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Alexandre F, Molinier V, Poulain M, Villiot-Danger E, Eichenauer B, Calvat A, Brandon L, Miffre C, Oliver N, Heraud N. [French survey of patients on current and future pulmonary rehabilitation programs]. Rev Mal Respir 2024; 41:399-408. [PMID: 38762393 DOI: 10.1016/j.rmr.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Over recent years, a growing number of studies have demonstrated the effectiveness of alternative models to centre-based pulmonary rehabilitation (PR) such as tele-PR or home-based unsupervised PR, offering perspectives for improved accessibility and adherence. Other studies have demonstrated the relevance and long-term benefits of maintenance PR programs. However, they remain poorly implemented in real-life settings. In order to encourage patient adherence to new PR models and to guide future orientations, we conducted a survey assessing patients' views on PR models and maintenance programs. METHOD The survey (37 questions) was circulated to COPD patients of the French national respiratory patient F.F.A.A.I.R network and in five specialised PR centres. RESULTS Among the 298 respondents, 75% had previously taken part in a PR program, mainly in hospital settings (91%), with a high degree of satisfaction. The main barriers to PR were being physically separated from their loved ones (21%) and fears of having to share a double room (47%). Regarding maintenance PR programs, patients expressed diversified opinions, in terms of ideal duration and frequency of follow-up, format of follow-up (home-based, telephone, videoconference) and type of professional involved. CONCLUSIONS Diversified PR settings offer perspectives to increase access and improve the effectiveness of current programs. Furthermore, comprehensive personalization (professionals involved, content, setting, duration) seems to be the key to success in concrete implementation and achievement of patient satisfaction.
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Affiliation(s)
- F Alexandre
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France.
| | - V Molinier
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France
| | - M Poulain
- Clinique du Souffle Inicea La Solane, Clariane, Ossèja, France
| | - E Villiot-Danger
- Clinique du Souffle Inicea Les Acacias, Clariane, Briançon, France
| | - B Eichenauer
- Clinique du Souffle Inicea Le Pontet, Clariane, Plateau d'Hauteville, France
| | - A Calvat
- Clinique du Souffle Inicea La Vallonie, Clariane, Lodève, France
| | - L Brandon
- Clinique du Souffle Inicea Les Clarines, Clariane, Riom-ès-Montagnes, France
| | - C Miffre
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France
| | - N Oliver
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France; Clinique du Souffle Inicea La Vallonie, Clariane, Lodève, France
| | - N Heraud
- Direction de la recherche et l'innovation en santé Clariane France, 800, avenue Joseph-Vallot, 34700 Lodève, France
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Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, Bhatt SP, Bourbeau J, Burtin C, Camp PG, Cascino TM, Dorney Koppel GA, Garvey C, Goldstein R, Harris D, Houchen-Wolloff L, Limberg T, Lindenauer PK, Moy ML, Ryerson CJ, Singh SJ, Steiner M, Tappan RS, Yohannes AM, Holland AE. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2023; 208:e7-e26. [PMID: 37581410 PMCID: PMC10449064 DOI: 10.1164/rccm.202306-1066st] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
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Janssen SMJ, van Helvoort HAC, Tjalma TA, Antons JC, Djamin RS, Simons SO, Spruit MA, van 't Hul AJ. Impact of Treatable Traits on Asthma Control and Quality of Life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1823-1833.e4. [PMID: 36893847 DOI: 10.1016/j.jaip.2023.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/08/2022] [Accepted: 02/26/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Many adult patients with asthma have uncontrolled disease and impaired quality of life, despite current asthma-specific drug therapies. OBJECTIVE This study aimed to investigate the prevalence of 9 traits in patients with asthma, their associations with disease control and quality of life, and referral rates to nonmedical health care professionals. METHODS Retrospectively, data from patients with asthma were collected in 2 Dutch hospitals (Amphia Breda and RadboudUMC Nijmegen). Adult patients without exacerbation <3 months who were referred for a first-ever elective, outpatient, hospital-based diagnostic pathway were deemed eligible. Nine traits were assessed: dyspnea, fatigue, depression, overweight, exercise intolerance, physical inactivity, smoking, hyperventilation, and frequent exacerbations. To assess the likelihood of having poor disease control or decreased quality of life, the odds ratio (OR) was calculated per trait. Referral rates were assessed by checking patients' files. RESULTS A total of 444 adults with asthma were studied (57% women, age: 48 ± 16 years, forced expiratory volume in 1 second: 88% ± 17% predicted). Most patients (53%) were found to have uncontrolled asthma (Asthma Control Questionnaire ≥1.5 points) and decreased quality of life (Asthma Quality of Life Questionnaire <6 points). Generally, patients had 3.0 ± 1.8 traits. Severe fatigue was most prevalent (60%) and significantly increased the likelihood of having uncontrolled asthma (OR: 3.0, 95% confidence interval [CI]: 1.9-4.7) and decreased quality of life (OR: 4.6, 95% CI: 2.7-7.9). Referrals to nonmedical health care professionals were low; most referrals were to a respiratory-specialized nurse (33%). CONCLUSION Adult patients with asthma with a first-ever referral to a pulmonologist frequently exhibit traits justifying the deployment of nonpharmacological interventions, especially in those with uncontrolled asthma. However, referrals to appropriate interventions appeared infrequent.
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Affiliation(s)
- Steffi M J Janssen
- Basalt Rehabilitation Centre, Department of Pulmonary Rehabilitation, Leiden, the Netherlands; Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Hanneke A C van Helvoort
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tjitske A Tjalma
- Department of Pulmonary Diseases, Amphia Hospital, Breda, the Netherlands
| | - Jeanine C Antons
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Remco S Djamin
- Department of Pulmonary Diseases, Amphia Hospital, Breda, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Department of Research and Development, CIRO, Horn, the Netherlands
| | - Alex J van 't Hul
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Reilly C, Sails J, Stavropoulos-Kalinoglou A, Birch RJ, McKenna J, Clifton IJ, Peckham D, Birch KM, Price OJ. Physical activity promotion interventions in chronic airways disease: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:32/167/220109. [PMID: 36697208 PMCID: PMC9879326 DOI: 10.1183/16000617.0109-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/02/2022] [Indexed: 01/27/2023] Open
Abstract
Physical inactivity is common in people with chronic airways disease (pwCAD) and associated with worse clinical outcomes and impaired quality of life. We conducted a systematic review and meta-analysis to characterise and evaluate the effectiveness of interventions promoting step-based physical activity (PA) in pwCAD. We searched for studies that included a form of PA promotion and step-count outcome measure. A random-effects model was used to determine the overall effect size using post-intervention values. 38 studies (n=32 COPD; n=5 asthma; n=1 bronchiectasis; study population: n=3777) were included. Overall, implementing a form of PA promotion resulted in a significant increase in step-count: median (IQR) 705 (183-1210) when compared with usual standard care: -64 (-597-229), standardised mean difference (SMD) 0.24 (95% CI: 0.12-0.36), p<0.01. To explore the impact of specific interventions, studies were stratified into subgroups: PA promotion+wearable activity monitor-based interventions (n=17) (SMD 0.37, p<0.01); PA promotion+step-count as an outcome measure (n=9) (SMD 0.18, p=0.09); technology-based interventions (n=12) (SMD 0.16, p=0.01). Interventions promoting PA, particularly those that incorporate wearable activity monitors, result in a significant and clinically meaningful improvement in daily step-count in pwCAD.
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Affiliation(s)
- Caroline Reilly
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Joe Sails
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | | | - Rebecca J. Birch
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Jim McKenna
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Ian J. Clifton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK,Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel Peckham
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK,Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karen M. Birch
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Oliver J. Price
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK,Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK,School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK,Corresponding author: Oliver J. Price ()
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5
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 PMCID: PMC11260396 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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6
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Rochester CL. Does Telemedicine Promote Physical Activity? Life (Basel) 2022; 12:life12030425. [PMID: 35330176 PMCID: PMC8948765 DOI: 10.3390/life12030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Exercise capacity and physical activity are different concepts: the former refers to what an individual is capable of performing, while the latter refers to what the individual does in daily life. Low levels of physical activity (PA), which are very common in individuals with COPD, are associated with poor health outcomes, including increased symptoms, a more rapid decline in lung function, increased health care utilization and increased mortality risk. Because of these pervasive negative outcomes, attempts have been made to increase physical activity in individuals with COPD, hoping that success in this area will mitigate the negative effects of inactivity. Based on its ability to increase exercise capacity and reduce dyspnea in COPD and other chronic respiratory diseases, pulmonary rehabilitation (PR) would be expected also increase physical activity in these patients. However, accessibility to pulmonary rehabilitation programs is problematic in some areas, and studies testing its effectiveness in this outcome area have had inconsistent results. Using telehealth interventions using technology to provide medical care conveniently over a distance would have the benefit of reaching a larger proportion of individuals with COPD. A systematic review of clinical trials testing telehealth to promote physical activity had mixed results and low-certainty evidence, resulting in the inability to recommend any single type of intervention. Thus, using telehealth interventions to promote physical activity for individuals with chronic respiratory diseases, while promising, remains an area where future investigations are needed to identify its optimal modalities and clarify its benefits.
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Affiliation(s)
- Carolyn L. Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; ; Tel.: +1-203-785-4163; Fax: +1-203-785-3627
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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7
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Encuesta realizada sobre la indicación y la utilización de la rehabilitación respiratoria en pacientes con fibrosis pulmonar idiopática por neumólogos españoles. OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496772 PMCID: PMC10369541 DOI: 10.1016/j.opresp.2021.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Holland AE, Cox NS, Houchen-Wolloff L, Rochester CL, Garvey C, ZuWallack R, Nici L, Limberg T, Lareau SC, Yawn BP, Galwicki M, Troosters T, Steiner M, Casaburi R, Clini E, Goldstein RS, Singh SJ. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 18:e12-e29. [PMID: 33929307 PMCID: PMC8086532 DOI: 10.1513/annalsats.202102-146st] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pulmonary rehabilitation is a highly effective treatment for people with chronic lung disease but remains underused across the world. Recent years have seen the emergence of new program models that aim to improve access and uptake, including telerehabilitation and low-cost, home-based models. This workshop was convened to achieve consensus on the essential components of pulmonary rehabilitation and to identify requirements for successful implementation of emerging program models. A Delphi process involving experts from across the world identified 13 essential components of pulmonary rehabilitation that must be delivered in any program model, encompassing patient assessment, program content, method of delivery, and quality assurance, as well as 27 desirable components. Only those models of pulmonary rehabilitation that have been tested in clinical trials are currently considered as ready for implementation. The characteristics of patients most likely to succeed in each program model are not yet known, and research is needed in this area. Health professionals should use clinical judgment to determine those patients who are best served by a center-based, multidisciplinary rehabilitation program. A comprehensive patient assessment is critical for personalization of pulmonary rehabilitation and for effectively addressing individual patient goals. Robust quality-assurance processes are important to ensure that any pulmonary rehabilitation service delivers optimal outcomes for patients and health services. Workforce capacity-building and training should consider the skills necessary for emerging models, many of which are delivered remotely. The success of all pulmonary rehabilitation models will be judged on whether the essential components are delivered and on whether the expected patient outcomes, including improved exercise capacity, reduced dyspnea, enhanced health-related quality of life, and reduced hospital admissions, are achieved.
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9
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[How to improve patient's access to Respiratory Rehabilitation?]. Rev Mal Respir 2021; 38:177-182. [PMID: 33583644 DOI: 10.1016/j.rmr.2020.12.001] [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: 09/17/2019] [Accepted: 09/14/2020] [Indexed: 11/23/2022]
Abstract
Despite effectiveness and clear international guidelines, respiratory rehabilitation remains underutilized: less than 15% of suitable patients in France and worldwide receive this treatment. The factors of this lack of referral and uptake have been studied and are not limited to a problem of quantitative adequacy of supply and demand. The lack of knowledge of health professionals, patients, payers, heterogeneous programs which does not necessary correspond to the needs of the patient (modalities, geography, duration), the lack of trained and available professionals, the profile of patients and prescribers and the quality of the programs are identified as potentially hindering the completion of a rehabilitation program. It is essential to analyze these barriers and to find solutions to the greatest number of respiratory patients can benefit optimal healthcare and integrate into a coherent care planning.
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10
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Laporte JC, Bellocq A. [Therapeutic education for people with chronic respiratory disease]. REVUE DE L'INFIRMIÈRE 2021; 70:20-23. [PMID: 33742586 DOI: 10.1016/j.revinf.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The physiotherapist's practice involves taking care of patients with various chronic pathologies: neurological, rheumatic, respiratory, etc. The physiotherapist must carry out an educational approach in these patients, at the same time as the physical work of re-education, in order to induce behavioural changes beneficial to their physical and psychological health and to empower them in the best possible way in the management of their pathology.
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Affiliation(s)
| | - Agnès Bellocq
- Récup'Air, 66, boulevard Saint-Michel, 75006 Paris, France; Service d'explorations fonctionnelles de la respiration, de l'exercice et de la dyspnée, GH Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMRS 1158, Sorbonne université, 91, boulevard de l'Hôpital, 75013 Paris, France
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11
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Augustine A, Bhat A, Vaishali K, Magazine R. Barriers to pulmonary rehabilitation - A narrative review and perspectives from a few stakeholders. Lung India 2021; 38:59-63. [PMID: 33402639 PMCID: PMC8066922 DOI: 10.4103/lungindia.lungindia_116_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary Rehabilitation (PR) is an essential and comprehensive intervention recommended in the management of people with chronic respiratory diseases (CRD). Scientific evidence suggests significant health benefits with respect to repeated hospital admissions, exercise tolerance and Health Related Quality of Life (HRQoL). However, the uptake and completion of PR programs are globally low. In order to understand the factors contributing to underutilization of PR, it is important to review and recognize the barriers to PR program. A literature search was conducted on Medline (PubMed) database. After reviewing the title and abstracts, full text articles were scrutinized for their relevance. Twenty-two studies involving factors affecting the uptake, participation and completion of PR program were included in this review. Reported barriers to PR were healthcare system, healthcare professional and patient related factors. Primary factors related to healthcare system and healthcare professionals were fewer PR centers, accessibility inconvenience, lack of awareness of PR program, low knowledge of referral process and lack of interdisciplinary teamwork. Difficulties faced by patients to take up and/or to complete PR programs were lack of transportation, co-morbidities, lack of perceived benefits, socio-economic status and lack of funding facilities. Identified and reported barriers resulted into discontinuity between knowledge of health benefits and utilization of PR service for patients with CRDs. Addressing the barriers would accelerate the healthcare professionals' referral and patients to avail the health benefits of rehabilitation service.
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Affiliation(s)
- Anulucia Augustine
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anup Bhat
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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12
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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13
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Antin-Ozerkis D, Hinchcliff M. Connective Tissue Disease-Associated Interstitial Lung Disease: Evaluation and Management. Clin Chest Med 2020; 40:617-636. [PMID: 31376896 DOI: 10.1016/j.ccm.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Interstitial lung disease is common among patients with connective tissue disease and is an important contributor to morbidity and mortality. Infection and drug toxicity must always be excluded as the cause of radiographic findings. Immunosuppression remains a mainstay of therapy despite few controlled trials supporting its use. When a decision regarding therapy initiation is made, considerations include an assessment of disease severity as well as a determination of the rate of progression. Because patients may have extrathoracic disease activity, a multidisciplinary approach is crucial and should include supportive and nonpharmacologic management strategies.
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Affiliation(s)
- Danielle Antin-Ozerkis
- Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, PO Box 208057, New Haven, CT 06520-8057, USA.
| | - Monique Hinchcliff
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, PO Box 208031, New Haven, CT 06520-8031, USA
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14
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Pulmonary Rehabilitation… Yes But No. Arch Bronconeumol 2019; 55:617-618. [PMID: 31676192 DOI: 10.1016/j.arbres.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
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15
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Spruit MA, Wouters EF. Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases. Respirology 2019; 24:838-843. [PMID: 30810256 PMCID: PMC6849848 DOI: 10.1111/resp.13512] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
Abstract
Adult patients with chronic respiratory diseases may suffer from multiple physical (pulmonary and extra-pulmonary), emotional and social features which necessitate a comprehensive, interdisciplinary rehabilitation programme. To date, pulmonary rehabilitation programmes show a lot of variation in setting, content, frequency and duration. Future projects should strive for a standard set of assessment measures to identify patients eligible for pulmonary rehabilitation, taking disease complexity into consideration, which should result in referral to an appropriate rehabilitation setting. Local circumstances may complicate this crucial endeavour.
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Affiliation(s)
- Martijn A. Spruit
- Department of Research and EducationCIRO, Centre of Expertise for Chronic Organ FailureHornThe Netherlands
- Department of Respiratory MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastrichtThe Netherlands
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation SciencesHasselt UniversityDiepenbeekBelgium
| | - Emiel F.M. Wouters
- Department of Research and EducationCIRO, Centre of Expertise for Chronic Organ FailureHornThe Netherlands
- Department of Respiratory MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
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16
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Polastri M, Clini EM, Nava S, Ambrosino N. Manual Massage Therapy for Patients with COPD: A Scoping Review. ACTA ACUST UNITED AC 2019; 55:medicina55050151. [PMID: 31108862 PMCID: PMC6572655 DOI: 10.3390/medicina55050151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/12/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Manual massage therapy is a therapeutic option for the treatment of several pathological conditions affecting the musculoskeletal system. It has been pointed out that massage might be beneficial for chronic obstructive pulmonary disease (COPD) patients thanks to therapeutic effects primarily related to hyperemia (increased skin temperature and blood flow), and activation of the lymphatic system. The present study reports current evidence on the systemic effects of manual massage in patients with COPD. Materials and Methods: A scoping review was conducted on five major databases. The search went through all databases since their inception until December 2018. Results: Seventy-eight citations were retrieved; after the selection process was completed, seven articles were considered eligible. In patients receiving manual massage, improvements were observed in Forced Expiratory Volume in 1 s, dyspnea perception, and in the 6-min walking test. Conclusions: To date, the use of manual massage in patients with COPD is not supported by substantial evidence in the literature: indeed, it is proposed as a therapeutic option in association with other interventions such as physical exercise.
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Affiliation(s)
- Massimiliano Polastri
- Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St. Orsola University Hospital, 40138 Bologna, Italy.
| | - Enrico Maria Clini
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy.
| | - Stefano Nava
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, 40138 Bologna, Italy.
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri, IRCCS, Pulmonary Rehabilitation Institute of Montescano, 27040 Montescano, Italy.
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