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Brighton LJ, Evans CJ, Farquhar M, Bristowe K, Kata A, Higman J, Ogden M, Nolan C, Yi D, Gao W, Koulopoulou M, Hasan S, Ingram K, Clarke S, Parmar KR, Baldwin E, Steves CJ, Man WDC, Maddocks M. Comprehensive geriatric assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial. ERJ Open Res 2024; 10:00774-2023. [PMID: 39076524 PMCID: PMC11284595 DOI: 10.1183/23120541.00774-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/26/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated. The aim of the present study was to determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation. Methods A multicentre mixed-methods randomised controlled feasibility trial ("Breathe Plus"; ISRCTN13051922) was carried out. People with COPD, aged ≥50 years, Clinical Frailty Scale ≥5 and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during COVID-19 restrictions. Outcomes (physical, psychosocial, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews. Results Recruitment stopped at 31 participants (mean±sd age 72.4±10.1 years, 68% Medical Research Council Dyspnoea Scale 4-5), due to COVID-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8-129) and prompted 46 individual care recommendations (median 3 per participant, range 0-12), 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it. Conclusion Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.
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Affiliation(s)
- Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, London, UK
| | - Catherine J. Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Morag Farquhar
- University of East Anglia, School of Health Sciences, Norwich, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | | | - Jade Higman
- King's College London, Clinical Trials Unit, London, UK
| | - Margaret Ogden
- King's College London, Cicely Saunders Institute Public Involvement Group, London, UK
| | - Claire Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Brunel University London, College of Health, Medicine and Life Sciences, London, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Maria Koulopoulou
- King's College Hospital NHS Foundation Trust, Pulmonary Rehabilitation, London, UK
| | - Sharmeen Hasan
- King's College Hospital NHS Foundation Trust, Department of Clinical Gerontology, London, UK
| | - Karen Ingram
- Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Stuart Clarke
- Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Kishan R. Parmar
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Eleni Baldwin
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Claire J. Steves
- King's College London, Department of Twin Research and Genetic Epidemiology, London, UK
- Guys and St. Thomas’ NHS Foundation Trust, Department of Ageing and Health, London, UK
| | - William D-C. Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Imperial College, National Heart and Lung Institute, London, UK
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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Maddocks M, Brighton LJ, Alison JA, Ter Beek L, Bhatt SP, Brummel NE, Burtin C, Cesari M, Evans RA, Ferrante LE, Flores-Flores O, Franssen FME, Garvey C, Harrison SL, Iyer AS, Lahouse L, Lareau S, Lee AL, Man WDC, Marengoni A, McAuley HJC, Rozenberg D, Singer JP, Spruit MA, Osadnik CR. Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:767-780. [PMID: 37261787 PMCID: PMC10257033 DOI: 10.1513/annalsats.202302-129st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a "frailty rehabilitation paradox" whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.
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Parola V, Coelho A, Neves H, Cardoso D, Almeida M, Cruz A, Apóstolo J. Palliative rehabilitation interventions in palliative care: a scoping review protocol. JBI Evid Synth 2020; 18:2349-2356. [PMID: 32925394 DOI: 10.11124/jbies-20-00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to examine and map interventions of palliative rehabilitation that are implemented and evaluated in palliative care. INTRODUCTION Palliative rehabilitation is defined as the process of helping individuals with a progressive, often advanced or incurable disease reach their physical, psychological, and social potential consistent with physiological and environmental limitations and life preferences. Rehabilitation may prolong functional independence and improve quality of life. Information on palliative rehabilitation interventions, their characteristics, contexts, and population is dispersed throughout the literature, hence the need for a scoping review. INCLUSION CRITERIA This scoping review will consider all studies that focus on qualified health care professionals working in palliative care who are caring for patients 18 years of age or older, and studies that focus on the concepts of palliative rehabilitation interventions. This scoping review will consider all palliative rehabilitation interventions implemented and evaluated in the context of palliative care. METHODS The search strategy aims to find published and unpublished studies. The databases to be searched will include CINAHL Complete, PubMed, Scopus, SciELO, Cochrane Central Register of Controlled Trials, and PEDro. The search for unpublished studies will include DART-Europe, OpenGrey, and RCAAP. Studies published in English, Spanish, and Portuguese carried out from 2009 onward will be considered for inclusion. Retrieved papers will be screened for inclusion by two reviewers. Data will be extracted and presented in tabular form and a narrative summary that aligns with the review's objective. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer.
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Affiliation(s)
- Vitor Parola
- University Fernando Pessoa, Faculty of Health Sciences, Porto, Portugal.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
| | - Adriana Coelho
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
| | - Hugo Neves
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
| | - Daniela Cardoso
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
| | - Maria Almeida
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Arménio Cruz
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
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Wouters TJ, van Dam van Isselt EF, Achterberg WP. Information needs of older patients living with chronic obstructive pulmonary disease (COPD) indicated for a specific geriatric rehabilitation programme: a prospective cohort study. Int J Palliat Nurs 2020; 26:238-245. [PMID: 32584692 DOI: 10.12968/ijpn.2020.26.5.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Post-acute rehabiitation is recommended in the treatment of chronic obstructive pulmonary disease (COPD). It enhances the sense of control by education, which should focus on patient information needs. However, it is unknown whether a geriatric rehabilitation programme for older patients with advanced COPD and severely impaired health status (the GR-COPD programme) does fit these patient information needs. OBJECTIVES The study aimed to identify the information needs of patients who were eligible for the GR-COPD programme, and investigated if health-related knowledge improved during rehabilitation. METHODS All patients indicated for the GR-COPD programme were eligible for this study. The information needs were measured with the Lung Information Needs Questionnaire (LINQ). FINDINGS The 158 patients (mean age 70.8 years; FEV1 %predicted: 35.5) showed relatively high baseline information needs (mean LINQ overall score: 8.6 [SD 3.1]), with the greatest need in the domains 'diet' and 'self-management'. After follow-up, the mean LINQ overall score significantly improved in patients who completed the GR-COPD programme (p=0.001). CONCLUSION Patients' knowledge showed a statistically significant improvement in some areas during the GR-COPD programme.
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Affiliation(s)
- Timotheus J Wouters
- Elderly Care Physician, Department of Public Health and Primary Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Eléonore F van Dam van Isselt
- Elderly Care Physician and Senior Researcher, Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilco P Achterberg
- Professor of Elderly Care Medicine, Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
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Brighton LJ, Evans CJ, Man WDC, Maddocks M. Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review. Int J Chron Obstruct Pulmon Dis 2020; 15:841-855. [PMID: 32368030 PMCID: PMC7182688 DOI: 10.2147/copd.s238680] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
Background People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercise-based interventions might improve outcomes for people living with both COPD and frailty. Methods This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.
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Affiliation(s)
- Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
- Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK
| | - William D C Man
- National Heart and Lung Institute, Imperial College, London, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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van Dam van Isselt EF, van Eijk M, van Geloven N, Groenewegen-Sipkema KH, van den Berg JWK, Nieuwenhuys CMA, Chavannes NH, Achterberg WP. A Prospective Cohort Study on the Effects of Geriatric Rehabilitation Following Acute Exacerbations of COPD. J Am Med Dir Assoc 2019; 20:850-856.e2. [PMID: 30982715 DOI: 10.1016/j.jamda.2019.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Older patients with chronic obstructive pulmonary disease (COPD), hospitalized for an acute exacerbation, often do not receive recommended post-acute pulmonary rehabilitation. This underuse might be related to the impaired clinical and functional status of these patients, who are more likely to present with frailty, comorbidities, and disability. Having developed and implemented a geriatric rehabilitation program for these patients (GR_COPD), the primary aim of this study was to investigate the effectiveness of this program. DESIGN AND INTERVENTION A prospective cohort study with a 3-month follow-up period. Patients who declined the GR_COPD program were considered as controls. SETTING AND PARTICIPANTS The study was conducted at the pulmonary department of 2 hospitals. Patients were eligible when hospitalized as a result of an acute exacerbation of COPD and indicated for the GR_COPD program based on standardized criteria. METHODS Primary outcome was defined as change in disease-specific health status measured with the clinical COPD questionnaire (CCQ), secondary outcome as the exacerbation rate ratio during follow-up. To balance potential confounders between the intervention and control group, propensity score-based weighted linear regression analyses were performed. RESULTS Of the 158 included patients [78 (49.4%) male, mean age 70.8 (±8.1) years, mean forced expiratory volume in 1 second: 35.5 (±12.8) as % of predicted], 78 received the GR_COPD program. The results of the CCQ showed a significant and clinically relevant treatment effect of -0.56 points [95% confidence interval (CI) -0.89, -0.23; P = .001). Patients in the control group had 2.77 times more exacerbations compared with the intervention group (95% CI 2.13, 3.58; P < .001). CONCLUSIONS/IMPLICATIONS This study shows a clinically relevant effect of the GR_COPD program on disease-specific health status and exacerbation rate. Implementation of the program for older patients with severe COPD hospitalized for an acute exacerbation is recommended.
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Affiliation(s)
- Eléonore F van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands; Zorggroep Solis, Deventer, the Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
| | - Nan van Geloven
- Department of Medical Statistics, Leiden University Medical Centre, the Netherlands
| | | | | | - Cécile M A Nieuwenhuys
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, the Netherlands
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7
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Javier NM, Montagnini M. The Role of Palliative Rehabilitation in Serious Illness #364. J Palliat Med 2018. [DOI: 10.1089/jpm.2018.0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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8
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Blindenbach S, Vrancken JWFA, van der Zeijden H, Reesink HJ, Brijker F, Smalbrugge M, Wattel EM. [Effects of Geriatric COPD rehabilitation on hospital admissions and exercise tolerance: a retrospective observational study]. Tijdschr Gerontol Geriatr 2018; 48:112-120. [PMID: 28447319 DOI: 10.1007/s12439-017-0214-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Frail COPD patients are frequently not accepted for regular pulmonary rehabilitation programs due to low physical condition and functional limitations. Rehabilitation programs in nursing homes for geriatric patients with COPD have been developed. The effects of such programs are largely unknown. AIMS To assess the course of COPD-related hospital admissions and exercise tolerance in a cohort of frail COPD patients participating in geriatric COPD rehabilitation. METHODS Retrospective observational study with a follow up of 12 months after discharge from rehabilitation. COPD related hospital admission days were measured in the year before and after participating rehabilitation. Exercise tolerance was measured by the six minute walk test (6MWT) at admission and at discharge from rehabilitation. RESULTS Fifty-eight participants accomplished the rehabilitation program. Twelve patients died in the first year after discharge. The median number of hospital admission days in the year before participating rehabilitation was 21 (IQR 10-33). The first year after discharge this was decreased to a median of 6 (IQR 0-12). The 6MWT increased from 194 (SD 85) meters at admission to 274 (SD 95) meters at discharge (mean difference 80 m, SD 72; p < 0.05). CONCLUSIONS Geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.
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Affiliation(s)
| | | | | | - Herre J Reesink
- St. Antonius Ziekenhuis, Utrecht/Nieuwegein, Nederland.,OLVG, Amsterdam, Nederland
| | | | - Martin Smalbrugge
- Afdeling Huisartsgeneeskunde en Ouderengeneeskunde, Amsterdam Public Health research institute, VU Medisch Centrum, Amsterdam, Nederland
| | - Elizabeth M Wattel
- Afdeling Huisartsgeneeskunde en Ouderengeneeskunde, Amsterdam Public Health research institute, VU Medisch Centrum, Amsterdam, Nederland
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Abstract
ABSTRACT: The objective of this study was to describe the activities and effects of functional rehabilitation in patients receiving palliative care. It is an integrative review, in which LILACS, BDENF, Coleciona SUS (Brazil) and PUBMED were used, 20 articles were selected, subsequently characterized as having designs of medium and low impact, more than half ranked with evidence levels II, III and IV and with samples not always consistent with the research designs. However, the results revealed the potential of rehabilitation to improve the functional status, quality of life and symptoms like pain and anxiety in this population, through interventions that are many times undervalued in palliative care. The conclusion is that rehabilitation is a feasible strategy to combat functional decline and improve the quality of life of patients in palliative care.
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11
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van Dam van Isselt EF, Spruit M, Groenewegen-Sipkema KH, Chavannes NH, Achterberg WP. Geriatric rehabilitation for patients with advanced chronic obstructive pulmonary disease: a naturalistic prospective cohort study on feasibility and course of health status. Chron Respir Dis 2015; 11:111-9. [PMID: 24728657 DOI: 10.1177/1479972314529674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In view of the worldwide aging population, disease-specific geriatric rehabilitation (GR) programs are needed. Therefore, we developed and implemented a postacute GR program for patients with advanced chronic obstructive pulmonary disease (COPD) (the GR-COPD program). The aim of this study is to investigate the feasibility of the GR-COPD program and to present clinical data on patient characteristics and course of functional capacity and health status. This is a naturalistic prospective cohort study of patients with advanced COPD. A total of 61 patients entered the GR-COPD program and were eligible to participate in this study. All patients suffered from advanced COPD, and comorbidities were frequent. On admission, functional capacity and health status were severely limited but showed significant and clinically relevant improvement during the GR-COPD program. Patients with advanced COPD admitted to hospital for an acute exacerbation suffer from severely impaired functional capacity and poor health status. Development and implementation of a postacute GR program for these patients are feasible and likely to offer substantial improvements. Further research is essential and should focus on designing a controlled intervention trial to investigate the efficacy of the program.
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Dignani L, Toccaceli A, Guarinoni MG, Petrucci C, Lancia L. Quality of Life in Chronic Obstructive Pulmonary Disease: An Evolutionary Concept Analysis. Nurs Forum 2014; 50:201-13. [PMID: 25155165 DOI: 10.1111/nuf.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore the concept of quality of life (QoL) of people with chronic obstructive pulmonary disease (COPD) in the nursing context. BACKGROUND The issue of QoL takes on a leading role in the COPD field because it is an incurable pathology. Despite its relevance, this concept is quite ambiguous, and there is no consensus of opinion in the literature regarding its definition. DESIGN AND METHODS Rodgers' method of evolutionary concept analysis was employed to delineate and clarify the concept of QoL in COPD. An electronic review was made on scientific databases from 2008 to 2013. The 75 selected articles were analyzed in order to highlight the main themes related to QoL concept. RESULTS The QoL appears as a dynamic and multidimensional concept that evolves with the progression of the pathology and the impairment of health status. It has both subjective and objective characteristics, intrinsic and extrinsic elements. CONCLUSIONS This analysis provides an overview of the QoL concept related to COPD patients that is useful as a guide to research into nursing care and for clinical practice.
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Affiliation(s)
| | - Andrea Toccaceli
- Department of Health, Life and Environmental Sciences, Nursing Science Doctorate School, University of L'Aquila, L'Aquila, Italy
| | | | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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13
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Troosters T, Hornikx M, Demeyer H, Camillo CA, Janssens W. Pulmonary Rehabilitation. Clin Chest Med 2014; 35:303-11. [DOI: 10.1016/j.ccm.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Health status measured by the Clinical COPD Questionnaire (CCQ) improves following post-acute pulmonary rehabilitation in patients with advanced COPD: a prospective observational study. NPJ Prim Care Respir Med 2014; 24:14007. [PMID: 24842278 PMCID: PMC4373298 DOI: 10.1038/npjpcrm.2014.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/21/2022] Open
Abstract
Aims: To evaluate outcomes of the Clinical Chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ) in patients with advanced COPD admitted for a post-acute pulmonary rehabilitation (PR) programme and to relate (change in) health status to lung function, degree of dyspnoea and (change in) functional capacity. Methods: This is a prospective observational study in patients with advanced COPD admitted for a post-acute PR programme in a skilled nursing facility. Health status (CCQ) and functional capacity were measured before and after rehabilitation. Results: Health status measured by the CCQ was severely impaired and showed significant and clinically relevant improvement during the post-acute PR programme. Moderate to strong correlations were found between CCQ scores and functional capacity on admission and at discharge. Moderate correlations were found between improvement in CCQ scores and improvement in functional capacity. No correlation was found between CCQ scores and lung function (forced expiratory volume in 1 s % predicted). Conclusions: Health status measured by the CCQ improves following a post-acute PR programme in patients with advanced COPD and correlates with improvement in functional capacity. These results suggest that the CCQ is sensitive to change in response to PR in this specific group of patients.
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Krival K. Dysphagia Services in Nursing Homes: An Opportunity for Improving Patient Outcomes Through Palliative Care. ACTA ACUST UNITED AC 2013. [DOI: 10.1044/gero18.3.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kate Krival
- Edinboro University of Pennsylvania, Edinboro, PA
- Kent State University, Kent, OH
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