Patient Profile of Drop-Outs From a Pulmonary Rehabilitation Program

Barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease in Iran: a descriptive qualitative study

OBJECTIVES

Chronic obstructive pulmonary disease is a chronic disease with numerous complications. Therefore, its effective management depends on home-based pulmonary rehabilitation. The effectiveness of home-based pulmonary rehabilitation programmes in turn depends on patient adherence to them. The aim of this study was to explore the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease.

DESIGN

Qualitative descriptive design.

SETTING

The lung care wards of Al-Zahra and Khorshid teaching hospitals and the comprehensive lung care clinic of Khorshid hospital, Isfahan, Iran.

PARTICIPANTS

Participants patients with chronic obstructive pulmonary disease (n=20), their family caregivers (n=15) and healthcare providers (n=14) recruited via purposive sampling.

RESULTS

The five main categories of the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease were patient-related barriers, caregivers' caregiving burden, limited support for patients, healthcare providers' limited professional competence and ineffective home-based pulmonary rehabilitation planning.

CONCLUSION

Different and complex factors related to patients, families and healthcare providers can affect adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. Healthcare authorities can use the findings of this study to develop strategies to support patients with chronic obstructive pulmonary disease and their family caregivers and thereby reduce the physical and mental complications of Chronic obstructive pulmonary disease.

Free diving-inspired breathing techniques for COPD patients: A pilot study

Objectives: Pulmonary rehabilitation (PR) is a key factor in enhancing self-management and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The content and length of PR varies between countries and authorities responsible for rehabilitation. After completion of rehabilitation, it is often difficult for patients to stay motivated and perform regular exercise. Methods: In this pilot study, nine patients with moderate to severe COPD completed a 6-week training programme consisting of free diving-inspired breathing techniques, designed to be incorporated into daily activities. Results: Participants significantly increased the distance walked in 6 min by 48 m (p < 0.05) and a significant reduction was seen on the COPD self-efficacy scale (p < 0.05). Furthermore, adherence to the programme sessions was very high at 96.3% and no adverse events occurred. Discussion: This pilot study tested the feasibility of introducing breathing techniques used by COPD patients to enhance their walking capacity. The techniques were well tolerated and participant's adherence to the weekly group sessions was high.

The effect of pulmonary rehabilitation on physical performance and health related quality of life in patients with chronic lung disease

Pulmonary rehabilitation (PR) is a multidisciplinary approach that improves exercise capacity and health-related quality of life in patients with chronic lung disease. We retrospectively reviewed the medical records of the patients with chronic lung disease who participated in the PR program at University Medical Center in Lubbock, Texas, between 2014 and 2019. Clinical information, 6-min walk test (6 MW T) results, the number of emergency department (ED) visits and hospitalizations, and psychosocial questionnaires (CAT score, PHQ9 and mMRC dyspnea score) were recorded before and after the completion of the program. Multiple variable linear regression and logistic regression were used to analyze the relationships between patient characteristics and changes in the 6-min walk distance and the achievement of a minimal clinically important differences (MCID) in the 6-min walk distance, the CAT score, the PHQ-9, and the mMRC. 279 patients enrolled in pulmonary rehabilitation; 144 patients (52%) completed the program. After completion of the program, 84 patients increased their 6 MW T distance to exceed the MCID with a mean increase of 178 feet, and the number of ED visits and hospitalizations decreased from 0.80 ± 1.11 to 0.55 ± 0.87 (p < 0.05) in the six months before and after rehabilitation. There were statistically significant improvements in all three psychosocial scores. Factors associated with non-completion included younger age, female gender, and shorter baseline 6 MW T distances. The MCID helps evaluate patient outcomes following pulmonary rehabilitation and provide more definite assessment of benefits. The high dropout rate indicates that programs must continuously monitor patient participation and interest.

Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults

Objectives

Obesity-related physiological changes can limit improvements of obese subjects after training. The aim was to investigate obesity, muscular strength, and physical function in community-dwelling nonsarcopenic old adults.

Methods

Nonsarcopenic subjects (N=229, 73.7 ± 5.7 years; 21% normal weight, 42% overweight, and 37% obese based on body mass index (BMI)) participated in a 12-week resistance exercise program. Leisure time physical activity (LTPA), body composition (dual-energy X-ray absorptiometry), quadriceps strength (maximum voluntary isometric contraction; absolute and relative to body weight), and physical function in terms of 6-minutes-walk-for-distance (6MWD) and timed up and go (TUG) were measured baseline and endpoint.

Results

At baseline, normal weight participants had lower absolute quadriceps strength (-43 ± 22 N, P=0.015) than obese, but better quadriceps strength relative to body weight (1.4 ± 0.7 N/kg, P < 0.001), 6MWD (53 ± 27 m, P < 0.001), and TUG (-1.4 ± 0.7 sec, P ≤ 0.001). LTPA was positively associated with 6MWD and TUG (both P < 0.05), but based on general linear models, differences in LTPA between BMI categories did not explain differences in 6MWD and TUG between BMI categories. During the program, dropout (11.9%) and attendance (85%) were similar between BMI groups. After the intervention, body composition and physical function significantly improved in all three BMI categories; however, normal weight participants lost more body fat (-1.53 ± 0.78%, P=0.014), gained more lean mass (0.70 ± 0.36 kg, P < 0.001) and relative quadriceps strength (0.31 ± 0.16 N/kg, P=0.017), and improved more on the 6MWD (24 ± 12 m, P < 0.001) but gained less grip strength (-2.4 ± 1.3 N/kg, P=0.020) compared to obese. There were no differences in TUG or absolute quadriceps strength changes between the BMI strata. Physical function at baseline as well as training success of overweight participants was located between the normal weight and obesity groups.

Conclusion

Nonsarcopenic obese community-dwelling old adults have lower physical function than their normal weight counterparts. This difference is not explained by lower LTPA. A 12-week resistance exercise program improves body composition and physical function in normal weight, overweight, and obese old adults; however, obese participants experience less favorable changes in body composition and physical function than normal weight individuals. This trial is registered with NCT01074879.