nijmegen Questionnaire (score >23). Demographic characteristics, asthma variables, and comorbidities were assessed. Multivariate logistic regression was performed for dysfunctional breathing, adjusted for age, sex, body mass index, and airflow obstruction. RESULTS Of 157 patients with difficult asthma, 73 (47%) had dysfunctional breathing. Compared with patients without dysfunctional breathing, those with dysfunctional breathing experienced poorer asthma status (symptom control, quality of life, and exacerbation rates) and greater unemployment. In addition, more frequently they had elevated sino-nasal outcome test scores, anxiety, depression, sleep apnea, and gastroesophageal reflux. On multivariate analysis, anxiety (odds ratio [OR], 3.26; 95% CI, 1.18-9.01; P = .02), depression (OR, 2.8; 95% CI, 1.14-6.9; P = .03), and 22-item sino-nasal outcome test score (OR, 1.03; 95% CI, 1.003-1.05; P = .03) were independent risk factors for dysfunctional breathing. CONCLUSIONS Dysfunctional breathing is common in difficult asthma and associated with worse asthma status and unemployment. The independent association with psychological disorders and nasal obstruction highlight an important interaction between comorbid treatable traits in difficult asthma.
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Affiliation(s)
- Eve Denton
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Janet Bondarenko
- Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - TunnRen Tay
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Joy Lee
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catherine Martin
- Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ryan Hoy
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn O'Hehir
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eli Dabscheck
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia; Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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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.
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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.
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Cox NS, McDonald CF, Alison JA, Mahal A, Wootton R, Hill CJ, Bondarenko J, Macdonald H, O’Halloran P, Zanaboni P, Clarke K, Rennick D, Borgelt K, Burge AT, Lahham A, Wageck B, Crute H, Czupryn P, Nichols A, Holland AE. Telerehabilitation versus traditional centre-based pulmonary rehabilitation for people with chronic respiratory disease: protocol for a randomised controlled trial. BMC Pulm Med 2018; 18:71. [PMID: 29764393 PMCID: PMC5952573 DOI: 10.1186/s12890-018-0646-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 11/09/2017] [Accepted: 05/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation is an effective therapeutic intervention for people with chronic respiratory disease. However, fewer than 5% of eligible individuals receive pulmonary rehabilitation on an annual basis, largely due to limited availability of services and difficulties associated with travel and transport. The Rehabilitation Exercise At Home (REAcH) study is an assessor-blinded, multi-centre, randomised controlled equivalence trial designed to compare the efficacy of home-based telerehabilitation and traditional centre-based pulmonary rehabilitation in people with chronic respiratory disease. METHODS Participants will undertake an 8-week group-based pulmonary rehabilitation program of twice-weekly supervised exercise training, either in-person at a centre-based pulmonary rehabilitation program or remotely from their home via the Internet. Supervised exercise training sessions will include 30 min of aerobic exercise (cycle and/or walking training). Individualised education and self-management training will be delivered. All participants will be prescribed a home exercise program of walking and strengthening activities. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and 12-months post intervention. The primary outcome is change in dyspnea score as measured by the Chronic Respiratory Questionnaire - dyspnea domain (CRQ-D). Secondary outcomes will evaluate the efficacy of telerehabilitation on 6-min walk distance, endurance cycle time during a constant work rate test, physical activity and quality of life. Adherence to pulmonary rehabilitation between the two models will be compared. A full economic analysis from a societal perspective will be undertaken to determine the cost-effectiveness of telerehabilitation compared to centre-based pulmonary rehabilitation. DISCUSSION Alternative models of pulmonary rehabilitation are required to improve both equity of access and patient-related outcomes. This trial will establish whether telerehabilitation can achieve equivalent improvement in outcomes compared to traditional centre-based pulmonary rehabilitation. If efficacious and cost-effective, the proposed telerehabilitation model is designed to be rapidly deployed into clinical practice. TRIAL REGISTRATION Clinical trial registered with the Australian and New Zealand Clinical Trials Register at ( ACTRN12616000360415 ). Registered 21 March 2016.
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Affiliation(s)
- Narelle S. Cox
- Discipline of Physiotherapy, La Trobe University and Institute for Breathing and Sleep, La Trobe University, Melbourne, VIC Australia
| | - Christine F. McDonald
- Department of Respiratory Medicine Austin Health; Institute for Breathing and Sleep and University of Melbourne, Austin Health, Heidelberg, VIC Australia
| | - Jennifer A. Alison
- Discipline of Physiotherapy, University of Sydney and Sydney Local Health District, University of Sydney, Lidcombe, NSW Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Richard Wootton
- Norwegian Center for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Catherine J. Hill
- Physiotherapy Department Austin Health and Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC Australia
| | | | | | - Paul O’Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC Australia
| | - Paolo Zanaboni
- Norwegian Center for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Ken Clarke
- Melbourne Networked Society Institute, University of Melbourne, Melbourne, VIC Australia
| | | | - Kaye Borgelt
- West Wimmera Health Service, Nhill, VIC Australia
| | - Angela T. Burge
- Discipline of Physiotherapy, La Trobe University; Department of Physiotherapy, Alfred Health and Institute for Breathing and Sleep, La Trobe University, Melbourne, VIC Australia
| | - Aroub Lahham
- Discipline of Physiotherapy, La Trobe University and Institute for Breathing and Sleep, La Trobe University, Melbourne, VIC Australia
| | - Bruna Wageck
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, VIC Australia
| | | | | | - Anne E. Holland
- Discipline of Physiotherapy, La Trobe University; Department of Physiotherapy, Alfred Health and Institute for Breathing and Sleep, La Trobe University, Melbourne, VIC Australia
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Tarrant BJ, Holland A, Le Maitre C, Robinson R, Corbett M, Bondarenko J, Button B, Thompson B, Snell G. The timing and extent of acute physiotherapy involvement following lung transplantation: An observational study. Physiother Res Int 2018. [PMID: 29528538 DOI: 10.1002/pri.1710] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Physiotherapy "standard care" for the acute post lung transplant recipient has not yet been documented. We aimed to analyse how soon patients commence exercise and how much time is dedicated to this during physiotherapy sessions acutely post lung transplantation. METHODS Prospective observational study of bilateral sequential and single lung transplant recipients for any indication, ≥18 years. Participants were observed during 6 physiotherapy sessions: 3 initial and 3 prior to acute inpatient discharge. Duration and content of each session was recorded, consisting of physical exercise and non-exercise tasks. RESULTS Thirty participants, 20 male, median age 58.5 (interquartile range 54.5-65.0) were observed over 173 sessions. Chronic obstructive pulmonary disease was the most common transplant indication (n = 12, 40%). Bilateral lung transplant was performed in 90% (n = 27) of participants. First time to mobilise was 2 (2-3) days. Participants received 14 (12.8-23.8) sessions over 18 (17-31) days. The mean duration of physiotherapy in the initial phase was 107.8 (standard deviation 21.8) min, with 22.9 (7.5) min spent exercising. In the final phase, exercise time increased to 28.1 (11.4) min out of 84.1 (24.6) min. Assessment was the most common non-exercise component, at 26.6 (7.9) and 22.1 (12.5) min across the three initial and final sessions. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE Lung transplant recipients spent 21-34% of observed sessions performing physical exercise beginning 48 hr following surgery. Remaining physiotherapist time was spent on assessment, respiratory interventions, education, and patient-specific duties. The use of physiotherapy assistants, structured, progressive exercise programs, and continued workplace innovation may enable a higher percentage of physiotherapist supervised physical exercise in the future.
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Affiliation(s)
- Benjamin James Tarrant
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Anne Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | - Rebecca Robinson
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Monique Corbett
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Brenda Button
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Cystic Fibrosis Service, Alfred Health, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Bruce Thompson
- Monash University, Melbourne, Australia
- Lung Function Laboratory, Alfred Health, Melbourne, Australia
| | - Greg Snell
- Monash University, Melbourne, Australia
- Lung Transplant, Alfred Health, Melbourne, Australia
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Fuller LM, El-Ansary D, Button B, Bondarenko J, Marasco S, Snell G, Holland AE. Reliability of sternal instability scale (SIS) for transverse sternotomy in lung transplantation (LTX). Physiother Theory Pract 2018; 34:931-934. [DOI: 10.1080/09593985.2018.1431342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Louise M Fuller
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Bundoora, Victoria Australia
| | - Doa El-Ansary
- Physiotherapy Department, The University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | - Brenda Button
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
- Monash University Physiotherapy Department, Clayton Campus, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Greg Snell
- Respiratory Department, The Alfred Hospital, Lung Transplant Services, Melbourne, Victoria, Australia
| | - Anne E Holland
- Physiotherapy Department Victoria, The Alfred Hospital Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Bundoora, Victoria Australia
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Fuller L, El-Ansary D, Button B, Bondarenko J, Marasco S, Gooi J, Snell G, Holland A. A Novel Sternal Instability Assessment Tool for Use Post Lung Transplant: Reliability and Early Results. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.654] [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] [Indexed: 10/23/2022] Open
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Wittenberg P, Sever K, Knoth S, Sahin N, Bondarenko J. Determining quantitative road safety targets by applying statistical prediction techniques and a multi-stage adjustment procedure. Accid Anal Prev 2013; 50:566-577. [PMID: 22770816 DOI: 10.1016/j.aap.2012.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/05/2012] [Accepted: 06/03/2012] [Indexed: 06/01/2023]
Abstract
Due to substantial progress made in road safety in the last ten years, the European Union (EU) renewed the ambitious agreement of halving the number of persons killed on the roads within the next decade. In this paper we develop a method that aims at finding an optimal target for each nation, in terms of being as achievable as possible, and with the cumulative EU target being reached. Targets as an important component in road safety policy are given as reduction rate or as absolute number of road traffic deaths. Determination of these quantitative road safety targets (QRST) is done by a top-down approach, formalized in a multi-stage adjustment procedure. Different QRST are derived under consideration of recent research. The paper presents a method to break the national target further down to regional targets in case of the German Federal States. Generalized linear models are fitted to data in the period 1991-2010. Our model selection procedure chooses various models for the EU and solely log-linear models for the German Federal States. If the proposed targets for the EU Member States are attained, the sum of fatalities should not exceed the total value of 15,465 per year by 2020. Both, the mean level and the range of mortality rates within the EU could be lowered from 28-113 in 2010 to 17-41 per million inhabitants in 2020. This study provides an alternative to the determination of safety targets by political commitments only, taking the history of road fatalities trends and population into consideration.
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Affiliation(s)
- P Wittenberg
- Helmut-Schmidt-University (University of the Federal Armed Forces Hamburg), Dept. of Mathematics & Statistics, Holstenhofweg 85, 22043 Hamburg, Germany.
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