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de Oliveira TMD, Pereira AL, Costa GB, de Souza Mendes LP, de Almeida LB, Velloso M, Malaguti C. Embedding Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in the Home and Community Setting: A Rapid Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:780736. [PMID: 36188941 PMCID: PMC9397727 DOI: 10.3389/fresc.2022.780736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/18/2022] [Indexed: 06/16/2023]
Abstract
This paper presents a rapid review of the literature for the components, benefits, barriers, and facilitators of pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) people in-home and community-based settings. seventy-six studies were included: 57 home-based pulmonary rehabilitation (HBPR) studies and 19 community-based pulmonary rehabilitation (CBPR) studies. The benefits of HBPR on exercise capacity and health-related quality of life were observed in one-group studies, studies comparing HBPR to usual care, and studies comparing to hospital-based pulmonary rehabilitation, although the benefits were less pronounced in the latter. HBPR reduced hospital admissions compared to usual care and was more cost-effective than hospital pulmonary rehabilitation. Most HBPRs were designed with low-density or customized equipment, are minimally supervised, and have a low intensity of training. Although the HBPR has flexibility and no travel burden, participants with severe disease, physical frailty, and complex comorbidities had barriers to complying with HBPR. The telerehabilitation program, a facilitator for HBPR, is feasible and safe. CBPR was offered in-person supervision, despite being limited to physical therapists in most studies. Benefits in exercise capacity were shown in almost all studies, but the improvement in health-related quality of life was controversial. Patients reported the benefits that facilities where they attended the CBPR including social support and the presence of an instructor. They also reported barriers, such as poor physical condition, transport difficulties, and family commitments. Despite the minimal infrastructure offered, HBPR and CBPR are feasible, safe, and provide clinical benefits to patients with COPD. Home and community settings are excellent opportunities to expand the offer of pulmonary rehabilitation programs, as long as they follow protocols that ensure quality and safety following current guidelines.
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Affiliation(s)
- Túlio Medina Dutra de Oliveira
- Department of Cardiorespiratory and Skeletal Muscle Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Adriano Luiz Pereira
- Department of Cardiorespiratory and Skeletal Muscle Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Giovani Bernardo Costa
- Empresa Brasileira de Serviços Hospitalares/Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Liliane P. de Souza Mendes
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Terapia Respiratória e do Sono, Pesquisa & Ensino, Belo Horizonte, Brazil
| | - Leonardo Barbosa de Almeida
- Empresa Brasileira de Serviços Hospitalares/Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Marcelo Velloso
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carla Malaguti
- Department of Cardiorespiratory and Skeletal Muscle Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Kuo WY, Chen MC, Lin YC, Yan SF, Shyu YIL. Trajectory of adherence to home rehabilitation among older adults with hip fractures and cognitive impairment. Geriatr Nurs 2021; 42:1569-1576. [PMID: 34763234 DOI: 10.1016/j.gerinurse.2021.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to identify different trajectories of adherence to home rehabilitation for older adults with hip fracture and cognitive impairment, to examine associations between different adherence trajectories and postoperative recovery outcomes, and to explore the predictors of adherence trajectories. Group-based trajectory modeling showed two adherence trajectories: low (39.06%) and high (60.94%) adherence. The high adherence group had better activities of daily living (β=11.77, p<.001), instrumental activities of daily living (β=0.56, p<.01), femoral muscular strength (β=3.35, p<.01) on the fractured side and quality of life (β=-0.81, p=.02) than the low adherence group. Participants who established exercise habits (OR=6.49, p<.01) and consulted a physical therapist (OR=4.29, p=.03) during hospitalization were more likely to be in the high adherence group.
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Affiliation(s)
- Wen-Yu Kuo
- School of Nursing, Chang Gung University of Science and Technology, 261 Wenhua 1(st) Road, Guishan District, Taoyuan City 33303, Taiwan, ROC; Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, 261 Wenhua 1(st) Road, Guishan District, Taoyuan City 33303, Taiwan, ROC
| | - Min-Chi Chen
- Department of Public Health & Biostatistics, College of Medicine, Consulting Center, Chang Gung University, 259 Wenhua 1(st) Road, Guishan District, Taoyuan City 33302, Taiwan, ROC; Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Ya-Chi Lin
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1(st) Road, Guishan District, Taoyuan City 33302, Taiwan, ROC
| | - Shu-Fang Yan
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1(st) Road, Guishan District, Taoyuan City 33302, Taiwan, ROC
| | - Yea-Ing Lotus Shyu
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1(st) Road, Guishan District, Taoyuan City 33302, Taiwan, ROC; Department of Orthopedic Surgery, Division of Orthopedic Traumatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; School of Nursing, College of Medicine, & Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan, ROC.
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Tabudlo JB. A Proposed Theory of Symptom Cluster Management. BELITUNG NURSING JOURNAL 2021; 7:78-87. [PMID: 37469941 PMCID: PMC10353591 DOI: 10.33546/bnj.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 07/21/2023] Open
Abstract
Background Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest. Objective This article presents the development of a Proposed Theory of Symptom Cluster Management. Methods The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles. Results The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced. Conclusion The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.
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Affiliation(s)
- Jerick B. Tabudlo
- University of the Philippines Manila, College of Nursing, Philippines
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Association between Social Support and Self-Care Behaviors in Adults with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2018; 14:1419-1427. [PMID: 28719225 DOI: 10.1513/annalsats.201701-026oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Higher social support is associated with a better quality of life and functioning in adults with chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine the association between structural and functional social support and self-care behaviors in adults with COPD. METHODS This was a longitudinal study using data from the CASCADE (COPD Activity: Serotonin Transporter, Cytokines, and Depression) study, which was focused on depression and functioning in COPD. Physical activity was measured with a validated accelerometer at baseline, year 1, and year 2. Additional self-care behaviors included pulmonary rehabilitation attendance, smoking status, receipt of influenza and/or pneumococcal vaccinations, and medication adherence. Structural social support indicators included living status, being partnered, number of close friends/relatives, and presence of a family caregiver. Functional social support was measured with the Medical Outcomes Social Support Survey (MOSSS). Mixed-effects and logistic regression models were used. RESULTS A total of 282 participants with Global Initiative for Chronic Obstructive Lung Disease stage II to IV COPD were included (age, 68 ± 9 yr; 80% men; FEV1% predicted, 45 ± 16). For physical activity, participants who lived with others accrued 903 more steps per day than those who lived alone (95% confidence interval [CI], 373-1,433; P = 0.001); increases in the MOSSS total score were associated with more steps per day (β = 10; 95% CI, 2-18; P = 0.02). The odds of pulmonary rehabilitation participation were more than 11 times higher if an individual had a spouse or partner caregiver compared with not having a caregiver (odds ratio [OR], 11.03; 95% CI, 1.93-62.97; P < 0.01). Higher functional social support (MOSSS total score) was associated with marginally lower odds of smoking (OR, 0.99; 95% CI, 0.98-1.00; P = 0.03) and higher odds of pneumococcal vaccination (OR, 1.02; 95% CI, 1.00-1.03; P = 0.02). Social support was not associated with influenza vaccination or medication adherence. CONCLUSIONS Structural social support, which was measured by reports of living with others and having a caregiver, was respectively associated with higher levels of physical activity and greater participation in pulmonary rehabilitation in adults with COPD. Our findings reinforce the critical importance of the social environment in shaping patients' success with self-care. Clinical Trial registered with clinicaltrials.gov (NCT01074515).
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A Lifestyle Physical Activity Intervention for Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial. Ann Am Thorac Soc 2017; 13:617-26. [PMID: 26785249 DOI: 10.1513/annalsats.201508-508oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
RATIONALE Physical inactivity is associated with poor outcomes among patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine effectiveness of a behavioral intervention intended to increase daily physical activity with the goal of improving health-related quality of life and functional performance. METHODS We conducted a randomized trial among patients with COPD cared for in primary care and pulmonary clinics. The patients were at least 45 years of age and eligible for pulmonary rehabilitation. All patients received self-management education during a 6-week run-in period. Subsequently, patients were randomized to usual care or the intervention delivered over 20 weeks. MEASUREMENTS AND MAIN RESULTS Co-primary outcomes were change from baseline in Chronic Respiratory Questionnaire dyspnea domain score and 6-minute-walk distance measured at 6, 12, and 18 months after randomization. A total of 325 patients were enrolled, with 156 randomized to receive usual care and 149 to receive the intervention. At 18 months, there was no overall statistical or clinically significant change in the dyspnea domain in either group. However, for 6-minute-walk distance, there were statistically significant declines in both groups. In contrast, 6-minute-walk distance remained stable (5.3 m; P = 0.54) among patients in the intervention group with moderate spirometric impairment, but it was associated with clinically and statistically significant declines (-28.7 m; P = 0.0001) among usual care patients with moderate spirometric impairment. Overall, there was no increase in adverse events associated with the intervention, which was associated with a lower prevalence of hospitalization for COPD exacerbations (28.3%) compared with usual care (49.5%). CONCLUSIONS During this 18-month trial among outpatients with COPD, a health coach-based behavioral intervention did not improve scores in the dyspnea domain of the Chronic Respiratory Questionnaire or 6-minute-walk test distance. However, subgroup analyses suggested that there may be differential effects for specific outcomes that vary with severity of COPD. Specifically, benefits of this low-intensity intervention may be limited to 6-minute walk distance among patients with moderate spirometric impairment. Clinical trial registered with www.clinicaltrials.gov (NCT1108991).
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Arslan S, Öztunç G. The Effects of a Walking Exercise Program on Fatigue in the Person with COPD. Rehabil Nurs 2016; 41:303-312. [DOI: 10.1002/rnj.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 01/23/2023]
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Russo R, Coultas D, Ashmore J, Peoples J, Sloan J, Jackson BE, Uhm M, Singh KP, Blair SN, Bae S. Chronic obstructive pulmonary disease self-management activation research trial (COPD-SMART): results of recruitment and baseline patient characteristics. Contemp Clin Trials 2015; 41:192-201. [PMID: 25657053 PMCID: PMC4380855 DOI: 10.1016/j.cct.2015.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe the recruitment methods, study participation rate, and baseline characteristics of a representative sample of outpatients with COPD eligible for pulmonary rehabilitation participating in a trial of a lifestyle behavioral intervention to increase physical activity. SETTING AND DESIGN A patient registry was developed for recruitment using an administrative database from primary care and specialty clinics of an academic medical center in northeast Texas for a parallel group randomized trial. RESULTS The registry was comprised of 5582 patients and over the course of the 30 month recruitment period 325 patients were enrolled for an overall study participation rate of 35.1%. After a 6-week COPD self-management education period provided to all enrolled patients, 305 patients were randomized into either usual care (UC; n=156) or the physical activity self-management intervention (PASM; n=149). There were no clinically significant differences in demographics, clinical characteristics, or health status indicators between the randomized groups. CONCLUSION The results of this recruitment process demonstrate the successful use of a patient registry for enrolling a representative sample of outpatients eligible for pulmonary rehabilitation with COPD from primary and specialty care. Moreover, this approach to patient recruitment provides a model for future studies utilizing administrative databases and electronic health records.
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Affiliation(s)
- Rennie Russo
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States
| | - David Coultas
- Veterans Administration Portland Healthcare System and Oregon Health Science University, Department of Medicine, Portland, OR, United States.
| | - Jamile Ashmore
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States; Baylor Medical Center, Behavioral Health Center, Plano, TX, United States
| | - Jennifer Peoples
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States
| | - John Sloan
- University of Texas at Tyler, Department of Health and Kinesiology, Tyler, TX, United States
| | - Bradford E Jackson
- University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, United States
| | - Minyong Uhm
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States
| | - Karan P Singh
- University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, United States
| | - Steven N Blair
- University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Sejong Bae
- University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, United States
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Dinicola G, Julian L, Gregorich SE, Blanc PD, Katz PP. The role of social support in anxiety for persons with COPD. J Psychosom Res 2013; 74:110-5. [PMID: 23332524 PMCID: PMC3552252 DOI: 10.1016/j.jpsychores.2012.09.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/28/2012] [Accepted: 09/30/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study examined the contribution of perceived social support to the presence of anxiety in persons with chronic obstructive pulmonary disease (COPD). METHODS A cross-sectional survey sample of 452 persons with COPD (61.3% female; 53.5% older than 65; 70.8% without a college degree or higher educational achievement, and 54.8% with household income of $40,000 or less) completed a telephone survey. Measures included the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), 5 social support subscales from the Positive and Negative Social Exchanges (PANSE) Scale, a COPD Severity Score (CSS; a weighted algorithmic combination of symptoms and the need for various COPD medical interventions), and the Geriatric Depression Scale, Short Form (GDS-SF). Zero order correlations and a series of multiple regression analyses were calculated. RESULTS Multiple regression analysis revealed that the receipt of instrumental support, feeling let down by the failure of others to provide needed help, and unsympathetic or insensitive behavior from others each positively predicted a higher level of patient anxiety in COPD patients, after controlling for demographic variables, smoking status, comorbid depression (GDS) and severity of illness (CSS). Additionally, the control variable of depression was the strongest predictor of anxiety, suggesting a high degree of co-morbidity in this sample. CONCLUSION Anxiety and depression are serious co-morbid mental health concerns for persons with COPD. It is important to examine both positive and negative aspects of perceived social support for COPD patients and how they may impact or interact with these mental health concerns.
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Affiliation(s)
- Gia Dinicola
- University of California, San Francisco, Department of Medicine, USA
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Sohanpal R, Hooper R, Hames R, Priebe S, Taylor S. Reporting participation rates in studies of non-pharmacological interventions for patients with chronic obstructive pulmonary disease: a systematic review. Syst Rev 2012; 1:66. [PMID: 23272768 PMCID: PMC3563605 DOI: 10.1186/2046-4053-1-66] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/26/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) and self-management (SM) support programmes are effective in the management of patients with chronic obstructive pulmonary disease (COPD), but these interventions are not widely implemented in routine care. One reason may be poor patient participation and retention. We conducted a systematic review to determine a true estimate of participation and dropout rates in research studies of these interventions. METHODS Studies were identified from eight electronic databases including MEDLINE, UK Clinical Trial Register, Cochrane library, and reference lists of identified studies. Controlled clinical trial studies of structured SM, PR and health education (HE) programmes for COPD were included. Data extraction included 'participant flow' data using the Consolidated Standards of Reporting Trials (CONSORT) statement and its extension to pragmatic trials. Patient 'participation rates' (study participation rate (SPR), study dropout rate (SDR) and intervention dropout rate (IDR)) were calculated using prior participation definitions consistent with CONSORT. Random effects logistic regression analysis was conducted to examine effects of four key study characteristics (group vs. individual treatment, year of publication, study quality and exercise vs. non-exercise) on participation rates. RESULTS Fifty-six quantitative studies (51 randomised controlled trials, three quasi-experimental and two before-after studies) evaluated PR (n = 31), SM (n = 21) and HE (n = 4). Reports of participant flow were generally incomplete; 'numbers of potential participants identified' were only available for 16%, and 'numbers assessed for eligibility' for only 39% of studies. Although 'numbers eligible' were better reported (77%), we were unable to calculate SPR for 23% of studies. Overall we found 'participation rates' for studies (n = 43) were higher than previous reports; only 19% of studies had less than 50% SPR and just over one-third (34%) had a SPR of 100%; SDR and IDR were less than or equal to 30% for around 93% of studies. There was no evidence of effects of study characteristics on participation rates. CONCLUSION Unlike previous reports, we found high participation and low dropout rates in studies of PR or SM support for COPD. Previous studies adopted different participation definitions; some reported proportions without stating definitions clearly, obscuring whether proportions referred to the study or the intervention. Clear, uniform definitions of patient participation in studies are needed to better inform the wider implementation of effective interventions.
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Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
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