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Calvo-Paniagua J, Díaz-Arribas MJ, Valera-Calero JA, Ramos-Sánchez M, Fernández-de-Las-Peñas C, Navarro-Santana MJ, Del Corral T, Plaza-Manzano G. Educational, Exercise, and Occupational Therapy-Based Telerehabilitation Program Versus "Wait-and-See" for Improving Self-perceived Exertion in Patients With Post-COVID Fatigue and Dyspnea: A Randomized Clinical Trial. Am J Phys Med Rehabil 2024; 103:797-804. [PMID: 38320238 DOI: 10.1097/phm.0000000000002441] [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: 02/08/2024]
Abstract
OBJECTIVE The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea. DESIGN Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods. RESULTS The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001). CONCLUSIONS Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention.
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Affiliation(s)
- José Calvo-Paniagua
- From the Gerencia Asistencial Atención Primaria de Madrid. Centro de Salud Espronceda, Madrid, Spain (JC-P); Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain (MJD-A, JAV-C, MJN-S, TdC, GP-M); Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (MJD-A, JAV-C, MJN-S, TdC, GP-M); Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain (MR-S); and Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain (CF-d-l-P)
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Greer JA, Post KE, Chabria R, Aribindi S, Brennan N, Eche-Ugwu IJ, Halpenny B, Fox E, Lo S, Waldman LP, Pintro K, Rabideau DJ, Pirl WF, Cooley ME, Temel JS. Randomized Controlled Trial of a Nurse-Led Brief Behavioral Intervention for Dyspnea in Patients With Advanced Lung Cancer. J Clin Oncol 2024:JCO2400048. [PMID: 39088766 DOI: 10.1200/jco.24.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 08/03/2024] Open
Abstract
PURPOSE In patients with lung cancer, dyspnea is one of the most prevalent and disabling symptoms, for which effective treatments are lacking. We examined the efficacy of a nurse-led brief behavioral intervention to improve dyspnea in patients with advanced lung cancer. METHODS Patients with advanced lung cancer reporting at least moderate breathlessness (n = 247) were enrolled in a randomized trial of a nurse-led two-session intervention (focused on breathing techniques, postural positions, and fan therapy) versus usual care. At baseline and weeks 8 (primary end point), 16, and 24, participants completed measures of dyspnea (Modified Medical Research Council Dyspnea Scale [mMRCDS]; Cancer Dyspnoea Scale [CDS]), quality of life (Functional Assessment of Cancer Therapy-Lung [FACT-L]), psychological symptoms (Hospital Anxiety and Depression Scale), and activity level (Godin-Shephard Leisure Time Physical Activity Questionnaire). To examine intervention effects, we conducted analysis of covariance and longitudinal mixed effects models. RESULTS The sample (Agemean = 66.15 years; 55.9% female) primarily included patients with advanced non-small cell lung cancer (85.4%). Compared with usual care, the intervention improved the primary outcome of patient-reported dyspnea on the mMRCDS (difference = -0.33 [95% CI, -0.61 to -0.05]) but not the CDS total score at 8 weeks. Intervention patients also reported less dyspnea on the CDS sense of discomfort subscale (difference = -0.59 [95% CI, -1.16 to -0.01]) and better functional well-being per the FACT-L (difference = 1.39 [95% CI, 0.18 to 2.59]) versus the control group. Study groups did not differ in overall quality of life, psychological symptoms, or activity level at 8 weeks or longitudinally over 24 weeks. CONCLUSION For patients with advanced lung cancer, a scalable behavioral intervention alleviated the intractable symptom of dyspnea. Further research is needed on ways to enhance intervention effects over the long-term and across additional outcomes.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kathryn E Post
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Erica Fox
- Dana-Farber Cancer Institute, Boston, MA
| | - Stephen Lo
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | - Dustin J Rabideau
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - William F Pirl
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Mary E Cooley
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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3
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Moine E, Molinier V, Castanyer A, Calvat A, Coste G, Vernet A, Faugé A, Magrina P, Aliaga-Parera JL, Oliver N, Alexandre F, Heraud N. Safety and Efficacy of Pulmonary Rehabilitation for Long COVID Patients Experiencing Long-Lasting Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:242. [PMID: 38397731 PMCID: PMC10888408 DOI: 10.3390/ijerph21020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
Due to the high prevalence and persistence of long COVID, it is important to evaluate the safety and efficacy of pulmonary rehabilitation (PR) for patients who experience long-lasting symptoms more than six months after initial COVID-19 onset. Enrolled patients were admitted for a four-week in-patient-PR due to long COVID symptoms (n = 47). The safety of PR was confirmed by the absence of adverse events. Symptom-related outcomes were evaluated pre- and post-PR with significant score changes for: 6 min walking distance (61 [28 to 103] m), quality of life (mental Short Form-12: 10 [6 to 13], and physical: 9 [6 to 12]), Montreal Cognitive Assessment (1 [0 to 3]), fatigue (MFI-20: -19 [-28 to -8]), dyspnea (DYSPNEA-12: -7 [-9 to -2] and mMRC; -1 [-1 to 0]), Nijmegen questionnaire (-8 [-11 to -5]), anxiety and depression (HADS:-4 [-5 to -2] and -2 [-4 to -1], respectively) and posttraumatic stress disorder checklist scale (-8 [-12 to -4]). At the individual level, the percentage of symptomatic patients for each outcome decreased, with a high response rate, and the number of persistent symptoms per patient was reduced from six at PR initiation to three at the end of the program. Our results show that in-PR is safe and efficient at decreasing long-lasting symptoms experienced by long COVID patients at more than six months after initial disease onset.
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Affiliation(s)
- Espérance Moine
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | - Virginie Molinier
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | | | - Amandine Calvat
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | | | - Antonin Vernet
- Clinique du Souffle La Solane, Inicea, 66340 Osséja, France
| | - Audrey Faugé
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | - Perrine Magrina
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | | | - Nicolas Oliver
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | - François Alexandre
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | - Nelly Heraud
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
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4
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Chen C, Li Z, Zhang Y, Zhou H, Li Y, He W, Ye T, Yang Y. What's the clinical significance of VAS, AOFAS, and SF-36 in progressive collapsing foot deformity. Foot Ankle Surg 2024; 30:103-109. [PMID: 37858492 DOI: 10.1016/j.fas.2023.10.002] [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: 08/07/2023] [Revised: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study aimed to ascertain the minimal clinically important difference (MCID), and substantial clinical benefit (SCB) of the American Orthopedic Foot and Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Short Form-36 Health Survey (SF-36) in progressive collapsing foot deformity (PCFD) surgery. METHODS In this retrospective cohort study, a total of 84 patients with PCFD (84 feet) who underwent surgery between July 2015 and April 2021 were included. The study assessed the patients' subjective perception, as well as their VAS, AOFAS, and SF-36 scores at a minimum two-year follow-up, and these data were subjected to statistical analysis. The study utilized Spearman correlation analysis to determine the degree of correlation between patients' subjective perception and their VAS, AOFAS, and SF-36 scores. The minimal detectable change (MDC), MCID, and SCB for VAS, AOFAS, and SF-36 were calculated using both distribution- and anchor-based methods. The classification outcomes obtained from the distribution- and anchor-based methods were assessed using Cohen's kappa. RESULTS Based on the subjective perception of the patients, a total of 84 individuals were categorized into three groups, with 7 in the no improvement group, 14 in the minimum improvement group, and 63 in the substantial improvement group. Spearman's correlation analysis indicated that the patients' subjective perception exhibited a moderate to strong association with VAS, AOFAS, SF-36 PCS, and SF-36 MCS, with all coefficients exceeding 0.4. The MCID of VAS, AOFAS, SF-36 PCS, and SF-36 MCS in PCFD surgery were determined to be 0.93, 5.84, 4.15, and 4.10 points using the distribution-based method and 1.50, 10.50, 8.34, and 3.03 points using the anchor-based method. The SCB of VAS, AOFAS, SF-36 PCS, and SF-36 MCS in PCFD surgery were 2.50, 18.50, 11.88, and 6.34 points, respectively. Moreover, the preliminary internal validation efforts have demonstrated the practical application and clinical utility of these findings. With the exception of the distribution-based MCID of SF-36 PCS, which showed fair agreement, all other measures demonstrated moderate to almost perfect agreement. CONCLUSIONS The MDC, MCID, and SCB intuitively enhance the interpretation of VAS, AOFAS, and SF-36 in PCFD surgery, assisting all stakeholders to better understand the therapeutic benefits and limitations of clinical care, and thus to make a more rational decision. Each of these parameters has its own emphasis and complements the others. These parameters are recommended for evaluating the clinical relevance of the results, and their promotion should extend to other areas of foot and ankle surgery.
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Affiliation(s)
- Cheng Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - ZhenDong Li
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yi Zhang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - HaiChao Zhou
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - YongQi Li
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - WenBao He
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - TianBao Ye
- Department of Cardiology, Shanghai JiaoTong University Affiliated Sixth Peoples Hospital, Shanghai 200233, China.
| | - YunFeng Yang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
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Almeida MP, Machado Vaz I, Winck JC, Marques A. Inpatient rehabilitation of a person with Guillain-Barré syndrome associated with COVID-19 infection: An expert interdisciplinary approach to a case study. Physiother Theory Pract 2023; 39:2479-2489. [PMID: 35521973 DOI: 10.1080/09593985.2022.2072252] [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: 11/08/2021] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Several cases of Guillain-Barré Syndrome (GBS) associated with a COVID-19 infection have been recently reported. Rehabilitation might be a key player in the recovery of these highly complex patients however, results are yet unknown. This case report aimed to describe the effects of an inpatient rehabilitation program, with an interdisciplinary team approach, in a patient with GBS in the context of a COVID-19 infection. CASE DESCRIPTION A 58-year-old man with GBS after COVID-19 started an inpatient rehabilitation program focused on reducing dyspnea and fatigue symptoms; improving muscle strength, balance, aerobic and functional training; practicing activities of daily living and energy conservation techniques; swallowing training; emotional support and patient and family education about daily routines. An expert interdisciplinary team delivered the intervention, approximately 5 h/day, 5 days/week for 6 weeks. OUTCOMES Improvements were observed in dyspnea, fatigue, nocturnal ventilation, muscle strength, balance, walking capacity, functional status, and swallowing function. CONCLUSION This clinical case report illustrates the impact of a tailored and interdisciplinary rehabilitation program, on promoting recovery in multiple health domains of a patient with GBS associated with COVID-19 infection. Our experience might be useful to guide other inpatient rehabilitation programs to successfully manage these highly complex patients.
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Affiliation(s)
- Miguel P Almeida
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Respiratory Research and Rehabilitation Laboratory (Lab3r), School of Health Sciences (ESSUA) and Institute of Biomedicine (IBiMED), University of Aveiro, Aveiro, Portugal
| | - Inês Machado Vaz
- Serviço de Medicina Física e de Reabilitação - Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal
| | - João Carlos Winck
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3r), School of Health Sciences (ESSUA) and Institute of Biomedicine (IBiMED), University of Aveiro, Aveiro, Portugal
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Rodriguez-Blanco C, Bernal-Utrera C, Anarte-Lazo E, Gonzalez-Gerez JJ, Saavedra-Hernandez M. A 14-Day Therapeutic Exercise Telerehabilitation Protocol of Physiotherapy Is Effective in Non-Hospitalized Post-COVID-19 Conditions: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12030776. [PMID: 36769425 PMCID: PMC9918076 DOI: 10.3390/jcm12030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The emergence of COVID-19 has led to serious public health problems. Now that the acute phase of the pandemic has passed, new challenges have arisen in relation to this disease. The post-COVID-19 conditions are a priority for intervention, as months after the onset of the disease, they continue to present symptoms, especially physical and respiratory symptoms. Our aim is to test the efficacy of a fourteen-day telerehabilitation program of respiratory and strength exercises in people with post-COVID-19 conditions. For this purpose, a randomized controlled trial was generated in which data from 48 patients were analyzed using the BS, 30STSTST, MD12, VAFS, and 6MWT tests. The obtained results showed the benefit of the intervention in generating great results with respect to the control group.
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Affiliation(s)
- Cleofas Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Sevilla, Spain
- Fisiosur I+D Research Institute, 04630 Garrucha, Spain
| | - Carlos Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Sevilla, Spain
- Fisiosur I+D Research Institute, 04630 Garrucha, Spain
| | - Ernesto Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, 41009 Seville, Spain
| | - Juan Jose Gonzalez-Gerez
- Fisiosur I+D Research Institute, 04630 Garrucha, Spain
- Department Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain
- Correspondence:
| | - Manuel Saavedra-Hernandez
- Fisiosur I+D Research Institute, 04630 Garrucha, Spain
- Department Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain
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7
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Huang J, Fan Y, Zhao K, Yang C, Zhao Z, Chen Y, Yang J, Wang T, Qu Y. Do patients with and survivors of COVID-19 benefit from telerehabilitation? A meta-analysis of randomized controlled trials. Front Public Health 2022; 10:954754. [PMID: 36249181 PMCID: PMC9555811 DOI: 10.3389/fpubh.2022.954754] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) significantly impacts physical, psychological, and social functioning and reduces quality of life, which may persist for at least 6 months. Given the fact that COVID-19 is a highly infectious disease and therefore healthcare facilities may be sources of contagion, new methods avoiding face-to-face contact between healthcare workers and patients are urgently needed. Telerehabilitation is the provision of rehabilitation services to patients at a distance via information and communication technologies. However, high-quality evidence of the efficacy of telerehabilitation for COVID-19 is still lacking. This meta-analysis aimed to investigate the efficacy of telerehabilitation for patients with and survivors of COVID-19. Methods We searched the Cochrane Library, EMBASE, Medline (via PubMed), PEDro, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from January 1st, 2020 to April 30th, 2022 for randomized controlled trials published in English, which aimed to evaluate the efficacy of telerehabilitation vs. face-to-face rehabilitation, usual care, or no treatment for COVID-19. Methodological quality and overall evidence quality of the included studies were assessed. The statistical reliability of the data was quantified using the trial sequential analysis. Results Seven randomized controlled trials with eight comparisons were included and all of them were used for meta-analysis. The meta-analyses of absolute values showed the superiority of telerehabilitation over no treatment or usual care for dyspnea (Borg scale: mean difference = -1.88, -2.37 to -1.39; Multidimensional dyspnea-12: mean difference = -3.70, -5.93 to -1.48), limb muscle strength (mean difference = 3.29; 2.12 to 4.47), ambulation capacity (standardized mean difference = 0.88; 0.62 to 1.14), and depression (mean difference = -5.68; -8.62 to -2.74). Significant improvement in these variables persisted in the meta-analyses of change scores. No significant difference was found in anxiety and quality of life. No severe adverse events were reported in any of the included studies. Conclusions Moderate- to very low-quality evidence demonstrates that telerehabilitation may be an effective and safe solution for patients with and survivors of COVID-19 in dyspnea, lower limb muscle strength, ambulation capacity, and depression. Further well-designed studies are required to evaluate the long-term effects, cost-effectiveness, and satisfaction in larger samples.
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Affiliation(s)
- Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Fan
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Kehong Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chunlan Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yin Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaen Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Guangdong, China
| | - Tingting Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Yun Qu
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Rodríguez-Blanco C, Bernal-Utrera C, Anarte-Lazo E, Saavedra-Hernandez M, De-La-Barrera-Aranda E, Serrera-Figallo MA, Gonzalez-Martin M, Gonzalez-Gerez JJ. Breathing exercises versus strength exercises through telerehabilitation in coronavirus disease 2019 patients in the acute phase: A randomized controlled trial. Clin Rehabil 2021; 36:486-497. [PMID: 34783270 DOI: 10.1177/02692155211061221] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the effectiveness of two different exercise-based programs through telerehabilitation in patients with coronavirus disease 2019. DESIGN Randomized, controlled, parallel, double-blinded, three-arm clinical trial. SETTING Patients' homes through telerehabilitation devices. SUBJECTS Subjects with coronavirus disease 2019 in the acute phase. INTERVENTIONS Subjects were divided into three groups: breathing exercises group, strength exercises group or no treatment/control group. MAIN MEASURES We analysed visual analogue scale for fatigue, 6-minute walking test, 30-seconds sit-to-stand test, multidimensional dyspnoea-12 questionnaire and Borg scale at baseline and 14 days later. RESULTS From 93 subjects recruited, 88 were enrolled, and 77 patients (mean [SD] age 39.40 [11.71]) completed the 14-days intervention and were included in the analysis: 26 in strength exercises group, 29 in breathing exercises group and 22 in control group. The intergroup analysis shows significant differences between the study groups and control group in all variables (p < 0.05); Borg scale, multidimensional dyspnoea-12 questionnaire (pre-post intervention score: strength exercises group: 7.85 [6.82] - 4.54[4.82], breathing exercises group: 11.04 [6.49] - 5.32 [3.63], control group: 10.27 [6.49] - 10.59[6.58]), visual analogue scale for fatigue, 6-minute walking test and 30-seconds sit-to-stand test (pre-post intervention score: strength exercises group: 12.19 [4.42] - 13.58 [5.37], breathing exercises group: 11.18 [3.42] - 12.79 [4.00], control group: 10.45 [2.15] - 9.86[1.88]). The greatest effect sizes were found in the variables Borg Scale (R2 = 0.548) and multidimensional dyspnoea-12 questionnaire (R2 = 0.475). CONCLUSIONS Strength exercises group and breathing exercises group obtained significant improvements in fatigue, dyspnoea, perceived effort, and physical state, compared to control group, although the greatest benefits were found for dyspnoea and aerobic capacity in breathing exercises group.
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Affiliation(s)
- Cleofas Rodríguez-Blanco
- Fisiosur I + D Research Institute, Garrucha, Spain.,Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, 16778University of Seville, Spain
| | - Carlos Bernal-Utrera
- Fisiosur I + D Research Institute, Garrucha, Spain.,Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, 16778University of Seville, Spain
| | | | - Manuel Saavedra-Hernandez
- Fisiosur I + D Research Institute, Garrucha, Spain.,Department Nursing, Physiotherapy and Medicine, Faculty of Almeria, 16721University of Almeria, Spain
| | | | | | | | - Juan Jose Gonzalez-Gerez
- Fisiosur I + D Research Institute, Garrucha, Spain.,Department Nursing, Physiotherapy and Medicine, Faculty of Almeria, 16721University of Almeria, Spain
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9
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Grbovic V, Markovic N, Bogojevic P, Nikolic J, Milosevic J, Simovic S, Cekerevac I, Jurišić-Škevin A, Zdravkovic N, Mijailovic S, Zdravkovic N. The effects of respiratory exercises on partial pressures of gases and anxiety in the acute phase of COVID-19 infection. Physiother Theory Pract 2021; 38:2736-2744. [PMID: 34698591 DOI: 10.1080/09593985.2021.1996497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Respiratory exercise in post-COVID-19 significantly improves pulmonary function, exercise capacity and quality of life. Our study aimed to investigate the effect of respiratory exercise on partial pressures of oxygen, carbon dioxide and oxygen saturation in arterial blood and anxiety assessed by the GAD-7 scale in the acute phase of COVID-19 infection. METHODS The study was conducted at the Clinical Center, Kragujevac, from June to July 2020. The study was a prospective clinical trial and included 62 patients with the acute-phase of COVID-19 infection (61.3% males, mean age 60.82 ± 11.72). The duration of the comprehensive pulmonary rehabilitation program was 14 days ± 2.28 days. Oxygen saturation and heart rate were determined by using the pulse oximeter, oxygen flow, and arterial blood gas analysis values by using the gas analyzer. The anxiety assessment was measured using the Generalized Anxiety Disorder (GAD-7). RESULTS The values of oxygen saturation significantly differed before and after the respiratory exercise sessions (95.77 vs 98.02, respectively; p < .001). After the respiratory exercise program, significantly lower values of the GAD-7 scale were observed compared to the values before the respiratory exercise program (p = .049). A significant negative correlation was observed between oxygen saturation after respiratory exercise and age and presence of chronic obstructive pulmonary disease (ρ = -0.329; p = .013; ρ = -0.334; p = .009, respectively). GAD-7 score after respiratory exercise negatively correlated with chronic obstructive pulmonary disease and malignancy (ρ = -0.285; p = .025; ρ = -0.350; p = .005, respectively). CONCLUSION The respiratory exercise program significantly improves oxygen saturation and anxiety levels in COVID-19 patients.
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Affiliation(s)
- Vesna Grbovic
- Department of Physical Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Natasa Markovic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Predrag Bogojevic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jovana Nikolic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jelena Milosevic
- Department of Physical Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Ivan Cekerevac
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Clinic for Pulmology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandra Jurišić-Škevin
- Department of Physical Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Nebojša Zdravkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sara Mijailovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Natasa Zdravkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Center for Gastroenterohepatology, Clinic for Internal Medicine, Clinical Center Kragujevac, Kragujevac, Serbia
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10
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Hsu FS, Huang SR, Huang CW, Huang CJ, Cheng YR, Chen CC, Hsiao J, Chen CW, Chen LC, Lai YC, Hsu BF, Lin NJ, Tsai WL, Wu YL, Tseng TL, Tseng CT, Chen YT, Lai F. Benchmarking of eight recurrent neural network variants for breath phase and adventitious sound detection on a self-developed open-access lung sound database-HF_Lung_V1. PLoS One 2021; 16:e0254134. [PMID: 34197556 PMCID: PMC8248710 DOI: 10.1371/journal.pone.0254134] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/20/2021] [Indexed: 01/15/2023] Open
Abstract
A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm for breath phase detection and adventitious sound detection at the recording level has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchus labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests using long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.
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Affiliation(s)
- Fu-Shun Hsu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | | | | | - Chao-Jung Huang
- Joint Research Center for Artificial Intelligence Technology and All Vista Healthcare, National Taiwan University, Taipei, Taiwan
| | - Yuan-Ren Cheng
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
- Department of Life Science, College of Life Science, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | | | - Jack Hsiao
- HCC Healthcare Group, New Taipei, Taiwan
| | - Chung-Wei Chen
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Li-Chin Chen
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Yen-Chun Lai
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Bi-Fang Hsu
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Nian-Jhen Lin
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
- Division of Pulmonary Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wan-Ling Tsai
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Yi-Lin Wu
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | | | | | - Yi-Tsun Chen
- Heroic Faith Medical Science Co., Ltd., Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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11
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Sobreira M, Almeida MP, Gomes A, Lucas M, Oliveira A, Marques A. Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury. Phys Ther 2021; 101:6039321. [PMID: 33336700 DOI: 10.1093/ptj/pzaa210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/26/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation. METHODS Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean. RESULTS Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL. CONCLUSION Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI. IMPACT Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.
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Affiliation(s)
- Margarida Sobreira
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Miguel P Almeida
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal.,Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Gomes
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal
| | - Marlene Lucas
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Ana Oliveira
- Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Agras do Crasto, Building 30, 3810-193, Aveiro, Portugal
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12
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Machado A, Matos Silva P, Afreixo V, Caneiras C, Burtin C, Marques A. Design of pulmonary rehabilitation programmes during acute exacerbations of COPD: a systematic review and network meta-analysis. Eur Respir Rev 2020; 29:29/158/200039. [PMID: 33208486 DOI: 10.1183/16000617.0039-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
This systematic review aimed to systematise the different designs used to deliver pulmonary rehabilitation during acute exacerbations of COPD (AECOPD) and explore which ones are the most effective. PubMed, Scopus, Web of Science, EBSCO and Cochrane were searched. Randomised controlled trials comparing pulmonary rehabilitation or at least one of its components with usual care or comparing different components of pulmonary rehabilitation were included. Network meta-analysis was conducted in MetaXL 5.3 using a generalised pairwise modelling framework. Pooled effects compared each treatment to usual care. 42 studies were included. Most studies were conducted in an inpatient setting (57%) and started the intervention 24-48 h after hospital admission (24%). Exercise training (71%), education and psychosocial support (57%) and breathing techniques (55%) were the most used components. Studies combining exercise with breathing techniques presented the larger effects on exercise capacity (weighted mean difference (WMD) -41.06, 95% CI -131.70-49.58) and health-related quality of life (WMD 16.07, 95% CI 10.29-21.84), and breathing techniques presented the larger effects on dyspnoea (WMD 1.90, 95% CI 0.53-3.27) and length of hospitalisation (effect size =0.15, 95% CI -0.28-0.57). A few minor adverse events were found.Pulmonary rehabilitation is a safe intervention during AECOPD. Exercise, breathing techniques, and education and psychosocial support seem to be the core components for implementing pulmonary rehabilitation during AECOPD. Studies may now focus on comparisons of optimal timings to start the intervention, total duration of the intervention, duration and frequency of sessions, and intensity for exercise prescription.
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Affiliation(s)
- Ana Machado
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal.,Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | | | - Vera Afreixo
- Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.,Center for Research and Development in Mathematics and Applications, Dept of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Cátia Caneiras
- Healthcare Dept, Nippon Gases Portugal, Vila Franca de Xira, Portugal.,Environmental Health Institute (ISAMB), Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal .,Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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13
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Vitacca M, Malovini A, Balbi B, Aliani M, Cirio S, Spanevello A, Fracchia C, Maniscalco M, Corica G, Ambrosino N, Paneroni M. Minimal Clinically Important Difference in Barthel Index Dyspnea in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:2591-2599. [PMID: 33116476 PMCID: PMC7585803 DOI: 10.2147/copd.s266243] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background The Barthel Index dyspnea (BId) is responsive to physiological changes and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). However, the minimum clinically important difference (MCID) has not been established yet. Aim To identify the MCID of BId in patients with COPD stratified according to the presence of chronic respiratory failure (CRF) or not. Materials and Methods Using the Medical Research Council (MRC) score as an anchor, receiver operating characteristic curves and quantile regression were retrospectively evaluated before and after pulmonary rehabilitation in 2327 patients with COPD (1151 of them with CRF). Results The median post-rehabilitation changes in BId for all patients were −10 (interquartile range = −17 to −3, p<0.001), correlating significantly with changes in MRC (r = 0.57, 95% CI = 0.53 to 0.59, p<0.001). Comparing different methods of assessment, the MCID ranged from −6.5 to −9 points for patients without and −7.5 to −12 points for patients with CRF. Conclusion The most conservative estimate of the MCID is −9 points in patients with COPD, without and −12 in those with CRF. This estimate may be useful in the clinical interpretation of data, particularly in response to intervention studies.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Alberto Malovini
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Pavia, Italy
| | - Bruno Balbi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Veruno, Novara, Italy
| | - Maria Aliani
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Cassano Delle Murge, Bari, Italy
| | - Serena Cirio
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Pavia, Pavia, Italy
| | - Antonio Spanevello
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Tradate, Varese, Italy.,University of Insubria, MACRO, Varese, Italy
| | - Claudio Fracchia
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Montescano, Pavia, Italy
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Telese, Benevento, Italy
| | - Giacomo Corica
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate of the Institute of Lumezzane, Brescia, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Montescano, Pavia, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
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Minimal Clinically Important Differences for Patient-Reported Outcome Measures of Fatigue in Patients With COPD Following Pulmonary Rehabilitation. Chest 2020; 158:550-561. [PMID: 32184112 DOI: 10.1016/j.chest.2020.02.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/26/2019] [Accepted: 02/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fatigue is a burdensome and prevailing symptom in patients with COPD. Pulmonary rehabilitation (PR) improves fatigue; however, interpreting when such improvement is clinically relevant is challenging. Minimal clinically important differences (MCIDs) for instruments assessing fatigue are warranted to better tailor PR and guide clinical decisions. RESEARCH QUESTION This study estimated MCIDs for the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-FS), the modified FACIT-FS, and the Checklist Individual Strength-Fatigue Subscale in patients with COPD following PR. STUDY DESIGN AND METHODS Data from patients with COPD who completed a 12-week community-based PR program were used to compute the MCIDs. The pooled MCID was estimated by calculating the arithmetic weighted mean, resulting from the combination of anchor-based (weight, two-thirds) and distribution-based (weight, one-third) methods. Anchors were patients' and physiotherapists' Global Rating of Change Scale, COPD Assessment Test, St. George's Respiratory Questionnaire (SGRQ), and exacerbations. To estimate MCIDs, we used mean change, receiver-operating characteristic curves, and linear regression analysis for anchor-based approaches, and 0.5 × SD, SE of measurement, 1.96 × SE of measurement, and minimal detectable change for distribution-based approaches. RESULTS Fifty-three patients with COPD (79% male, 68.4 ± 7.6 years of age, and FEV1 48.7 ± 17.4% predicted) were included in the analysis. Exacerbations and the SGRQ-impact and the SGRQ-total scores fulfilled the requirements to be used as anchors. Pooled MCIDs were 4.7 for FACIT-FS, 3.8 for the modified FACIT-FS, and 9.3 for the Checklist Individual Strength-Fatigue Subscale. INTRPRETATION The MCIDs proposed in this study can be used by different stakeholders to interpret PR effectiveness. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03799666; URL: www.clinicaltrials.gov.
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15
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Rebelo P, Oliveira A, Paixão C, Valente C, Andrade L, Marques A. Minimal Clinically Important Differences for Patient-Reported Outcome Measures of Cough and Sputum in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:201-212. [PMID: 32099345 PMCID: PMC6996113 DOI: 10.2147/copd.s219480] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background Cough and sputum are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of minimal clinically important differences (MCIDs). Purpose This study established MCIDs for the Leicester cough questionnaire (LCQ) and the cough and sputum assessment questionnaire (CASA-Q), in patients with COPD after PR. Patients and Methods An observational prospective study was conducted in patients with COPD who participated in a 12-weeks community-based PR program. Anchor- (mean change, receiver operating characteristic curves and linear regression analysis) and distribution-based methods [0.5*standard deviation; standard error of measurement (SEM); 1.96*SEM; minimal detectable change and effect size] were used to compute the MCIDs. The anchors used were: i) patients and physiotherapists global rating of change scale, ii) COPD assessment test, iii) St. George's respiratory questionnaire and iv) occurrence of an exacerbation during PR. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 for anchor- and 1/3 for distribution-based methods). Results Forty-nine patients with COPD (81.6% male, 69.8±7.4years, FEV150.4±19.4%predicted) were used in the analysis. The pooled MCIDs were 1.3 for LCQ and for CASA-Q domains were: 10.6 - cough symptoms; 10.1 - cough impact; 9.5 - sputum symptoms and 7.8 - sputum impact. Conclusion The MCIDs found in this study are potential estimates to interpret PR effects on cough and sputum, and may contribute to guide interventions.
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Affiliation(s)
- Patrícia Rebelo
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Cátia Paixão
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Carla Valente
- Pulmonology Department, Centro Hospitalar Do Baixo Vouga (CHBV), Aveiro, Portugal
| | - Lília Andrade
- Pulmonology Department, Centro Hospitalar Do Baixo Vouga (CHBV), Aveiro, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
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Marques A, Pinho C, De Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med 2020; 162:105861. [PMID: 31916533 DOI: 10.1016/j.rmed.2019.105861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/18/2019] [Accepted: 12/28/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Physiotherapy may play a role in the recovery of signs, symptoms and function of patients with lower respiratory tract infections (LRTI) but its effectiveness is still controversial. OBJECTIVES To assess the effects of respiratory physiotherapy compared with standard pharmacological care on symptoms and function in outpatients with LRTI. DESIGN Single-blind, randomised controlled trial. SETTING Outpatients were recruited from the casualties of a central hospital. PARTICIPANTS Outpatients with LRTI were recruited and randomly allocated to the control (pharmacological) or experimental (pharmacological and respiratory physiotherapy) group. INTERVENTION The intervention consisted of conventional pharmacological treatment and conventional pharmacological treatment plus respiratory physiotherapy. Respiratory physiotherapy included breathing and airway clearance techniques, exercise training and education during 3-weeks, 3 times per week. MAIN OUTCOME MEASURE Primary outcome measures - occupation rate of wheezes Wh%; Secondary outcome measures - number of crackles, peripheral oxygen saturation (SpO2) modified Borg scale (mBorg), modified Medical Research Council scale (mMRC), 6-min walk test (6MWT), forced expiratory volume in 1 s and forced vital capacity, and volume and density of the lung and bronchial tree volume. RESULTS Ninety-seven patients (53 controls and 44 experimental) completed the intervention. After the intervention, both groups improved significantly in all variables (0.0001 < p < 0.04; 0.001<ƞ2<0.092), with the exception of the mBorg. The magnitude of improvement of the experimental group exceeded the control group in the number of crackles, SpO2 levels, mMRC and 6MWT (0.002 < p < 0.032; 0.002<ƞ2<0.092). CONCLUSION Adding respiratory physiotherapy to the pharmacological treatment of outpatients with LRTI results in greater recovery of symptoms and function parameters. TRIAL REGISTRATION NCT02053870.
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Affiliation(s)
- Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | - Cátia Pinho
- Instituto de Telecomunicações (IT) and Department of Electronics, Telecommunications and Informatics (DETI), University of Aveiro, 3810-193, Aveiro, Portugal.
| | - Silvia De Francesco
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal.
| | - Paula Martins
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal; Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal.
| | - Joana Neves
- Centro Hospital Do Baixo Vouga, Internal Medicine Department, Aveiro, Portugal.
| | - Ana Oliveira
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
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17
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Machado A, Oliveira A, Valente C, Burtin C, Marques A. Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease – A quasi-experimental pilot study. Pulmonology 2020; 26:27-38. [DOI: 10.1016/j.pulmoe.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022] Open
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Rodríguez Torres J, Cabrera Martos I, López López L, Torres Sánchez I, Granados Santiago M, Valenza MC. Psychological distress at hospital admission is related to symptoms severity and health status in malignant pleural effusion patients. Eur J Cancer Care (Engl) 2019; 29:e13212. [PMID: 31880035 DOI: 10.1111/ecc.13212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 12/09/2022]
Abstract
OBJECTIVE The incidence and associated healthcare costs of malignant pleural effusion (MPE) are expected to rise, but there is limited evidence about which factors affect patients' prognosis. So, the aim of this study was to determine whether psychological distress at hospital admission is associated with symptom severity and health status in patients with MPE. METHODS A longitudinal observational prospective cohort study was carried out in the Pulmonology Service of the Granada University Hospital Complex in Granada, Spain. Patients diagnosed with MPE were included and evaluated at hospital admission, at discharge and at one month after discharge. Outcome measures included symptom severity (i.e. dyspnoea, pain and cough) and health status (functionality and self-perceived health status). RESULTS Significant differences were found in symptoms and the health status, with worse results in the group with psychological distress at discharge. One month after discharge, MPE patients with psychological distress exhibited greater symptoms, including more cough and dyspnoea (p < .05). Moreover, these patients showed worse functionality (p < .05) and self-perceived health status (p < .05). CONCLUSION Psychological distress is an important factor to take into account in patients with MPE. The presence of psychological distress appears to increase the symptoms and is associated with worse health status after hospitalisation.
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Affiliation(s)
- Janet Rodríguez Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - María Granados Santiago
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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