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Fettes L, Bayly J, Chukwusa E, Ashford S, Higginson I, Maddocks M. Predictors of increasing disability in activities of daily living among people with advanced respiratory disease: a multi-site prospective cohort study, England UK. Disabil Rehabil 2024; 46:4735-4744. [PMID: 38073190 DOI: 10.1080/09638288.2023.2288673] [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: 03/31/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. METHOD Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton-Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. FINDINGS Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14-1⋅74], p = 0⋅002). CONCLUSION Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs.
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Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Di Raimondo D, Pirera E, Pintus C, De Rosa R, Profita M, Musiari G, Siscaro G, Tuttolomondo A. The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications. Nutrients 2024; 16:2303. [PMID: 39064746 PMCID: PMC11279935 DOI: 10.3390/nu16142303] [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: 06/19/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Current management of COPD is predominantly focused on respiratory aspects. A multidimensional assessment including nutritional assessment, quality of life and disability provides a more reliable perspective of the true complexity of COPD patients. METHODS This was a prospective observational study of 120 elderly COPD patients at high risk of acute exacerbations. The Mini Nutritional Assessment (MNA) was administered in addition to the usual respiratory assessment. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. RESULTS The median MNA Short Form (SF) score was 11 (8-12), 39 participants (32.50%) had a normal nutritional status, 57 (47.5%) were at risk of malnutrition and 24 (20%) were malnourished. Our multivariate linear regression models showed that the MNA score was associated with dyspnea and respiratory symptom severity, assessed by the Modified British Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) score, with spirometric variables, in particular with the severity of airflow limitation based on the value of FEV1, and with poorer QoL, as assessed by the EQ-5D-3 questionnaire. Competing risk analysis according to nutritional status based on the MNA Total Score showed that COPD participants "at risk of malnutrition" and "malnourished" had a higher risk of moderate to severe acute exacerbations with sub-hazard ratios of 3.08 (1.40-6.80), p = 0.015, and 4.64 (1.71-12.55), p = 0.0002, respectively. CONCLUSION Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value.
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Affiliation(s)
- Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
- PhD Programme “Molecular and Clinical Medicine”, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
| | - Edoardo Pirera
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Chiara Pintus
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Riccardo De Rosa
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Martina Profita
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Gaia Musiari
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
- PhD Programme “Molecular and Clinical Medicine”, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
| | | | - Antonino Tuttolomondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
- PhD Programme “Molecular and Clinical Medicine”, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
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Zhou Z, Wang Y, Wang Y, Yang B, Xu C, Wang S, Yang W. A Diagnostic Nomogram for Predicting Hypercapnic Respiratory Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:1079-1091. [PMID: 38783895 PMCID: PMC11112130 DOI: 10.2147/copd.s454558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose To develop and validate a nomogram for assessing the risk of developing hypercapnic respiratory failure (HRF) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Patients and Methods From January 2019 to August 2023, a total of 334 AECOPD patients were enrolled in this research. We employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to determine independent predictors and develop a nomogram. This nomogram was appraised by the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow goodness-of-fit test (HL test), decision curve analysis (DCA), and clinical impact curve (CIC). The enhanced bootstrap method was used for internal validation. Results Sex, prognostic nutritional index (PNI), hematocrit (HCT), and activities of daily living (ADL) were independent predictors of HRF in AECOPD patients. The developed nomogram based on the above predictors showed good performance. The AUCs for the training, internal, and external validation cohorts were 0.841, 0.884, and 0.852, respectively. The calibration curves and HL test showed excellent concordance. The DCA and CIC showed excellent clinical usefulness. Finally, a dynamic nomogram was developed (https://a18895635453.shinyapps.io/dynnomapp/). Conclusion This nomogram based on sex, PNI, HCT, and ADL demonstrated high accuracy and clinical value in predicting HRF. It is a less expensive and more accessible approach to assess the risk of developing HRF in AECOPD patients, which is more suitable for primary hospitals, especially in developing countries with high COPD-related morbidity and mortality.
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Affiliation(s)
- Zihan Zhou
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Yuhui Wang
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
- Department of Cardiology, Hefei Hospital Affiliated to Anhui Medical University, Hefei, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China
| | - Yongsheng Wang
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Bo Yang
- Affiliated Hospital of West Anhui Health Vocational College, The Second People’s Hospital of Lu’an City, Lu’an, 237005, People’s Republic of China
| | - Chuchu Xu
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Shuqin Wang
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Wanchun Yang
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, Anhui, 230011, People’s Republic of China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
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Meys R, Franssen FME, Nakken N, Vaes AW, Janssen DJA, Stoffels AAF, van Hees HWH, van den Borst B, Burtin C, Spruit MA. Effects of Asthma on the Performance of Activities of Daily Living: A Retrospective Study. Occup Ther Health Care 2024:1-17. [PMID: 38709648 DOI: 10.1080/07380577.2024.2346899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/20/2024] [Indexed: 05/08/2024]
Abstract
The study aim was to identify the most problematic self--reported activities of daily living (ADLs). In a retrospective study, 1935 problematic ADLs were reported by 538 clients with 95% experiencing two or more problematic ADLs. Problematic ADLs were assessed by occupational therapists using the Canadian Occupational Performance Measure with walking (67%), household activities (41%), and climbing the stairs (41%) identified as the most prevalent problematic ADLs. Significant but weak associations were found between clinical determinants (e.g. physical, psychosocial) and problematic ADLs. The wide variety of problematic ADLs and the absence of a strong association with clinical determinants emphasizes the need for using individualized interview-based performance measures in clients with asthma.
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Affiliation(s)
- Roy Meys
- Department of Research and Development, Ciro, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Frits M E Franssen
- Department of Research and Development, Ciro, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nienke Nakken
- Department of Research and Development, Ciro, The Netherlands
| | - Anouk W Vaes
- Department of Research and Development, Ciro, The Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, Ciro, The Netherlands
- Department of Health Services Research & Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anouk A F Stoffels
- Department of Research and Development, Ciro, The Netherlands
- Department of Pulmonary Diseases, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hieronymus W H van Hees
- Department of Pulmonary Diseases, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Martijn A Spruit
- Department of Research and Development, Ciro, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Stoustrup AL, Janssen DJA, Nakken N, Wouters EFM, Marques A, Weinreich UM, Spruit MA. Association of inadequate social support and clinical outcomes in patients with chronic obstructive pulmonary disease - A cross-sectional study. Respir Med 2024; 226:107625. [PMID: 38570144 DOI: 10.1016/j.rmed.2024.107625] [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: 12/18/2023] [Revised: 02/27/2024] [Accepted: 04/01/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION In patients with chronic obstructive pulmonary disease (COPD), loneliness and social isolation are associated with increased morbidity and decreased mobility, self-reliance, and health-related quality of life. Social support has been shown to improve these outcomes. AIMS This cross-sectional study aimed to investigate the level of experienced social support and the clinical outcomes associated with inadequate social support among patients with COPD with a resident loved one. METHODS Level of social support was assessed with the Medical Outcomes Study - Social Support Survey (MOS-SSS) in patients with COPD with a resident loved one. Patients were sub-grouped into adequate or inadequate social support. Multiple clinical outcomes were assessed, including lung function, degree of dyspnoea, health status, symptoms of anxiety and depression, the degree of care dependency, functional status, and mobility. RESULTS The study included 191 Dutch patients with COPD (53.4% men, age: 65.6 ± 8.9 years, FEV1: 47.3 ± 17.7% predicted). Eighteen percent of the patients reported inadequate social support. Patients with inadequate social support reported a significantly symptom severity of COPD (p = 0.004), a higher care dependency level (p = 0.04) and a higher level of depression (p = 0.004) compared to patients with adequate social support. Other traits were comparable for both groups. CONCLUSION Patients with COPD with a resident loved one who perceive an inadequate level of social support are more likely to report a higher impact of COPD, a higher care dependency and symptoms of depression. Other characteristics are comparable with patients who perceive adequate social support.
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Affiliation(s)
- Anna L Stoustrup
- Department of Respiratory Diseases, Aalborg University Hospital, Denmark.
| | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Nienke Nakken
- Department of Research and Development, Ciro, Horn, the Netherlands.
| | - Emiel F M Wouters
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
| | | | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
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Goubeau G, Mandigout S, Sombardier T, Borel B. Occupational Therapy for Improving Occupational Performance in COPD Patients: A Scoping Review. Can J Occup Ther 2023; 90:353-362. [PMID: 36575643 DOI: 10.1177/00084174221148037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background. Chronic obstructive pulmonary disease (COPD) is a multisystemic chronic condition which may induce significant consequences in daily life activities. Preserving activities of daily living in COPD is therefore a common treatment goal among people living with COPD, which leaves ample opportunity for occupational therapy interventions to comprise part of their rehabilitation. However, the question of how exactly occupational therapists can and do contribute to pulmonary rehabilitation remains underexplored. Purpose. To reveal the contribution of occupational therapy intervention in the pulmonary rehabilitation on improving the occupational performance of patients with COPD. Method. A scoping review was performed by selecting articles focusing on occupational therapy in pulmonary rehabilitation for patients with COPD. A total of four databases were surveyed for article selection. Findings. Among nine studies selected, seven studies reported a significant improvement in the occupational performance of patients with occupational therapy. However, two studies did not observe differences between the groups regarding occupational performance. Implications. Occupational therapy in pulmonary rehabilitation seems to contribute to the improvement of occupational performances of patients with COPD. Nevertheless, research focused on this field needs to be further developed to support the positive impact of occupational therapy in COPD management.
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Fettes L, Neo J, Ashford S, Higginson IJ, Maddocks M. Trajectories of disability in activities of daily living in advanced cancer or respiratory disease: a systematic review. Disabil Rehabil 2022; 44:1790-1801. [PMID: 32961067 DOI: 10.1080/09638288.2020.1820587] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Advanced cancer and/or respiratory disease threaten a person's independence in activities of daily living (ADL). Understanding how disability develops can help direct appropriate and timely interventions. AIM To identify different trajectories and associations of disability in ADL and appraise its measurement. METHODS Medline, Embase, PsychINFO, and CINAHL databases were searched for cohort studies with measures of disability in ADL in advanced cancer or respiratory disease at three or more timepoints. Data were narratively synthesized to produce a typology of disability trajectories and a model of factors and outcomes associated with increasing disability. RESULTS Of 5702 publications screened, 11 were included. Seventy-four disability trajectories were categorized into typologies of unchanging (n = 20), fluctuating (n = 21), and increasing disability (n = 33). Respiratory disease did not predict any particular disability trajectory. Advanced cancer frequently followed trajectories of increasing disability. Factors associated with increasing disability included: frailty, multi-morbidity, cognitive impairment, and infection. Increased disability led to recurrent hospital admissions, long-term care, and/or death. Methodological limitations included use of non-validated measures. CONCLUSIONS Increasing disability trajectories in advanced cancer and/or respiratory disease is related to potentially modifiable personal and environmental factors. We recommend future studies using validated disability instruments.Implications for rehabilitationDisability in activities of daily living (ADL) is a common unmet need in advanced cancer or respiratory disease and represents an important outcome for patients, caregivers and health and social care services.Trajectories of ADL disability can be categorized into increasing, fluctuating, and unchanging disability, which could help planning of rehabilitation services in advanced cancer or respiratory disease.Increasing disability in advanced cancer or respiratory disease relates to personal and environmental factors as well as bodily impairments, which can all be modifiable by intervention.This review highlights implications for the measurement of ADL disability in advanced cancer or respiratory disease and recommends use of validated measures of ADL to understand what factors can be modified through rehabilitation interventions.
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Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, UK
- University College London Hospitals, National Hospital for Neurology and Neurosurgery, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Fettes L, Bone AE, Etkind SN, Ashford S, Higginson IJ, Maddocks M. Disability in Basic Activities of Daily Living Is Associated With Symptom Burden in Older People With Advanced Cancer or Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis. J Pain Symptom Manage 2021; 61:1205-1214. [PMID: 33096219 DOI: 10.1016/j.jpainsymman.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Managing activities of daily living is important to people with advanced cancer or chronic obstructive pulmonary disease (COPD). Understanding disability in activities of daily living may inform service planning. OBJECTIVE To identify the prevalence of disability in activities of daily living, associations and change over time, in older people with advanced cancer or COPD. METHODS Secondary analysis of International Access, Rights and Empowerment (IARE) studies in adults aged ≥65 years with advanced disease in the United Kingdom, Ireland, and United States, using cross-sectional (IARE I & II) and longitudinal (IARE II, 3 timepoints over 6 months) data. Measures included disability in activities of daily living (Barthel Index), symptom severity (Palliative Outcome Scale), and assistive device use (self-reported). Logistic regression was used to identify relationships between disability and age, sex, living alone, diagnosis, and symptom burden; visual graphical analysis explores individual disability trajectories. RESULTS One hundred fifty-nine participants were included (140 cancer, 19 COPD). Sixty-five percent had difficulty climbing stairs, 48% bathing, 39% dressing, and 36% mobilizing. Increased disability was independently associated with increased symptom burden (odds ratio, 1.08 [95% CI:1.02-1.15], P = 0.01) and walking unaided (z = 2.35, P = 0.02), but not with primary diagnosis (z = -0.47, P = 0.64). Disability generally increased over time but with wide interindividual variation. CONCLUSION Disability in activities of daily living in advanced cancer or COPD is common, associated with increased symptom burden, and may be attenuated by use of assistive devices. Individual disability trajectories vary widely, with diverse disability profiles. Services should include rehabilitative interventions, guided by disability in individual activities of daily living.
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Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK.
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK; Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK; Centre for Nursing Midwifery and Allied health Research and the National Hospital for Neurology and Neurosurgery, University College London Hospitals, Holborn, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
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de la Cruz SP, Cebrino J. Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006-2017: Evidence from Spanish National Health Surveys. J Clin Med 2021; 10:jcm10112291. [PMID: 34070391 PMCID: PMC8197509 DOI: 10.3390/jcm10112291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
Certain conditions such as common mental disorders (CMDs), functional limitation (FL) and poor diet quality may affect the lives of individuals who suffer from chronic obstructive pulmonary disease (COPD). This study sought to examine time trends in the prevalence of CMDs, FL and diet quality among male and female COPD patients living in Spain from 2006 to 2017 and to identify which factors were related to CMDs, FL and a poor/improvable diet quality in these patients. We performed a cross-sectional study among COPD patients aged ≥ 40 years old using data from the Spanish National Health Surveys conducted in 2006, 2011 and 2017, identifying a total of 2572 COPD patients. Binary logistic regressions were performed to determine the characteristics related to CMDs, FL and poor/improvable diet quality. Over the years of the study, the prevalence of FL among female COPD patients increased (p for trend <0.001). In addition, CMDs were associated to body mass index (BMI), educational level, physical activity, smoking status, occupation, chronic conditions and alcohol consumption; FL was related to age, living with a partner, educational level, physical activity and chronic conditions; and poor/improvable diet quality was associated to age, smoking status, BMI and physical activity.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain;
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain
- Correspondence: ; Tel.: +34-954-551-771
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