1
|
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.
Collapse
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
| |
Collapse
|
2
|
Aburub A, Darabseh MZ, Badran R, Eilayyan O, Shurrab AM, Degens H. The Effects of Digital Health Interventions for Pulmonary Rehabilitation in People with COPD: A Systematic Review of Randomized Controlled Trials. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:963. [PMID: 38929580 PMCID: PMC11206104 DOI: 10.3390/medicina60060963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is the third most common cause of death globally. Pulmonary rehabilitation (PR) programmes are important to reduce COPD symptoms and improve the quality of life of people with COPD. Digital health interventions have recently been adopted in PR programmes, which allow people with COPD to participate in such programmes with low barriers. The aim of this study is to review and discuss the reported effects of digital health interventions on PR outcomes in people with COPD. Materials and Methods: To achieve the study goals, a systematic literature search was conducted using PubMed (MEDLINE), CINAHL, AMED, SPORTDiscus and the Physiotherapy Evidence Database. Randomised clinical trials (RCTs) were included if they met specified criteria. Two reviewers independently checked titles, abstracts, and performed full-text screening and data extraction. The quality assessment and risk of bias were performed in accordance with the PEDRO scale and Cochrane Risk of Bias tool 2, respectively. Results: Thirteen RCTs were included in this systematic review with 1525 participants with COPD. This systematic review showed the potential positive effect of digital health PR on the exercise capacity-measured by 6- and 12-min walking tests, pulmonary function, dyspnoea and health-related quality of life. There was no evidence for advantages of digital health PR in the improvement of anxiety, depression, and self-efficacy. Conclusions: Digital health PR is more effective than traditional PR in improving the pulmonary and physical outcomes for people with COPD, but there was no difference between the two PR programmes in improving the psychosocial outcomes. The certainty of the findings of this review is affected by the small number of included studies.
Collapse
Affiliation(s)
- Aseel Aburub
- Department of Physiotherapy, Applied Science Private University, Amman 11931, Jordan;
| | - Mohammad Z. Darabseh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Rahaf Badran
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Middle East University, Amman 11831, Jordan
| | - Owis Eilayyan
- Department of Physical Therapy, Al-Ahliyya Amman University, Amman 19111, Jordan;
| | - Ala’a M. Shurrab
- Department of Basic Medical Science, Faculty of Medicine, Al-Balqa Applied University, Al Salt 19117, Jordan;
| | - Hans Degens
- Department of Life Sciences, Institute of Sport, Manchester Metropolitan University, Manchester M1 5GD, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| |
Collapse
|
3
|
Baldwin MM, Singh SJ. Are the Brakes Off for Constant Work Rate Exercise Tests to Be Used in Regulatory Decision Making in Chronic Obstructive Pulmonary Disease? Ann Am Thorac Soc 2024; 21:699-700. [PMID: 38691005 PMCID: PMC11109911 DOI: 10.1513/annalsats.202401-090ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Affiliation(s)
- Molly M Baldwin
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, United Kingdom; and
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre Respiratory, Leicester, United Kingdom; and
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
4
|
Harvey J, Ingram K, Edwards G, Jenkins TO, Gardener G, Patel S, Man WDC, Barker RE. Motivations for completing pulmonary rehabilitation - A qualitative analysis. Chron Respir Dis 2024; 21:14799731241264789. [PMID: 38901833 PMCID: PMC11191621 DOI: 10.1177/14799731241264789] [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: 02/14/2023] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Background: Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors that promote completion of PR. Methods: A mixed methods survey was offered to participants completing a discharge assessment following PR. Descriptive statistics and inductive thematic analysis were used to analyse the survey responses, with investigator triangulation. Results: 62 of 187 (33%) patients attending a PR discharge assessment between November 2022 and April 2023 returned the anonymised survey. Desire to improve health and wellbeing was the main reason for both initially committing to a course and for continuing with PR past transient thoughts of leaving. The positive impact of staff was the second most common reason. The enjoyment of the PR programme, being held accountable to attend classes, and the importance of other group members were other key themes identified. Conclusions: In conclusion, our findings suggest PR services need to implement strategies which ensure regular promotion and reinforcement of the health benefits of PR as well as implementation of PR modalities which best monopolise on the positive impact skilled staff have on motivating patients to complete PR.
Collapse
Affiliation(s)
- Jennifer Harvey
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Karen Ingram
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - George Edwards
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Timothy O Jenkins
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Gina Gardener
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - William D-C Man
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Health Innovation Wessex, Southampton Science Park, Southampton, UK
| |
Collapse
|
5
|
Liou HL, Lai ZY, Huang YT, Chu WT, Tsai YC, Chen MS, Tsai PC. The effectiveness of an unsupervised home-based pulmonary rehabilitation with self-management program in patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2023; 29:e13185. [PMID: 37515349 DOI: 10.1111/ijn.13185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
AIMS To assess the effectiveness of an unsupervised home-based pulmonary rehabilitation with self-management program in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND A few recent studies have shown that unsupervised home-based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. DESIGN This study used a quasi-experimental design. METHODS Seventy-two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self-Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. RESULTS The Medical Research Council dyspnea scale and COPD Self-Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. CONCLUSION A short-term unsupervised home-based pulmonary rehabilitation with self- management program had significant benefits for patients with COPD. The long-term effects need to be confirmed.
Collapse
Affiliation(s)
- Huey L Liou
- Department of Living Sciences, National Open University, New Taipei City, Taiwan (R.O.C.)
| | - Zi Y Lai
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Yu T Huang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Wan T Chu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Ya C Tsai
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Mei S Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Pei C Tsai
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| |
Collapse
|
6
|
Osadnik CR, Brighton LJ, Burtin C, Cesari M, Lahousse L, Man WDC, Marengoni A, Sajnic A, Singer JP, Ter Beek L, Tsiligianni I, Varga JT, Pavanello S, Maddocks M. European Respiratory Society statement on frailty in adults with chronic lung disease. Eur Respir J 2023; 62:2300442. [PMID: 37414420 DOI: 10.1183/13993003.00442-2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
Frailty is a complex, multidimensional syndrome characterised by a loss of physiological reserves that increases a person's susceptibility to adverse health outcomes. Most knowledge regarding frailty originates from geriatric medicine; however, awareness of its importance as a treatable trait for people with chronic respiratory disease (including asthma, COPD and interstitial lung disease) is emerging. A clearer understanding of frailty and its impact in chronic respiratory disease is a prerequisite to optimise clinical management in the future. This unmet need underpins the rationale for undertaking the present work. This European Respiratory Society statement synthesises current evidence and clinical insights from international experts and people affected by chronic respiratory conditions regarding frailty in adults with chronic respiratory disease. The scope includes coverage of frailty within international respiratory guidelines, prevalence and risk factors, review of clinical management options (including comprehensive geriatric care, rehabilitation, nutrition, pharmacological and psychological therapies) and identification of evidence gaps to inform future priority areas of research. Frailty is underrepresented in international respiratory guidelines, despite being common and related to increased hospitalisation and mortality. Validated screening instruments can detect frailty to prompt comprehensive assessment and personalised clinical management. Clinical trials targeting people with chronic respiratory disease and frailty are needed.
Collapse
Affiliation(s)
- Christian R Osadnik
- Monash University, Department of Physiotherapy, Frankston, Australia
- Monash Health, Monash Lung, Sleep, Allergy and Immunology, Frankston, Australia
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Will D C Man
- Heart Lung and Critical Care Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alessandra Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Andreja Sajnic
- Department for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb, Croatia
| | - Jonathan P Singer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lies Ter Beek
- Vrije Universiteit Amsterdam, University Medical Center Groningen, Amsterdam, The Netherlands
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janos T Varga
- Semmelweis University, Department of Pulmonology, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Department of Pulmonary Rehabilitation, Budapest, Hungary
| | | | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
Collapse
Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | | |
Collapse
|
9
|
Nyberg A, Sondell A, Lundell S, Marklund S, Tistad M, Wadell K. Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis. JMIR Hum Factors 2023; 10:e43269. [PMID: 36995743 PMCID: PMC10131608 DOI: 10.2196/43269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/13/2022] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management. OBJECTIVE The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice. METHODS This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach. RESULTS The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis. CONCLUSIONS This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis. TRIAL REGISTRATION ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.
Collapse
Affiliation(s)
- André Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Sondell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sara Lundell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
10
|
Spielmanns M, Schulze ST, Guenes E, Pekacka-Falkowska K, Windisch W, Pekacka-Egli AM. Clinical Effects of Pulmonary Rehabilitation in Very Old Patients with COPD. J Clin Med 2023; 12:jcm12072513. [PMID: 37048597 PMCID: PMC10095259 DOI: 10.3390/jcm12072513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Pulmonary rehabilitation (PR) improves physical and mental performance as well as quality of life in patients with chronic obstructive pulmonary disease (COPD). However, data on outcomes in very old patients are insufficient. We analyzed whether the elderly with COPD benefit in a similar way to younger patients from participation in an inpatient PR according to the assessments usually collected. Methods: Data from 3173 patients with COPD were retrospectively analyzed. Patients were referred to PR at the Zurich RehaZentren, Switzerland, between January 2013 and December 2019. PR was performed 6 days per week with an average duration of 18.85 days. Functional Independence Measurement (FIM), Feeling Thermometer (FT), and 6-Minute Walk Test (6MWT) were recorded on admission and discharge. Results: In all age groups, the 6MWT and FT improved significantly. FIM results also showed a significant increase. The results of the different age groups showed no significant differences in percentage improvements according to the assessments that were considered. Conclusions: All patient groups with COPD, even the oldest (>85 years), benefited from PR regardless of their age and according to the assessments. Prospective studies are needed to support this hypothesis.
Collapse
|
11
|
Brighton LJ, Nolan CM, Barker RE, Patel S, Walsh JA, Polgar O, Kon SSC, Gao W, Evans CJ, Maddocks M, Man WDC. Frailty and Mortality Risk in COPD: A Cohort Study Comparing the Fried Frailty Phenotype and Short Physical Performance Battery. Int J Chron Obstruct Pulmon Dis 2023; 18:57-67. [PMID: 36711228 PMCID: PMC9880562 DOI: 10.2147/copd.s375142] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/22/2022] [Indexed: 01/20/2023] Open
Abstract
Background Identifying frailty in people with chronic obstructive pulmonary disease (COPD) is deemed important, yet comparative characteristics of the most commonly used frailty measures in COPD are unknown. This study aimed to compare how the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB) characterise frailty in people with stable COPD, including prevalence of and overlap in identification of frailty, disease and health characteristics of those identified as living with frailty, and predictive value in relation to survival time. Methods Cohort study of people with stable COPD attending outpatient clinics. Agreement between frailty classifications was described using Cohen's Kappa. Disease and health characteristics of frail versus not frail participants were compared using t-, Mann-Whitney U and Chi-Square tests. Predictive value for mortality was examined with multivariable Cox regression. Results Of 714 participants, 421 (59%) were male, mean age 69.9 years (SD 9.7), mean survival time 2270 days (95% CI 2185-2355). Similar proportions were identified as frail using the FFP (26.2%) and SPPB (23.7%) measures; classifications as frail or not frail matched in 572 (80.1%) cases, showing moderate agreement (Kappa = 0.469, SE = 0.038, p < 0.001). Discrepancies seemed driven by FFP exhaustion and weight loss criteria and the SPPB balance component. People with frailty by either measure had worse exercise capacity, health-related quality of life, breathlessness, depression and dependence in activities of daily living. In multivariable analysis controlling for the Age Dyspnoea Obstruction index, sex, BMI, comorbidities and exercise capacity, both the FFP and SPPB had predictive value in relation to mortality (FFP aHR = 1.31 [95% CI 1.03-1.66]; SPPB aHR = 1.29 [95% CI 0.99-1.68]). Conclusion In stable COPD, both the FFP and SPPB identify similar proportions of people living with/without frailty, the majority with matching classifications. Both measures can identify individuals with multidimensional health challenges and increased mortality risk and provide additional information alongside established prognostic variables.
Collapse
Affiliation(s)
- Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK.,Division of Physiotherapy, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,Insight Innovation, Wessex Academic Health Science Network, Southampton, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Samantha S C Kon
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,Department of Respiratory Medicine, The Hillingdon Hospital NHS Trust, London, UK
| | - Wei Gao
- 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
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, 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.,National Heart and Lung Institute, Imperial College, London, UK.,Harefield Pulmonary Rehabilitation Unit, Guy's and St Thomas NHS Foundation Trust, London, UK.,Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
12
|
Khan MMKS, Cole AG, Mannino DM. Precision medicine in chronic obstructive pulmonary disease: how far have we come? Curr Opin Pulm Med 2022; 28:115-120. [PMID: 34652296 DOI: 10.1097/mcp.0000000000000837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we will discuss the current status and recent developments in precision medicine in chronic obstructive pulmonary disease (COPD) through the lens of treatable traits. RECENT FINDINGS Although the term 'treatable traits' in the treatment of COPD is relatively recent, this concept has been used for many years if one considers interventions such as long-term oxygen therapy or alpha-1 antitrypsin replacement therapy. Recent advances have included expanding the definition of COPD to include a broader population of people with lower respiratory disease but not meeting the strict criteria for obstruction, advances in imaging to aid in the diagnosis and treatment of COPD, advances in understanding symptoms and exacerbations to define severity, using biomarkers to guide therapy and better understanding and addressing polymorbidity and frailty. In addition, there is a concerted effort to use these concepts to identify COPD patients earlier in the disease process wherein disease modification may be possible. SUMMARY Focusing on subsets of patients with COPD with certain characteristics should lead to better outcomes and fewer adverse effects from treatment. VIDEO ABSTRACT http://links.lww.com/COPM/A30.
Collapse
|
13
|
Sami R, Salehi K, Hashemi M, Atashi V. Exploring the barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a qualitative study. BMC Health Serv Res 2021; 21:828. [PMID: 34404393 PMCID: PMC8369747 DOI: 10.1186/s12913-021-06814-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The complexity of chronic obstructive pulmonary disease (COPD) and its different physical, mental, familial, occupational, and social complications highlight the necessity of pulmonary rehabilitation (PR) for afflicted patients. However, PR for patients with COPD usually faces some barriers. The aim of this study was to explore the barriers to PR for patients with COPD. METHODS This qualitative descriptive study was conducted in January 2019 to October 2020. Participants were 19 patients with COPD, 11 family caregivers of patients with COPD, and 12 healthcare providers, who all were recruited purposively from two teaching hospitals in Isfahan, Iran. Data were collected through semi-structured interviews and were analyzed through conventional content analysis. RESULTS The barriers to PR for patients with COPD fell into three main categories, namely barriers related to patients and their families, inefficiency of PR services, and inappropriate organizational context for PR. Each category had four subcategories, namely patients' and families' lack of knowledge, complexity and chronicity of COPD, heavy financial burden of COPD, patients' frustration and discontinuation of PR, lack of patient-centeredness, lack of coordination in PR team, inadequate professional competence of PR staff, lack of a holistic approach to PR, limited access to PR services, inadequate insurance for PR services, ineffective PR planning, and discontinuity of care. CONCLUSION PR for patients with COPD is a complex process which faces different personal, familial, social, financial, organizational, and governmental barriers. Strategies for managing these barriers are needed in order to improve the effectiveness and the quality of PR services for patients with COPD.
Collapse
Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Kobra Salehi
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Marzieh Hashemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Vajihe Atashi
- Adult Health Nursing Department, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| |
Collapse
|
14
|
Volpato E, Centanni S, Banfi P, D'Antonio S, Peterle E, Bugliaro F, Grattagliano I, Piraino A, Cavalieri L, Pennisi A, Danesi G, Santoiemma L, Marini MG. Narrative Analysis of the Impact of COVID-19 on Patients with Chronic Obstructive Pulmonary Disease, Their Caregivers, and Healthcare Professionals in Italy. Int J Chron Obstruct Pulmon Dis 2021; 16:2181-2201. [PMID: 34335023 PMCID: PMC8318732 DOI: 10.2147/copd.s312372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/19/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose The COVID-19 pandemic has disrupted many lives, including those of people suffering from chronic obstructive pulmonary disease (COPD) and their caregivers. The main aim of this study was to use narrative medicine, a validated approach promoting quality of care to explore how the COVID-19 pandemic impacted the quality of care, quality of life, psychological factors and social factors of people affected by COPD and their caregivers and healthcare professionals (HCPs). A secondary aim was to explore the role of telemedicine in combating isolation and providing access to care. Methods A cross-sectional observational narrative medicine study was conducted between July and November 2020 across Italy. An online semi-structured questionnaire with a narrative plot was completed by 146 participants (79 COPD patients, 24 caregivers, and 43 HCPs). Narrations were analyzed with descriptive statistics and evaluated using NVivo 11 software to break down the text and identify recurring themes and major semantic clusters. Results During the first lockdown, 58.22% of responses from COPD patients indicated terror, fear and/or apprehension; at reopening, this figure was 35.44%. Among caregivers, these figures were 100% at first lockdown and 45.83% at reopening. The metaphors most commonly used by patients to describe COPD and COVID-19 were monster and murderer, respectively. Patients described their homes more often as clean and lonely than as offering no shelter. The narratives of 42 COPD patients (45.2%) described coping. Only 12.6% of COPD patients reported regular access to medical visits during lockdown, while 59.1% of general practitioners and pulmonologists reported using telemedicine, which was perceived as satisfactory by both patients and caregivers. Conclusion It is relevant to aim for a multidisciplinary and multilevel system of care that empowers telemedicine and integrates specific psychological support programs for COPD patients and their caregivers.
Collapse
Affiliation(s)
- Eleonora Volpato
- Healthcare Area, ISTUD Foundation, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Stefano Centanni
- Department of Health Sciences Università degli Studi di Milano - Respiratory UnitASST Santi Paolo e Carlo, Milan, Italy
| | - Paolo Banfi
- Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | - Enrico Peterle
- General Practitioner, Local Health Department 3 Serenissima, Venezia, Italy
| | - Filomena Bugliaro
- Federasma e Allergie-Federazione Italiana Pazienti OdV, Prato, Italy
| | | | | | | | - Alfio Pennisi
- Rehabilitation Clinic Monsignor Calaciura Biancavilla, Catania, Italy
| | - Gianluca Danesi
- Local Health Department Romagna Pulmonology Ravenna, Ravenna, Italy
| | | | | |
Collapse
|
15
|
Stoffels AAF, De Brandt J, Meys R, van Hees HWH, Vaes AW, Klijn P, Burtin C, Franssen FME, van den Borst B, Sillen MJH, Janssen DJA, Spruit MA. Short Physical Performance Battery: Response to pulmonary rehabilitation and minimal important difference estimates in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2021; 102:2377-2384.e5. [PMID: 34175275 DOI: 10.1016/j.apmr.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the response to a pulmonary rehabilitation (PR) program and minimal important differences (MIDs) for the Short Physical Performance Battery (SPPB) subtests and SPPB summary score in patients with Chronic Obstructive Pulmonary Disease (COPD). DESIGN Retrospective analysis using distribution- and anchor-based methods. SETTING PR center in the Netherlands including a comprehensive 8-week inpatient and 14-week outpatient program of 40 sessions. PARTICIPANTS 632 patients with COPD (age: 65±8 years, 50% male, FEV1: 43 (27-47) % predicted) INTERVENTION: Not applicable. MAIN OUTCOME MEASURE Baseline and post PR results of the SPPB, consisting of three balance standing tests, 4-meter gait speed (4MGS) test and 5-repetition sit-to-stand (5STS) test. The chosen anchors were 6-minute walk test and COPD Assessment Test. Patients were stratified according to their SPPB summary scores into a low-performance, moderate-performance or high-performance group. RESULTS 5STS (∆= -1.14 (-4.20- -0.93) seconds) and SPPB summary score (∆= 1 (0-2) points) improved after PR in patients with COPD. In patients with low-performance at baseline, balance tandem and 4MGS significantly increased as well. Based on distribution-based calculations, the MID estimates range between 2.19-6.33 seconds for 5STS and 0.83-0.96 points for SPPB summary score. CONCLUSIONS The 5STS and SPPB summary score are both responsive to PR in patients with COPD. The balance tandem test and 4MGS are only responsive to PR in patients with COPD with a low-performance at baseline. Based on distribution-based calculations, a MID estimate of 1 point for the SPPB summary score is recommended in patients with COPD. Future research is needed to confirm MID estimates for SPPB in different centres.
Collapse
Affiliation(s)
- Anouk A F Stoffels
- Department of Pulmonary Diseases, Dekkerswald Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Research and Development, CIRO, Horn, 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.
| | - Jana De Brandt
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Roy Meys
- Department of Research and Development, CIRO, Horn, 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
| | - Hieronymus W H van Hees
- Department of Pulmonary Diseases, Dekkerswald Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Anouk W Vaes
- Department of Research and Development, CIRO, Horn, the Netherlands
| | - Peter Klijn
- Department of Pulmonology, Merem pulmonary rehabilitation centre, Hilversum, the Netherlands; Department of Pulmonary, Amsterdam university medical centre, Amsterdam, the Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, 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
| | - Bram van den Borst
- Department of Pulmonary Diseases, Dekkerswald Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Daisy J A Janssen
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, 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; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | | |
Collapse
|
16
|
Gephine S, Mucci P, Grosbois JM, Maltais F, Saey D. Physical Frailty in COPD Patients with Chronic Respiratory Failure. Int J Chron Obstruct Pulmon Dis 2021; 16:1381-1392. [PMID: 34045852 PMCID: PMC8144849 DOI: 10.2147/copd.s295885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/14/2021] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of physical frailty and its clinical characteristics in advanced chronic obstructive pulmonary disease (COPD) is unknown, as well as the usefulness of functional capacity tests to screen for physical frailty. The aim of the study was to evaluate the proportion and clinical portrait of COPD patients with chronic respiratory failure exhibiting physical frailty at the time of referral to home-based pulmonary rehabilitation. We also evaluate the usefulness of the short physical performance battery (SPPB) and timed-up and go (TUG) as potential screening tools for physical frailty. Finally, we evaluated the specific contribution of gait speed to the frailty Fried total score. Methods This was a prospective observational study in which physical frailty was defined using Fried criteria (body mass loss, exhaustion, low physical activity, slower walking and weakness). Clinical portrait was documented from daily physical activity, exercise tolerance, functional capacity, anxiety and depressive symptoms, health-related quality of life, and fatigue scores. The ability of the SPPB and TUG to predict physical frailty was investigated using receiver operating characteristic curves. Contribution of each Fried criteria was evaluated with a principal component analysis (PCA). Results Amongst the 44 included participants (FEV1, 33 ± 13% of predicted), 19 were physically frail. Frail individuals had lower daily steps number, exercise tolerance and functional capacity, and higher fatigue, anxiety, and depressive symptom scores (p<0.05) compared to non-frail individuals. SPPB and TUG did not have an acceptable detection accuracy for screening physical frailty. PCA indicated that gait speed was the main contributor to the Fried total score of physical frailty. Conclusion Physical frailty affects a large proportion of COPD patients with chronic respiratory failure starting a home-based intervention and was associated with worse clinical status. Although the present results need to be confirmed by adequately powered studies, gait speed seems to have the potential to become a simple screening tool for physical frailty in this population.
Collapse
Affiliation(s)
- Sarah Gephine
- University Lille, University Artois, University Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France.,Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Patrick Mucci
- University Lille, University Artois, University Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France
| | | | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Didier Saey
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| |
Collapse
|
17
|
Walsh JA, Barker RE, Kon SSC, Jones SE, Banya W, Nolan CM, Patel S, Polgar O, Haselden BM, Polkey MI, Cullinan P, Man WDC. Gait speed and adverse outcomes following hospitalised exacerbation of COPD. Eur Respir J 2021; 58:13993003.04047-2020. [PMID: 33926974 DOI: 10.1183/13993003.04047-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/04/2021] [Indexed: 11/05/2022]
Abstract
Four-metre gait speed (4MGS) is a simple physical performance measure and surrogate marker of frailty that is associated with adverse outcomes in older adults. We aimed to assess the ability of 4MGS to predict prognosis in patients hospitalised with acute exacerbations of COPD (AECOPD).213 participants hospitalised with AECOPD (52% male, mean age and FEV1, 72 years and 35% predicted) were enrolled. 4MGS and baseline demographics were recorded at hospital discharge. All-cause readmission and mortality were collected for 1 y after discharge, and multivariable Cox-proportional hazards regression were performed. Kaplan-Meier and Competing risk analysis was conducted comparing time to all-cause readmission and mortality between 4MGS quartiles.111 participants (52%) were readmitted, and 35 (16%) died during the follow-up period. 4MGS was associated with all-cause readmission, with an adjusted subdistribution hazard ratio of 0.868 (95% CI 0.797-0.945; p=0.001) per 0.1 m·s-1 increase in gait speed, and with all-cause mortality with an adjusted subdistribution hazard ratio of 0.747 (95% CI: 0.622-0.898; p=0.002) per 0.1 m·s-1 increase in gait speed. Readmission and mortality models incorporating 4MGS had higher discrimination than age or FEV1% predicted alone, with areas under the receiver operator characteristic curves of 0.73 and 0.80 respectively. Kaplan-Meier and Competing Risk curves demonstrated that those in slower gait speed quartiles had reduced time to readmission and mortality (log rank both p<0.001).4MGS provides a simple means of identifying at-risk patients with COPD at hospital discharge. This provides valuable information to plan post-discharge care and support.
Collapse
Affiliation(s)
- Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,Contributed equally
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK .,National Heart & Lung Institute, Imperial College, London, UK.,Department of Respiratory Medicine, The Hillingdon Hospital NHS Trust, London, UK.,Contributed equally
| | - Samantha S C Kon
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,Department of Respiratory Medicine, The Hillingdon Hospital NHS Trust, London, UK.,Contributed equally
| | - Sarah E Jones
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Winston Banya
- Department of Medical Statistics, Research & Development, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Brigitte M Haselden
- Department of Respiratory Medicine, The Hillingdon Hospital NHS Trust, London, UK
| | - Michael I Polkey
- National Heart & Lung Institute, Imperial College, London, UK.,Department of Respiratory Medicine, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Paul Cullinan
- National Heart & Lung Institute, Imperial College, London, UK.,Department of Occupational and Environmental Medicine, Imperial College, London, , London, UK
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College, London, UK.,Department of Respiratory Medicine, Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
18
|
Ritchie AI, Baker JR, Parekh TM, Allinson JP, Bhatt SP, Donnelly LE, Donaldson GC. Update in Chronic Obstructive Pulmonary Disease 2020. Am J Respir Crit Care Med 2021; 204:14-22. [PMID: 33856972 DOI: 10.1164/rccm.202102-0253up] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andy I Ritchie
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jonathon R Baker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Trisha M Parekh
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - James P Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Louise E Donnelly
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
19
|
Brighton LJ, Evans CJ, Farquhar M, Bristowe K, Kata A, Higman J, Ogden M, Nolan C, Yi D, Gao W, Koulopoulou M, Hasan S, Steves CJ, Man WDC, Maddocks M. Integrating Comprehensive Geriatric Assessment for people with COPD and frailty starting pulmonary rehabilitation: the Breathe Plus feasibility trial protocol. ERJ Open Res 2021; 7:00717-2020. [PMID: 33816606 PMCID: PMC8005693 DOI: 10.1183/23120541.00717-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
One in five people with COPD also lives with frailty. People living with both COPD and frailty are at increased risk of poorer health and outcomes, and face challenges to completing pulmonary rehabilitation. Integrated approaches that are adapted to the additional context of frailty are required. The aim of the present study is to determine the feasibility of conducting a randomised controlled trial of an integrated Comprehensive Geriatric Assessment for people with COPD and frailty starting pulmonary rehabilitation. This is a multicentre, mixed-methods, assessor-blinded, randomised, parallel group, controlled feasibility trial (“Breathe Plus”; ISRCTN13051922). We aim to recruit 60 people aged ≥50 with both COPD and frailty referred for pulmonary rehabilitation. Participants will be randomised 1:1 to receive usual pulmonary rehabilitation, or pulmonary rehabilitation with an additional Comprehensive Geriatric Assessment. Outcomes (physical, psycho-social and service use) will be measured at baseline, 90 days and 180 days. We will also collect service and trial process data, and conduct qualitative interviews with a sub-group of participants and staff. We will undertake descriptive analysis of quantitative feasibility outcomes (recruitment, retention, missing data, blinding, contamination, fidelity), and framework analysis of qualitative feasibility outcomes (intervention acceptability and theory, outcome acceptability). Recommendations on progression to a full trial will comprise integration of quantitative and qualitative data, with input from relevant stakeholders. This study has been approved by a UK Research Ethics Committee (ref.: 19/LO/1402). This protocol describes the first study testing the feasibility of integrating a Comprehensive Geriatric Assessment alongside pulmonary rehabilitation, and testing this intervention within a mixed-methods randomised controlled trial. This protocol describes the first study testing the feasibility of integrating a Comprehensive Geriatric Assessment alongside pulmonary rehabilitation for people with both COPD and frailty, and the appropriate trial methods to test its effectivenesshttps://bit.ly/39lZ7f1
Collapse
Affiliation(s)
- Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 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
- Guy's and St Thomas NHS Foundation Trust, Harefield Respiratory Research Group, London, UK.,Imperial College, National Heart and Lung Institute, 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, Dept of Clinical Gerontology, London, UK
| | - Claire J Steves
- King's College London, Dept of Twin Research and Genetic Epidemiology, London, UK.,Guys and St. Thomas' NHS Foundation Trust, Dept of Ageing and Health, London, UK
| | - William D-C Man
- Guy's and St Thomas NHS Foundation Trust, Harefield Respiratory Research Group, London, UK.,Imperial College, National Heart and Lung Institute, London, UK.,Guy's and St Thomas NHS Foundation Trust, Harefield Pulmonary Rehabilitation Unit, London, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| |
Collapse
|
20
|
Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
Collapse
Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
21
|
Smith E, Thomas M, Calik-Kutukcu E, Torres-Sánchez I, Granados-Santiago M, Quijano-Campos JC, Sylvester K, Burtin C, Sajnic A, De Brandt J, Cruz J. ERS International Congress 2020 Virtual: highlights from the Allied Respiratory Professionals Assembly. ERJ Open Res 2021; 7:00808-2020. [PMID: 33585651 PMCID: PMC7869591 DOI: 10.1183/23120541.00808-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
This article provides an overview of outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the European Respiratory Society International Congress 2020, which this year assumed a virtual format. The content of the sessions was mainly targeted at allied respiratory professionals, including respiratory function technologists and scientists, physiotherapists, and nurses. Short take-home messages related to spirometry and exercise testing are provided, highlighting the importance of quality control. The need for quality improvement in sleep interventions is underlined as it may enhance patient outcomes and the working capacity of healthcare services. The promising role of digital health in chronic disease management is discussed, with emphasis on the value of end-user participation in the development of these technologies. Evidence on the effectiveness of airway clearance techniques in chronic respiratory conditions is provided along with the rationale for its use and challenges to be addressed in future research. The importance of assessing, preventing and reversing frailty in respiratory patients is discussed, with a clear focus on exercise-based interventions. Research on the impact of disease-specific fear and anxiety on patient outcomes draws attention to the need for early assessment and intervention. Finally, advances in nursing care related to treatment adherence, self-management and patients' perspectives in asthma and chronic obstructive pulmonary disease are provided, highlighting the need for patient engagement and shared decision making. This highlights article provides readers with valuable insight into the latest scientific data and emerging areas affecting clinical practice of allied respiratory professionals.
Collapse
Affiliation(s)
- Elizabeth Smith
- Children's Lung Health, Wal-Yan Respiratory Centre, Telethon Kids Institute, Perth, Australia
- These authors contributed equally
| | - Max Thomas
- Cardiopulmonary Exercise Testing Service, University Hospitals Birmingham, Birmingham, UK
- These authors contributed equally
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
- These authors contributed equally
| | - Irene Torres-Sánchez
- Dept of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- These authors contributed equally
| | - Maria Granados-Santiago
- Dept of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- These authors contributed equally
| | - Juan Carlos Quijano-Campos
- Research and Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
- These authors contributed equally
| | - Karl Sylvester
- Respiratory Physiology, Royal Papworth and Cambridge University Hospitals NHS Foundation Trusts, Cambridge, UK
| | - Chris Burtin
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreja Sajnic
- Dept for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb, Croatia
| | - Jana De Brandt
- REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| |
Collapse
|