1
|
Yang H, Liu S, Chen J, Qiao Y, Wang C, Zhang W, Wei L, Chen R. Perceptions of barriers to and facilitators of exercise rehabilitation in adults with lung transplantation: a qualitative study in China. BMC Pulm Med 2024; 24:65. [PMID: 38297272 PMCID: PMC10832146 DOI: 10.1186/s12890-024-02882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Exercise is crucial for pulmonary rehabilitation and improving the prognosis of lung transplantation (LTx) patients. However, many LTx patients in China have low exercise tolerance and compliance, and the reasons behind these challenges have not been fully elucidated. Therefore, this qualitative research aims to identify the barriers to and facilitators of exercise rehabilitation in LTx patients. METHODS From January to July 2023, 15 stable LTx patients were recruited and participated in in-depth, semi-structured, face-to-face interviews at Henan Provincial People's Hospital. The interview transcripts were analyzed using the COM-B model and the Theoretical Domains Framework (TDF). RESULTS Six general themes including 19 barriers and 14 facilitators for the exercise rehabilitation of LTx patients were identified based on the COM-B model and TDF. The barriers to exercise included physical limitations, insufficient exercise endurance, lack of knowledge, and lack of motivation. The facilitators of exercise included motivation, self-efficacy, perceived significance of exercise rehabilitation, and social support. CONCLUSION The study offers detailed insight into the development and implementation of exercise rehabilitation intervention strategies for LTx patients. By combining COM-B model and TDF, the study provides strong evidence that active behavior change strategies are required for LTx patients to promote their participation in exercise rehabilitation. Professional support, pulmonary rehabilitation training, behavior change technology, and digital health tools are essential for strengthening the evidence system for reporting exercise efficacy and effectiveness.
Collapse
Affiliation(s)
- Hui Yang
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Saisai Liu
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Jingru Chen
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Yaxin Qiao
- Institute of Nursing and Health, Henan University, Kaifeng, 475004, Henan, China
| | - Chengcheng Wang
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Wenping Zhang
- Department of Thoracic surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Li Wei
- Department of Thoracic surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Ruiyun Chen
- Department of Thoracic surgery, Henan Key Laboratory for Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan University People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan Province, People's Republic of China.
| |
Collapse
|
2
|
Coyle-Asbil HJ, Habegger J, Oliver M, Vallis LA. Enabling the ActiGraph GT9X Link's Idle Sleep Mode and Inertial Measurement Unit Settings Directly Impacts Data Acquisition. SENSORS (BASEL, SWITZERLAND) 2023; 23:5558. [PMID: 37420725 DOI: 10.3390/s23125558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
The ActiGraph GT9X has been implemented in clinical trials to track physical activity and sleep. Given recent incidental findings from our laboratory, the overall aim of this study was to notify academic and clinical researchers of the idle sleep mode (ISM) and inertial measurement unit (IMU)'s interaction, as well as their subsequent effect on data acquisition. Investigations were undertaken using a hexapod robot to test the X, Y and Z sensing axes of the accelerometers. Seven GT9X were tested at frequencies ranging from 0.5 to 2 Hz. Testing was performed for three sets of setting parameters: Setting Parameter 1 (ISMONIMUON), Setting Parameter 2 (ISMOFFIMUON), Setting Parameter 3 (ISMONIMUOFF). The minimum, maximum and range of outputs were compared between the settings and frequencies. Findings indicated that Setting Parameters 1 and 2 were not significantly different, but both were significantly different from Setting Parameter 3. Upon inspection, it was discovered that the ISM was only active during Setting Parameter 3 testing, despite it being enabled in Setting Parameter 1. Researchers should be aware of this when conducting future research using the GT9X.
Collapse
Affiliation(s)
- Hannah J Coyle-Asbil
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Janik Habegger
- School of Engineering, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Michele Oliver
- School of Engineering, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Lori Ann Vallis
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| |
Collapse
|
3
|
Schuurmans MM, Muszynski M, Li X, Marcinkevičs R, Zimmerli L, Monserrat Lopez D, Michel B, Weiss J, Hage R, Roeder M, Vogt JE, Brunschwiler T. Multimodal Remote Home Monitoring of Lung Transplant Recipients during COVID-19 Vaccinations: Usability Pilot Study of the COVIDA Desk Incorporating Wearable Devices. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030617. [PMID: 36984618 PMCID: PMC10051543 DOI: 10.3390/medicina59030617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: Remote patient monitoring (RPM) of vital signs and symptoms for lung transplant recipients (LTRs) has become increasingly relevant in many situations. Nevertheless, RPM research integrating multisensory home monitoring in LTRs is scarce. We developed a novel multisensory home monitoring device and tested it in the context of COVID-19 vaccinations. We hypothesize that multisensory RPM and smartphone-based questionnaire feedback on signs and symptoms will be well accepted among LTRs. To assess the usability and acceptability of a remote monitoring system consisting of wearable devices, including home spirometry and a smartphone-based questionnaire application for symptom and vital sign monitoring using wearable devices, during the first and second SARS-CoV-2 vaccination. Materials and Methods: Observational usability pilot study for six weeks of home monitoring with the COVIDA Desk for LTRs. During the first week after the vaccination, intensive monitoring was performed by recording data on physical activity, spirometry, temperature, pulse oximetry and self-reported symptoms, signs and additional measurements. During the subsequent days, the number of monitoring assessments was reduced. LTRs reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. Results: Ten LTRs planning to receive the first COVID-19 vaccinations were recruited. For the intensive monitoring study phase, LTRs recorded symptoms, signs and additional measurements. The most frequent adverse events reported were local pain, fatigue, sleep disturbance and headache. The duration of these symptoms was 5-8 days post-vaccination. Adherence to the main monitoring devices was high. LTRs rated usability as high. The majority were willing to continue monitoring. Conclusions: The COVIDA Desk showed favorable technical performance and was well accepted by the LTRs during the vaccination phase of the pandemic. The feasibility of the RPM system deployment was proven by the rapid recruitment uptake, technical performance (i.e., low number of errors), favorable user experience questionnaires and detailed individual user feedback.
Collapse
Affiliation(s)
- Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | | | - Xiang Li
- Department of Mathematics, ETH Zurich, 8092 Zurich, Switzerland
- Department of Computer Science, ETH Zurich, 8092 Zurich, Switzerland
| | | | | | - Diego Monserrat Lopez
- IBM Research Europe, 8803 Rüschlikon, Switzerland
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland
| | - Bruno Michel
- IBM Research Europe, 8803 Rüschlikon, Switzerland
| | - Jonas Weiss
- IBM Research Europe, 8803 Rüschlikon, Switzerland
| | - René Hage
- Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Maurice Roeder
- Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Julia E Vogt
- Department of Computer Science, ETH Zurich, 8092 Zurich, Switzerland
| | | |
Collapse
|
4
|
Complementary Therapy Learning in the Setting of Lung Transplantation: A Single-Center Observational Study of Appropriation and Efficacy. J Clin Med 2023; 12:jcm12051722. [PMID: 36902509 PMCID: PMC10002550 DOI: 10.3390/jcm12051722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Transplanted patients could benefit from complementary techniques. This prospective single-center, open study, performed in a tertiary university hospital, evaluates the appropriation and efficacy of a toolbox-kit of complementary techniques. Self-hypnosis, sophrology, relaxation, holistic gymnastics, and transcutaneous electric nerve stimulation (TENS) were taught to adult patients scheduled for double-lung transplantation. Patients were asked to use them before and after transplantation, as needed. The primary outcome was appropriation of each technique within the first three postoperative months. Secondary outcomes included efficacy on pain, anxiety, stress, sleep, and quality-of-life. Among the 80 patients included from May 2017 to September 2020, 59 were evaluated at the 4th postoperative month. Over the 4359 sessions performed, the most frequent technique used before surgery was relaxation. After transplantation, the techniques most frequently used were relaxation and TENS. TENS was the best technique in terms of autonomy, usability, adaptation, and compliance. Self-appropriation of relaxation was the easiest, while self-appropriation of holistic gymnastics was difficult but appreciated by patients. In conclusion: the appropriation by patients of complementary therapies such as mind-body therapies, TENS and holistic gymnastics is feasible in lung transplantation. Even after a short training session, patients regularly practiced these therapies, mainly TENS and relaxation.
Collapse
|
5
|
Kolaitis NA, Gao Y, Soong A, Greenland JR, Hays SR, Golden JA, Venado A, Leard LE, Shah RJ, Kleinhenz ME, Katz PP, Kukreja J, Blanc PD, Smith PJ, Singer JP. Depressive symptoms in lung transplant recipients: trajectory and association with mortality and allograft dysfunction. Thorax 2022; 77:891-899. [PMID: 35354643 DOI: 10.1136/thoraxjnl-2021-217612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Most studies observing an association between depressive symptoms following lung transplantation and mortality are limited to depressive symptom measurement at a single time point, unrelated to allograft function. We aimed to test the association of depressive symptoms over multiple assessments with allograft dysfunction and with mortality. METHODS We assessed depressive symptoms before and serially up to 3 years after lung transplantation in lung transplant recipients. We quantified depressive symptoms with the Geriatric Depression Scale (GDS; range 0-15; minimally important difference (MID): 2). We quantified changes in GDS using linear mixed effects models and tested the association with mortality using Cox proportional hazards models with GDS as a time-dependent predictor. To determine if worsening in GDS preceded declines in lung function, we tested the association of GDS as a time-dependent predictor with the lagged outcome of FEV1 at the following study visit. RESULTS Among 266 participants, depressive symptoms improved early after transplantation. Worsening in post-transplant GDS by the MID was associated with mortality (HR 1.25, 95% CI 1.05 to 1.50), and in lagged outcome analyses with decreased per cent predicted FEV1 (Δ, -1.62%, 95% CI -2.49 to -0.76). Visual analyses of temporal changes in GDS demonstrated that worsening depressive symptoms could precede chronic lung allograft dysfunction. CONCLUSIONS Depressive symptoms generally improve after lung transplantation. When they worsen, however, there is an association with declines in lung function and mortality. Depression is one of the few, potentially modifiable, risk factors for chronic lung allograft dysfunction and death.
Collapse
Affiliation(s)
- Nicholas A Kolaitis
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ying Gao
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Allison Soong
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - John R Greenland
- Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Steven R Hays
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey A Golden
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aida Venado
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lorriana E Leard
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rupal J Shah
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mary Ellen Kleinhenz
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patricia P Katz
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jasleen Kukreja
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul D Blanc
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Paul Singer
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
6
|
Michel-Cherqui M, Szekely B, Fessler J, Glorion M, Sage E, Le Guen M, Trichereau J, Vallée A, Fischler M. Feasibility and usefulness of self-hypnosis in patients undergoing double-lung transplantation during the pre and postoperative periods: A randomized study. J Cardiothorac Vasc Anesth 2022; 36:2490-2499. [DOI: 10.1053/j.jvca.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/20/2021] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
|
7
|
Smith P, Kandakatla A, Frankel CW, Bacon DR, Bush E, Mentz RJ, Snyder LD. Sleep quality, depressive symptoms, and transplant outcomes: Follow-up analyses from the ADAPT prospective pilot study. Gen Hosp Psychiatry 2021; 72:53-58. [PMID: 34298477 DOI: 10.1016/j.genhosppsych.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggested that depressive symptoms and sleep quality may be important for long-term clinical outcomes following cardiothoracic transplant. Few studies, however, have systematically examined objective markers of these behavioral factors among ambulatory transplant recipients, or their association with clinical outcomes. METHODS We examined sleep quality and depressive symptoms with subsequent clinical outcomes (hospitalizations and death) in a sample of 66 lung or heart transplant recipients using a single-center, prospective cohort study. Recipients were assessed at approximately 6 months post-transplant and completed one week of actigraphy assessment to examine sleep quality and self-report measures of mood (Centers for Epidemiologic Studies of Depression [CESD]). Recipients were followed for clinical outcomes. RESULTS At 6-months following transplantation, recipients spent the majority of daytime activity at a sedentary level (61% of daily activity [SD = 10]) and elevated depressive symptoms were common (subclinical = 17%, mild = 12%, or moderate = 8%). Over a median follow-up of 4.5 years (IQR = 0.9, 5.1), 51 participants (77%) had at least one unplanned hospitalization and 11 (17%) participants died. In addition, sleep efficiency measurements suggested that a subset of participants exhibited suboptimal sleep (mean efficiency = 87% [SD = 7]). Poorer sleep quality, indexed by lower sleep efficiency and greater sleep fragmentation, was associated with greater depressive symptoms (r's = 0.37-0.50, P < .01). Better sleep quality at 6-months (HR = 0.75 [0.60, 0.95], P = .015), including sleep efficiency (HR = 0.74 [0.56, 0.99], P = .041) and sleep fragmentation (HR = 0.71 [0.53, 0.95], P = .020) were associated with lower risk of hospitalization or death. Compared with individuals without elevated depressive symptoms or sleep difficulties, individuals with either factor (HR = 1.72 [1.05, 2.81], P = .031) or both factors (HR = 2.37 [1.35, 4.18], P = .003) exhibited greater risk of clinical events in adjusted analyses. CONCLUSIONS Sleep quality is associated with depressive symptoms among cardiothoracic transplant recipients and enhances the prognostic association between biobehavioral risk factors and clinical outcomes.
Collapse
Affiliation(s)
- PatrickJ Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America; Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America.
| | - Apoorva Kandakatla
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Courtney W Frankel
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Daniel R Bacon
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, United States of America
| | - Erika Bush
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Robert J Mentz
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| | - Laurie D Snyder
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| |
Collapse
|