Computerized adventitious respiratory sounds as outcome measures for respiratory therapy: a systematic review

INTRODUCTION

There is a need to develop simple, noninvasive, and sensitive outcome measures for respiratory therapy. Adventitious respiratory sounds (ie, crackles and wheezes) can be objectively characterized with computerized respiratory sound analysis (CORSA) and have been shown to contribute for diagnosis purposes; however, their potential for use as outcome measures is unknown. Thus, this systematic review synthesizes the evidence on the use of computerized adventitious respiratory sounds as outcome measures.

METHODS

The Web of Knowledge, MEDLINE, EMBASE, and SCOPUS databases were searched. Reviewers independently selected studies according to the eligibility criteria. Effect sizes and 95% CIs were computed.

RESULTS

Twelve studies with different designs (observational, n = 3; quasi-experimental n = 7; and randomized controlled trial, n = 2) were included. Eight studies were conducted with adults, and 4 studies with children. Most studies explored only one type of adventitious respiratory sound. For wheezes, the occupation rate seemed to be the most promising parameter to be used as an outcome measure, with high/medium effect sizes (0.62-1.82). For crackles, the largest deflection width showed high effect sizes (1.31 and 1.04); however, this was explored in only one study. Crackle number and 2-cycle duration presented conflicting information, with high/poor effect sizes depending on the study.

CONCLUSIONS

Specific variables of each adventitious respiratory sound detected and characterized by CORSA showed high effect sizes and, thus, the potential to be used as outcome measures. Further research with robust study designs and larger samples (both of children and adult populations), and following CORSA guidelines is needed to build evidence-based knowledge on this topic.

Caring for people with early and advanced chronic obstructive pulmonary disease: how do family carers cope?

AIMS AND OBJECTIVES

To examine the coping strategies of family carers of people with early and advanced chronic obstructive pulmonary disease and how those relate to their subjective health.

BACKGROUND

Caring for a family member with chronic obstructive pulmonary disease can be a stressful experience. Understanding how carers cope with this is critical for improving outcomes. However, this topic has received little attention in the literature, particularly considering the care-giving experience with early chronic obstructive pulmonary disease.

DESIGN

A cross-sectional study with a convenience sample of family carers of people with chronic obstructive pulmonary disease.

METHODS

A structured questionnaire was used to collect data on socio-demographics and care-giving characteristics. Self-rated physical and mental health was measured by two items from the International Classification of Functioning, Disability and Health checklist. Coping strategies were assessed with the Carers' Assessment of Managing Index. Descriptive and inferential analyses were performed.

RESULTS

A total of 158 family carers participated: 109 caring for people with early and 49 with advanced chronic obstructive pulmonary disease. The two groups differed significantly on self-rated mental health and on problem-solving, emotional-cognitive and managing stress coping type. Significant correlations between self-rated physical health and problem-solving coping and between self-rated mental health and emotion-cognitive and managing stress coping were found for carers of patients with advanced chronic obstructive pulmonary disease.

CONCLUSIONS

This study provides a unique insight into family carer coping strategies at different stages of chronic obstructive pulmonary disease. Carers of people with early and advanced chronic obstructive pulmonary disease cope differently with their caring demands. Nevertheless, problem-focused coping strategies were perceived as the most helpful by both groups.

RELEVANCE TO CLINICAL PRACTICE

The findings are relevant to informing early supportive interventions aiming to prevent burden and promote healthy adjustment to care-giving demands within the specific context of chronic obstructive pulmonary disease.

Linking the EASY-care standard to the international classification of functioning, disability and health

PURPOSE

This study aimed to document the content of the EASY-Care Standard questionnaire to the International Classification of Functioning, Disability and Health (ICF) and present its ICF Core Set.

METHOD

The EASY-Care was linked to the ICF by two trained health professionals according to the established linking rules. The agreement between the health professionals was determined using the Cohen's kappa.

RESULTS

The agreement between the two health professionals was almost perfect for each level of the ICF (Cohen's kappas between 0.91 and 0.97). The 65 items of the EASY-Care were linked to 61 different ICF categories, 16 (26%) from the Body functions component, 3 from the Body structures (5%), 30 from the Activities and participation (49%) and 12 from the Environmental factors (20%). Twelve concepts could not be linked to the ICF at all: 6 were classified as Personal factors, 1 as not defined-general health and 5 were not classified.

CONCLUSIONS

The integration of the universal language of the ICF in the EASY-Care illustrates the potential of use this instrument in primary care settings at community level.

IMPLICATIONS FOR REHABILITATION

The integration of the universal language of the ICF in the EASY-Care potentiates the use of this comprehensive instrument in assessing older people needs at primary care settings. The information obtained with the EASY-Care Standard can be worldwide understood and can be used to plan rehabilitation interventions at community settings for older adults.