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Schmucker M, Küpper A, Mahler C, Elsbernd A. The usability of rollators as part of the human-centred quality of mobility devices: a systematic narrative literature review. Disabil Rehabil Assist Technol 2024:1-18. [PMID: 38963016 DOI: 10.1080/17483107.2024.2368651] [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: 10/05/2023] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
Purpose: The aim of this literature review was to identify and summarize aspects of the usability of rollators from the currently available research literature. Further objectives were the exploration of rollator requirements and the search for possible disciplinary differences in the consideration or elaboration of usability aspects. Materials and Methods: Following the PRISMA guidelines, the databases CINAHL, Pubmed and Academic Search Elite were examined in the period from April - May 2023. For the synthesis of the quantitative and qualitative data and the identification of prominent themes in this work, a theory driven thematic analysis approach was used. Results: A total of 45 publications were included (25 quantitative, 14 mixed methods, 6 qualitative) from various disciplines, the majority belonging to physiotherapy 42%, followed by engineering 16% and health sciences 16%. Aspects of usability were extracted using a deductive code catalogue based on QUEST 2.0. The categories "easy to use" (28/126), "comfort" (20/126), and "safety" (14/126) were most frequently assigned. While "repairs & servicing" (5/126), "service delivery" (4/126), and "durability" (3/126) were coded least frequently. Conclusion: So far, no specific publications on the usability of rollators has been published, which made it necessary to summarize individual usability aspects using a deductive code catalogue. The results obtained, therefore, do not allow any generalized statement about the usability of rollators. However, this initiates discussions about the usability of rollators that should be studied in the future in a participatory and user-centred manner and, placing satisfaction more in the focus of usability engineering and evaluation of rollators.
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Affiliation(s)
- Marcel Schmucker
- Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen, Germany
- Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Andreas Küpper
- Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen, Germany
- Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Cornelia Mahler
- Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Astrid Elsbernd
- Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen, Germany
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Prihartadi AS, Impelliziere Licastro G, Pearson M, Johnson MJ, Luckett T, Swan F. Non-medical devices for chronic breathlessness: use, barriers and facilitators for patients, carers and clinicians - a scoping review. BMJ Support Palliat Care 2023; 13:e244-e253. [PMID: 34215567 DOI: 10.1136/bmjspcare-2021-002962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Non-medical devices such as the handheld fan (fan), mobility aids (wheeled walkers with seats) and inspiratory muscle training (IMT) devices offer benefits for patient management of chronic breathlessness. We examined the published evidence regarding patient, carer and clinician use of the fan, mobility aids and IMT devices for chronic breathlessness management, and the potential barriers and facilitators to day-to-day use in a range of settings. METHODS MEDLINE, Embase, Scopus, EBSCO and the Cochrane Database of Systematic Reviews were searched. Papers were imported into EndNote and Rayyan for review against a priori eligibility criteria. Outcome data relevant to use were extracted and categorised as potential barriers and facilitators, and a narrative synthesis exploring reasons for similarities and differences conducted. RESULTS Seven studies met the inclusion criteria (n=5 fan, n=2 mobility aids and n=0 IMT devices). All of the studies presented patient use of non-medical devices only. Patients found the fan easy to use at home. Mobility aids were used mainly for outdoor activities. Outdoor use for both devices were associated with embarrassment. Key barriers included: appearance; credibility; self-stigma; technical specifications. Common facilitators were ease of use, clinical benefit and feeling safe with the device. CONCLUSION The efforts of patients, carers and clinicians to adopt and use non-medical devices for the management of chronic breathlessness is impeded by lack of implementation research. Future research should improve knowledge of the barriers and facilitators to use. This would enhance understanding of how decision-making in patient-carer-clinician triads impacts on non-medical devices use for breathlessness management.
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Affiliation(s)
| | | | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Tim Luckett
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Riegler TF, Frei A, Haile SR, Radtke T. Accompanied versus unaccompanied walking for continuous oxygen saturation measurement during 6-min walk test in COPD: a randomised crossover study. ERJ Open Res 2021; 7:00921-2020. [PMID: 34350276 PMCID: PMC8326679 DOI: 10.1183/23120541.00921-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/13/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to determine if there is a difference in 6-min walk test (6MWT) distance when the assessor accompanies the patient to continuously measure peripheral oxygen saturation (SpO2) compared to the patient walking unaccompanied. We conducted a randomised crossover study to evaluate the impact of the assessor walking with the patient during the 6MWT (6MWTwith) versus the patient walking alone (6MWTwithout). At the end of a pulmonary rehabilitation programme, each patient performed two 6MWTs in random order and separated by a 30-min rest. 49 patients with chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease classification II–IV) were included. In a regression model adjusting for period and subject, accompanying the patient resulted in a lower walking distance (mean difference −9.1 m, 95% CI −13.9– −4.3, p=0.0004). Notably, six patients walked more than 30 m farther (minimal important difference) in one of the two conditions (6MWTwith: n=1, 6MWTwithout: n=5). There were no between-sequence-group differences in heart rate, dyspnoea, leg fatigue and SpO2. The median (interquartile range) number and duration of SpO2 signal artefacts were high but not different between the experimental conditions (6MWTwith: 17 (4–24), 34 s (7–113 s); 6 MWTwithout: 11 (3–26), 24 s (4–62 s)). At a study population level, we observed a statistically significant difference in 6MWT distance between the two experimental conditions; however, the magnitude of difference was small and may not be clinically relevant. Nevertheless, in a clinical setting, unaccompanied walking resulted in a substantially higher walking distance in individual patients, pointing towards strictly standardised testing methodology, in particular in pre–post study designs. Accompanied walking during a 6MWT versus unaccompanied walking results in shorter walked distance (mean difference −9.1 m, 95% CI −13.9– −4.3 m). No differences in nadir SpO2 or oximetry artefacts were noted between accompanied and unaccompanied walking.https://bit.ly/3tBjfCq
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Affiliation(s)
- Thomas F Riegler
- Berner Reha Zentrum AG, Heiligenschwendi, Switzerland.,Institute for Physiotherapy, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Clinical and Physiological Effects of Rollators in Individuals With Chronic Obstructive Pulmonary Disease: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2017; 38:366-373. [PMID: 29120969 DOI: 10.1097/hcr.0000000000000280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the effects of using a rollator in people with chronic obstructive pulmonary disease (COPD). METHODS Studies were systematically identified from literature searches of MEDLINE, CINAHL, PEDro, PubMed, EMBASE, and the Cochrane Library databases and the reference lists of included studies. Two reviewers independently selected randomized controlled or crossover studies examining the effects of rollator usage compared with no aid in individuals with COPD. Methodologic quality was assessed by 2 reviewers independently using the Cochrane Risk of Bias tool. Two reviewers also used a customized form to extract characteristics of and outcomes for subjects related to exercise capacity, symptoms, health-related quality of life (HRQOL), physiological, and gait parameters. Weighted mean differences (WMD) with 95% CI were calculated using a fixed-effects model. RESULTS A total of 7 studies (126 participants) were included. Use of a rollator during a 6-Minute Walk Test (6MWT) improved distance walked (WMD = 13 m; 95% CI, 5-22) and lowered end-6MWT dyspnea rating (WMD = 0.97; 95% CI, 0.63-1.32). Longer-term use did not appear to impact exercise capacity or HRQOL, although this may be related to the frequency of use. CONCLUSIONS When used in the short-term, rollators resulted in a small increase in 6MWT and a reduction in dyspnea. Details on patient adherence are required to accurately evaluate the longer-term effects of rollator usage.
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Holland AE, Spruit MA, Singh SJ. How to carry out a field walking test in chronic respiratory disease. Breathe (Sheff) 2015; 11:128-39. [PMID: 26306113 PMCID: PMC4487379 DOI: 10.1183/20734735.021314] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
EDUCATIONAL AIMS To provide recommendations for conducting field walking tests in people with chronic respiratory disease, from the new European Respiratory Society/American Thoracic Society Technical StandardTo provide information to assist in selecting a field walking test in people with chronic respiratory disease. KEY POINTS The 6MWT, ISWT and ESWT are valid and reliable tests of functional exercise capacity in people with COPD. The 6MWT is also widely used in other chronic respiratory disorders.There is a learning effect for the 6MWT and ISWT, so two tests must be performed if the tests are being used to measure change over time, with the best distance recorded.The 6MWT is very sensitive to changes in the way it is conducted, including use of encouragement, provision of supplemental oxygen, changes in track layout and length, and use of wheeled walkers. These factors should be held constant when the test is repeated.The 6MWT, ISWT and ESWT are strenuous tests, with cardiorespiratory responses that are similar to those during a maximal incremental exercise test. As a result, the contraindications and precautions for these field walking tests should be the same as for a laboratory-based incremental exercise test. SUMMARY The European Respiratory Society (ERS) and American Thoracic Society (ATS) have recently published a Technical Standard which documents the standard operating procedures for the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT). The Technical Standard shows that all three tests are valid and reliable measures of functional exercise capacity in people with chronic respiratory disease and makes recommendations for standardising their performance. Key findings and recommendations of the Technical Standard include: The 6MWT, ISWT and ESWT are strenuous tests which elicit cardiorespiratory responses that are similar to those observed during a maximal incremental exercise test. As a result, the contraindications and precautions for field walking tests should be consistent with those used for a laboratory-based incremental exercise test.There is strong evidence of a learning effect for the 6MWT and ISWT. Two tests should be performed when the 6MWT or ISWT are used to measure change over time.The 6MWT, ISWT and ESWT are responsive to treatment effects in people with chronic respiratory disease, particularly for rehabilitation.The 6MWT is very sensitive to variations in methodology, including use of encouragement, provision of supplemental oxygen, changes in track layout and length, and use of wheeled walkers. These factors should be documented and held constant on repeat testing.The lowest S pO2 recorded during a 6MWT is an important marker of disease severity and prognosis. Continuous pulse oximetry is recommended during the 6MWT, to ensure that the lowest S pO2 is recorded.In adults with chronic respiratory disease, a change in 6-min walk distance of 30 m or more indicates a clinically significant change has occurred.
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Affiliation(s)
- Anne E Holland
- Dept of Physiotherapy, La Trobe University, Melbourne, Australia ; Dept of Physiotherapy, Alfred Health, Melbourne, Australia ; Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Martijn A Spruit
- Dept of Research & Education, CIRO+ centre of expertise for chronic organ failure, Horn, the Netherlands ; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK ; Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Fotheringham I, Meakin G, Punekar YS, Riley JH, Cockle SM, Singh SJ. Comparison of laboratory- and field-based exercise tests for COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2015; 10:625-43. [PMID: 25834421 PMCID: PMC4372024 DOI: 10.2147/copd.s70518] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Exercise tests are often used to evaluate the functional status of patients with COPD. However, to the best of our knowledge, a comprehensive systematic comparison of these tests has not been performed. We systematically reviewed studies reporting the repeatability and/or reproducibility of these tests, and studies comparing their sensitivity to therapeutic intervention. A systematic review identified primary manuscripts in English reporting relevant data on the following exercise tests: 6-minute walk test (6MWT) and 12-minute walk test, incremental and endurance shuttle walk tests (ISWT and ESWT, respectively), incremental and endurance cycle ergometer tests, and incremental and endurance treadmill tests. We identified 71 relevant studies. Good repeatability (for the 6MWT and ESWT) and reproducibility (for the 6MWT, 12-minute walk test, ISWT, ESWT, and incremental cycle ergometer test) were reported by most studies assessing these tests, providing patients were familiarized with them beforehand. The 6MWT, ISWT, and particularly the ESWT were reported to be sensitive to therapeutic intervention. Protocol variations (eg, track layout or supplemental oxygen use) affected performance significantly in several studies. This review shows that while the validity of several tests has been established, for others further study is required. Future work will assess the link between these tests, physiological mechanisms, and patient-reported measures.
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Affiliation(s)
- Iain Fotheringham
- Value Demonstration Practice, Oxford PharmaGenesis, Oxford, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Georgina Meakin
- Value Demonstration Practice, Oxford PharmaGenesis, Oxford, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yogesh Suresh Punekar
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - John H Riley
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah M Cockle
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, McCormack MC, Carlin BW, Sciurba FC, Pitta F, Wanger J, MacIntyre N, Kaminsky DA, Culver BH, Revill SM, Hernandes NA, Andrianopoulos V, Camillo CA, Mitchell KE, Lee AL, Hill CJ, Singh SJ. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014; 44:1428-46. [PMID: 25359355 DOI: 10.1183/09031936.00150314] [Citation(s) in RCA: 1441] [Impact Index Per Article: 144.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Field walking tests are commonly employed to evaluate exercise capacity, assess prognosis and evaluate treatment response in chronic respiratory diseases. In recent years, there has been a wealth of new literature pertinent to the conduct of the 6-min walk test (6MWT), and a growing evidence base describing the incremental and endurance shuttle walk tests (ISWT and ESWT, respectively). The aim of this document is to describe the standard operating procedures for the 6MWT, ISWT and ESWT, which can be consistently employed by clinicians and researchers. The Technical Standard was developed by a multidisciplinary and international group of clinicians and researchers with expertise in the application of field walking tests. The procedures are underpinned by a concurrent systematic review of literature relevant to measurement properties and test conduct in adults with chronic respiratory disease. Current data confirm that the 6MWT, ISWT and ESWT are valid, reliable and responsive to change with some interventions. However, results are sensitive to small changes in methodology. It is important that two tests are conducted for the 6MWT and ISWT. This Technical Standard for field walking tests reflects current evidence regarding procedures that should be used to achieve robust results.
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Affiliation(s)
- Anne E Holland
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Martijn A Spruit
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Thierry Troosters
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Milo A Puhan
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Véronique Pepin
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Didier Saey
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Meredith C McCormack
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Brian W Carlin
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Frank C Sciurba
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Fabio Pitta
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Jack Wanger
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Neil MacIntyre
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - David A Kaminsky
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Bruce H Culver
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Susan M Revill
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Nidia A Hernandes
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | | | | | - Katy E Mitchell
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Annemarie L Lee
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Catherine J Hill
- For a full list of the authors' affiliations please refer to the Acknowledgements
| | - Sally J Singh
- For a full list of the authors' affiliations please refer to the Acknowledgements
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Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, Lee AL, Camillo CA, Troosters T, Spruit MA, Carlin BW, Wanger J, Pepin V, Saey D, Pitta F, Kaminsky DA, McCormack MC, MacIntyre N, Culver BH, Sciurba FC, Revill SM, Delafosse V, Holland AE. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J 2014; 44:1447-78. [DOI: 10.1183/09031936.00150414] [Citation(s) in RCA: 493] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease.Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013.The 6-min walking distance (6MWD) is a reliable measure (intra-class correlation coefficients ranged from 0.82 to 0.99 in seven studies). There is a learning effect, with greater distance walked on the second test (pooled mean improvement of 26 m in 13 studies). Reliability was similar for ISWT and ESWT, with a learning effect also evident for ISWT (pooled mean improvement of 20 m in six studies). The 6MWD correlates more strongly with peak work capacity (r=0.59–0.93) and physical activity (r=0.40–0.85) than with respiratory function (r=0.10–0.59). Methodological factors affecting 6MWD include track length, encouragement, supplemental oxygen and walking aids. Supplemental oxygen also affects ISWT and ESWT performance. Responsiveness was moderate to high for all tests, with greater responsiveness to interventions that included exercise training.The findings of this review demonstrate that the 6MWT, ISWT and ESWT are robust tests of functional exercise capacity in adults with chronic respiratory disease.
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2126] [Impact Index Per Article: 193.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Bausewein C, Booth S, Gysels M, Higginson IJ. WITHDRAWN: Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev 2013; 2013:CD005623. [PMID: 24272974 PMCID: PMC6564079 DOI: 10.1002/14651858.cd005623.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review is now out of date although it is correct as of the date of publication [Issue 2, 2008]. The authors are developing a new protocol which will replace this review. Publication of the protocol is expected in 2014, and serves to update the existing review and incorporate the latest evidence into a new Cochrane Review. The latest version of this review (available in 'Other versions' tab on The Cochrane Library) may still be useful to readers until the new review is published. In 2016, the replacement review titled 'Non‐pharmacological interventions for breathlessness in advanced stages of malignant and non‐malignant diseases' was deregistered and split into four separate reviews of individual interventions: Respiratory interventions for breathlessness in adults with advanced diseases; Physical interventions for breathlessness in adults with advanced diseases; Cognitive‐emotional interventions for breathlessness in adults with advanced diseases; Multi‐dimensional interventions for breathlessness in adults with advanced diseases. At September 2020, these replacement titles were deregistered (Multi‐dimensional interventions) or the protocols withdrawn (Cognitive‐emotional interventions; Multi‐dimensional interventions; Respiratory interventions) as they did not meet Cochrane standards or expectations. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Claudia Bausewein
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Kings College London, Bessemer Road, Denmark Hill, London, UK, SE5 9PJ
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O’Hare MP, Pryde SJ, Gracey JH. A systematic review of the evidence for the provision of walking frames for older people. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J 2012; 18:69-78. [PMID: 21499589 DOI: 10.1155/2011/745047] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD), and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts. The evidence supports the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in the individual patient with advanced COPD. Oxygen is recommended for COPD patients with resting hypoxemia, but its use for the targeted management of dyspnea in this setting should be reserved for patients who receive symptomatic benefit. There is insufficient evidence to support the routine use of anxiolytic medications, nebulized opioids, acupuncture, acupressure, distractive auditory stimuli (music), relaxation, handheld fans, counselling programs or psychotherapy. There is also no evidence to support the use of supplemental oxygen to reduce dyspnea in nonhypoxemic patients with advanced COPD. Recognizing the current unfamiliarity with prescribing and dosing of opioid therapy in this setting, a potential approach for their use is illustrated. The role of opioid and other effective therapies in the comprehensive management of refractory dyspnea in patients with advanced COPD is discussed.
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Rollator Use Does Not Consistently Change the Metabolic Cost of Walking in People With Chronic Obstructive Pulmonary Disease. Arch Phys Med Rehabil 2012; 93:1077-80. [DOI: 10.1016/j.apmr.2012.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/10/2012] [Accepted: 01/13/2012] [Indexed: 11/18/2022]
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El Helou A, Bastuji-Garin S, Paillaud E, Gracies JM, Skalli W, Decq P. Determinants for the use of ambulation AIDS in a geriatric rehabilitation care unit: a retrospective study. J Am Med Dir Assoc 2011; 13:279-83. [PMID: 21450233 DOI: 10.1016/j.jamda.2010.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/03/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed at assessing the profile of ambulation aid users among patients admitted for geriatric rehabilitation care. DESIGN Retrospective chart review. SETTING Geriatric Rehabilitation Department of the Hôpital Albert Chenevier, Créteil, France. PARTICIPANTS The sample comprised 206 records of patients aged 65 or older with no previous use of assistive device before admission and length of stay longer than 7 days. MEASUREMENTS Ambulation levels were classified as independent ambulators (IA, reference category), ambulation aid users (AA), or nonambulatory patients (NA). we explored age, gender, purpose of initial admission, comorbidities, and past medical history as factors potentially associated with ambulation levels, using multinomial logistic regression. RESULTS The study population (mean age 84 years [6.1 standard deviation], 68.5 % women) comprised 110 IA (53.4% of the overall population), 72 AA (34.9%), and 24 NA (11.6%). Factors independently associated with AA use were the following: older age (odds ratio = 1.17; [95% confidence interval 1.09-1.25]), previous history of lower limb surgery (2.15; [1.0-4.73]), and admission for hip surgery (8.14; [2.60-25.53]). Factors independently associated with NA were the following: older age (1.12 [1.02-1.23]) and low Mini-Mental State Exam score (0.77 [0.70-0.85]). A borderline association was observed for visual impairment (3.36 [0.93-12.95]). Cardiac disease, respiratory disease, falls, and dementia were not associated with ambulation aid use. CONCLUSIONS History of lower-limb surgery, particularly recent hip surgery, and old age are the primary predictive factors of ambulation aid use in a geriatric rehabilitation hospital.
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Affiliation(s)
- Amine El Helou
- Arts et Métiers ParisTech, Laboratoire de Biomécanique (LBM), Paris, France.
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Cavalheri V, Camillo C, Brunetto A, Probst V, Cipulo Ramos E, Pitta F. Efeitos do apoio dos membros superiores sobre a força muscular respiratória e função pulmonar de doentes com doença pulmonar obstrutiva crónica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)31250-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Rejbi IBC, Trabelsi Y, Chouchene A, Ben Turkia W, Ben Saad H, Zbidi A, Kerken A, Tabka Z. Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects. Int J Chron Obstruct Pulmon Dis 2010; 5:209-15. [PMID: 20714374 PMCID: PMC2921688 DOI: 10.2147/copd.s7955] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Indexed: 11/30/2022] Open
Abstract
Background: The six-minute walking distance (6MWD) test has demonstrated validity and reliability to assess changes in functional capacity following pulmonary rehabilitation in patients with chronic obstructive lung disease. However, no attempt has been made to establish an iterative measurement of 6MWD during the overall period of pulmonary rehabilitation. Therefore, the aim of this study was to evaluate the impact of a twelve-week rehabilitation program on the iterative weekly measurement of 6MWD in chronic obstructive pulmonary disease (COPD) patients and healthy subjects. Methods: Twenty-six patients with COPD and nine age-matched healthy subjects were studied. Measurements were taken at baseline and after twelve weeks except for the 6MWD. The exercise measurements included a six-minute walking test (6MWT) and an incremental exercise test. Oxygen saturation, heart rate, and dyspnea will be monitored during all these tests. Results: At baseline there were significant differences between groups, except in age, body mass index, and oxygen saturation. After 12 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. The 6MWD, peak oxygen uptake V̇O2peak and anaerobic threshold increased significantly after training in both groups (P < 0.01). The averaged trace of the 6MWD of patients with COPD and healthy subjects was followed-up respectively by a logarithmic and linear fitting. 6MWD showed a plateau after eight weeks in patients with COPD, however, it increased continually overall in healthy subjects. Conclusion: Both patients with COPD and healthy subjects demonstrated functional responses to training but with somewhat different patterns in quality of the improvement of the 6MWD.
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Perez Bogerd S, Selleron B, Hotton R, Ferrali O, Sergysels R. Les techniques de médecine physique peuvent-elles pallier la distension ? Rev Mal Respir 2009; 26:1107-17. [DOI: 10.1016/s0761-8425(09)73537-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Simon ST, Bausewein C. Management of refractory breathlessness in patients with advanced cancer. Wien Med Wochenschr 2009; 159:591-8. [DOI: 10.1007/s10354-009-0728-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 10/09/2009] [Indexed: 10/19/2022]
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Thomas B, Connelly D, Laliberte-Rudman D. The Impact and Use of Walkers among Older Adults: A Pilot. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/02703180802275327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bausewein C, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev 2008:CD005623. [PMID: 18425927 DOI: 10.1002/14651858.cd005623.pub2] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Breathlessness is a common and distressing symptom in the advanced stages of malignant and non-malignant diseases. Appropriate management requires both pharmacological and non-pharmacological interventions. OBJECTIVES The primary objective was to determine the effectiveness of non-pharmacological and non-invasive interventions to relieve breathlessness in participants suffering from the five most common conditions causing breathlessness in advanced disease. SEARCH STRATEGY We searched the following databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index, PsycINFO, Science Citation Index Expanded, AMED, The Cochrane Pain, Palliative and Supportive Care Trials Register, The Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effectiveness in June 2007. We also searched various websites and reference lists of relevant articles and textbooks. SELECTION CRITERIA We included randomised controlled and controlled clinical trials assessing the effects of non-pharmacological and non-invasive interventions to relieve breathlessness in participants described as suffering from breathlessness due to advanced stages of cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease, chronic heart failure or motor neurone disease. DATA COLLECTION AND ANALYSIS Two review authors independently assessed relevant studies for inclusion. Data extraction and quality assessment was performed by three review authors and checked by two other review authors. Meta-analysis was not attempted due to heterogeneity of studies. MAIN RESULTS Forty-seven studies were included (2532 participants) and categorised as follows: single component interventions with subcategories of walking aids (n = 7), distractive auditory stimuli (music) (n = 6), chest wall vibration (CWV, n = 5), acupuncture/acupressure (n = 5), relaxation (n = 4), neuro-electrical muscle stimulation (NMES, n = 3) and fan (n = 2). Multi-component interventions were categorised in to counselling and support (n = 5), breathing training (n = 3), counselling and support with breathing-relaxation training (n = 2), case management (n = 2) and psychotherapy (n = 2). There was a high strength of evidence that NMES and CWV could relieve breathlessness and moderate strength for the use of walking aids and breathing training. There is a low strength of evidence that acupuncture/acupressure is helpful. There is not enough data to judge the evidence for distractive auditory stimuli (music), relaxation, fan, counselling and support, counselling and support with breathing-relaxation training, case management and psychotherapy. Most studies have been conducted in COPD patients, only a few studies included participants with other conditions. AUTHORS' CONCLUSIONS Breathing training, walking aids, NMES and CWV appear to be effective non-pharmacological interventions for relieving breathlessness in advanced stages of disease.
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Affiliation(s)
- C Bausewein
- King's College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, Denmark Hill, London, UK, SE5 9RJ.
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Derom E, Marchand E, Troosters T. Pulmonary rehabilitation in chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2007; 50:615-26, 602-14. [PMID: 17559963 DOI: 10.1016/j.annrmp.2007.04.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 04/24/2007] [Indexed: 10/23/2022]
Abstract
Pulmonary rehabilitation, a multidisciplinary and structured intervention for patients with chronic pulmonary diseases, has been shown to improve exercise tolerance, reduce dyspnea and improve health-related quality of life. Pulmonary rehabilitation appears to be cost-effective, since it reduces health care utilization. Exercise training represents the cornerstone of every pulmonary rehabilitation program. To obtain clinically relevant effects, training should closely supervised, of high intensity, lasting 30-45 min for at least 3 days/week. Patients should undertake a minimum of 20 sessions, but longer programs result in larger and more long-lasting effects. Education and self-management programs have been shown to result in a substantial reduction in hospital admissions. Nutritional intervention should be considered for patients who are underweight or those with body composition abnormalities. Patients reporting fear and anxiety may benefit from psychosocial support, and the integration of occupational therapy in a pulmonary rehabilitation program can improve independence in activity. Multidisciplinary pulmonary rehabilitation is preferably implemented in an outpatient hospital- or community-based setting. Inpatient programs are suited for patients with limited transportation capabilities or severe deconditioning. The most convincing effects of home-based rehabilitation are in maintaining the improvements obtained in an outpatient setting.
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Affiliation(s)
- E Derom
- Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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22
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Derom E, Marchand E, Troosters T. Réhabilitation du malade atteint de bronchopneumopathie chronique obstructive. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Jenkins SC. 6-Minute walk test in patients with COPD: clinical applications in pulmonary rehabilitation. Physiotherapy 2007. [DOI: 10.1016/j.physio.2007.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Crisafulli E, Costi S, De Blasio F, Biscione G, Americi F, Penza S, Eutropio E, Pasqua F, Fabbri LM, Clini EM. Effects of a Walking Aid in COPD Patients Receiving Oxygen Therapy. Chest 2007; 131:1068-74. [PMID: 17426211 DOI: 10.1378/chest.06-2108] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister. DESIGN Randomized crossover trial. SETTING Physiopathology laboratory of three rehabilitation centers. PATIENTS AND INTERVENTIONS We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality). MEASUREMENTS AND RESULTS The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline. CONCLUSIONS This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.
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Affiliation(s)
- Ernesto Crisafulli
- University of Modena-Reggio Emilia, Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, Italy, Via Gaiato 127, 41026 Pavullo n/F (MO), USA
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Andersen DA, Roos BA, Stanziano DC, Gonzalez NM, Signorile JF. Walker use, but not falls, is associated with lower physical functioning and health of residents in an assisted-living environment. Clin Interv Aging 2007; 2:123-37. [PMID: 18044085 PMCID: PMC2684088 DOI: 10.2147/ciia.2007.2.1.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The relationship between perceived health and walker use has seldom been addressed. Concerns over falls and falls risk are precursors to walker use. We compared the SF-36 scores of 26 women and 14 men, mean age 86.8 +/- 6.0 years based on walker use and faller status. An analysis of covariance (ANCOVA) with age as the covariate, compared groups for the SF-36 constructs and totals score. Significant differences were noted between walker users and nonusers in physical functioning, role limitations due to physical problems, general health, and the total SF-36 score. Pairwise comparisons favored nonusers, while no differences were seen due to faller status. Walker use is associated with lower self-perceptions of physical functioning, role limitations due to physical problems, and general health in assisted-living residents. Faller status is not associated with self-perceived health status. Although walker use aids mobility and lowers the probability of falls, further research is needed to determine if the prescription of assistive devices has a more negative impact on self-perceived health than does falling. This possibility could be explained, in part, by the greater activity levels of those individuals who do not depend on walkers.
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Affiliation(s)
- Daniel A Andersen
- Stein Gerontological Institute, Miami, FL
- Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, FL, USA
| | | | - Damian C Stanziano
- Stein Gerontological Institute, Miami, FL
- Department of Exercise and Sport Sciences, University of Miami, Coral Gables, FL
| | - Natasha M Gonzalez
- Department of Exercise and Sport Sciences, University of Miami, Coral Gables, FL
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Gupta RB, Brooks D, Lacasse Y, Goldstein RS. Effect of Rollator Use on Health-Related Quality of Life in Individuals With COPD. Chest 2006; 130:1089-95. [PMID: 17035442 DOI: 10.1378/chest.130.4.1089] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. DESIGN Randomized controlled trial. METHODS Thirty-one postrehabilitation patients with COPD were randomized to receive a rollator (n = 18) or usual care (n = 13) for 8 weeks and to record the frequency of rollator use. Outcome measures at baseline, 4 weeks, and 8 weeks included the Chronic Respiratory Questionnaire (CRQ) and the 6-min walk (6MW). RESULTS During acute testing, subjects consistently walked further when assisted (baseline 6MW: 292 +/- 67 m vs 263 +/- 67 m; 8 weeks: 283 +/- 65 m vs 259 +/- 68 m [+/-SD]; p = 0.013). However, provision of a rollator at home was not associated with group differences in the CRQ (p > 0.08) or in the unassisted 6MW (p = 0.4) or the assisted 6MW (p = 0.5). Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week. Regular users demonstrated a consistent improvement in mastery compared with infrequent users (4 weeks: 4.7 +/- 0.6 vs 5.2 +/- 0.8, respectively; 8 weeks: 5.3 +/- 0.8 vs 4.7 +/- 0.4; p = 0.014). CONCLUSIONS Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it.
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Affiliation(s)
- Renu B Gupta
- University of Toronto, West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON, Canada M6M 2J5
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Abstract
PURPOSE To investigate whether the acute benefits of rollator use are consistent over time in individuals with moderate to severe chronic obstructive pulmonary disease. METHODS Thirty-one stable subjects with chronic obstructive pulmonary disease (13 men, 18 women), aged 68 +/- 8 years, with a forced expiratory volume in 1 second of 0.7 +/- 0.2 L (33% +/- 12% predicted) and a baseline 6-minute walk (6MW) of 261 +/- 68 m, were recruited from a respiratory clinic after completion of a pulmonary rehabilitation program. Two 6MWs were performed at baseline, 4 weeks, and 8 weeks, one walking unaided and the other walking with the assistance of a rollator. The test order was randomly chosen at baseline, and the same test order was used at each time point. The primary outcome measures were distance walked in 6 minutes (meters), perceived dyspnea using a modified Borg scale, and number of rests taken. RESULTS Subjects achieved higher 6MW distances during assisted compared with unassisted walking at baseline (292 +/- 67 vs 263 +/- 67 m), 4 weeks (296 +/- 62 vs 275 +/- 63m), and 8 weeks (283 +/- 65 vs 259 +/- 68 m) (P = .013), with no time effect (P = .5). In addition, use of a rollator resulted in a significant improvement in dyspnea (P = .004) at baseline, 4 weeks, and 8 weeks, with no time effect (P = .7). The use of a rollator also reduced the number of rests taken during the 6MW (P < .001), with no time effect (P = .9). CONCLUSIONS Rollator use resulted in improvements in performance in the 6MW, which were consistent over time among individuals with moderate to severe chronic obstructive pulmonary disease who walk less than 375 m during an unaided 6MW.
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Affiliation(s)
- Renu Gupta
- Graduate Department of Rehabilitation Science, University of Toronto, Ontario, Canada
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Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2005; 172:19-38. [PMID: 15778487 DOI: 10.1164/rccm.200408-1109so] [Citation(s) in RCA: 295] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thierry Troosters
- Respiratory Rehabilitation and Respiratory Division, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Probst VS, Troosters T, Coosemans I, Spruit MA, Pitta FDO, Decramer M, Gosselink R. Mechanisms of Improvement in Exercise Capacity Using a Rollator in Patients With COPD. Chest 2004; 126:1102-7. [PMID: 15486370 DOI: 10.1378/chest.126.4.1102] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE We analyzed the effects of the use of a rollator on walking distance and physiologic variables: pulmonary gas exchange, heart rate, minute ventilation (Ve), oxygen saturation, and symptoms during the 6-min walk test (6MWT) in patients with COPD. SETTING Outpatient clinic at university hospital. PATIENTS Fourteen patients with COPD in stable clinical condition. One patient had mild COPD, five patients had moderate COPD, six patients had severe COPD, and two patients had very severe COPD. INTERVENTIONS Two 6MWTs were performed with a portable metabolic system (VmaxST 1.0; Viasys Healthcare; MEDA; Aartselaar, Belgium) with a rollator and without a rollator, in random order. In addition, maximal voluntary ventilation (MVV) was measured with and without a rollator, randomly. RESULTS The median 6MWT distance increased significantly with a rollator: 416 m without a rollator (interquartile range [IQR], 396 to 435 m), vs 462 m with a rollator (IQR, 424 to 477 m) [p = 0.04]. Significant increases were also seen in oxygen uptake (0.04 L/min [IQR, - 0.002 to 0.09 L/min]); tidal volume (0.06 L/min [IQR, - 0.001 to 0.11 L/min]); and Ve (0.95 L/min [IQR, - 0.67 to 7.1 L/min]), recorded in the last minute of the 6MWT; as well as in MVV (3 L/min [IQR, 0 to 12 L/min]) [p < 0.05 for all]. Borg dyspnea scores tended to be lower with a rollator: 6 (IQR, 4 to 7) without a rollator, vs 5 (IQR, 4 to 7) with a rollator (p = 0.10). The variation in the 6MWT was explained by individual changes in walking efficiency (partial R(2) = 0.31) and changes in Ve (partial R(2) = 0.36) [p model < 0.04]. CONCLUSION The use of a rollator improves walking distance of patients with COPD through an increased ventilatory capacity and/or better walking efficiency.
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Affiliation(s)
- Vanessa S Probst
- Respiratory Rehabilitation and Respiratory Division, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Brooks D, Solway S, Weinacht K, Wang D, Thomas S. Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2003; 84:873-6. [PMID: 12808541 DOI: 10.1016/s0003-9993(03)00011-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the feasibility of an outdoor 6-minute walk test (6MWT) as a measure of functional status among individuals with chronic obstructive pulmonary disease (COPD), and to examine the relationship between performance on an indoor and an outdoor 6MWT. DESIGN An experimental, repeated-measures crossover design. Subjects were studied on 2 separate days in the same week. Two 6MWTs-one indoors and the other outdoors-were performed on each study day, with a rest in between. The test order was randomly selected on the first day and reversed on the second day. Outdoor tests were performed on days of moderate weather conditions (mean temperature +/- standard deviation, 21 degrees +/-3 degrees C; mean wind speed, 15+/-7km/h; no precipitation) and on a flat surface (sidewalk). SETTING Outpatient rehabilitation program in Ontario. PARTICIPANTS Eighteen subjects with COPD (10 men, 8 women; age, 70+/-8y), 5 using supplemental oxygen at rest (forced expiratory volume in 1s, 1.0+/-0.3L; 42%+/-8% of predicted). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Distance walked in 6 minutes (in meters), duration of rest (in seconds), and change in rate of perceived dyspnea. RESULTS There was no significant effect of setting (indoors vs outdoors) on distance walked (394+/-86m vs 398+/-84m, P=0.4), duration of rest (13+/-28s vs 9+/-20s, P=0.4), or change in rate of perceived dyspnea (2.3+/-1.7 vs 2.3+/-2.0, P=0.8). Testing day had no significant effect on walk test performance (all P>0.1). CONCLUSIONS The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors.
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Affiliation(s)
- Dina Brooks
- Department of Physical Therapy, University of Toronto, ON, Canada.
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Abstract
The role of smoking cessation and the use of measures to reduce the disability associated with COPD are reviewed. The political profile of patients with COPD is increasing as patient support groups develop the confidence to campaign for better services.
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Affiliation(s)
- M D L Morgan
- Institute for Lung Health, Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, Leicester LE3 9QP, UK.
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Solway S, Brooks D, Lau L, Goldstein R. The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD. Chest 2002; 122:56-65. [PMID: 12114339 DOI: 10.1378/chest.122.1.56] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use. DESIGN Repeated-measures randomized crossover design using the 6-min walk test (6MWT) as the primary outcome measure. SETTING Respiratory rehabilitation center. PATIENTS Forty stable subjects who had received a diagnosis of COPD. INTERVENTIONS Two 6MWTs were performed on each study day. One 6MWT was performed unaided, and the other was performed with a rollator. The order was randomized on the first day and reversed on the second day. RESULTS Use of the rollator was associated with a significant reduction in dyspnea (p < 0.001) and duration of rest (reduction for the total group, 19 s; and reduction for those who walked < 300 m unaided, 40 s; p = 0.001) during the 6MWT. For subjects who walked < 300 m unaided, there was also a significant improvement in distance walked (p = 0.02). No changes were found for the measures of cardiorespiratory function or gait (p > 0.05). The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator (p < 0.005). The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided. CONCLUSIONS Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD. Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea, reduced rest time, and improved distance walked.
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Affiliation(s)
- Sherra Solway
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada.
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Anslow R, Pinnington LL, Pratt DJ, Spicer J, Ward CD, Weyman N. Stability and Manoeuvrability of Wheeled Walking Frames. Physiotherapy 2001. [DOI: 10.1016/s0031-9406(05)65459-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van Stel HF, Bogaard JM, Rijssenbeek-Nouwens LH, Colland VT. Multivariable assessment of the 6-min walking test in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 163:1567-71. [PMID: 11401875 DOI: 10.1164/ajrccm.163.7.2001071] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Functional exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) is often assessed by the 6-min walking test (6MWT). To assess if the use of multiple factors adds to walking distance in describing performance in the 6MWT, an exploratory factor analysis was performed on physiological measurements and dyspnea ratings recorded during testing. Eighty-three patients with mild to severe COPD performed repeated 6MWTs before inpatient pulmonary rehabilitation. Factor analysis on 15 variables yielded a stable four-factor structure explaining 78.4% of the total variance. Recorded heart rate variables contributed to factor 1 (heart rate pattern), walking distance, heart rate increase, and decrease contributed to factor 2 (endurance capacity), oxygen desaturation variables contributed to factor 3 (impairment of oxygen transport), and dyspnea and effort variables contributed to factor 4 (perceived symptoms). Walking distance decreased in half of the 53 patients measured posttreatment, but self-perceived change in exercise tolerance improved in 84% and was explained by change in walking distance, by less desaturation, and by less dyspnea (R(2) = 0.55, p = 0.005). Qualitative analysis showed that 29 of 53 patients improved in three or four factors. Performance in the 6MWT can be described with four statistically independent and clinically interpretable factors. Because clinically relevant changes consist of more than only walking distance, assessment of functional exercise tolerance in patients with COPD improves by reporting multiple variables.
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Affiliation(s)
- H F van Stel
- Asthmacentre Heideheuvel, Hilversum, The Netherlands.
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Affiliation(s)
- M C Steiner
- Institute For Lung Health, Department of Respiratory Medicine, Glenfield Hospital, Leicester LE3 9QP, UK
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Elpern EH, Stevens D, Kesten S. Variability in performance of timed walk tests in pulmonary rehabilitation programs. Chest 2000; 118:98-105. [PMID: 10893366 DOI: 10.1378/chest.118.1.98] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To describe variability in the conduct of walk tests in pulmonary rehabilitation programs. DESIGN : Analysis of information obtained by means of a structured written questionnaire. SETTING Outpatient pulmonary rehabilitation programs in the United States and Canada. PARTICIPANTS Clinical coordinators of 75 pulmonary rehabilitation programs. INTERVENTIONS None RESULTS Timed walk tests were obtained in 71 of 99 programs surveyed. Considerable variability in all aspects of testing practices was evident. Fifty-seven respondents (80%) based results on a single walk. Walk tests were completed in a hallway (73%), on a walking track (9%), and on a treadmill (7%). In 29 programs (44%), a walk supervisor carried or pulled the oxygen source, while in 25 programs (38%), the oxygen was carried or pulled by the patient. Informal nonstandardized instructions were provided to patients prior to walking in 41 programs (58%). In 53 programs (76%), the walk supervisor could direct a patient to speed up, to slow down, or to rest. Evaluations of breathlessness and perceived exertion were measured during the walk by 73% and 16% of programs, respectively. CONCLUSIONS Practices regarding performance of timed walk tests are poorly standardized among pulmonary rehabilitation programs. Further research is needed to evaluate the impact of certain variations in testing practices on test results.
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Affiliation(s)
- E H Elpern
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA.
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