1
|
Hug S, Cavalheri V, Hill K, Gucciardi DF. Road to referral success in COPD: Enhancing patient engagement through dedicated conversations about pulmonary rehabilitation programs. Respir Med 2024; 233:107790. [PMID: 39218320 DOI: 10.1016/j.rmed.2024.107790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/25/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
RESEARCH QUESTION From the perspectives of healthcare professionals (HCPs) and people with chronic obstructive pulmonary disease (COPD) known to tertiary care, what influences successful referrals to a pulmonary rehabilitation program (PRP)? METHODS This cross-sectional qualitative study was informed by a critical realist perspective. We purposively sampled people with COPD and HCPs who deliver COPD care and used semi-structured interviews and focus groups to explore determinants of a successful referral to a PRP. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Data were available on 38 HCPs and 15 people with COPD. We generated three core themes pertaining to successful referrals. The first theme was that HCPs should be mindful of how professional responsibilities (such as their personal value and interest in a PRP, their degree of understanding of PRPs, and the organisational culture the PRPs are embedded within) shape decision-making during a therapeutic interaction. The second theme, there's more to me than my COPD, characterised psychological perceptions that shape a person's readiness to engage in a PRP. The third theme, communication is a two-way street that requires careful navigation, characterised the interpersonal dynamic between HCP and patient, and how dedicated conversations about PRPs can encourage successful referrals. CONCLUSION Therapeutic interactions that include dedicated conversations about PRPs can foster successful referrals among people with COPD. During these interactions, HCPs should take the time to understand and carefully unpack psychological perceptions whilst imparting value, interest and enthusiasm for PRPs. Doing so can shape patient engagement toward referral success.
Collapse
Affiliation(s)
- Sarah Hug
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Department of Physiotherapy, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Allied Health, South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Kylie Hill
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| |
Collapse
|
2
|
Wshah A, Alqatarneh N, Al-Nassan S, Goldstein R. Factors related to the implementation of pulmonary rehabilitation in Jordan: Perspective of healthcare professionals. Respir Med 2024; 231:107728. [PMID: 38969025 DOI: 10.1016/j.rmed.2024.107728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/05/2024] [Accepted: 06/29/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Although the benefits of pulmonary rehabilitation (PR) in the management of chronic respiratory disease conditions (CRC) are well-documented, it remains underutilized. In Jordan, the scarcity of PR services denies those with CRC the opportunity to improve their functional capacity, mental health, and quality of life. OBJECTIVE To explore the factors related to the implementation of PR in Jordan from the perspective of the healthcare professionals (HCPs). METHODS This was a qualitative study that utilized semi-structured interviews informed by the Theoretical Domains Framework (TDF). Twenty-one HCPs were interviewed. Interview transcripts were coded against the relevant TDF domain(s) and then domains' summaries were generated. RESULTS A total of 997 quotes were coded against the TDF domains. Knowledge, environmental context and resources, social influences, and skills domains were the ones most coded. The study identified several barriers to PR implementation such as: limited knowledge and skills pertaining to PR among HCPs, limited public awareness of PR, financial costs, limited legislation related to establishment of PR and role confusion of HCPs in PR. The main facilitators include: HCPs willingness to be involved in new programs such as PR, the perception of the importance and need for PR and HCPs beliefs about capabilities to overcome barriers for a successful implementation of PR. CONCLUSION The current study provided information that will inform stakeholders and policymakers about the factors affecting PR implementation in Jordan. Improvements in HCPs skills and knowledge about PR, financial support, improvements in undergraduate syllabi and policies to control PR service provision are considered to be key to a successful implementation of PR.
Collapse
Affiliation(s)
- Adnan Wshah
- Department of Physical and Occupational Therapy, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan; Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.
| | - Nisrin Alqatarneh
- Department of Physical and Occupational Therapy, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Saad Al-Nassan
- Department of Physical and Occupational Therapy, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan; Department of Physiotherapy, Al-Ahliyya Amman University, Amman, Jordan
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Jolliffe L, Andrew NE, Srikanth V, Beare R, Noeske KE, Snowdon DA. Development of an implementation strategy for routine collection of generic patient reported outcome measures: a qualitative study in multidisciplinary community rehabilitation. Disabil Rehabil 2024; 46:3895-3904. [PMID: 37735798 DOI: 10.1080/09638288.2023.2258334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To explore staff perceptions of barriers and enablers towards implementing the EQ-5D-5L in community rehabilitation, and develop a theory-informed implementation approach for routine administration of generic patient-reported outcome measures (PROMs) using implementation science frameworks. MATERIALS AND METHODS A qualitative study was conducted at three sites. Multidisciplinary rehabilitation staff completed individual semi-structured interviews, which were transcribed and coded against the Theoretical Domains Framework (TDF). We identified and selected potentially effective behaviour change techniques using the Behavior Change Wheel. Hypothetical strategies were operationalised. RESULTS Twenty-one interviews were conducted, and four themes emerged: (1) The Impact of PROMs on patient centered-care; (2) Considerations for validity of PROMs; (3) Service-level impact of embedding PROMs; (4) Practical issues of embedding PROMs within the service. Barriers and enablers were mapped to seven of the TDF domains; relating most to clinicians' "belief about consequences", "reinforcement", and "environmental context and resources". Five hypothetical strategies were developed to overcome identified barriers and strengthen enablers. Key behaviour change techniques underpinning the strategies include: restructuring the physical environment, incentivisation, persuasion and education, enablement, and, social support. CONCLUSIONS Our implementation approach highlights the importance of automating processes, engaging site champions, routinely reporting, and using PROM data to inform service provision.
Collapse
Affiliation(s)
- Laura Jolliffe
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Richard Beare
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Kate E Noeske
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - David A Snowdon
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| |
Collapse
|
4
|
Chong M, Holland AE, Burge AT, Perryman J, Cox NS. Telerehabilitation: a key player in reducing the travel emissions cost of respiratory healthcare? Eur Respir J 2024; 64:2400450. [PMID: 39060014 DOI: 10.1183/13993003.00450-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Melissa Chong
- Physiotherapy Department, Alfred Health, Melbourne Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne Australia
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Angela T Burge
- Physiotherapy Department, Alfred Health, Melbourne Australia
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Jaycie Perryman
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Australia
| | - Narelle S Cox
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| |
Collapse
|
5
|
Xin H, Wei S, Zheng H, Qi Y, Xu S, Wang B, Jiang W, Deng N, Chen J. Comparison of a Supervised Home-Based Tele-Rehabilitation with Center-Based Pulmonary Rehabilitation: Protocol for a Randomized Non-Inferiority Multicenter Study in Ningxia. Int J Chron Obstruct Pulmon Dis 2024; 19:1707-1719. [PMID: 39081777 PMCID: PMC11287464 DOI: 10.2147/copd.s467945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
Background Pulmonary rehabilitation (PR) is an effective intervention for people with chronic obstructive pulmonary disease (COPD). However, fewer than 5% of eligible individuals receive pulmonary rehabilitation, largely due to limited by the accessibility of rehabilitation and difficulties associated with travel and transport. Supervised home-based tele-rehabilitation (SHTR) is an alternative model to center-based pulmonary rehabilitation. We will determine whether supervised home-based tele-rehabilitation is non-inferior to center-based pulmonary rehabilitation. Methods The participants will undergo an 8-week rehabilitation program. Pulmonary rehabilitation comprises four main modules: exercise training, education, nutritional support, and psychological and behavioral interventions. We mainly focus on the module of exercise training and education. The education module includes information on exercise training, nutrition, and psychology, which are presented in an educational booklet provided to each participant. Blinded assessors will evaluate the outcomes at baseline, post-intervention, and 6 months after the intervention. The primary outcome is the change in the 6-minute walking distance. Secondary outcomes will assess changes in the patients' 1-minute sit-to-stand test, maximal inspiratory pressure (MIP), scales (CAT, mMRC, HAD), diaphragm ultrasound (TD, DE, DIF), changes in extrathoracic muscle volume and mass, completion rate of patient exercise prescriptions, occurrence of adverse events, as well as disease exacerbation and rehospitalization rates after rehabilitation and during the 6-month follow-up. Discussion In order to improve the accessibility of pulmonary rehabilitation and patient-related outcomes, it is necessary to propose an alternative model of pulmonary rehabilitation. This trial will establish whether a supervised home-based tele-rehabilitation is not inferior to traditional center-based pulmonary rehabilitation. Trial Registration Chinese Clinical Trial Registry ChiCTR2300076969. Registered on October 25, 2023.
Collapse
Affiliation(s)
- Hongxia Xin
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
| | - Shuoshuo Wei
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Affiliated Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, People’s Republic of China
| | - Hao Zheng
- Department of Pulmonary and Critical Care Medicine, Yanchi County People’s Hospital, Wuzhong, Ningxia, People’s Republic of China
| | - Yanchao Qi
- Department of Pulmonary and Critical Care Medicine, Second People’s Hospital of Shizuishan, Shizuishan, Ningxia, People’s Republic of China
| | - Shuping Xu
- Department of Pulmonary and Critical Care Medicine II, Wuzhong People’s Hospital, WuZhong, Ningxia, People’s Republic of China
| | - Bei Wang
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
| | - Wangshu Jiang
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People’s Republic of China
| | - Ning Deng
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People’s Republic of China
| | - Juan Chen
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
| |
Collapse
|
6
|
Early F, Ward J, Komashie A, Kipouros T, Clarkson J, Fuld J. A systems approach to developing user requirements for increased pulmonary rehabilitation uptake by COPD patients. NPJ Prim Care Respir Med 2024; 34:20. [PMID: 39013894 PMCID: PMC11252258 DOI: 10.1038/s41533-024-00370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/24/2024] [Indexed: 07/18/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease is a progressive lung disease associated with anxiety, depression, and reduced health-related quality of life. Pulmonary rehabilitation (PR) is a cost-effective and transformative treatment, but 31% of referred patients do not take up their PR appointment. The study aimed to develop user requirements for an intervention to increase PR uptake. A systems approach, the Engineering Better Care framework, was used to develop a system map of the PR pathway, translate evidence-based user needs into user requirements, and validate the user requirements in a stakeholder workshop. Eight user requirements addressed patient and health care practitioner needs to understand what PR entails, understand the benefits of PR and have positive conversations about PR to address patient concerns. The solution-independent user requirements can be applied to the development of any intervention sharing similar goals. The study demonstrates potential in taking a systems approach to more challenges within respiratory medicine.
Collapse
Affiliation(s)
- Frances Early
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - James Ward
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Alexander Komashie
- Department of Engineering, University of Cambridge, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | | | - John Clarkson
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Jonathan Fuld
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
7
|
Alexandre F, Molinier V, Poulain M, Villiot-Danger E, Eichenauer B, Calvat A, Brandon L, Miffre C, Oliver N, Heraud N. [French survey of patients on current and future pulmonary rehabilitation programs]. Rev Mal Respir 2024; 41:399-408. [PMID: 38762393 DOI: 10.1016/j.rmr.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Over recent years, a growing number of studies have demonstrated the effectiveness of alternative models to centre-based pulmonary rehabilitation (PR) such as tele-PR or home-based unsupervised PR, offering perspectives for improved accessibility and adherence. Other studies have demonstrated the relevance and long-term benefits of maintenance PR programs. However, they remain poorly implemented in real-life settings. In order to encourage patient adherence to new PR models and to guide future orientations, we conducted a survey assessing patients' views on PR models and maintenance programs. METHOD The survey (37 questions) was circulated to COPD patients of the French national respiratory patient F.F.A.A.I.R network and in five specialised PR centres. RESULTS Among the 298 respondents, 75% had previously taken part in a PR program, mainly in hospital settings (91%), with a high degree of satisfaction. The main barriers to PR were being physically separated from their loved ones (21%) and fears of having to share a double room (47%). Regarding maintenance PR programs, patients expressed diversified opinions, in terms of ideal duration and frequency of follow-up, format of follow-up (home-based, telephone, videoconference) and type of professional involved. CONCLUSIONS Diversified PR settings offer perspectives to increase access and improve the effectiveness of current programs. Furthermore, comprehensive personalization (professionals involved, content, setting, duration) seems to be the key to success in concrete implementation and achievement of patient satisfaction.
Collapse
Affiliation(s)
- F Alexandre
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France.
| | - V Molinier
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France
| | - M Poulain
- Clinique du Souffle Inicea La Solane, Clariane, Ossèja, France
| | - E Villiot-Danger
- Clinique du Souffle Inicea Les Acacias, Clariane, Briançon, France
| | - B Eichenauer
- Clinique du Souffle Inicea Le Pontet, Clariane, Plateau d'Hauteville, France
| | - A Calvat
- Clinique du Souffle Inicea La Vallonie, Clariane, Lodève, France
| | - L Brandon
- Clinique du Souffle Inicea Les Clarines, Clariane, Riom-ès-Montagnes, France
| | - C Miffre
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France
| | - N Oliver
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France; Clinique du Souffle Inicea La Vallonie, Clariane, Lodève, France
| | - N Heraud
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France
| |
Collapse
|
8
|
Atkins E, Birmpili P, Kellar I, Johal AS, Li Q, Waton S, Boyle JR, Pherwani AD, Chetter I, Cromwell DA. Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours. J Foot Ankle Res 2024; 17:e12015. [PMID: 38703396 PMCID: PMC11296715 DOI: 10.1002/jfa2.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. METHODS Semi-structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. RESULTS Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. CONCLUSION We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory-driven behaviour change interventions to reduce delays in CLTI pathways.
Collapse
Affiliation(s)
- Eleanor Atkins
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Hull York Medical SchoolHullUK
| | - Panagiota Birmpili
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Hull York Medical SchoolHullUK
| | | | - Amundeep S. Johal
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Qiuju Li
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sam Waton
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Jonathan R. Boyle
- Department of Vascular SurgeryCambridge University Hospitals NHS Trust & Department of SurgeryUniversity of CambridgeCambridgeUK
| | - Arun D. Pherwani
- Staffordshire & South Cheshire Vascular NetworkRoyal Stoke University HospitalStoke‐on‐TrentUK
| | | | - David A. Cromwell
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| |
Collapse
|
9
|
Atkins E, Birmpili P, Kellar I, Glidewell L, Cromwell DA. Documentary analysis of national and international guidance for community clinicians referring patients with suspected chronic limb-threatening ischaemia. BMJ Open Qual 2024; 13:e002784. [PMID: 38769026 PMCID: PMC11110609 DOI: 10.1136/bmjoq-2024-002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Delayed referral of patients with chronic limb-threatening ischaemia (CLTI) from the community to vascular services may increase risk of amputation due to delayed revascularisation. Lack of appropriate guidance for clinicians in the community may contribute to this problem. This documentary analysis investigated referral guidance available to primary care clinicians. METHODS National and international documents providing guidance on CLTI management were identified by searching sources including Medline, Embase, Guidelines International Network and College/Society websites. Data were extracted on referral recommendations, target audience and author groups. Recommendations were coded according to the Behaviour Change Technique Taxonomy. Clinical practice guideline quality and ease of implementation were assessed independently by two reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II and Guideline Implementability Appraisal (GLIA) tools, respectively. RESULTS 12 documents containing guidance on CLTI referrals were included. Five were clinical practice guidelines. Nine targeted clinicians in the community among their audience, yet only one included a primary care clinician in their author group. Recommendations on identification and referral of CLTI were often in non-specific language and frequently assumed specialist knowledge of vascular disease. Just 4 of the 93 behaviour change techniques were identified in the guidance documents. Three relevant domains of the AGREE II tool were scored for five clinical practice guidelines: stakeholder involvement (range 21.4%-52.4%, mean 42.9%), clarity of presentation (range 71.4%-92.9%, mean 82.9%) and applicability (25.0%-57.1%, mean 36.8%). The GLIA tool identified barriers to ease of implementation for all five clinical practice guidelines. CONCLUSIONS Most guidance for clinicians in the community on the management of CLTI has been written without their input and assumes knowledge of vascular disease, which may be lacking. Future guidance development should involve community clinicians, consider using additional behaviour change techniques, and improve the applicability and ease of implementation of recommendations.
Collapse
Affiliation(s)
- Eleanor Atkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Hull York Medical School, Hull, UK
| | | | | | - David A Cromwell
- Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
10
|
Silva L, Mota Â, Lemos L, Santos M, Cunha H, Maricoto T, Costa P, Padilha M. Characterisation of Patients With Chronic Obstructive Pulmonary Disease (COPD) From an Urban Municipality in the Northern Region of Portugal: A Cross-Sectional Study. Cureus 2024; 16:e59262. [PMID: 38813270 PMCID: PMC11134521 DOI: 10.7759/cureus.59262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Background Pulmonary rehabilitation (PR) is formally indicated to all COPD patients in groups B and E. It positively impacts dyspnoea, health-related quality of life and exercise tolerance, reducing admissions among people with chronic obstructive pulmonary disease (COPD) who have had a recent exacerbation and symptoms of anxiety and depression. There is limited access to PR programmes in Portugal, partially due to insufficient resources or referrals. This study aims to characterise COPD patients and assess whether they have criteria for PR programmes. Data from this study may provide strategic information for healthcare organisations to differentiate and innovate their response to COPD patients. Methodology A cross-sectional study was conducted in an urban municipality in the northern region of Portugal. The sample was randomly extracted from the national primary electronic health records. The sample size (n = 339) was determined considering the population of COPD patients in this region (N = 2818), a 95% confidence level and a margin of error of 5%. Results In this population, the prevalence of COPD is 1.8%. Furthermore, in this sample, 40% (n = 136) of people diagnosed with COPD have a formal indication to participate in PR programmes, although only 14.2% (n = 48) of these patients had access to PR. Conclusion COPD is probably underdiagnosed in this Portuguese region. Most COPD patients have eligibility criteria to be offered PR programmes, although most of them do not benefit from this vital treatment. Investing in community and home-based programmes may increase PR access, reducing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admissions.
Collapse
Affiliation(s)
- Liliana Silva
- Rehabilitation Nursing, Matosinhos Local Health Unit, Matosinhos, PRT
- Technologies for Education and Simulation in Healthcare (Tech4edusim), Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, PRT
| | - Ângela Mota
- Rehabilitation Nursing, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Lara Lemos
- Rehabilitation Nursing, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Mariana Santos
- Rehabilitation Nursing, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Hélder Cunha
- Rehabilitation Nursing, Matosinhos Local Health Unit, Matosinhos, PRT
| | - Tiago Maricoto
- Beira Ria Family Heath Unit, Unidade Local de Saúde da Região de Aveiro, Ílhavo, PRT
- Health Sciences Research Centre & UBIAir - Clinical & Experimental Lung Centre (CICS-UBI), University of Beira Interior, Covilhã, PRT
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS) School of Medicine, University of Minho, Braga, PRT
- Life and Health Sciences Research Institute (ICVS) ICVS'3, PT Government Associate Laboratory, Braga, PRT
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, PRT
| | - Miguel Padilha
- Rehabilitation Nursing, Porto Higher School of Nursing, Porto, PRT
- Technologies for Education and Simulation in Healthcare (Tech4edusim), Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, PRT
- Porto Higher School of Nursing, Centro de Investigação em Tecnologias e Serviços de Saúde - Rede de Investigação em Saúde (CINTESIS@RISE), Porto, PRT
| |
Collapse
|
11
|
Gilworth G, Harris K, Morgan TL, Ayis S, Fox-Rushby J, Godfrey E, Hopkinson NS, Lewin S, Lim KK, Spinou A, Taylor SJC, White P. The IMPROVE trial: study protocol for a pragmatic cluster randomised controlled trial to assess the effectiveness of using lay health workers to improve uptake and completion of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Trials 2024; 25:194. [PMID: 38500191 PMCID: PMC10949634 DOI: 10.1186/s13063-024-07998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is a programme of exercise and education and the most effective treatment for the symptoms and disability associated with chronic obstructive pulmonary disease. However, the benefits of PR are limited by poor uptake and completion. This trial will determine whether using trained volunteer lay health workers, called "PR buddies," improves uptake and completion of PR and is cost-effective. This trial protocol outlines the methods for evaluating effectiveness, cost-effectiveness, and acceptability. METHODS The IMPROVE trial is a pragmatic, open, cluster randomised controlled trial planned in 38 PR services across England and Wales. PR services will be randomised to either intervention arm-offering support from PR buddies to patients with chronic obstructive pulmonary disease-or to usual care as the control arm. PR staff in trial sites randomised to the intervention arm will receive training in recruiting and training PR buddies. They will deliver training to volunteers, recruited from among people who have recently completed PR in their service. The 3-day PR-buddy training programme covers communication skills, confidentiality, boundaries of the PR-buddy role and behaviour change techniques to help patients overcome obstacles to attending PR. An internal pilot will test the implementation of the trial in eight sites (four intervention sites and four in control arm). The primary outcome of the trial is the uptake and completion of PR. A process evaluation will investigate the acceptability of the intervention to patients, PR staff and the volunteer PR buddies, and intervention fidelity. We will also conduct a cost-effectiveness analysis. DISCUSSION Improving outcomes for chronic obstructive pulmonary disease and access to PR are priorities for the UK National Health Service (NHS) in its long-term plan. The trial hypothesis is that volunteer PR buddies, who are recruited and trained by local PR teams, are an effective and cost-effective way to improve the uptake and completion rates of PR. The trial is pragmatic, since it will test whether the intervention can be incorporated into NHS PR services. Information obtained in this trial may be used to influence policy on the use of PR buddies in PR and other similar services in the NHS. TRIAL REGISTRATION ISRCTN12658458. Registered on 23/01/2023.
Collapse
Affiliation(s)
- Gill Gilworth
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Sheffield, UK
| | - Katherine Harris
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Toby L Morgan
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Salma Ayis
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Julia Fox-Rushby
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Emma Godfrey
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Simon Lewin
- Department of Health Sciences Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Ka Keat Lim
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK
| | - Arietta Spinou
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's Centre for Lung Health, King's College London, London, UK
| | - Stephanie J C Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Patrick White
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, London, SE1 IUL, UK.
| |
Collapse
|
12
|
Noordman J, Meurs M, Poortvliet R, Rusman T, Orrego-Villagran C, Ballester M, Ninov L, de Guzmán EN, Alonso-Coello P, Groene O, Suñol R, Heijmans M, Wagner C. Contextual factors for the successful implementation of self-management interventions for chronic diseases: A qualitative review of reviews. Chronic Illn 2024; 20:3-22. [PMID: 36744382 DOI: 10.1177/17423953231153337] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify and describe the most relevant contextual factors (CFs) from the literature that influence the successful implementation of self-management interventions (SMIs) for patients living with type 2 diabetes mellitus, obesity, COPD and/or heart failure. METHODS We conducted a qualitative review of reviews. Four databases were searched, 929 reviews were identified, 460 screened and 61 reviews met the inclusion criteria. CFs in this paper are categorized according to the Tailored Implementation for Chronic Diseases framework. RESULTS A great variety of CFs was identified on several levels, across all four chronic diseases. Most CFs were on the level of the patient, the professional and the interaction level, while less CFs were obtained on the level of the intervention, organization, setting and national level. No differences in main themes of CFs across all four diseases were found. DISCUSSION For the successful implementation of SMIs, it is crucial to take CFs on several levels into account simultaneously. Person-centered care, by tailoring SMIs to patients' needs and circumstances, may increase the successful uptake, application and implementation of SMIs in real-life practice. The next step will be to identify the most important CFs according to various stakeholders through a group consensus process.
Collapse
Affiliation(s)
- Janneke Noordman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Maaike Meurs
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Rune Poortvliet
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Tamara Rusman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Carola Orrego-Villagran
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Ballester
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | | | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Rosa Suñol
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Monique Heijmans
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Liu K, Tronstad O, Flaws D, Churchill L, Jones AYM, Nakamura K, Fraser JF. From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome. J Intensive Care 2024; 12:11. [PMID: 38424645 PMCID: PMC10902959 DOI: 10.1186/s40560-024-00724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed. MAIN BODY This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions. CONCLUSION PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.
Collapse
Affiliation(s)
- Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan.
| | - Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Science, Queensland University of Technology, Brisbane, Australia
| | - Luke Churchill
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Alice Y M Jones
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Kanagawa, Japan
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- St. Andrews War Memorial Hospital, Brisbane, Australia
| |
Collapse
|
14
|
Sarmento A, King K, Sanchez-Ramirez DC. Using Remote Technology to Engage Patients with Interstitial Lung Diseases in a Home Exercise Program: A Pilot Study. Life (Basel) 2024; 14:265. [PMID: 38398774 PMCID: PMC10890249 DOI: 10.3390/life14020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION The access and compliance of patients with interstitial lung diseases (ILDs) to exercise programs (EPs) remain challenges. OBJECTIVES We assessed the dropout rate, intervention completion, compliance with data acquisition and submission, safety, and satisfaction of a home EP delivered via video conference (EPVC group) or self-directed (EPSD group) to patients with ILD. Pre- and post-intervention changes in patient outcomes (dyspnea, fatigue, exercise capacity, lung function, and quality of life) were secondarily explored. MATERIAL AND METHODS Groups performed an eight-week virtual EP three times/week. Video conferences were led by a registered respiratory therapist, whereas self-directed exercises were completed following a pre-recorded video. Participants submitted spirometry, heart rate, and SpO2 results weekly to the research team. RESULTS Fourteen patients with ILD were equally assigned to the EPVC and EPSD groups, but three from the EPSD group dropped out after the initial assessment (dropout rate of 42.8% in the EPSD group). Eleven patients (mean age of 67 ± 12 years) completed 96.5% of sessions. Compliance with data acquisition and submission was optimal (≥97.6% in both groups), and no adverse events were reported. Changes in overall fatigue severity were significantly different between groups (p = 0.014, Cohen's r = 0.64). CONCLUSIONS The results suggest that a structured virtual EP delivered via video conference or pre-recorded video can be feasible, safe, and acceptable for patients with ILD.
Collapse
Affiliation(s)
| | | | - Diana C. Sanchez-Ramirez
- Department of Respiratory Therapy, University of Manitoba, Winnipeg, MB R3E 0T6, Canada; (A.S.); (K.K.)
| |
Collapse
|
15
|
Clet A, Guy M, Muir JF, Cuvelier A, Gravier FE, Bonnevie T. Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:436. [PMID: 38391811 PMCID: PMC10887527 DOI: 10.3390/healthcare12040436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the "Environmental context and resources" domain (57.6%, 95%CI: 49.5-65.4), e.g., lack of professionals, funding, and coordination, and the "Knowledge" domain (52.8%, 95%CI: 44.7-60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS.
Collapse
Affiliation(s)
- Augustin Clet
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
| | - Marin Guy
- Centre Aquitain Du Dos, Hôpital Privé Saint-Martin, F-33600 Pessac, France
| | - Jean-François Muir
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, F-76000 Rouen, France
| | - Antoine Cuvelier
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, F-76000 Rouen, France
| | - Francis-Edouard Gravier
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
| | - Tristan Bonnevie
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
| |
Collapse
|
16
|
Habib GMM, Uzzaman N, Rabinovich R, Akhter S, Ali M, Sultana M, Pinnock H. Exploring the perceptions of patients with chronic respiratory diseases and their insights into pulmonary rehabilitation in Bangladesh. J Glob Health 2024; 14:04036. [PMID: 38299780 PMCID: PMC10832548 DOI: 10.7189/jogh.14.04036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Chronic respiratory diseases (CRDs) require holistic management which considers patients' preferences, appropriate pharmacotherapy, pulmonary rehabilitation, and integrated care. We aimed to understand the perceptions of people with CRDs about their condition and pulmonary rehabilitation in Bangladesh. Methods We conducted semi-structured interviews with a maximum variation sample of people with CRDs who had participated in a feasibility study of pulmonary rehabilitation in 2021/2022. A multidisciplinary team transcribed the interviews verbatim and analysed them in Bengali using a grounded theory approach. Results We interviewed 15 participants with chronic obstructive pulmonary disease, asthma, or post-tuberculosis. The analysis revealed three themes. The first encompassed understanding CRDs: Patients characterised their condition by the symptoms (e.g. 'Hapani' meaning 'breathlessness') rather than describing a disease entity. Some believed occupation, previous infection, or family history to be a cause. The second theme included perceptions of pulmonary rehabilitation: Exercise was counterintuitive, as it exacerbated the breathlessness symptom that defined their disease. Views varied, though many acknowledged the benefits after a few sessions. Even with home-based programmes, participants described practical barriers to finding time for the sessions and adopted strategies to overcome the challenges. The third theme focused on implementation: Participants highlighted the need for raising awareness of CRDs and the potential of pulmonary rehabilitation in the community, adapting to the local context, and establishing an accessible resourced service. Conclusions Understanding how patients and their communities perceive their condition and the barriers (both conceptual and logistical) to acceptance is the first step to embedding this highly effective intervention into routine health care services in Bangladesh with potential benefits for the increasing number of people living with CRDs in low- and middle-income countries.
Collapse
Affiliation(s)
- GM Monsur Habib
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazim Uzzaman
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Roberto Rabinovich
- ELEGI/Colt laboratory, Centre for Inflammation Research, Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
| | - Sumaiya Akhter
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Mohsin Ali
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Mustarin Sultana
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - RESPIRE Collaboration
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- ELEGI/Colt laboratory, Centre for Inflammation Research, Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
17
|
Mackintosh JA, Keir G, Troy LK, Holland AE, Grainge C, Chambers DC, Sandford D, Jo HE, Glaspole I, Wilsher M, Goh NSL, Reynolds PN, Chapman S, Mutsaers SE, de Boer S, Webster S, Moodley Y, Corte TJ. Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: A position statement from the Thoracic Society of Australia and New Zealand 2023 revision. Respirology 2024; 29:105-135. [PMID: 38211978 PMCID: PMC10952210 DOI: 10.1111/resp.14656] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease leading to significant morbidity and mortality. In 2017 the Thoracic Society of Australia and New Zealand (TSANZ) and Lung Foundation Australia (LFA) published a position statement on the treatment of IPF. Since that time, subsidized anti-fibrotic therapy in the form of pirfenidone and nintedanib is now available in both Australia and New Zealand. More recently, evidence has been published in support of nintedanib for non-IPF progressive pulmonary fibrosis (PPF). Additionally, there have been numerous publications relating to the non-pharmacologic management of IPF and PPF. This 2023 update to the position statement for treatment of IPF summarizes developments since 2017 and reaffirms the importance of a multi-faceted approach to the management of IPF and progressive pulmonary fibrosis.
Collapse
Affiliation(s)
- John A. Mackintosh
- Department of Respiratory MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Gregory Keir
- Department of Respiratory MedicinePrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Lauren K. Troy
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Anne E. Holland
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of PhysiotherapyThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Respiratory Research@AlfredCentral Clinical School, Monash UniversityMelbourneVictoriaAustralia
| | - Christopher Grainge
- Department of Respiratory MedicineJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Daniel C. Chambers
- Department of Respiratory MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Debra Sandford
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Thoracic MedicineCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Helen E. Jo
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Ian Glaspole
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Respiratory MedicineThe Alfred HospitalMelbourneVictoriaAustralia
| | - Margaret Wilsher
- Department of Respiratory MedicineTe Toka Tumai AucklandAucklandNew Zealand
| | - Nicole S. L. Goh
- Department of Respiratory MedicineAustin HospitalMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneVictoriaAustralia
- University of MelbourneMelbourneVictoriaAustralia
| | - Paul N. Reynolds
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Thoracic MedicineCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Sally Chapman
- Institute for Respiratory Health, University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Steven E. Mutsaers
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Sally de Boer
- Department of Respiratory MedicineTe Toka Tumai AucklandAucklandNew Zealand
| | - Susanne Webster
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Yuben Moodley
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Institute for Respiratory Health, University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Tamera J. Corte
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
18
|
Auyeung T, Jiang O, Taylor M, Chang V, Kwan B. A pilot study on the effectiveness of a language-specific (Chinese) pulmonary rehabilitation programme for individuals with chronic pulmonary disease: a 2-year prospective cohort study in Sydney, Australia. Intern Med J 2024; 54:274-282. [PMID: 37548152 DOI: 10.1111/imj.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS Pulmonary rehabilitation (PR) improves dyspnoea, fatigue and healthcare-related quality of life (QoL) in patients with chronic lung disease (CLD). Non-English-speaking background (NESB) patients face language and cultural barriers that hinder their access to PR programmes, contributing to health disparities. Our trial aimed to demonstrate the effectiveness and feasibility of a Chinese language-specific PR programme on lung function, functional exercise capacity and QoL measures. METHODS A prospective cohort study was conducted over a 2-year period. Participants were enrolled in an 8-week PR programme with biweekly sessions conducted by Chinese-speaking physiotherapists. Baseline and post-rehabilitation testing included pulmonary function testing, 6-min walk test (6MWT), St. George Respiratory Questionnaire (SGQR) and Short Form Health Survey (SF-36). RESULTS We enrolled 76 patients (58% male) with a median age of 77 years (interquartile range (IQR) 68-81) and achieved a completion rate of 86.8% (n = 66). CLD included chronic obstructive pulmonary disease (42%), asthma (15%) and interstitial lung disease (3%). Baseline median forced expiratory volume in 1 s (FEV1) was 1.63 L (IQR 1.17-2.05), and the median 6MWT was 282 m (IQR 232-332). Post-intervention median 6MWT increased to 332 m (IQR 290-390), and the median FEV1 was 1.99 L (IQR 1.3-2.1). Both QoL measures (SGQR and SF-36) showed significant improvement after intervention (P < 0.05). CONCLUSION Our study demonstrates that a language-specific PR programme is feasible, improving outcomes in NESB patients with CLD. The improvement in 6MWT and QoL measures was comparable to English-based programmes. Ensuring equal access to healthcare programmes, regardless of cultural background or language barriers, is crucial in promoting health equity.
Collapse
Affiliation(s)
- Titus Auyeung
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- South Eastern Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Osborn Jiang
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mitchell Taylor
- Functional Lungs Physiotherapy, Sydney, New South Wales, Australia
| | - Vicky Chang
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Benjamin Kwan
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
19
|
Hashemi M, Atashi V, Haghighat S, Sadegh R, Sami R. Short-term Pulmonary Rehabilitation after Recovering from Severe COVID-19. Int J Prev Med 2024; 14:134. [PMID: 38449686 PMCID: PMC10916409 DOI: 10.4103/ijpvm.ijpvm_320_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/10/2023] [Indexed: 03/08/2024] Open
Abstract
Background Patients with severe COVID-19 suffer from various problems such as impaired lung function, decreased exercise capacity, mental disorders, and reduced quality of life. This study aimed to evaluate the effectiveness of short-term pulmonary rehabilitation in patients recovering from severe COVID-19. Methods The present study was a retrospective cohort study. This study was conducted in 2021 on 92 patients with severe COVID-19 who met the inclusion criteria. Inter-professional pulmonary rehabilitation sessions were performed for 3 weeks, twice a week (six sessions in total), for this group of patients, which included physical exercises, educational activities, and other health-related services (counseling and psychotherapy). Outcomes assessed included a 6-min walk test, the score of the Hospital Anxiety and Depression Scale, and the SF-12 Quality of Life Questionnaire, which were completed before and after pulmonary rehabilitation. Data analysis was performed using analytical and descriptive statistics. Results The statistical analyses showed that 60.86% of patients participating in the study were male and 39.14% were female, and the mean age of patients was 54.9 ± 12.3 years. The findings also showed that the average distance traveled in the 6-min walk test before pulmonary rehabilitation was 289.2174 ± 130.5 m; however, after the intervention, this rate reached 343.0870 ± 103.5 m, which demonstrated a statistically significant difference (P = 0.00). Also, significant changes were observed in anxiety and depression, the ability to perform daily activities, and the physical health of patients before and after the intervention (P < 0.05). Conclusions Short-term pulmonary rehabilitation is a safe and useful treatment without side effects that can be effective in reducing anxiety and depression, increasing the ability to perform daily activities and exercise capacity, and consequently, improving the quality of life of patients recovering from severe COVID-19.
Collapse
Affiliation(s)
- Marzieh Hashemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Atashi
- Department of Nursing and Midwifery Care Research Center, Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Raheleh Sadegh
- Department of Community and Prevention, Isfahan University of Medical Science, Isfahan, Iran
| | - Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
20
|
Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Health Technol Assess 2024; 28:1-129. [PMID: 38229579 PMCID: PMC11017633 DOI: 10.3310/pawa7221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Background People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone. Participants Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration This trial is registered as ISRCTN59537391. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Ratna Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Moira J Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paulino Font Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Melbourne, VIC, Australia
| | | | | | - Sally Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick White
- Department of Population Health, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
21
|
Bondarenko J, Dal Corso S, Dillon MP, Singh S, Miller BR, Kein C, Holland AE, Jones AW. Clinically important changes and adverse events with centre-based or home-based pulmonary rehabilitation in chronic respiratory disease: A systematic review and meta-analysis. Chron Respir Dis 2024; 21:14799731241277808. [PMID: 39187265 PMCID: PMC11348370 DOI: 10.1177/14799731241277808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/06/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Objectives: To determine the proportion of people who achieve minimal clinically important differences (MCID) with centre-based or home-based pulmonary rehabilitation and to synthesise data on adverse events.Methods: Cochrane reviews and electronic databases were searched to identify randomised trials comparing centre-based to home-based pulmonary rehabilitation, or either model to usual care, in people with chronic respiratory disease. Primary outcomes were the proportion of participants achieving MCIDs in exercise capacity and disease-specific quality of life. Secondary outcomes were symptoms and adverse events. Cochrane Risk of Bias 1.0 and GRADE were used to assess the risk of bias and certainty of evidence respectively.Results: Forty-nine trials were eligible. Compared to usual care, a higher proportion of pulmonary rehabilitation participants achieved the MCID for exercise capacity (6MWT: 47% vs 20%, p = 0.11), dyspnoea (43% vs 29%, p = 0.0001), fatigue (48% vs 27%, p = 0.0002) and emotional function (37% vs 25%, p = 0.02), with all of these between group differences statistically significant except for exercise capacity. There were no differences between centre-based and home-based pulmonary rehabilitation in the proportion of participants who achieved MCIDs (34%- 58% across studies). Ninety percent of trials reported no adverse events. Certainty of evidence was low-to- moderate with all outcomes except for CRQ-mastery (centre-based vs home-based pulmonary rehabilitation, or pulmonary rehabilitation vs usual care in COPD), ESWT (pulmonary rehabilitation vs usual care in COPD) and 6MWT (pulmonary rehabilitation vs usual care in bronchiectasis) where evidence was very uncertain.Discussion: Clinically meaningful outcomes are achieved by similar proportions of participants in centre-based and home-based pulmonary rehabilitation, with few adverse events. Reporting of trial outcomes according to MCIDs is necessary for informed decision making regarding pulmonary rehabilitation models.
Collapse
Affiliation(s)
- Janet Bondarenko
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
| | - Simone Dal Corso
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
| | - Michael P Dillon
- Department of Physiotherapy, Podiatry, Prosthetics and orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Sally Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Belinda R Miller
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Caroline Kein
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
22
|
Lewis A, Turner LA, Fryer S, Smith R, Dillarstone H, Patrick YW, Bevan-Smith E. The acceptability, practicality, implementation and efficacy of a physical and social activity intervention 'BreatheHappy' for people with long-term respiratory conditions: A feasibility study. Chron Respir Dis 2024; 21:14799731241238435. [PMID: 38553857 PMCID: PMC10981237 DOI: 10.1177/14799731241238435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/24/2024] [Accepted: 02/19/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study aimed to determine the feasibility of a group-based pilot programme of low-to-moderate physical activity training, education and social activities, by investigating acceptability, practicality, implementation and efficacy testing. We offer suggestions on programme adaptions for future study. METHODS People with a range of chronic respiratory diseases were invited to participate in a pilot 12 week group activity programme. Activities included outdoor walking, tai-chi, education and a range of social activities. Acceptability was determined by participant experiences determined during interviews. Practicality was determined by programme and outcome measure completion, cost and adverse events. Implementation was determined according to whether the programme ran as planned. Efficacy was determined by statistical analyses of outcomes including hand grip strength, timed up and go test, COPD Helplessness Index, COPD Assessment Test, and measures of physical activity via accelerometry. RESULTS Thematic analysis indicated that the "BreatheHappy" programme was acceptable. Seven of nine participants completed eight out of 10 sessions and the majority completed all outcome measures. "BreatheHappy" was therefore considered practical. The programme was not implemented as planned, with only 10 sessions running rather than the 12 intended. There was a significant increase in daily step counts (MD: 1284 95% CI: 240-2329 p: 0.024 effect size: 0.988), stepping time (MD: 16 min 95% CI: 5-27 min p: 0.011 effect size: 1.36) and daily minutes completing light physical activity (MD: 23 95% CI: 6-38 p: 0.006 effect size: 1.6). However, time spent sitting for ≥30 min but ≤60 min significantly increased (MD: 26 95% CI: 0.2-52 min p: 0.049 effect size: 0.931), showing signs of efficacy and changing physical activity behaviour patterns. DISCUSSION A 10-week programme of low-moderate physical activity training, education and social activities shows signs of feasibility for future research. Suggested adaptions for future study include using physical activity measures such as daily step count or light physical activity for a primary outcome, and mental health and social health related outcome measures relatable to participant's beneficial experiences of the programme. Recruitment in future studies will try and reach both those less socially active and possibly those who have completed pulmonary rehabilitation (PR). Venues should be close to efficient transport links whilst different frequencies and durations of programme delivery should be trialled. Adequate funding should be provided for both staff running the programme and blinded research staff for outcome measurement.
Collapse
Affiliation(s)
- A Lewis
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- School of Health Sciences, University of Southampton, Southampton, UK
| | - LA Turner
- School of Education and Science, University of Gloucestershire, Cheltenham, UK
| | - S Fryer
- School of Education and Science, University of Gloucestershire, Cheltenham, UK
| | - R Smith
- Department of Geography, University College London, London, UK
| | - H Dillarstone
- Institute for Global Health, University College London, London, UK
| | - YW Patrick
- Department of Health and Social Care, University of Gloucestershire, Cheltenham, UK
| | - E Bevan-Smith
- Department of Health and Social Care, University of Gloucestershire, Cheltenham, UK
| |
Collapse
|
23
|
Yao X, Li J, He J, Zhang Q, Yu Y, He Y, Wu J, Tang W, Ye C. A Kano model-based demand analysis and perceived barriers of pulmonary rehabilitation interventions for patients with chronic obstructive pulmonary disease in China. PLoS One 2023; 18:e0290828. [PMID: 38109304 PMCID: PMC10727440 DOI: 10.1371/journal.pone.0290828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has been recognized to be an effective therapy for chronic obstructive pulmonary disease (COPD). However, in China, the application of PR interventions is still less promoted. Therefore, this cross-sectional study aimed to understand COPD patients' intention to receive PR, capture the potential personal, social and environmental barriers preventing their willingness of receiving PR, and eventually identify demanding PR services with the highest priority from patients' point of view. METHODS In total 237 COPD patients were recruited from 8 health care facilities in Zhejiang, China. A self-designed questionnaire was applied to investigate patients' intention to participate in PR and potentially associated factors, including personal dimension such as personal awareness, demographic factors, COPD status and health-related literacy/behaviors, as well as social policies and perceived environmental barriers. The demand questionnaire of PR interventions based on the Kano model was further adopted. RESULTS Among the 237 COPD patients, 75.1% of COPD patients were willing to participate in PR interventions, while only 62.9% of the investigated patients had heard of PR interventions. Over 90% of patients believed that the cost of PR services and the ratio of medical insurance reimbursement were potential obstacles hindering them from accepting PR services. The multiple linear regression analysis indicated that the PR skills of medical staff, knowledge promotion and public education levels of PR in the community, patients' transportation concerns and degree of support from family and friends were significantly associated with willingness of participation in PR interventions. By using the Kano model, the top 9 most-requisite PR services (i.e., one-dimensional qualities) were identified from patients' point of view, which are mainly diet guidance, education interventions, psychological interventions and lower limb exercise interventions. Subgroup analysis also revealed that patients' demographics, such as breathlessness level, age, education and income levels, could influence their choice of priorities for PR services, especially services related to exercise interventions, respiratory muscle training, oxygen therapy and expectoration. CONCLUSIONS This study suggested that PR-related knowledge education among patients and their family, as well as providing basic package of PR services with the most-requisite PR items to COPD patients, were considerable approaches to promote PR attendance in the future.
Collapse
Affiliation(s)
- Xinmeng Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jinmei Li
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jialu He
- Department of Epidemiology and Biostatistics, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Qinzhun Zhang
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yi Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yinan He
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jinghua Wu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Weihong Tang
- Department of Gastroenterology, Hangzhou Children's Hospital, Hangzhou, Zhejiang, China
| | - Chengyin Ye
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| |
Collapse
|
24
|
Man W, Chaplin E, Daynes E, Drummond A, Evans RA, Greening NJ, Nolan C, Pavitt MJ, Roberts NJ, Vogiatzis I, Singh SJ. British Thoracic Society Clinical Statement on pulmonary rehabilitation. Thorax 2023; 78:s2-s15. [PMID: 37770084 DOI: 10.1136/thorax-2023-220439] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- William Man
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Enya Daynes
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Alistair Drummond
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Rachael A Evans
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claire Nolan
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Matthew J Pavitt
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Nicola J Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumberland University Newcastle, Newcastle Upon Tyne, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| |
Collapse
|
25
|
Robinson SA, Shimada SL, Sliwinski SK, Wiener RS, Moy ML. Stakeholder Perceptions of a Web-Based Physical Activity Intervention for COPD: A Mixed-Methods Study. J Clin Med 2023; 12:6296. [PMID: 37834938 PMCID: PMC10574016 DOI: 10.3390/jcm12196296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Technology-based physical activity interventions have been shown to be efficacious in chronic obstructive pulmonary disease (COPD), though their potential impact has not been fully realized due to ineffective implementation. We used a convergent, parallel mixed-methods design to identify patient- and provider-facing barriers and facilitators to implementing a rigorously studied web-based physical activity intervention for COPD. Quantitative surveys (based on the unified theory of acceptance and use of technology; range 1 (poor usability)-5 (high usability)) and semi-structured interviews (guided by the practical robust implementation and sustainability model) assessed the perspectives of 15 patients and 15 health care providers. The patients and providers rated the usability of the intervention as high (median = 5.0, IQR = 1.0). For both patients and providers, the main facilitators included: the potential high impact of the intervention on patient health, the usefulness of the intervention for unmet clinical needs, and the perceived ease of use of the intervention. The main barriers identified were digital literacy and its fit with current clinical workflows. Implementation efforts may benefit from supporting patients' use of the website and developing strategies to integrate referrals to the intervention and the monitoring of patients into current clinical infrastructures.
Collapse
Affiliation(s)
- Stephanie A. Robinson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA 01730, USA;
- The Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Stephanie L. Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA 01730, USA;
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Samantha K. Sliwinski
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA;
| | - Renda S. Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA;
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA;
- Pulmonary, Critical Care, and Sleep Medicine Section, VA Boston Healthcare System, Boston, MA 02130, USA;
| | - Marilyn L. Moy
- Pulmonary, Critical Care, and Sleep Medicine Section, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
26
|
Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, Bhatt SP, Bourbeau J, Burtin C, Camp PG, Cascino TM, Dorney Koppel GA, Garvey C, Goldstein R, Harris D, Houchen-Wolloff L, Limberg T, Lindenauer PK, Moy ML, Ryerson CJ, Singh SJ, Steiner M, Tappan RS, Yohannes AM, Holland AE. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2023; 208:e7-e26. [PMID: 37581410 PMCID: PMC10449064 DOI: 10.1164/rccm.202306-1066st] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
Collapse
|
27
|
Watson JS, Jordan RE, Gardiner L, Adab P, Jolly K. A Systematic Review of the Effectiveness of Interventions to Promote Referral; Adherence; and Uptake of Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1637-1654. [PMID: 37547859 PMCID: PMC10402719 DOI: 10.2147/copd.s396317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pulmonary rehabilitation (PR) is an effective treatment for patients with chronic obstructive pulmonary disease (COPD). However, referral, uptake, and adherence remain low. Objective To determine effectiveness of interventions to increase patient referral, uptake, and adherence to PR programs for patients with COPD. Methods Randomized controlled trials (RCTs), non-randomized controlled trials, pre-post studies, and uncontrolled studies were sought from 7 databases and 3 clinical trial registries, to end August 2021. Full articles/conference abstracts were included if a coordinated set of activities was targeted to healthcare professionals (HCPs) caring for COPD patients, adults with COPD or their carers, to increase referral, uptake or adherence to any type of PR program. Two review authors independently screened titles, abstracts and full texts, extracted data and critically appraised studies using standard risk of bias tools. Results From 11,272 records, 30 studies (23 full-text; 7 abstracts) met inclusion criteria: study interventions and designs were varied and generally low quality, targeting patients (n=13), HCPs (n=14) or both (n=3 studies). A CCT of patient held evidence score cards increased referral by 7.3% compared to 1.3% for usual care (p-0.03). A cluster RCT involving COPD nurse home visits with individualized care plans increased uptake to 31% compared to 10% in usual care (p=0.002). For people with anxiety or depression, one RCT of cognitive behavioral therapy alongside PR increased adherence (mean sessions 14.0 (sd 1.7) compared to 12.4 (sd 2.6)). Conclusion Although a small number of studies, the weight of evidence suggested that interventions incorporating partnership working between patients and HCPs appeared to increase referral, uptake, and adherence with greater effectiveness than those targeting single populations. Increasing knowledge and empowering HCPs and patients may be important strategies. Concerns about study design and risk of bias suggest clear need for well-designed trials of interventions to report full pathway outcomes.
Collapse
Affiliation(s)
- Jane S Watson
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
- Department of Respiratory Medicine, St George’s NHS Trust, London, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Lucy Gardiner
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| |
Collapse
|
28
|
Rozenberg D, Shore J, Camacho Perez E, Nourouzpour S, Ibrahim Masthan M, Santa Mina D, Campos JL, Huszti E, Green R, Khan MH, Lau A, Gold D, Stanbrook MB, Reid WD. Feasibility of a Home-Based Cognitive-Physical Exercise Program in Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Feasibility and Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48666. [PMID: 37436794 PMCID: PMC10372770 DOI: 10.2196/48666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive condition associated with physical and cognitive impairments contributing to difficulty in performing activities of daily living (ADLs) that require dual tasking (eg, walking and talking). Despite evidence showing that cognitive decline occurs among patients with COPD and may contribute to functional limitations and decreased health-related quality of life (HRQL), pulmonary rehabilitation continues to focus mainly on physical training (ie, aerobic and strength exercises). An integrated cognitive and physical training program compared to physical training alone may be more effective in increasing dual-tasking ability among people living with COPD, leading to greater improvements in performance of ADLs and HRQL. OBJECTIVE The aims of this study are to evaluate the feasibility of an 8-week randomized controlled trial of home-based, cognitive-physical training versus physical training for patients with moderate to severe COPD and derive preliminary estimates of cognitive-physical training intervention efficacy on measures of physical and cognitive function, dual task performance, ADLs, and HRQL. METHODS A total of 24 participants with moderate to severe COPD will be recruited and randomized into cognitive-physical training or physical training. All participants will be prescribed an individualized home physical exercise program comprising 5 days of moderate-intensity aerobic exercise (30-50 minutes/session) and 2 days of whole-body strength training per week. The cognitive-physical training group will also perform cognitive training for approximately 60 minutes, 5 days per week via the BrainHQ platform (Posit Science Corporation). Participants will meet once weekly with an exercise professional (via videoconference) who will provide support by reviewing the progression of their training and addressing any queries. Feasibility will be assessed through the recruitment rate, program adherence, satisfaction, attrition, and safety. The intervention efficacy regarding dual task performance, physical function, ADLs, and HRQL will be evaluated at baseline and at 4 and 8 weeks. Descriptive statistics will be used to summarize intervention feasibility. Paired 2-tailed t tests and 2-tailed t tests will be used to compare the changes in the outcome measures over the 8-week study period within and between the 2 randomized groups, respectively. RESULTS Enrollment started in January 2022. It is estimated that the enrollment period will be 24 months long, with data collection to be completed by December 2023. CONCLUSIONS A supervised home-based cognitive-physical training program may be an accessible intervention to improve dual-tasking ability in people living with COPD. Evaluating the feasibility and effect estimates is a critical first step to inform future clinical trials evaluating this approach and its effects on physical and cognitive function, ADL performance, and HRQL. TRIAL REGISTRATION ClinicalTrials.gov NCT05140226; https://clinicaltrials.gov/ct2/show/NCT05140226. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48666.
Collapse
Affiliation(s)
- Dmitry Rozenberg
- Respirology and Lung Transplantation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Josh Shore
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | | | - Sahar Nourouzpour
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Jennifer L Campos
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Robin Green
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, ON, Canada
| | | | - Ambrose Lau
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | - David Gold
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Matthew B Stanbrook
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respirology, University Health Network, Toronto, ON, Canada
| | - W Darlene Reid
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
29
|
Pagano L, Dennis S, Wootton S, Chan ASL, Zwar N, Mahadev S, Pallavicini D, McKeough Z. The effects of an innovative GP-physiotherapist partnership in improving COPD management in primary care. BMC PRIMARY CARE 2023; 24:142. [PMID: 37430190 DOI: 10.1186/s12875-023-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Evidence suggests that management of people with Chronic Obstructive Pulmonary Disease (COPD) in primary care has been suboptimal, in particular, with low referral rates to pulmonary rehabilitation (PR). The aim of this study was to evaluate the effectiveness of a GP-physiotherapist partnership in optimising management of COPD in primary care. METHODS A pragmatic, pilot, before and after study was conducted in four general practices in Australia. A senior cardiorespiratory physiotherapist was partnered with each general practice. Adults with a history of smoking and/or COPD, aged ≥ 40 years with ≥ 2 practice visits in the previous year were recruited following spirometric confirmation of COPD. Intervention was provided by the physiotherapist at the general practice and included PR referral, physical activity and smoking cessation advice, provision of a pedometer and review of inhaler technique. Intervention occurred at baseline, one month and three months. Main outcomes included PR referral and attendance. Secondary clinical outcomes included changes in COPD Assessment Test (CAT) score, dyspnoea, health activation and pedometer step count. Process outcomes included count of initiation of smoking cessation interventions and review of inhaler technique. RESULTS A total of 148 participants attended a baseline appointment where pre/post bronchodilator spirometry was performed. 31 participants with airflow obstruction on post-bronchodilator spirometry (mean age 75yrs (SD 9.3), mean FEV1% pred = 75% (SD 18.6), 61% female) received the intervention. At three months, 78% (21/27) were referred to PR and 38% (8/21) had attended PR. No significant improvements were seen in CAT scores, dyspnoea or health activation. There was no significant change in average daily step count at three months compared to baseline (mean difference (95% CI) -266 steps (-956 to 423), p = 0.43). Where indicated, all participants had smoking cessation interventions initiated and inhaler technique reviewed. CONCLUSION The results of this study suggest that this model was able to increase referrals to PR from primary care and was successful in implementing some aspects of COPD management, however, was insufficient to improve symptom scores and physical activity levels in people with COPD. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx .
Collapse
Affiliation(s)
- Lisa Pagano
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Sally Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
| | - Andrew S L Chan
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sriram Mahadev
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | | | - Zoe McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| |
Collapse
|
30
|
Nakshbandi G, Moor CC, Wijsenbeek MS. Role of the internet of medical things in care for patients with interstitial lung disease. Curr Opin Pulm Med 2023; 29:285-292. [PMID: 37212372 PMCID: PMC10241441 DOI: 10.1097/mcp.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE OF REVIEW Online technologies play an increasing role in facilitating care for patients with interstitial lung disease (ILD). In this review, we will give an overview of different applications of the internet of medical things (IoMT) for patients with ILD. RECENT FINDINGS Various applications of the IoMT, including teleconsultations, virtual MDTs, digital information, and online peer support, are now used in daily care of patients with ILD. Several studies showed that other IoMT applications, such as online home monitoring and telerehabilitation, seem feasible and reliable, but widespread implementation in clinical practice is lacking. The use of artificial intelligence algorithms and online data clouds in ILD is still in its infancy, but has the potential to improve remote, outpatient clinic, and in-hospital care processes. Further studies in large real-world cohorts to confirm and clinically validate results from previous studies are needed. SUMMARY We believe that in the near future innovative technologies, facilitated by the IoMT, will further enhance individually targeted treatment for patients with ILD by interlinking and combining data from various sources.
Collapse
Affiliation(s)
- Gizal Nakshbandi
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Telerehabilitation is an alternative delivery model for pulmonary rehabilitation, an evidence-based nonpharmacological intervention, in people with chronic pulmonary disease. This review synthesizes current evidence regarding the telerehabilitation model for pulmonary rehabilitation with an emphasis on its potential and implementation challenges, as well as the clinical experiences from the COVID-19 pandemic. RECENT FINDINGS Different models of telerehabilitation for delivering pulmonary rehabilitation exist. Current studies comparing telerehabilitation to centre-based pulmonary rehabilitation primarily focus on the evaluation in people with stable chronic obstructive pulmonary disease, which demonstrated equivalent improvements in exercise capacity, health-related quality of life and symptoms with improved programme completion rates. Although telerehabilitation may improve access to pulmonary rehabilitation by addressing travel burden, improving schedule flexibility and geographic disparity, there are challenges of ensuring satisfaction of healthcare interactions and delivering core components of initial patient assessment and exercise prescription remotely. SUMMARY Further evidence is needed on the role of telerehabilitation in various chronic pulmonary diseases, as well as the effectiveness of different modalities in delivering telerehabilitation programmes. Economic and implementation evaluation of currently available and emerging models of telerehabilitation in delivering pulmonary rehabilitation are needed to ensure sustainable adoption into clinical management for people with chronic pulmonary disease.
Collapse
Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
- Institute for Breathing and Sleep
| | - Yet H Khor
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
- Institute for Breathing and Sleep
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
32
|
Neves LHG, Malaguti C, Santos MR, Cabral LA, da Silva LB, de Oliveira HH, Brugiolo ASS, José A, Holland AE, Oliveira CC. Pulmonary Telerehabilitation for People With Chronic Obstructive Pulmonary Disease in Brazil: A Mixed-Methods Feasibility Study. Int J Telerehabil 2023; 15:e6555. [PMID: 38046551 PMCID: PMC10688024 DOI: 10.5195/ijt.2023.6555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
This study assessed the feasibility of pulmonary telerehabilitation‧s (PTR) acceptability, implementation, practicality, and adaptation for people with Chronic Obstructive Pulmonary Disease (COPD) in Brazil. It also explored associations with clinical and socioeconomic features of Brazilians with COPD. This mixed-method study included thirty-one participants with COPD (age 62±10 years; FEV1= 72±14% predicted). Most participants (74.2%) reported good PTR session acceptability on the System Usability Scale and scores of 4.6±0.3 and 4.5±0.6 on a 1-5 Likert-type scale of implementation and practicality, respectively. Participants suggested adaptations for better comfort on the exercise bike and varying exercise modalities. PTR acceptability was associated with participants' younger age (rs=-0.57, p<0.01) and higher education (rs=0.51, p<0.01). PTR is feasible for people with COPD in Brazil regarding acceptability, implementation, practicality, and adaptation. Younger age and higher educational level are associated with greater PTR acceptability.
Collapse
Affiliation(s)
- Luis H. G. Neves
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Carla Malaguti
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Marissa R. Santos
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
- Post-Graduate Research Program on Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laura A. Cabral
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Laura B.D. da Silva
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Hugo H. de Oliveira
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Alessa S. S. Brugiolo
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Anderson José
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Anne E. Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Cristino C. Oliveira
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
- Post-Graduate Research Program on Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
33
|
Kotejoshyer R, Eve J, Priya A, Mazor K, Spitzer KA, Pekow PS, Pack QR, Lindenauer PK. Strategies to Improve Enrollment and Participation in Pulmonary Rehabilitation Following a Hospitalization for COPD: RESULTS OF A NATIONAL SURVEY. J Cardiopulm Rehabil Prev 2023; 43:192-197. [PMID: 36137210 PMCID: PMC10148891 DOI: 10.1097/hcr.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) improves outcomes for patients with chronic obstructive pulmonary disease (COPD); however, very few patients attend. We sought to describe strategies used to promote participation in PR after a hospitalization for COPD. METHODS A random sample of 323 United States based PR programs was surveyed. Using a positive deviance approach, a 39-item survey was developed based on interviews with clinicians at hospitals demonstrating high rates of participation in PR. Items focused on strategies used to promote participation as well as relevant contextual factors. RESULTS Responses were received from 209 programs (65%), of which 88% (n = 184) were hospital-based outpatient facilities. Most (91%, n = 190) programs described enrolling patients continuously, and 80% (n = 167) reported a wait time from referral to the initial PR visit of <4 wk. Organization-level strategies to increase referral to PR included active surveillance (48%, n = 100) and COPD-focused staff (49%, n = 102). Provider-level strategies included clinician education (45%, n = 94), provider outreach (43%, n = 89), order sets (45%, n = 93), and automated referrals (23%, n = 48). Patient-level strategies included bedside education (53%, n = 111), flyers (49%, n = 103), motivational interviewing (33%, n = 69), financial counseling (64%, n = 134), and transportation assistance (35%, n = 73). Fewer than one-quarter (18%, n = 38) of PR programs reported using both bedside education and automatic referral, and 42% (n = 88) programs did not use either strategy. CONCLUSIONS This study describes current practices in the United States, and highlights opportunities for improvement at the organization, provider, and patient level. Future research needs to demonstrate the effectiveness of these strategies, alone or in combination.
Collapse
Affiliation(s)
- Rajashree Kotejoshyer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield (Drs Kotejoshyer, Eve, Spitzer, Pekow, Pack, and Lindenauer and Ms Priya); University of Massachusetts Chan Medical School, Worcester (Dr Mazor); and UMass Donahue Institute, Amherst, Massachusetts (Dr Spitzer)
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Blank L, Cantrell A, Sworn K, Booth A. Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-59. [PMID: 37464900 DOI: 10.3310/klwr9463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background There is a considerable body of systematic review evidence considering the effectiveness of rehabilitation programmes on clinical outcomes. However, much less is known about effectively engaging and sustaining patients in rehabilitation. There is a need to understand the full range of potential intervention strategies. Methods We conducted a mapping review of UK review-level evidence published 2017-21. We searched MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health (CINAHL) and conducted a narrative synthesis. Included reviews reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention to facilitate these factors. Study selection was undertaken independently by two reviewers. Results In total, we identified 20 review papers that met our inclusion criteria. There was a bias towards reviews considering cardiac rehabilitation, with these numbering 16. An additional 11 unpublished interventions were also identified through internet searching of key websites. The reviews included 60 identifiable UK primary studies that considered factors which affected attendance at rehabilitation; 42 considered cardiac rehabilitation and 18 considering pulmonary rehabilitation. They reported on factors from the patients' point of view, as well as the views of professionals involved in referral or treatment. It was more common for factors to be reported as impeding attendance at rehabilitation rather than facilitating it. We grouped the factors into patient perspective (support, culture, demographics, practical, health, emotions, knowledge/beliefs and service factors) and professional perspective (knowledge: staff and patient, staffing, adequacy of service provision and referral from other services, including support and wait times). We found considerably fewer reviews (n = 3) looking at interventions to facilitate participation in rehabilitation. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. The majority of access challenges identified by patients would not therefore be addressed by the identified interventions. The more recent unevaluated interventions implemented during the COVID-19 pandemic may have the potential to act on some of the patient barriers in access to services, including travel and inconvenient timing of services. Conclusions The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. The small number of published interventions we identified that aim to improve access are unlikely to address the majority of these factors, especially those identified by patients as limiting their access. Better understanding of these factors will allow future interventions to be more evidence based with clear objectives as to how to address the known barriers to improve access. Limitations Time limitations constrained the consideration of study quality and precluded the inclusion of additional searching methods such as citation searching and contacting key authors. This may have implications for the completeness of the evidence base identified. Future work High-quality effectiveness studies of promising interventions to improve attendance at rehabilitation, both overall and for key patient groups, should be the focus moving forward. Funding This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HSDR programme or the Department of Health. Study registration The study protocol is registered with PROSPERO [CRD42022309214].
Collapse
Affiliation(s)
- Lindsay Blank
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Sworn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
35
|
Spitzer KA, Stefan MS, Priya A, Pack QR, Pekow PS, Lagu T, Mazor K, Pinto-Plata VM, Bradley K, Heineman B, ZuWallack RL, Lindenauer PK. Promoting Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease, Strategies of Top-performing Systems: A Qualitative Study. Ann Am Thorac Soc 2023; 20:532-538. [PMID: 36449407 PMCID: PMC10112402 DOI: 10.1513/annalsats.202203-237oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Rationale: Pulmonary rehabilitation (PR) after hospitalization for chronic obstructive pulmonary disease (COPD) is recommended by guidelines; however, few patients participate, and rates vary between hospitals. Objectives: To identify contextual factors and strategies that may promote participation in PR after hospitalization for COPD. Methods: Using a positive-deviance approach, we calculated hospital-specific rates of PR after hospitalization for COPD among a cohort of Medicare beneficiaries. At a purposive sample of high-performing and innovative hospitals in the United States, we conducted in-depth interviews with key stakeholders. We defined high-performing hospitals as having a PR rate above the 95th percentile, at least 6.58%. To learn from hospitals that demonstrated a commitment to improving rates of PR, regardless of PR rates after discharge, we identified innovative hospitals on the basis of a review of American Thoracic Society conference research presentations from prior years. Interviews were audio-recorded and transcribed verbatim. Using a directed content analysis approach, transcripts were coded iteratively to identify themes. Results: Interviews were conducted with 38 stakeholders at nine hospitals (seven high-performers and two innovators). Hospitals were diverse regarding size, teaching status, PR program characteristics, and geographic location. Participants included PR medical directors, PR managers, respiratory therapists, inpatient and outpatient providers, and others. We found that high-performing hospitals were broadly focused on improving care for patients with COPD, and several had recently implemented new initiatives to reduce rehospitalizations after admission for COPD in response to the Centers for Medicare and Medicaid Services/Medicare's Hospital Readmission Reduction Program. Innovative and high-performing hospitals had systems in place to identify patients with COPD that enabled them to provide patient education and targeted discharge planning. Strategies took several forms, including the use of a COPD navigator or educator. In addition, we found that high-performing hospitals reported effective interprofessional and patient communication, had clinical champions or external change agents, and received support from hospital leadership. Specific strategies to promote PR included education of referring providers, education of patients to increase awareness of PR and its benefits, and direct assistance in overcoming barriers. Conclusions: Our findings suggest that successful efforts to increase participation in PR may be most effective when part of a larger strategy to improve outcomes for patients with COPD. Further research is necessary to test the generalizability of our findings.
Collapse
Affiliation(s)
| | - Mihaela S. Stefan
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Aruna Priya
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
- Department of Healthcare Delivery and Population Sciences and
| | - Quinn R. Pack
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
- Division of Cardiovascular Medicine and
| | - Penelope S. Pekow
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
- Department of Healthcare Delivery and Population Sciences and
| | - Tara Lagu
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Kathy Mazor
- Meyers Primary Care Institute, Worcester, Massachusetts
- Department of Medicine and
| | | | - Kolbi Bradley
- Department of Healthcare Delivery and Population Sciences and
| | - Brent Heineman
- Department of Healthcare Delivery and Population Sciences and
| | | | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences and
- Department of Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts; and
| |
Collapse
|
36
|
Cox NS, Holland AE, Jones AW, McDonald CF, O'Halloran P, Mahal A, Hepworth G, Lannin NA. Implementation of offering choice of pulmonary rehabilitation location to people with COPD: a protocol for the process evaluation of a cluster randomised controlled trial. Trials 2023; 24:173. [PMID: 36890526 PMCID: PMC9994770 DOI: 10.1186/s13063-023-07179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is a core component of management people with chronic obstructive pulmonary disease (COPD); yet, people with COPD face significant barriers to attending centre-based PR programs. The emergence of new models of PR, remotely delivered directly into people's homes, has the potential to improve rehabilitation access and completion by providing patients with a choice of rehabilitation location (centre or home). However, offering patients a choice of rehabilitation model is not usual practice. We are undertaking a 14-site cluster randomised controlled trial to determine whether offering choice of PR location improves rehabilitation completion rates resulting in reduced all-cause unplanned hospitalisation over 12 months. The aim of this paper is to describe the protocol for the process evaluation of the HomeBase2 trial. METHODS A mixed methods process evaluation, to be undertaken in real time, has been developed in accordance with UK Medical Research Council (MRC) recommendations on process evaluation of complex interventions. This protocol describes the intended use of two theoretical frameworks (RE-AIM framework (Reach; Effectiveness; Adoption; Implementation; Maintenance) and Theoretical Domains Framework (TDF)) to synthesise findings and interpret data from a combination of qualitative (semi-structured interviews) and quantitative (questionnaires, clinical outcome data, intervention fidelity) methodologies. Data will be collected at an intervention, patient and clinician level. Qualitative and quantitative data will be used to derive context-specific potential and actual barriers and facilitators to offering patients choice of rehabilitation location. Acceptability and sustainability of the intervention will be evaluated for future scale-up. DISCUSSION The process evaluation described here will appraise the clinical implementation of offering a choice of rehabilitation program location for people with COPD. It will identify and evaluate key factors for future scale-up and sustainability and scale-up of offering choice of pulmonary rehabilitation program model for people. TRIAL REGISTRATION ClinicalTrials.gov NCT04217330 Registration date: January 3 2020.
Collapse
Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Institute for Breathing and Sleep, Melbourne, Australia.
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Physiotherapy, Alfred Health, Melbourne, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Department of Immunology and Pathology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ajay Mahal
- The Nossal Global Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Occupational Therapy, Alfred Health, Melbourne, Australia
| |
Collapse
|
37
|
Norweg AM, Wu Y, Troxel A, Whiteson JH, Collins E, Haas F, Skamai A, Goldring R, Jean-Louis G, Reibman J, Ehrlich-Jones L, Simon N. Mind-Body Intervention for Dysfunctional Breathing in Chronic Obstructive Pulmonary Disease: Feasibility Study and Lessons Learned. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:156-168. [PMID: 36800224 PMCID: PMC10024272 DOI: 10.1089/jicm.2022.0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Purpose: Dysfunctional breathing behaviors are prevalent in chronic obstructive pulmonary disease (COPD). Although these behaviors contribute to dyspnea, abnormal carbon dioxide (CO2) levels, and COPD exacerbations, they are modifiable. Current dyspnea treatments for COPD are suboptimal, because they do not adequately address dysfunctional breathing behaviors and anxiety together. We developed a complementary mind-body breathlessness therapy, called capnography-assisted respiratory therapy (CART), that uses real-time CO2 biofeedback at the end of exhalation (end-tidal CO2 or ETCO2), to target dysfunctional breathing habits and improve dyspnea treatment and pulmonary rehabilitation (PR) adherence in COPD. The study aim was to test the feasibility of integrating CART with a traditional, clinic-based PR program in an urban setting. Methods: We used a feasibility pre- and post-test design, with 2:1 randomization to CART+PR or control (PR-alone) groups, to test and refine CART. Multi-component CART consisted of six, 1-h weekly sessions of slow breathing and mindfulness exercises, ETCO2 biofeedback, motivational counseling, and a home program. All participants were offered twice weekly, 1-h sessions of PR over 10 weeks (up to 20 sessions). Results: Thirty-one participants with COPD were enrolled in the study. Approximately a third of participants had symptoms of psychological distress. Results showed that CART was feasible and acceptable based on 74% session completion and 91.7% homework exercise completion (n = 22). Within-group effect sizes for CART+PR were moderate to large (Cohen's d = 0.51-1.22) for reduction in resting Borg dyspnea (anticipatory anxiety) and respiratory rate, St. George's Respiratory Questionnaire (SGRQ) respiratory symptoms; and increase in Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and physical activity; all p < 0.05. Conclusions: CART is a new mind-body breathing therapy that targets eucapnic breathing, interoceptive function, and self-regulated breathing to relieve dyspnea and anxiety symptoms in COPD. Study findings supported the feasibility of CART and showed preliminary signals that CART may improve exercise tolerance, reduce dyspnea, and enhance PR completion by targeting reduced dysfunctional breathing patterns (CTR No. NCT03457103).
Collapse
Affiliation(s)
- Anna Migliore Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yinxiang Wu
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Andrea Troxel
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Jonathan H. Whiteson
- Department of Rehabilitation, and New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Eileen Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Francois Haas
- Department of Rehabilitation, and New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Anne Skamai
- Department of Family and Community Medicine, Downstate Medical Center, State University of New York, New York, NY, USA
| | - Roberta Goldring
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Girardin Jean-Louis
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | | | - Naomi Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
38
|
Li J, Zeng Q, Huang H, Song Y, Guo W, Fong DYT. "Finding the Way in the Dark"- Working experience of specific-duty-post nurses in a nurse-led in-hospital pulmonary rehabilitation program: A qualitative study. Heart Lung 2023; 58:39-46. [PMID: 36375396 DOI: 10.1016/j.hrtlng.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The globally low access to pulmonary rehabilitation can be attributed to the shortage of competent professionals. Setting up specific-duty-post nurses in pulmonary rehabilitation is a novel attempt to solve it. However, their work experience in this position has not been examined. OBJECTIVES To describe the working experience of special-duty-post pulmonary rehabilitation nurses to improve the efficiency of this mode and provide guidance for management hospitals contemplating setting up and optimizing this position. METHODS A descriptive phenomenology qualitative approach with semi-structured in-depth interviews was adopted. RESULTS Fourteen special-duty-post pulmonary rehabilitation nurses were recruited by purposive and snowball sampling from May to July 2021. Four main themes emerged: finding the way in the dark, meeting qualifications and requirements, seeking independence, and anticipating better development. The lack of relevant standards, inadequate support, and variation in chronic respiratory diseases had made them felt like they were finding their way in the dark. As a result of meeting new requirements and qualifications, they experienced role transition shock. Moreover, they were seeking a clear role boundary and independence to foster their sense of belonging. They suggested ways that future management and policies could nurture them to invest more in pulmonary rehabilitation development. CONCLUSION Developing detailed working standards before work begins and providing adequate support, especially from pulmonologists was key. Compared to a clinical position, this position requires a high level of specialty knowledge, communication skills, self-learning, innovative ability, decision-making, and resilience. Special-duty-post pulmonary rehabilitation nurses suggested ways that tailored management based on the identified factors could counteract their transition shock. A clear role boundary and independence help foster belongingness. To maximize effectiveness and overcome challenges requires identifying obstacles to success, initiating strategies to overcome these and ongoing efforts to promote interdisciplinary support of the role.
Collapse
Affiliation(s)
- Jiaying Li
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Qiuxuan Zeng
- The First Affiliated Hospital of Guangzhou Medicine University, Guangzhou, China
| | - Huixin Huang
- The First Affiliated Hospital of Guangzhou Medicine University, Guangzhou, China
| | - Yang Song
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenwei Guo
- The First Affiliated Hospital of Guangzhou Medicine University, Guangzhou, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR.
| |
Collapse
|
39
|
Maddocks S, Camp P, Tang C. Engaging Ethnically Diverse Populations in Self-Management Interventions for Chronic Respiratory Diseases: A Narrative Review. Pulm Ther 2023; 9:195-206. [PMID: 36773131 PMCID: PMC9922039 DOI: 10.1007/s41030-023-00218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
The burden of chronic respiratory diseases continues to rise globally. Comprehensive management relies on a combination of treatment approaches including patient self-management, where health professionals are required to educate and support patients to take control of their disease. When self-management interventions are suitably directed and effectively executed, outcomes point to increases in quality of life and a reduction in unscheduled or emergency consultations for people living with chronic respiratory disease. However, despite these positive gains, the literature reveals poor trends of engagement with this management approach and reduced access to appropriately designed programs for people from ethnically diverse populations, including migrants and refugees. The purpose of this review article is to discuss factors influencing engagement in chronic respiratory disease self-management among people from ethnically diverse backgrounds and to propose strategies to improve the participation of this population in these interventions in the future.
Collapse
Affiliation(s)
- Stacy Maddocks
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada ,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada ,Physiotherapy University of KwaZulu-Natal, Durban, South Africa
| | - Pat Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada ,Physiotherapy University of KwaZulu-Natal, Durban, South Africa
| | - Clarice Tang
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Allied Health, South Western Sydney Local Health District, Sydney, Australia.
| |
Collapse
|
40
|
Junior MGDN, Xavier DM, Abreu RAL, da Silva LF, de Miranda JP, Aquino MJDV, Dos Santos MA, Filho VJDS. Home Based Rehabilitation in Children and Adolescents with Cystic Fibrosis: A Systematic Review with Meta-Analysis and Grade Recommendations. Phys Occup Ther Pediatr 2023; 43:528-547. [PMID: 36655279 DOI: 10.1080/01942638.2023.2169093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/13/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of this study is to elucidate the effectiveness of home based rehabilitation (HBR) and compare its results with those obtained in conventional rehabilitation (CR) programs, carried out in clinics and/or outpatient clinics. METHODS Searches were conducted in five databases of randomized clinical trials. Study selection, data extraction, and assessment of the methodological quality of included studies were conducted independently by two reviewers, with discrepancies resolved by a third reviewer. RESULTS The results demonstrate post-intervention values favorable to the use of HBR when compared to control group in the outcomes of forced expiratory volume in 1 second (FEV1) (MD = 14% CI: 5.42 to 22.58, p = 0.001), forced vital capacity (FVC) (MD = 8.00% CI: 0.83 to 15.17, p = 0.03) and quality of life by the Cystic Fibrosis Questionnaire - revised in the categories (Child version score" (MD= 0.71%CI: 0.15 to 1.27, p = 0.01) and "Parent version score" (MD= 0.67%CI: 0.11 to 1.23, p = 0.02). Furthermore, we noticed an increase in the distance covered in the 6-minute walk test (MD= 34.75%CI: -8.00 to 77.50, p = 0.14), in favor of HBR. CONCLUSIONS We found that supervised or partially supervised HBR promotes improvements in FEV1, FVC and related quality of life in children and/or adolescents with cystic fibrosis.
Collapse
Affiliation(s)
| | - Diêgo Mendes Xavier
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | | | - Júlio Pascoal de Miranda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Mario Adriano Dos Santos
- Doctor in Medicine, Concentration in Pathology, University of São Paulo (USP), São Paulo, Brazil
| | | |
Collapse
|
41
|
Completion Rate of Hybrid Videoconferencing Pulmonary Telerehabilitation During the COVID-19 Pandemic. J Cardiopulm Rehabil Prev 2022; 42:E100-E103. [DOI: 10.1097/hcr.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
42
|
Tang CY, Lavercombe M, Southcott AM, Taylor NF, Blackstock FC. Access to pulmonary rehabilitation for people from culturally and linguistically diverse communities: A cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4133-e4143. [PMID: 35352435 DOI: 10.1111/hsc.13807] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Little is known about the extent of cultural and linguistic diversity among people with chronic obstructive pulmonary disease (COPD) in Australia and if ethno-cultural factors influence engagement in pulmonary rehabilitation (PR). We conducted a prospective cohort study to evaluate the extent of cultural and linguistic diversity among people with COPD and identify variables that influence engagement in PR. Patients with COPD attending the respiratory outpatient clinic at a metropolitan health service completed a study-specific questionnaire with results descriptively analysed. Access issues of awareness, referrals, attendance and completion of PR were examined. A multiple regression analysis was conducted to identify variables that influenced engagement in PR. Ninety-seven participants were recruited, of whom 36 (37%) self-identified a culturally and linguistically diverse (CALD) community. While participants from CALD communities had less awareness of PR as compared with the English Australian group (χ2 (df) = 5.3 (1), p = 0.02), there were no significant between-group differences in number of observed referrals (p = 0.30), attendance (p = 0.50) and completions of PR (p = 0.90). Only 11 (11%) out of 97 participants completed PR. Age (p = 0.006) and being from a CALD community (p = 0.03) were independent factors impacting on the awareness of PR while English proficiency (p = 0.04) was an independent factor impacting on referrals to PR. While older age and being from a CALD community were associated with having less awareness in PR, referrals to, attendance and completion rates of PR were similar regardless of ethnicity.
Collapse
Affiliation(s)
- Clarice Y Tang
- Physiotherapy Department, Western Health, St Albans, Victoria, Australia
- Physiotherapy, School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Mark Lavercombe
- Department of Respiratory & Sleep Disorders Medicine, Western Health, St Albans, Victoria, Australia
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne M Southcott
- Department of Respiratory & Sleep Disorders Medicine, Western Health, St Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Felicity C Blackstock
- Physiotherapy, School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
43
|
Aldhahir AM, Alqahtani JS, AlDraiwiesh IA, Alghamdi SM, Alsulayyim AS, Alqarni AA, Alhotye M, Alwafi H, Siraj R, Alrajeh A, Aldabayan YS, Alzahrani EM, Hakamy A. Healthcare providers' attitudes, beliefs and barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in Saudi Arabia: a cross-sectional study. BMJ Open 2022; 12:e063900. [PMID: 36302583 PMCID: PMC9621177 DOI: 10.1136/bmjopen-2022-063900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral. DESIGN A cross-sectional online survey consisting of nine multiple-choice questions. SETTINGS Saudi Arabia. PARTICIPANTS 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists. PRIMARY OUTCOME MEASURES HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia. RESULTS Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was 'mobility affected by breathlessness' (64%), while the 'availability of PR centres' (61%), the 'lack of trained HCPs' (52%) and the 'lack of authority to refer patients' (44%) were the most common barriers to referral. CONCLUSION PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers.
Collapse
Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Respiratory Care Program, College of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah S Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Rayan Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Ahmed Alrajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Yousef S Aldabayan
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Eidan M Alzahrani
- Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ali Hakamy
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| |
Collapse
|
44
|
Evaluating Virtual and Inpatient Pulmonary Rehabilitation Programs for Patients with COPD. J Pers Med 2022; 12:jpm12111764. [PMID: 36573730 PMCID: PMC9699594 DOI: 10.3390/jpm12111764] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/30/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an increasingly frequent disorder that is likely to become the third leading cause of morbidity worldwide. It significantly degrades the quality of life of patients affected and poses a significant financial burden to the healthcare systems providing treatment and rehabilitation. Consequently, our study’s purpose was to compare conventional inpatient pulmonary rehabilitation (PR) with virtual (online) PR using a mobile phone application. During a three-month period, two groups of patients followed the research protocol by participating in a pulmonary rehabilitation program administered and supervised by a physical therapist five times per week. A number of respiratory variables were examined before and after the test. At the end of the study period, a total of 72 patients completed the rehabilitation in the inpatient group, respectively 58 in the online group. It was observed that post-test comparison between patients undergoing the traditional and online rehabilitation methods did not show any significant differences. However, the calculated mean differences between pre-test and post-test results were significantly higher in favor of the virtual method. The most significant variations were encountered in maximal inspiratory pressure (MIP) (6.6% vs. 8.5%, p-value < 0.001), 6-min walking test (6MWT) (6.7% vs. 9.4%, p-value < 0.001), and COPD assessment test (CAT) values (4.8 vs. 6.2, p-value < 0.001), respectively. However, the maximal expiratory pressure (MEP) variation was significantly higher in patients undergoing the traditional rehabilitation method, from an average of 4.1% to 3.2% (p-value < 0.001). In this preliminary study, the online pulmonary rehabilitation program proved non-inferiority to the traditional method, with significantly better results in several measurements. Additional studies using larger cohorts of patients and longer exposure to the online rehabilitation program are required to validate these findings.
Collapse
|
45
|
Uzzaman MN, Agarwal D, Chan SC, Patrick Engkasan J, Habib GMM, Hanafi NS, Jackson T, Jebaraj P, Khoo EM, Mirza FT, Pinnock H, Shunmugam RH, Rabinovich RA. Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/165/220076. [PMID: 36130789 DOI: 10.1183/16000617.0076-2022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/14/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87). CONCLUSION Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.
Collapse
Affiliation(s)
- Md Nazim Uzzaman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
| | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital and Research centre, Pune, India
| | - Soo Chin Chan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - G M Monsur Habib
- Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | | | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
| | - Paul Jebaraj
- Rural Unit for Health and Social Affairs, Christian Medical College, Vellore, India
| | - Ee Ming Khoo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
| | | | | |
Collapse
|
46
|
Telerehabilitation as a Form of Pulmonary Rehabilitation in Chronic Lung Disease: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10091795. [PMID: 36141407 PMCID: PMC9499038 DOI: 10.3390/healthcare10091795] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Tele-rehabilitation is increasingly used to deliver pulmonary rehabilitation. The aim of this systematic review was to compare the effect between tele-pulmonary rehabilitation and classical supervised pulmonary rehabilitation. Method: Three databases were analysed (PubMed, PEDro, Scopus). The selection and evaluation of studies followed the PRISMA guidelines. The risk of bias was evaluated using the PEDro Scale. Results: From the initial selection (n = 245), ten studies were retrieved, including from 10 to 67 patients. All but two (IPF) included patients with COPD. Based on the FEV1, patients with COPD were mainly categorised as moderate and severe. The teleactivities were heterogenous in terms of proposed exercises and way of settings and often not in agreement with the guidelines about pulmonary rehabilitation. Despite this, the effects of the interventions were globally positive on functional exercise capacity, quality of life, anxiety and depression, and impact of COPD on personal life but not on dyspnoea. The PEDro scores varied from 4 to 8. The adherence was higher than 80% when supervision during the exercise was included. Conclusion: This review demonstrated that the telerehabilitation is safe and well accepted by the patients, and could be considered as one option of classical pulmonary rehabilitation to improve the functional exercise capacity, quality of life, anxiety and depression, and the impact of COPD on personal’s life. This conclusion cannot be extrapolated to the other chronic lung diseases due to the lack of data.
Collapse
|
47
|
Michaelchuk W, Oliveira A, Marzolini S, Nonoyama M, Maybank A, Goldstein R, Brooks D. Design and delivery of home-based telehealth pulmonary rehabilitation programs in COPD: A systematic review and meta-analysis. Int J Med Inform 2022; 162:104754. [PMID: 35395474 DOI: 10.1016/j.ijmedinf.2022.104754] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 12/11/2022]
Abstract
RATIONALE Home-based telehealth pulmonary rehabilitation (HTPR) for chronic obstructive pulmonary disease (COPD) is increasingly common partly due to the COVID-19 pandemic. However, optimal HTPR programming has not been described. This review provides a comprehensive overview of the design, delivery, and effects of HTPR for people with COPD. METHODS Relevant databases were searched to July 2021 for studies on adults with COPD utilizing information or communication technology to monitor or deliver HTPR. A meta-analysis was performed on a subset of randomized controlled trials. RESULTS Of 3124 records retrieved, 38 studies evaluating 1993 individuals with stable COPD (age 54-75 and FEV1 31-92% predicted) were included. Program components included exercise and education (n = 17) or exercise alone (n = 15) with in-clinic baseline assessments commonly conducted (n = 26). Few trials (n = 7) featured synchronous virtual exercise supervision. Aerobic exercise commonly involved walking (n = 14) and cycling (n = 11) and most programs included resistance training (n = 25). Exercise progressions and emergency action plans were inconsistently reported. Meta-analysis demonstrated HTPR was comparable to outpatient PR and had a greater effect than usual care for the modified Medical Research Council dyspnea scale (mean difference [95 %CI]: -0.49 [-0.77, -0.22], p < 0.01) and COPD Assessment Test score (-4.90 [-7.13, -2.67], p < 0.01). Neither HTPR nor outpatient PR impacted sedentary time or step count. Only 6% of studies reported race and no studies reported participant ethnicity. CONCLUSION This review revealed the heterogeneity of HTPR program designs in COPD. HTPR programs had similar effects to outpatient PR programs and greater effects than usual care for people with COPD.
Collapse
Affiliation(s)
- Wade Michaelchuk
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Canada; Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada
| | - Ana Oliveira
- Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada; Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; IBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Susan Marzolini
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Canada; KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Mika Nonoyama
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Canada; Faculty of Health Sciences, Ontario Tech University, Canada
| | - Aline Maybank
- Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; Medical Sciences, Dalhousie University, Halifax, Canada
| | - Roger Goldstein
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Canada; Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Dina Brooks
- Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Canada.
| |
Collapse
|
48
|
Rochester CL. Does Telemedicine Promote Physical Activity? Life (Basel) 2022; 12:life12030425. [PMID: 35330176 PMCID: PMC8948765 DOI: 10.3390/life12030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Exercise capacity and physical activity are different concepts: the former refers to what an individual is capable of performing, while the latter refers to what the individual does in daily life. Low levels of physical activity (PA), which are very common in individuals with COPD, are associated with poor health outcomes, including increased symptoms, a more rapid decline in lung function, increased health care utilization and increased mortality risk. Because of these pervasive negative outcomes, attempts have been made to increase physical activity in individuals with COPD, hoping that success in this area will mitigate the negative effects of inactivity. Based on its ability to increase exercise capacity and reduce dyspnea in COPD and other chronic respiratory diseases, pulmonary rehabilitation (PR) would be expected also increase physical activity in these patients. However, accessibility to pulmonary rehabilitation programs is problematic in some areas, and studies testing its effectiveness in this outcome area have had inconsistent results. Using telehealth interventions using technology to provide medical care conveniently over a distance would have the benefit of reaching a larger proportion of individuals with COPD. A systematic review of clinical trials testing telehealth to promote physical activity had mixed results and low-certainty evidence, resulting in the inability to recommend any single type of intervention. Thus, using telehealth interventions to promote physical activity for individuals with chronic respiratory diseases, while promising, remains an area where future investigations are needed to identify its optimal modalities and clarify its benefits.
Collapse
Affiliation(s)
- Carolyn L. Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; ; Tel.: +1-203-785-4163; Fax: +1-203-785-3627
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| |
Collapse
|
49
|
Wen J, Milne S, Sin DD. Pulmonary rehabilitation in a postcoronavirus disease 2019 world: feasibility, challenges, and solutions. Curr Opin Pulm Med 2022; 28:152-161. [PMID: 34690256 PMCID: PMC8815640 DOI: 10.1097/mcp.0000000000000832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Pulmonary rehabilitation improves clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). Traditional centre-based (in-person) pulmonary rehabilitation was largely shut down in response to the COVID-19 pandemic, forcing many centres to rapidly shift to remote home-based programs in the form of telerehabilitation (tele-pulmonary rehabilitation). This review summarizes the recent evidence for the feasibility and effectiveness of remote pulmonary rehabilitation programs, and their implications for the delivery of pulmonary rehabilitation in a postpandemic world. RECENT FINDINGS A number of innovative adaptations to pulmonary rehabilitation in response to COVID-19 have been reported, and the evidence supports tele-pulmonary rehabilitation as a viable alternative to traditional centre-based pulmonary rehabilitation. However, these studies also highlight the challenges that must be surmounted in order to see its widespread adoption. SUMMARY There are outstanding questions regarding the optimal model for tele-pulmonary rehabilitation. In the post-COVID-19 world, a 'hybrid' model may be more desirable, with some components held in person and others via telehealth technology. This would be determined by the infrastructure and expertise of individual centres, and the needs of their patients. In order to achieve a truly patient-centred pulmonary rehabilitation program, high-quality studies addressing these outstanding questions, as well as multidisciplinary collaboration, are required.
Collapse
Affiliation(s)
- Jing Wen
- Centre for Heart Lung Innovation, St. Paul's Hospital
| | - Stephen Milne
- Centre for Heart Lung Innovation, St. Paul's Hospital
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Don D. Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
50
|
BICKTON FANUELMECKSON, Mankhokwe T, Mitengo M, Limbani F, Shannon H, Rylance J, Chisati E. “My life is not going to be the same, my health is going to improve”: a cross-sectional qualitative study of patients’ experiences of living with chronic respiratory symptoms and their views on a proposed pulmonary rehabilitation program at Queen Elizabeth Central Hospital, Blantyre, Malawi. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17702.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Malawi’s population has a substantial burden of chronic respiratory symptoms. Elsewhere, patients with these symptoms have benefited from pulmonary rehabilitation (PR), a program of exercise training, education, and behaviour management. Practically, PR in Malawi may not be delivered in the same format as elsewhere due to substantial contextual differences. These differences necessitate adaptation of the intervention to Malawi’s setting to be acceptable and effective. This study explored patients’ experiences of living with chronic respiratory symptoms and their views on a proposed PR program at Queen Elizabeth Central Hospital, Blantyre, Malawi, to inform the design of an individualized and culturally adapted PR program. Methods: This was a cross-sectional qualitative study. Face-to-face, one-to-one semi-structured in-depth interviews were undertaken to data saturation. Interviews were audio-recorded, transcribed verbatim, and Chichewa transcripts were translated into English. The transcripts were anonymized and thematically analysed using an inductive approach. Results: We recruited 10 patients (five males and five females) with functionally limiting chronic respiratory symptoms, with documented causes including chronic obstructive pulmonary disease, asthma, post-tuberculosis lung disease, and bronchiectasis. Symptoms most frequently included dyspnoea, with associated functional limitations including the reduced performance of activities of daily living. Participants’ coping strategies most frequently included the use of inhalers. Participants were motivated to undertake the PR program owing to its anticipated benefits including improved health. They perceived transport costs and competing commitments as barriers to participation. The participant group gender mix and public nature of the program were considered socio-culturally sensitive by some participants. Conclusions: The functionally limiting dyspnoea most frequently experienced by the study participants would be amenable to a PR program. To ensure participation by eligible patients, pre-program assessments should consider patient access to transport, suitability of the timing for the program’s sessions, and patient views on organizational aspects of the program considered social-culturally sensitive.
Collapse
|