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Dennis S, Kwok W, Alison J, Hassett L, Nisbet G, Refshauge K, Sherrington C, Williams A. How effective are allied health group interventions for the management of adults with long-term conditions? An umbrella review of systematic reviews and its applicability to the Australian primary health system. BMC PRIMARY CARE 2024; 25:325. [PMID: 39232663 PMCID: PMC11373467 DOI: 10.1186/s12875-024-02570-7] [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: 01/18/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context. METHODS An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised. RESULTS Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45-60 min per session, 2-3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control. CONCLUSIONS Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions.
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Affiliation(s)
- Sarah Dennis
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Ingham Institute of Applied Medical Research, Liverpool, Australia.
- South Western Sydney Local Health District, Liverpool, Australia.
| | - Wing Kwok
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Jennifer Alison
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Allied Health, Sydney Local Health District, Sydney, Australia
| | - Leanne Hassett
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Gillian Nisbet
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kathryn Refshauge
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Anna Williams
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Hug S, Cavalheri V, Lawson-Smith H, Gucciardi DF, Hill K. Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review. J Physiother 2024; 70:193-207. [PMID: 38918084 DOI: 10.1016/j.jphys.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
QUESTIONS In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains? DESIGN Systematic review, meta-analysis and meta-regression of randomised controlled trials. PARTICIPANTS People with stable COPD. INTERVENTION Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component. OUTCOME MEASURES Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living. DATA SOURCES EMBASE, PEDro, PubMed and the Cochrane Library. RESULTS Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program. CONCLUSION At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains. REGISTRATION CRD42020193833.
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Affiliation(s)
- Sarah Hug
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, Australia.
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Allied Health, South Metropolitan Health Service, Perth, Australia; Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Hollie Lawson-Smith
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Kylie Hill
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Australia
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Moy ML. Maintenance Pulmonary Rehabilitation: An Update and Future Directions. Respir Care 2024; 69:724-739. [PMID: 38744473 PMCID: PMC11147634 DOI: 10.4187/respcare.11609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend pulmonary rehabilitation (PR) for individuals with COPD to improve exercise capacity and health-related quality of life (HRQOL) and reduce symptoms of dyspnea. For cost-effectiveness in COPD care, PR is second only to smoking cessation. However, PR programs typically last 9-12 weeks. The benefits of PR in terms of exercise capacity and HRQOL often decrease toward pre-PR levels as early as 3-6 months after completing PR if patients do not continue to engage in exercise. This review will (1) briefly summarize the efficacy data that informed the 2023 American Thoracic Society (ATS) clinical practice guidelines for maintenance PR, (2) discuss exercise components of maintenance PR studied since 2020 when the last papers were included in the ATS guidelines, (3) explore future directions for delivery of maintenance PR using technology-mediated models, and (4) examine the need for behavior change techniques informed by theoretical models that underpin long-term behavior change. This review will focus on persons with COPD who have completed an out-patient core initial PR program as most of the data on maintenance PR have been published in this patient population. Core PR typically implies a facility-based initial intensive structured program. All patients who complete a core initial PR program should be counseled by PR staff at the discharge visit to engage in ongoing exercise. This usual care is equally as important as referral to a formal PR maintenance program. It is critical to emphasize that usual care after core initial PR means all patients should be supported to participate in regular ongoing exercise, regardless of whether supervised maintenance PR is available. Currently, the optimal frequency, exercise and/or physical activity content, and delivery mode for maintenance PR in persons with COPD and other chronic respiratory diseases remain unknown. Patient safety and degree of in-person supervision required due to the severity of the underlying lung disease need to be considered. Future research of maintenance PR should be underpinned by behavior change techniques. Finally, in the setting of finite resources, balancing the competing priorities of core initial programs with those of maintenance PR programs needs to be achieved.
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Affiliation(s)
- Marilyn L Moy
- Harvard Medical School, Boston, Massachusetts; and Pulmonary and Critical Care Medicine Department, VA Boston Healthcare System, Boston, Massachusetts.
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Silva L, Maricoto T, Mota Â, Lemos L, Santos M, Cunha H, Azevedo I, Berger-Estilita J, Costa P, Padilha JM. Effectiveness of a home-based pulmonary rehabilitation maintenance programme: the Rehab2Life study protocol. BMC Nurs 2024; 23:338. [PMID: 38773568 PMCID: PMC11107066 DOI: 10.1186/s12912-024-01999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Pulmonary rehabilitation (PR) is the bedrock of non-pharmacological treatment for people with COPD. Nonetheless, it is well described in the literature that unless the patient changes his behaviour, the benefits of PR programmes will decline in six to twelve months after finishing the programme. Therefore, maintenance programmes can address the problem of PR programmes' effect loss over time.Community care units can provide multidisciplinary care in the current Portuguese primary health care context. These units have an interdisciplinary team that aims to develop competencies in COPD patients to self-manage the disease.This study aims to test the effectiveness of a 12-month home-based PR programme (Rehab2Life) compared to usual care through a single-blind randomised controlled trial with two parallel groups. The Rehab2Life programme includes two distinct phases. The first is an 8-week PR programme delivered to both groups, and the second is a PR maintenance programme delivered to the intervention group after the initial eight weeks. The control group receive the usual care and regular appointments. The primary outcome is functional capacity, and secondary outcomes are dyspnea, Health-Related Quality of Life (HRQoL), number of exacerbations, symptoms burden, anxiety and depression symptoms, and physical activity.We expect to observe that the home-based PR programme brings clinically relevant benefits to the participants at the end of the first eight weeks and that, at 12 months after the maintenance phase of the programme, benefits are less dissipated than in the control group. We expect to identify the characteristics of the patients who benefit the most from home-based programmes.The trial was registered on 7 April 2022 at ClinicalTrials.gov (NCT05315505).
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Affiliation(s)
- Liliana Silva
- Matosinhos Local Health Unit, Matosinhos, Portugal.
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Tiago Maricoto
- Beira Ria Family Heath Unit/ULS Aveiro, Ílhavo, Portugal
- CICS-UBI - Health Sciences Research Centre & UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal
| | - Ângela Mota
- Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Lara Lemos
- Matosinhos Local Health Unit, Matosinhos, Portugal
| | | | - Hélder Cunha
- Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Inês Azevedo
- Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Joana Berger-Estilita
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Anaesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group, Bern, Switzerland
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS'3, PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - José Miguel Padilha
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Nursing School, Porto, Portugal
- CINTESIS@RISE, Porto, Portugal
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Rebelo P, Brooks D, Cravo J, Mendes MA, Oliveira AC, Rijo AS, Moura MJ, Marques A. Beyond pulmonary rehabilitation: can the PICk UP programme fill the gap? A randomised trial in COPD. Pulmonology 2024:S2531-0437(24)00047-3. [PMID: 38734564 DOI: 10.1016/j.pulmoe.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/11/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary rehabilitation (PR) is a fundamental intervention to manage COPD, however, maintaining its benefits is challenging. Engaging in physical activity might help to prolong PR benefits. This study assessed the efficacy and effectiveness of a personalised community-based physical activity programme to sustain physical activity and other health-related PR benefits, in people with COPD. MATERIALS AND METHODS This was a multicentre, assessor blinded, randomised controlled trial. Following 12-weeks of PR, people with COPD were assigned to a six-months personalised community-based physical activity programme (experimental group), or to standard care (control group). Physical activity was assessed via: time spent in moderate to vigorous physical activities per day (primary outcome measure), steps/day and the brief physical activity assessment tool. Secondary outcomes included sedentary behaviour, functional status, peripheral muscle strength, balance, symptoms, emotional state, health-related quality of life, exacerbations and healthcare utilization. Assessments were performed immediately post-PR and after three- and six-months. Efficacy and effectiveness were evaluated using intention-to-treat and per-protocol analysis with linear mixed models. RESULTS Sixty-one participants (experimental group: n = 32; control group: n = 29), with balanced baseline characteristics between groups (69.6 ± 8.5 years old, 84 % male, FEV1 57.1 ± 16.7 %predicted) were included. Changes in all physical activity outcomes and in one-minute sit-to-stand were significantly different (P < 0.05) between groups at the six-month follow-up. In the remaining outcomes there were no differences between groups. CONCLUSIONS The community-based physical activity programme resulted in better physical activity levels and sit-to-stand performance, six-months after completing PR, in COPD. No additional benefits were observed for other secondary outcomes.
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Affiliation(s)
- P Rebelo
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - D Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada
| | - J Cravo
- Pulmonology Service, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - M A Mendes
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal; Pulmonology Service, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - A C Oliveira
- Agrupamento dos Centros de Saúde do Baixo Vouga, Aveiro, Portugal
| | - A S Rijo
- Agrupamento dos Centros de Saúde do Baixo Vouga, Aveiro, Portugal
| | - M J Moura
- Agrupamento dos Centros de Saúde do Baixo Vouga, Aveiro, Portugal
| | - A Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
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Jenkins AR, Cox NS, Tappan RS, Holland AE, Rochester CL, Alison JA, Carlin B, Ruminjo JK, Thomson CC. Summary for Clinicians: Clinical Practice Guideline on Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease. Ann Am Thorac Soc 2024; 21:533-537. [PMID: 38241016 DOI: 10.1513/annalsats.202310-909cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Alex R Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Narelle S Cox
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Rachel S Tappan
- Department of Physical Therapy and Human Movement Sciences and Department of Medicine (Pulmonary and Critical Care), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Carolyn L Rochester
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Jennifer A Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Allied Health, Sydney Local Health District, Sydney, Australia
| | - Brian Carlin
- Sleep Medicine and Lung Health Consultants, Pittsburgh, Pennsylvania
| | | | - Carey C Thomson
- Division of Pulmonary and Critical Care, Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; and
- Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
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Yaremenko AV, Pechnikova NA, Porpodis K, Damdoumis S, Aggeli A, Theodora P, Domvri K. Association of Fetal Lung Development Disorders with Adult Diseases: A Comprehensive Review. J Pers Med 2024; 14:368. [PMID: 38672994 PMCID: PMC11051200 DOI: 10.3390/jpm14040368] [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: 02/22/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Fetal lung development is a crucial and complex process that lays the groundwork for postnatal respiratory health. However, disruptions in this delicate developmental journey can lead to fetal lung development disorders, impacting neonatal outcomes and potentially influencing health outcomes well into adulthood. Recent research has shed light on the intriguing association between fetal lung development disorders and the development of adult diseases. Understanding these links can provide valuable insights into the developmental origins of health and disease, paving the way for targeted preventive measures and clinical interventions. This review article aims to comprehensively explore the association of fetal lung development disorders with adult diseases. We delve into the stages of fetal lung development, examining key factors influencing fetal lung maturation. Subsequently, we investigate specific fetal lung development disorders, such as respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), congenital diaphragmatic hernia (CDH), and other abnormalities. Furthermore, we explore the potential mechanisms underlying these associations, considering the role of epigenetic modifications, transgenerational effects, and intrauterine environmental factors. Additionally, we examine the epidemiological evidence and clinical findings linking fetal lung development disorders to adult respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and other respiratory ailments. This review provides valuable insights for healthcare professionals and researchers, guiding future investigations and shaping strategies for preventive interventions and long-term care.
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Affiliation(s)
- Alexey V. Yaremenko
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Nadezhda A. Pechnikova
- Laboratory of Chemical Engineering A’, School of Chemical Engineering, Faculty of Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (N.A.P.); (A.A.)
- Saint Petersburg Pasteur Institute, Saint Petersburg 197101, Russia
| | - Konstantinos Porpodis
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Savvas Damdoumis
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
| | - Amalia Aggeli
- Laboratory of Chemical Engineering A’, School of Chemical Engineering, Faculty of Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (N.A.P.); (A.A.)
| | - Papamitsou Theodora
- Laboratory of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Kalliopi Domvri
- Oncology Unit, Pulmonary Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.P.); (S.D.)
- Laboratory of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- Pathology Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Lee AL, Burge AT. Adding Up the Value of Pulmonary Rehabilitation in COPD: Money, Morbidity, and Mortality. Chest 2024; 165:231-232. [PMID: 38336430 DOI: 10.1016/j.chest.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia.
| | - Angela T Burge
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia; Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Liu N, Wu W, Chen Z, Hu J, Yang F, Yu Z, Chen R, Zheng Z, Li Y. Compliance and rehabilitation effects of Zheng's supine rehabilitation exercise performed at home among patients with chronic obstructive pulmonary disease: a retrospective study. J Thorac Dis 2023; 15:6525-6533. [PMID: 38249922 PMCID: PMC10797367 DOI: 10.21037/jtd-23-779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
Background Zheng's supine rehabilitation exercise (ZSRE) can be performed by elderly patients with the acute exacerbation of severe or extremely severe chronic obstructive pulmonary disease (COPD) with high safety and compliance and was helpful for their recovery. Investigation is warranted of the compliance and rehabilitation effects of ZSRE performed at home in patients with COPD. Methods We performed telephone interviews with 157 patients with COPD who were hospitalized on the 26th floor of the National Clinical Research Center for Respiratory Disease and who received COPD education and ZSRE training from 1 September 2015 to 31 August 2016. We retrospectively analyzed the patients' compliance with performing ZSRE at home after discharge and the frequency of hospitalization for treatment of acute exacerbation in both the previous and subsequent years. Results Among the 157 patients, 66 failed to complete home ZSRE after discharge (non-rehabilitation group), 41 performed home ZSRE once a day after discharge (one-session rehabilitation group), and 50 performed home ZSRE at least twice a day after discharge (multiple-session rehabilitation group). The home ZSRE compliance rate was 57.96% (91/157). There were no significant differences in the mean number of hospitalizations in the year prior to receiving COPD education and ZSRE training among the non-rehabilitation group (1.06±0.75), one-session rehabilitation group (1.27±0.78), and multiple-session rehabilitation group (1.16±0.91). However, there was a significant difference in the mean number of hospitalizations among the groups in the year following discharge (1.44±1.17, 0.78±0.82, and 0.66±0.75, respectively). The number of hospitalizations significantly increased in the non-rehabilitation group and significantly decreased in the one- and multiple-session rehabilitation groups. Conclusions Home ZSRE can be performed with high compliance by elderly patients with severe or extremely severe COPD and can reduce the number of readmissions.
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Affiliation(s)
- Ni Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenying Wu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Nanhua University, School of Nursing University of South China, Hengyang, China
| | - Zhuqiao Chen
- Yabao Pharmaceutical Group Co., Ltd., Beijing, China
| | - Jieying Hu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhou Yu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Nanhua University, School of Nursing University of South China, Hengyang, China
| | - Rongchang Chen
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen People’s Hospital (Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Zeguang Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yinhuan Li
- Department of Respiratory Medicine, Panyu Central Hospital of Guangzhou, Guangzhou, China
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Ghram A, Latiri I, Methnani J, Souissi A, Benzarti W, Toulgui E, Ben Saad H. Effects of cardiorespiratory rehabilitation program on submaximal exercise in patients with long-COVID-19 conditions: a systematic review of randomized controlled trials and recommendations for future studies. Expert Rev Respir Med 2023; 17:1095-1124. [PMID: 38063359 DOI: 10.1080/17476348.2023.2293226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/06/2023] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Long-COVID-19 patients (LC19Ps) often experience cardiovascular and respiratory complications. Cardiorespiratory rehabilitation programs (CRRPs) have emerged as promising interventions to enhance exercise capacity in this population. This systematic review aimed to assess the impact of CRRPs on submaximal exercise performance, specifically the 6-minute walk test (6MWT) outcomes, in LC19Ps through an analysis of available randomized controlled trials (RCTs). METHODS A systematic search was conducted in PubMed/Medline and Scopus to identify relevant RCTs. Six RCTs meeting inclusion criteria were included in this review, investigating the effects of CRRPs on 6MWT outcomes in LC19Ps. RESULTS The findings from the included RCTs provide compelling evidence supporting the effectiveness of CRRPs in improving submaximal exercise performance in LC19Ps. These results underscore the potential of CRRPs to enhance submaximal exercise capacity and overall functional well-being in this population. However, future research is imperative to determine optimal CRRPs, including duration, intensity, and specific intervention components. Additionally, the long-term sustainability and durability of CRRP-induced improvements warrant further exploration. Future studies should prioritize patient-centric outcomes and address potential implementation barriers. CONCLUSION CRRPs show promise in ameliorating submaximal exercise performance among LC19Ps. Further research is needed to refine these programs and ensure their lasting impact on this patient group. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/HMN38. [Figure: see text].
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Affiliation(s)
- Amine Ghram
- Department of Cardiac Rehabilitation, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Imed Latiri
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Jabeur Methnani
- LR19ES09, Laboratoire de Physiologie de l'Exercice et Physiopathologie: de l'Intégré au Moléculaire 10 « Biologie, Médecine et Santé », Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Amine Souissi
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Wafa Benzarti
- Department of Pneumology, Farhat HACHED Hospital, Sousse, Tunisia
| | - Emna Toulgui
- Department of Physical Medicine and Rehabilitation, Sahloul Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Physiology and Functional Exploration, Farhat HACHED Hospital, Sousse, Tunisia
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11
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Hakimi A, Bergoin C, De Jesus A, Hoorelbeke A, Ramon P, Florea O, Fabre C, Mucci P. Multiple Sustainable Benefits of a Rehabilitation Program in Therapeutic Management of Hypermobile Ehlers-Danlos Syndrome: A Prospective and Controlled Study at Short- and Medium-Term. Arch Phys Med Rehabil 2023; 104:2059-2066. [PMID: 37406924 DOI: 10.1016/j.apmr.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To evaluate the effects of a 9-week rehabilitation program (RP) for patients with hypermobile Ehlers-Danlos syndrome (hEDS) in the short- and medium-term. DESIGN Nonrandomized controlled trial with 6 months follow-up. SETTING Outpatient rehabilitation program. PARTICIPANTS A referred sample of 36 hEDS patients were assessed for eligibility (N=36), 25 were included, 22 completed the RP and 19 completed the follow-up. INTERVENTIONS A 9 -week control period without intervention followed by a 9-week RP. MAIN OUTCOME MEASURE Functional exercise capacity was used as a primary outcome measure. Balance, kinesiophobia, fatigue, pain, quality of life, anxiety, depression, and hyperventilation were measured as secondary outcomes. RESULTS No significant change was observed during the 9-week control period before the RP. There was a significant improvement immediately after the RP for the functional exercise capacity, balance with eyes closed, fatigue, and quality of life (P<.05). Even more improvements were found 6 weeks after the end of the RP, and there was still an improvement after 6 months in functional exercise capacity, kinesiophobia, depression, hyperventilation, and some components of the quality of life. CONCLUSION This study supports the effectiveness of an RP as a useful management tool for hEDS patients.
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Affiliation(s)
- Adrien Hakimi
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369-URePSSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France; Clinique de la Mitterie, Lomme, France.
| | - Cyrille Bergoin
- Clinique de la Mitterie, Lomme, France; Cabinet de pneumologie, Tourcoing, France
| | - Anna De Jesus
- Clinique de la Mitterie, Lomme, France; Cabinet de pneumologie, Tourcoing, France
| | | | | | | | - Claudine Fabre
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369-URePSSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Patrick Mucci
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369-URePSSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
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12
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Zhou D, Fu D, Yan L, Peng L. Pulmonary Rehabilitation Strategies for the Treatment of Pneumoconiosis: A Narrative Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2234-2247. [PMID: 38106829 PMCID: PMC10719697 DOI: 10.18502/ijph.v52i11.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/19/2023] [Indexed: 12/19/2023]
Abstract
Pneumoconiosis is a collection of lung diseases caused by inhaling mineral dust that poses an important risk to public health worldwide. Effective clinical treatments are currently limited, but pulmonary rehabilitation (PR) has shown promise in treating respiratory diseases. This review aims to assess the effectiveness of PR strategies for treating pneumoconiosis. We searched research studies that investigated the effectiveness of PR interventions for pneumoconiosis patients in international scientific databases and comprehensively reviewed PR strategies for the treatment of pneumoconiosis. Pneumoconiosis patients are increasingly being treated with a multimodal PR program. PR interventions could save healthcare costs, reduce dyspnea, improve exercise performance, and enhance overall health-related quality of life in patients with pneumoconiosis. PR interventions are effective in improving respiratory function and quality of life in patients with pneumoconiosis. However, further research is needed to determine the optimal PR strategies for pneumoconiosis patients and to investigate the long-term effects of these interventions.
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Affiliation(s)
- Dingzi Zhou
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Daigang Fu
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Yan
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Lijun Peng
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
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13
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Hartman M, Mináriková J, Batalik L, Pepera G, Su JJ, Formiga MF, Cahalin L, Dosbaba F. Effects of Home-Based Training with Internet Telehealth Guidance in COPD Patients Entering Pulmonary Rehabilitation: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2305-2319. [PMID: 37876660 PMCID: PMC10591652 DOI: 10.2147/copd.s425218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Telehealth rehabilitation may offer new opportunities in patient therapy. This systematic review aimed to evaluate the effects of internet-mediated telerehabilitation and compare them with the outcomes of conventional pulmonary rehabilitation in COPD patients. Methods Electronic databases PubMed, Prospero, Scopus, and Cochrane were searched for randomized controlled trials from January 2005 to December 2021. Two investigators reviewed studies for relevance and extracted study population, methods, and results data. Results Ten studies were eligible for systematic review from the initial selection (n = 1492). There was considerable heterogeneity in telerehabilitation approaches. Functional exercise capacity and quality of life were assessed in all studies. None of the results were inferior to conventional care. High adherence and high levels of safety were observed. Conclusion Telerehabilitation in COPD patients is a safe therapy approach that increases and maintains functional exercise capacity and quality of life, making it an equivalent option to conventional outpatient rehabilitation. However, there is currently a lack of a unified approach to the composition of therapy and the use of technology, which needs to be addressed in the future.
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Affiliation(s)
- Martin Hartman
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Jitka Mináriková
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, 62500, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno, 62500, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Magno F Formiga
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Fisioterapia, Fortaleza, Ceará, Brazil
| | - Lawrence Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Filip Dosbaba
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
- Department of Rehabilitation, University Hospital Brno, Brno, 62500, Czech Republic
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14
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Tappan RS, Ettinger JR, Mahon D, Mroz SE, Hall W, Maajid E, Stratton C, Zynda DT, Conroy DE, Danilovich M. Development of a physical activity counseling intervention for people with chronic respiratory disease based on the health action process approach. Pilot Feasibility Stud 2023; 9:173. [PMID: 37828614 PMCID: PMC10568913 DOI: 10.1186/s40814-023-01397-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Physical activity (PA) counseling holds promise for increasing PA levels in people with chronic respiratory disease, though little long-term change has been shown to date. Here, we describe the development of a Health Action Process Approach-based PA counseling intervention that aims to promote PA and exercise in people with chronic respiratory disease who are enrolled in pulmonary rehabilitation. METHODS To collaborate in defining and refining the intervention, we convened a varied team of authors that included a panel of five stakeholder partners: three patients, one clinician, and one health behavior change researcher. We completed three steps in the intervention development process: (1) initial intervention creation, (2) iterative intervention refinement, and (3) assessment of intervention acceptability. In step 1, we created an initial draft of the PA counseling intervention based on the HAPA theoretical framework, previous evidence in people with chronic respiratory disease, and clinical experience. In step 2, we used qualitative methods of focus groups and interviews to further develop and refine the intervention. Fifteen meetings occurred with the five-member stakeholder partner panel (six focus groups with the three patient partners, four interviews with the clinician partner, and five interviews with the researcher partner) over 5 months to systematically elicit input and incorporate it into the intervention. In step 3, we measured the intervention acceptability using five-point Likert scale ratings. RESULTS Intervention materials included the eligibility screen, participant workbook, and leader guide. We identified key themes in the input from the stakeholder partners and incorporated this input into the intervention content and methods. Ratings of the intervention by the stakeholder partners (n=5) were high with mean ratings ranging 4.0-5.0 on a five-point scale. CONCLUSIONS This development process successfully engaged an intervention development team with diverse perspectives and resulted in a PA counseling intervention for people with chronic respiratory disease. The intervention's strong theoretical underpinning, person-centeredness, and the contributions from varied perspectives during intervention development position it well for future evaluations of feasibility, efficacy, and effectiveness.
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Affiliation(s)
- Rachel S Tappan
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA.
- Department of Medicine (Pulmonary and Critical Care), Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Suite 1100, Chicago, Illinois, 60611, USA.
| | - Jennifer R Ettinger
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Delaney Mahon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Sarah E Mroz
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Walter Hall
- , 933 Garden Lane, Homewood, Illinois, 60430, USA
| | - Estelle Maajid
- , 536 East 32nd Street Unit E, Chicago, Illinois, 60616, USA
| | - Chelsea Stratton
- Department of Physical Therapy, Marquette University, Schroeder Complex, Room 346, P.O. Box 1881, Milwaukee, Wisconsin, 53210, USA
| | | | - David E Conroy
- Department of Kinesiology, Human Development & Family Studies and Public Health Sciences, The Pennsylvania State University, 268U Recreation Building, University Park, Pennsylvania, 16802, USA
| | - Margaret Danilovich
- Leonard Schanfield Research Institute, CJE SeniorLife, 3003 W. Touhy Avenue, Chicago, Illinois, 60645, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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15
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Man W, Chaplin E, Daynes E, Drummond A, Evans RA, Greening NJ, Nolan C, Pavitt MJ, Roberts NJ, Vogiatzis I, Singh SJ. British Thoracic Society Clinical Statement on pulmonary rehabilitation. Thorax 2023; 78:s2-s15. [PMID: 37770084 DOI: 10.1136/thorax-2023-220439] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- William Man
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Enya Daynes
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Alistair Drummond
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Rachael A Evans
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claire Nolan
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Matthew J Pavitt
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Nicola J Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumberland University Newcastle, Newcastle Upon Tyne, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
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16
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Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, Bhatt SP, Bourbeau J, Burtin C, Camp PG, Cascino TM, Dorney Koppel GA, Garvey C, Goldstein R, Harris D, Houchen-Wolloff L, Limberg T, Lindenauer PK, Moy ML, Ryerson CJ, Singh SJ, Steiner M, Tappan RS, Yohannes AM, Holland AE. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2023; 208:e7-e26. [PMID: 37581410 PMCID: PMC10449064 DOI: 10.1164/rccm.202306-1066st] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
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17
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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18
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Chen S, Li X, Wu Y, Li Y, Cao P, Yin Y, Chen Z. Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis. J Cardiothorac Surg 2023; 18:160. [PMID: 37095505 PMCID: PMC10127428 DOI: 10.1186/s13019-023-02283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE The effects of preoperative respiratory muscle training (RMT) on postoperative complications in patients surgically treated for myasthenia gravis (MG) remain unclear. The present study therefore evaluated the effects of preoperative moderate-to-intense RMT and aerobic exercise, when added to respiratory physiotherapy, on respiratory vital capacity, exercise capacity, and duration of hospital stay in patients with MG. METHODS Eighty patients with MG scheduled for extended thymectomy were randomly divided into two groups. The 40 subjects in the study group (SG) received preoperative moderate-to-intense RMT and aerobic exercise in addition to respiratory physiotherapy, whereas the 40 subjects in the control group (CG) received only chest physiotherapy. Respiratory vital capacity (as determined by VC, FVC, FEV1, FEV1/FVC, and PEF) and exercise capacity (as determined by the 6-min walk test [6 MWT]) were measured pre- and postoperatively and before discharge. The duration of hospital stay and activity of daily living (ADL) were also determined. RESULTS Demographic and surgical characteristics, along with preoperative vital capacity and exercise capacity, were similar in the two groups. In the CG, VC (p = 0.001), FVC (p = 0.001), FEV1 (p = 0.002), PEF (p = 0.004), and 6MWT (p = 0.041) were significantly lower postoperatively than preoperatively, whereas the FEV1/FVC ratio did not differ significantly. Postoperative VC (p = 0.012), FVC (p = 0.030), FEV1 (p = 0.014), and PEF (p = 0.035) were significantly higher in the SG than in the CG, although 6MWT results did not differ. ADL on postoperative day 5 was significantly higher in the SG than in the CG (p = 0.001). CONCLUSION RMT and aerobic exercise can have positive effects on postoperative respiratory vital capacity and daily life activity, and would enhance recovery after surgery in MG patients.
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Affiliation(s)
- Sai Chen
- Center for Private Medical Service and Healthcare, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Xin Li
- Department of Rehabilitation, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Yunshan Wu
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China
| | - Yana Li
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China
| | - Peili Cao
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China
| | - Yuchun Yin
- Center for Private Medical Service and Healthcare, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Zhenguang Chen
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China.
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, People's Republic of China.
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19
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Jing Y, Ma Y, Zhang H, Wu Z, Li Y, Li H, Huang M, Lin L, Xu Y. Pulmonary rehabilitation integrated coached exercise training for patients with COPD: a study protocol for a randomized controlled trial. Trials 2023; 24:69. [PMID: 36717916 PMCID: PMC9887849 DOI: 10.1186/s13063-022-07058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease creating an immense burden on social health care systems. Pulmonary rehabilitation (PR) has proven to be effective in patients with COPD. However, exercise training as the basis of PR becomes extremely tedious, occasionally causing a loss of perseverance in patients. Therefore, we considered an approach that makes this technique interesting and easier to persist. The aim of this project was to explore an exercise training approach based on PR-integrated coached exercise training to promote the new exercise training approach as a form of group rehabilitation activity in the future. METHODS Participants will be randomly divided into the trial and control groups. The trial group will be treated with PR-integrated coached exercise training (plus usual care). All exercise programs will be guided by sports coaches with a physical education background. Meanwhile, the control group will receive traditional PR and home exercises, including walking and swimming. The study will last for 12 weeks. The primary outcome measure is exercise tolerance using the 6-min walking test and secondary outcomes are the peak oxygen uptake of cardiopulmonary exercise tests, the COPD Assessment Test, and the St. Georges Respiratory Questionnaire. Other evaluated outcomes include changes in postbronchodilator forced expiratory volume at 1st second, forced vital capacity, body fat and muscle composition, and mental status measured using the Hamilton Anxiety and Depression Scales. DISCUSSION This study provides a simple, feasible, repeatable, and fun exercise training approach. To the best of our knowledge, there are no randomized controlled trials in the existing literature on PR-integrated coached exercise. The protocol shared in our study can be used as a reference for exercise training in patients with COPD. TRIAL REGISTRATION Ethical approval (BF2020-236-02) was obtained from the Guangdong Provincial Hospital of Chinese Medicine Human Research Ethics Committee. All participants signed an informed consent form. ChiCTR-2100043543. The registration date is 2021/02/21 and it is the third version.
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Affiliation(s)
- Yuting Jing
- grid.413402.00000 0004 6068 0570Department of Pulmonary Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 Guangdong Province China
| | - Yuying Ma
- grid.411866.c0000 0000 8848 7685The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510403 Guangdong Province China
| | - Hongxing Zhang
- grid.411847.f0000 0004 1804 4300College of Health, Guangdong Pharmaceutical University, Guangzhou, 510006 Guangdong Province China
| | - Zhenhu Wu
- grid.413402.00000 0004 6068 0570Department of Pulmonary Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 Guangdong Province China
| | - Yongwen Li
- grid.413402.00000 0004 6068 0570Department of Pulmonary Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 Guangdong Province China
| | - Haoxuan Li
- grid.411866.c0000 0000 8848 7685The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510403 Guangdong Province China
| | - Minling Huang
- grid.413402.00000 0004 6068 0570Department of Pulmonary Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 Guangdong Province China
| | - Lin Lin
- grid.413402.00000 0004 6068 0570Department of Pulmonary Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 Guangdong Province China
| | - Yinji Xu
- grid.413402.00000 0004 6068 0570Department of Pulmonary Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 Guangdong Province China
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20
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Satar S, Şahin ME, Ergün P. The effect of comprehensive multidisciplinary pulmonary rehabilitation on 5-year survival in COPD: does maintaining a home exercise program improve survival? Turk J Med Sci 2022; 52:1785-1792. [PMID: 36945992 PMCID: PMC10390114 DOI: 10.55730/1300-0144.5524] [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: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is one of the most common causes of death worldwide. Therefore, optimizing medical therapy in the comprehensive management of the disease, as well as including pulmonary rehabilitation (PR) in the treatment, is essential. The goal of our study was to determine the impact of PR on the survival of COPD patients. METHODS Between 2007-2015, 509 COPD patients who completed the PR constituted the PR group, while 167 patients who applied but could not complete it after the initial evaluations formed the control group. In the PR group, dyspnea perception, exercise capacity, muscle strength, body composition, quality of life, psychosocial status, and i-BODE scores were assessed at the beginning and end of the program, whereas in the control group, these assessments could only be conducted at the beginning. Also, after PR, our PR participants have prescribed a home exercise program, and they were recalled to the hospital at the 3rd, 6th, 12th, 18th, and 24th months for follow-up visits. RESULTS A statistically significant improvement was found in almost all the data (except FEV1/FVC, BORG after exercise, and FFMI) after PR. There was a statistically significant difference in 5-year survival in favor of the PR group (p = 0.006), and in PR patients who accompanied the home exercise program vs. those who did not (p = 0.000). Also the gains in MRC (p = 0.003; OR: 2.20; CI: 1.319- 3.682), MEP (p = 0.041; OR: 1.02; CI: 1.001-1.035), and i-BODE (p = 0.006; OR: 0.914; CI: 0.857-0.974) increased the survival. DISCUSSION Apart from incorporating PR into treatment in the comprehensive management of COPD, we demonstrated that maintaining a home exercise program for at least two years following PR increased 5-year survival significantly.
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Affiliation(s)
- Seher Satar
- Department of Chest Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Health Sciences University, Turkey
| | - Mustafa Engin Şahin
- Department of Chest Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Health Sciences University, Turkey
| | - Pınar Ergün
- Department of Chest Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Health Sciences University, Turkey
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Zhang L, Maitinuer A, Lian Z, Li Y, Ding W, Wang W, Wu C, Yang X. Home based pulmonary tele-rehabilitation under telemedicine system for COPD: a cohort study. BMC Pulm Med 2022; 22:284. [PMID: 35871652 PMCID: PMC9310454 DOI: 10.1186/s12890-022-02077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pulmonary tele-rehabilitation can improve adherence to pulmonary rehabilitation. However, there are few reports on home based pulmonary tele-rehabilitation. We assessed the effectiveness of home based pulmonary tele-rehabilitation under telemedicine system in patients with chronic obstructive pulmonary disease (COPD). Methods This cohort study enrolled 174 patients with COPD who received home based pulmonary tele-rehabilitation under telemedicine system. The follow-up time was 12 weeks. Patients were grouped according to pulmonary rehabilitation weeks, number of rehabilitation times and total duration time, and when these three data were inconsistent, the two lowest values were grouped: control group (total rehabilitation weeks < 1 week, total number of rehabilitation times < 5, total duration time < 150 min, n = 46), pulmonary rehabilitation group 1 (PR-1) (1 week ≤ rehabilitation weeks < 4 weeks, 5 ≤ total number of rehabilitation times < 20, 150 min ≤ total duration time < 1200 min, n = 31), pulmonary rehabilitation group 2 (PR-2) (4 weeks ≤ rehabilitation weeks < 8 weeks, 20 ≤ total number of rehabilitation times < 40, 600 min ≤ total duration time < 2400 min, n = 23), pulmonary rehabilitation group 3 (PR-3) (8 weeks ≤ rehabilitation weeks < 12 weeks, 40 ≤ total number of rehabilitation times < 60, 1200 min ≤ total duration time < 3600 min, n = 40) and pulmonary rehabilitation group 4 (PR-4) (rehabilitation weeks = 12 weeks, total number of rehabilitation times = 60, total duration time = 3600 min, n = 34). The clinical data before and after rehabilitation were collected and evaluated, including dyspnea symptoms, 6-min walk distance (6MWD), diaphragmatic mobility, anxiety and depression. Results There was no significance difference between control group and PR-1 group. PR-2 group after rehabilitation had significantly decreased CAT and HAMA scores than control (P < 0.05). Compared with control, PR-3 group and PR-4 group after rehabilitation had significantly higher 6MWD and diaphragmatic motility during deep breathing, but significantly lower CAT score, mMRC score, HAMA score, and HAMD score (P < 0.05). Compared with before pulmonary rehabilitation, in PR-3 and PR-4 groups, the 6MWD and the diaphragmatic motility during deep breathing were significantly higher, while CAT score, mMRC score, HAMA score, and HAMD score (for PR-4 only) were significantly lower after pulmonary rehabilitation (P < 0.05). There was no significant difference between PR-3 group and PR-4 group (P > 0.05). In the 12-week pulmonary rehabilitation program, patients who completed at least 8 weeks, namely those in the PR-3 and PR-4 groups, accounted for 42.5% of the total number. Education, income and response rate to telemedicine system reminders were the main risk factors associated with home based pulmonary tele-rehabilitation. Conclusions Home based pulmonary tele-rehabilitation under telemedicine system for more than 8 weeks can significantly improve the dyspnea symptoms, 6MWD, diaphragmatic mobility during deep breathing, and negative emotions of patients with moderate to severe stable COPD. Trial registration: This study was registered at Chinese Clinical Trial Registry under registration number of ChiCTR2200056241CTR2200056241. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02077-w.
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Silva L, Maricoto T, Costa P, Berger-Estilita J, Padilha JM. A meta-analysis on the structure of pulmonary rehabilitation maintenance programmes on COPD patients' functional capacity. NPJ Prim Care Respir Med 2022; 32:38. [PMID: 36192398 PMCID: PMC9530215 DOI: 10.1038/s41533-022-00302-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
Pulmonary rehabilitation (PR) improves functional capacity, health-related quality of life (HRQoL) in COPD patients, and maintenance programmes are relevant in preserving those improvements. However, little is known about the structure of maintenance programmes after PR. We performed a systematic review and meta-analysis of experimental and quasi-experimental studies evaluating individuals with COPD admitted to a maintenance PR programme, delivered after an initial PR programme. We reported functional capacity evaluation (6-minute-walking-test), HRQoL, dyspnoea and symptom control. Searches were performed on the 11th April 2021 using MEDLINE, Embase, EBSCO, CINAHL, Web of Science and Cochrane Library. We extracted summary-level data from trial publications and used a random-effects model, predicting that severe heterogeneity was detected. The protocol was registered in PROSPERO (CRD42021247724). Fifteen studies were included in the meta-analysis, with 1151 participants. Maintenance programmes were associated with a pooled mean increase of 27.08 meters in 6mWT (CI: 10.39 to 43.77; I2 = 93%; p < 0.0001), being better in supervised, long (>12 month) home-based programmes; and having a potential MD of -4.20 pts in SGRQ (CI: -4.49 to -3.91; I2 = 0%; p = 0.74). Regarding dyspnoea and exacerbations, we found a nonsignificant trend for improvement after maintenance PR programmes. Severe COPD patients showed smaller improvements in programmes up to a year. Overall, the strength of the underlying evidence was moderate. Despite limitations of risk of bias and heterogeneity, our results support that home-based, supervised, long-term maintenance PR programmes may significantly improve functional capacity in COPD patients and HRQoL.
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Affiliation(s)
- Liliana Silva
- Matosinhos Local Health Unit, Porto, Portugal.
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
| | - Tiago Maricoto
- Aradas Health Center, Aveiro, Portugal
- Faculty of Health Sciences - University of Beira Interior, CACB - Clinical Academic Centre of Beiras, Covilhã, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Joana Berger-Estilita
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - José Miguel Padilha
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
- Porto Nursing School, Porto, Portugal
- RISE@CINTESIS, Porto, Portugal
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23
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Toulgui E, Benzarti W, Rahmani C, Aissa S, Ghannouchi I, Knaz A, Sayhi A, Sellami S, Mahmoudi K, Jemni S, Gargouri I, Hayouni A, Ouanes W, Ammar A, Ben saad H. Impact of cardiorespiratory rehabilitation program on submaximal exercise capacity of Tunisian male patients with post-COVID19: A pilot study. Front Physiol 2022; 13:1029766. [PMID: 36246110 PMCID: PMC9555273 DOI: 10.3389/fphys.2022.1029766] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/12/2022] [Indexed: 12/12/2022] Open
Abstract
Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients’ hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points (p < 0.001), forced expiratory volume in one second by 110 ± 180 ml (p = 0.04), 6-min walk distance by 35 ± 42 m (p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg (p = 0.048), resting heart-rate by 7 ± 9 bpm (p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg (p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work.
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Affiliation(s)
- Emna Toulgui
- Department of Physical Medicine and Rehabilitation, Sahloul Hospital, Sousse, Tunisia
| | - Wafa Benzarti
- Department of Pneumology, Farhat HACHED Hospital, Sousse, Tunisia
| | - Chiraz Rahmani
- Department of Physical Medicine and Rehabilitation, Sahloul Hospital, Sousse, Tunisia
| | - Sana Aissa
- Department of Pneumology, Farhat HACHED Hospital, Sousse, Tunisia
| | - Ines Ghannouchi
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, University of Sousse, Sousse, Tunisia
| | - Asma Knaz
- Department of Pneumology, Farhat HACHED Hospital, Sousse, Tunisia
| | - Amani Sayhi
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, University of Sousse, Sousse, Tunisia
| | - Sana Sellami
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, University of Sousse, Sousse, Tunisia
| | - Khaoula Mahmoudi
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, University of Sousse, Sousse, Tunisia
| | - Sonia Jemni
- Department of Physical Medicine and Rehabilitation, Sahloul Hospital, Sousse, Tunisia
| | - Imene Gargouri
- Department of Pneumology, Farhat HACHED Hospital, Sousse, Tunisia
| | | | - Walid Ouanes
- Department of Physical Medicine and Rehabilitation, Sahloul Hospital, Sousse, Tunisia
| | - Achraf Ammar
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UPL, Paris Nanterre University, UFR STAPS, Nanterre, France
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
- *Correspondence: Achraf Ammar,
| | - Helmi Ben saad
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, University of Sousse, Sousse, Tunisia
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24
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Burge AT, Malaguti C, Hoffman M, Shiell A, McDonald CF, Berlowitz DJ, Holland AE. Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2022; 17:1871-1882. [PMID: 35999942 PMCID: PMC9393021 DOI: 10.2147/copd.s368336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is an effective intervention for people with chronic obstructive pulmonary disease (COPD). People with COPD undertake repeat programs, but synthesis of evidence regarding such practice has not been undertaken. The aim of this systematic review was to establish the effects of repeating pulmonary rehabilitation subsequent to an initial program in people with COPD. Methods Studies where participants with COPD undertook >1 pulmonary rehabilitation program were included, incorporating RCT (randomized controlled trial) and non-randomized studies. Electronic database searches were undertaken. Two authors independently undertook study identification, data extraction and risk of bias assessment. The primary outcome was health-related quality of life (HRQoL); secondary outcomes were exercise capacity, hospitalizations and exacerbations, adherence, mortality and adverse events. Narrative synthesis was undertaken for clinically heterogeneous trials. Data from RCTs and non-randomized studies were not combined for analysis. Results Ten included studies (2 RCTs) involved 907 participants with COPD (n=653 had undertaken >1 program). The majority of studies were at high risk of bias. One RCT (n=33) reported no difference in HRQol after a repeat program vs usual care following exacerbation (Chronic Respiratory Disease Questionnaire dyspnea domain score MD 0.4, 95% CI -0.5 to 3). In stable patients, clinically important and statistically significant improvements in HRQoL and exercise capacity were reported after repeat programs, but of a smaller magnitude than initial programs. There was evidence for reductions in exacerbations and hospitalizations, and shorter hospital length of stay for patients who repeated a program twice in 12 months compared to those who repeated once. No data for mortality or adverse events were available. Conclusion This systematic review provides limited evidence for benefits of repeating pulmonary rehabilitation in people with COPD, including improved HRQoL and exercise capacity, and reduced hospitalizations. However, most studies have high risk of bias, which reduces the certainty of these conclusions. Study Registration PROSPERO (CRD42020215093).
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Affiliation(s)
- Angela T Burge
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Carla Malaguti
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Mariana Hoffman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Alan Shiell
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
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25
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Rocha V, Cabral J, Souto-Miranda S, Machado AF, Jácome C, Cruz J, Martins V, Simão P, Mendes MA, Afreixo V, Marques A. Monthly Follow-Ups of Functional Status in People with COPD: A Longitudinal Study. J Clin Med 2022; 11:jcm11113052. [PMID: 35683440 PMCID: PMC9181503 DOI: 10.3390/jcm11113052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022] Open
Abstract
Functional status is an important and meaningful outcome in people with chronic obstructive pulmonary disease (COPD), although its measurement is not embedded in routine clinical assessments. This study described the functional status of people with COPD using the 1-min sit-to-stand test (1minSTS) over a 6-month period and the examined sociodemographic and clinical characteristics associated with this outcome. Data from a prospective study including people with COPD were analyzed. Functional status was assessed monthly with the 1minSTS over 6 months. Linear-mixed effect models assessed the 1minSTS number of repetitions mean change. One-hundred and eight participants (82.4% men; 66.9 ± 9.5 years) were included. A significantly lower number of repetitions in the 1minSTS over the 6-month period was associated with being female (estimate: −4.69, 95%CI: −8.20; −1.18), being older (estimate: −0.56, 95%CI: −0.77; −0.34), having higher BMI (estimate: −0.55, 95%CI: −0.81; −0.28) and having higher activity-related dyspnea (estimate: −2.04, 95%CI: −3.25; −0.83). Half of the participants showed improvements above three repetitions in the 1minSTS over the 6-month period, independently of their baseline impairment (1minSTS < 70% predicted: 52.5%; ≥70% predicted: 54.4%). To conclude, monthly follow-up assessments were associated with clinically relevant benefits in the functional status of people with COPD. Age, body composition, and activity-related dyspnea were the main predictors of functional status over time. Further research is needed to corroborate our findings and to support the beneficial effects of regular COPD monitoring.
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Affiliation(s)
- Vânia Rocha
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Jorge Cabral
- Center for Research & Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Sara Souto-Miranda
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Ana Filipa Machado
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), 4200-450 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto (FMUP), 4200-450 Porto, Portugal
| | - Joana Cruz
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- ciTechCare-Center for Innovative Care and Health Technology, School of Health Sciences (ESSLei), Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Vitória Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, 3094-001 Figueira da Foz, Portugal
| | - Paula Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, 4450-021 Matosinhos, Portugal
| | - Maria Aurora Mendes
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- Pulmonology Department, Centro Hospitalar do Baixo Vouga (CHBV), 3810-096 Aveiro, Portugal
| | - Vera Afreixo
- Center for Research & Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
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26
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Wu YK, Su WL, Yang MC, Chen SY, Wu CW, Lan CC. Associations Between Physical Activity, Smoking Status, and Airflow Obstruction and Self-Reported COPD: A Population-Based Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1195-1204. [PMID: 35620350 PMCID: PMC9128642 DOI: 10.2147/copd.s337683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with an increased mortality rate in recent years, mainly caused by exposure to tobacco smoke. Regular physical activity is thought to diminish the risk of COPD exacerbation, while very few studies investigate the interaction between smoking and physical activity on COPD development. This study aims to investigate the association between smoking status, physical activity and prevalent COPD. Methods This study analyzed data of adults 20 to 79 years old from the National Health and Nutrition Examination Survey (NHANES) 2007–2012. Results A total of 6404 participants aged 20–79 were included and divided into four groups by their physical activity levels and smoking status. Amongst, 2819 (43.7%) were physically active non-smokers, 957 (14.8%) were physically inactive non-smokers, 1952 (30.3%) were physically active smokers, and 717 (11.1%) were physically inactive smokers. Prevalence of airflow obstruction were 5.7%, 7.1%, 17.7% and 18.6%, respectively. After adjustment, physically active smokers (aOR=2.71, 95% CI=1.94–3.80) and physically inactive smokers (aOR=2.70, 95% CI=1.78–4.09) but not physically active non-smokers were more likely to have airflow obstruction than physically active non-smokers. These associations were similar among most subgroups by age, sex, or BMI. Among smokers, being physically inactive was not significantly associated with a greater chance for prevalent airflow obstruction than being physically active. Conclusion Smokers, regardless of their physical activity level, are more likely to have airflow obstruction as compared with physically active non-smokers. Within smokers, being physically inactive poses no excess chance to be airflow obstructed. The findings indicate that physical activity level seem not altering the relationship between smoking and airflow obstruction.
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Affiliation(s)
- Yao-Kuang Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Wen-Lin Su
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Sin-Yi Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chih-Wei Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
- Correspondence: Chou-Chin Lan, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Road, Xindian Dist., New Taipei City, Taiwan, Tel +886-2-66289779 ext 5709, Fax +886-2-66289009, Email
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27
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Barbosa M, Andrade R, de Melo CA, Torres R. Community-Based Pulmonary Rehabilitation Programs in Individuals With COPD. Respir Care 2022; 67:579-593. [PMID: 35473839 PMCID: PMC9994255 DOI: 10.4187/respcare.09627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND Community-based pulmonary rehabilitation (PR) programs can be offered to patients with COPD, but the literature on its effects is still not well summarized. Our purpose was to investigate the health-, physical-, and respiratory-related effects of community-based PR in individuals with COPD as compared to control groups. METHODS The PubMed and Embase databases were searched up to May 17, 2021. We included randomized control trials that compared the effects of community-based PR as compared to control groups in individuals with COPD. The risk of bias was judged using the Cochrane Risk of Bias 2 (RoB2). Meta-analysis was performed using a random-effects model to estimate the standardized mean difference (SMD) with 95% CI of the mean changes from baseline between groups. The Grading of Recommendations Assessment, Development, and Evaluation was used to interpret certainty of results. RESULTS We included 10 randomized control studies comprising a total of 9,350 participants with weighted mean age of 62.3 ± 2.38 y. The community-based interventions were based on exercise programs (resistance and/or endurance). All studies were judged as high risk and/or some concerns in one or more domains the risk of bias. All meta-analyses displayed very low certainty of evidence. The community-based PR interventions were significantly superior to control interventions in improving the St. George Respiratory Questionnaire Activity subscore (-0.40 [95% CI -0.72 to -0.08]; k = 5, n = 382) and total score (-0.73 [95% CI -1.29 to -0.18]; k = 4, n = 268) and the Chronic Respiratory Disease Questionnaire dyspnea subscore (0.36 [95% CI 0.03-0.69]; k = 6, n = 550). The mean changes from baseline were not different between the groups for all other outcomes. CONCLUSIONS Community-based PR tended to result in superior health-related quality of life and symptoms than control interventions, but the findings were inconsistent across outcomes and with very low certainty of evidence. Further studies are warranted for stronger conclusions.
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Affiliation(s)
| | | | | | - Rui Torres
- Ms Barbosa is affiliated with Gaia/Espinho Hospital Center, North Rehabilitation Center, Gaia, Portugal; and Câmara Municipal de Arouca, Complexo Municipal Desportivo de Arouca e Piscinas Municipais de Escariz. Mr Andrade is affiliated with Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; and Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto Portugal. Dr de Melo is affiliated with School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal; and CIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal. Dr Torres is affiliated with CESPU, North Polytechnic Institute of Health, Paredes, Portugal; and CIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal
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28
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Alqahtani KA, Gerlis C, Nolan CM, Gardiner N, Szczepura A, Man W, Singh SJ, Houchen-Wolloff L. SPACE FOR COPD delivered as a maintenance programme on pulmonary rehabilitation discharge: protocol of a randomised controlled trial evaluating the long-term effects on exercise tolerance and mental well-being. BMJ Open 2022; 12:e055513. [PMID: 35470190 PMCID: PMC9039383 DOI: 10.1136/bmjopen-2021-055513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The benefits achieved during pulmonary rehabilitation (PR) are known to be sustained for 6-12 months after the initial programme. Several maintenance trials have been conducted but were heterogeneous in terms of duration, frequency and labour cost. There is no consensus on one best strategy. SPACE FOR COPD (Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease) is a home-based self-management programme, which has been shown previously to be effective in primary and secondary care settings and is to be tested here as a maintenance programme. The aim is to evaluate the efficacy of the SPACE FOR COPD programme (manual and group sessions), on exercise tolerance and mental well-being, compared with usual care following PR in patients with COPD. METHODS AND ANALYSIS A prospective, multicentre, single-blinded randomised controlled trial requiring 116 participants with a clinical diagnosis of COPD who have finished PR within 4 weeks will be randomised 1:1 to either a usual care group or a SPACE FOR COPD programme group. The intervention comprises a home-based manual and 4, 2-hour group sessions adopting motivational interviewing techniques over 12 months. The primary outcome is endurance capacity measured by the Endurance Shuttle Walking Test at 12 months. Secondary outcomes are: maximal exercise capacity, health-related quality of life, mood, patient activation, physical activity, lung function and healthcare costs. The measures will be taken at baseline, 6 and 12 months. Patient interviews and staff focus groups will be conducted to explore barriers, facilitators and views about the intervention at the end of the study. A framework analysis will be used for the interpretation of qualitative data. ETHICS AND DISSEMINATION The trial was granted ethical approval from Health Research Authority and Health and Care Research Wales (HCRW19/EM/0267 on 10 October 2019). Results will be made available to all stakeholders through a dissemination event, conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN30110012.
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Affiliation(s)
- Khaled A Alqahtani
- Respiratory Therapy Department, Jazan University, Jazan, Saudi Arabia
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charlotte Gerlis
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
| | - Claire M Nolan
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nikki Gardiner
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
| | - Ala Szczepura
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - William Man
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Sally J Singh
- Respiratory Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
| | - Linzy Houchen-Wolloff
- Respiratory Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
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29
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La kinésithérapie en per- et post-exacerbation immédiate de BPCO. Rev Mal Respir 2022; 39:386-397. [DOI: 10.1016/j.rmr.2022.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022]
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Souto-Miranda S, Dias C, Jácome C, Melo E, Marques A. Long-Term Maintenance Strategies after Pulmonary Rehabilitation: Perspectives of People with Chronic Respiratory Diseases, Informal Carers, and Healthcare Professionals. Healthcare (Basel) 2022; 10:healthcare10010119. [PMID: 35052283 PMCID: PMC8775561 DOI: 10.3390/healthcare10010119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary rehabilitation (PR) is an effective intervention for people with chronic respiratory diseases (CRD); however, its effects fade after 6–12 months. Community-based strategies might be valuable to sustain PR benefits, but this has been little explored. People with CRD, informal carers, and healthcare professionals (HCPs) were recruited from pulmonology appointments of two local hospitals, two primary care centres, and one community institutional practice and through snowballing technique. Focus groups were conducted using a semi-structured guide. Data were thematically analysed. Twenty-nine people with CRD (24% female, median 69 years), 5 informal carers (100% female, median 69 years), and 16 HCPs (75% female, median 36 years) were included. Three themes were identified: “Maintaining an independent and active lifestyle” which revealed common strategies adopted by people with “intrinsic motivation and professional and peer support” as key elements to maintain benefits, and that “access to information and partnerships with city councils’ physical activities” were necessary future steps to sustain active lifestyles. This study suggests that motivation, and professional and peer support are key elements to maintaining the benefits of PR in people with CRD, and that different physical activity options (independent or group activities) considering peoples’ preferences, should be available through partnerships with the community, namely city councils.
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Affiliation(s)
- Sara Souto-Miranda
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- iBiMED—Institute of Biomedicine, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Cláudia Dias
- Home Care Department, Linde Healthcare, 1200-217 Lisbon, Portugal;
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Elsa Melo
- iBiMED—Institute of Biomedicine, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Alda Marques
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- Correspondence:
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31
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Mikolaizak AS, Harvey L, Toson B, Lord SR, Tiedemann A, Howard K, Close JCT. Linking health service utilisation and mortality data-unravelling what happens after fall-related paramedic care. Age Ageing 2022; 51:6514234. [PMID: 35077557 DOI: 10.1093/ageing/afab254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A randomised controlled trial implemented and evaluated a new model of care for non-transported older fallers to prevent future falls and unplanned health service use. This current study uses linked data to evaluate the effects of the intervention beyond the initial 12-month study period. METHOD Study data from an established cohort of 221 adults were linked to administrative data from NSW Ambulance, Emergency Department Data Collection, Admitted Patient Data Collection and Registry of Births, Deaths and Marriages evaluating health service use at 12, 24 and 36 months following randomisation including time to event (health service utilisation) and mortality. Negative binomial and Cox's proportional hazard regression were performed to capture the impact of the study between groups and adherence status. RESULTS At 36 months follow-up, 89% of participants called an ambulance, 87% attended the Emergency Department and 91% were admitted to hospital. There were no significant differences in all-cause health service utilisation between the control and intervention group (IG) at 12, 24 and 36 months follow-up. Fall-related health service use was significantly higher within the IG at 12 (IRR:1.40 (95%CI:1.01-1.94) and 24 months (IRR:1.43 (95%CI:1.05-1.95)). Medication use, impaired balance and previous falls were associated with subsequent health service use. Over 40% of participants died by the follow-up period with risk of death lower in the IG at 36 months (HR:0.64, 95%CI:0.45-0.91). CONCLUSION Non-transported fallers have a high risk of future health service use for fall and other medical-related reasons. Interventions which address this risk need to be further explored.
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CANDEMIR İ, ERGÜN P, ŞAHİN ME. Maintenance of pulmonary rehabilitation benefits in patients with COPD: is a structured 5-year follow-up program helpful? Turk J Med Sci 2021; 51:2915-2923. [PMID: 34247463 PMCID: PMC10734876 DOI: 10.3906/sag-2101-245] [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: 01/19/2021] [Revised: 12/13/2021] [Accepted: 07/10/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD), but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program. Materials and methods COPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George’s respiratory questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the forced midexpiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study. Results Thirty-three COPD patients with a mean age of 58 ± 8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47 ± 16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p < 0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p = 0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p = 0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p < 0.001) and year 3 (p = 0.005/0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years. Conclusion Structured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Long-term randomized controlled studies are needed to verify these results.
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Affiliation(s)
- İpek CANDEMIR
- Department of Chest Disease, Health Science University Atatürk Chest Diseases and Surgery Education and Research Hospital, Ankara,
Turkey
| | - Pınar ERGÜN
- Department of Chest Disease, Health Science University Atatürk Chest Diseases and Surgery Education and Research Hospital, Ankara,
Turkey
| | - Mustafa Engin ŞAHİN
- Department of Chest Disease, Health Science University Atatürk Chest Diseases and Surgery Education and Research Hospital, Ankara,
Turkey
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33
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Borghi-Silva A, Garcia-Araújo AS, Winkermann E, Caruso FR, Bassi-Dibai D, Goulart CDL, Dixit S, Back GD, Mendes RG. Exercise-Based Rehabilitation Delivery Models in Comorbid Chronic Pulmonary Disease and Chronic Heart Failure. Front Cardiovasc Med 2021; 8:729073. [PMID: 34722662 PMCID: PMC8548415 DOI: 10.3389/fcvm.2021.729073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Among the most prevalent multimorbidities that accompany the aging process, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) stand out, representing the main causes of hospital admissions in the world. The prevalence of COPD coexistence in patients with CHF is higher than in control subjects, given the common risk factors associated with a complex process of chronic diseases developing in the aging process. COPD-CHF coexistence confers a marked negative impact on mechanical-ventilatory, cardiocirculatory, autonomic, gas exchange, muscular, ventilatory, and cerebral blood flow, further impairing the reduced exercise capacity and health status of either condition alone. In this context, integrated approach to the cardiopulmonary based on pharmacological optimization and non-pharmacological treatment (i.e., exercise-based cardiopulmonary and metabolic rehabilitation) can be emphatically encouraged by health professionals as they are safe and well-tolerated, reducing hospital readmissions, morbidity, and mortality. This review aims to explore aerobic exercise, the cornerstone of cardiopulmonary and metabolic rehabilitation, resistance and inspiratory muscle training and exercise-based rehabilitation delivery models in patients with COPD-CHF multimorbidities across the continuum of the disease. In addition, the review address the importance of adjuncts to enhance exercise capacity in these patients, which may be used to optimize the gains obtained in these programs.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Adriana S Garcia-Araújo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Eliane Winkermann
- Graduate Program in Comprehensive Health Care, Universidade de Cruz Alta/Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, Brazil
| | - Flavia R Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Management and Health Services, Ceuma University, São Luís, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Guilherme Dionir Back
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
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Prefaut C, Costes F. [Pulmonary rehabilitation, a historical perspective from Hippocrates to tele-rehabilitation]. Rev Mal Respir 2021; 38:1005-1012. [PMID: 34654587 DOI: 10.1016/j.rmr.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
In ancient times Hippocrates described a disease, the 3rd phthisis, which seems to correspond to COPD and is mainly treated by walking, gradually increasing the number of steps until reaching 10,000 steps a day at the end of the initial period of treatment. The recent era began in the second half of the 20th century and ended in 2015, with an unusual Cochrane Library editorial in which it was stated that the accumulated evidence (statistically significant and clinically relevant improvements in clinical signs, tolerance to exercise, quality of life, days hospitalization…) on the effects of rehabilitation programs suffice to suspend research on the subject and to justify focus on new elements in the programs. It is essential, in fact, to establish uniform practical recommendations for the prescription of routine rehabilitation (number and duration of physical activity sessions, therapeutic education, re-training intensity…). In addition, studies should be carried out on new practices: community or home rehabilitation, long-term rehabilitation, tele-rehabilitation.
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Affiliation(s)
- C Prefaut
- Faculté de médecine, université de Montpellier, Occitanie Est, 34080 Montpellier, France.
| | - F Costes
- Université Clermont Auvergne, unité de nutrition humaine, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
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35
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Finamore P, Scarlata S, Delussu AS, Traballesi M, Incalzi RA, Laudisio A. Frailty Impact during and after Pulmonary Rehabilitation. COPD 2021; 18:518-524. [PMID: 34427156 DOI: 10.1080/15412555.2021.1967915] [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] [Indexed: 10/20/2022]
Abstract
Frailty is a condition of reduced physiologic reserve common in COPD candidates to pulmonary rehabilitation, however no study has investigated whether frailty impacts the decline that a great part of COPD patients face after the completion of the rehabilitation program. Study objectives are to verify frailty impact on pulmonary rehabilitation outcomes during and after the program. This is a secondary analysis of a longitudinal study. Stable COPD patients GOLD I-III were randomized to a three-month endurance versus endurance and resistance training. Participants performed a multidimensional assessment at baseline, at the end of the rehabilitation program and after six months. Frailty was defined using a two-step approach including PRISMA-7 and Timed "Up and Go" test. Frailty interaction with time was evaluated using generalized least-squared regression models for repeated measures, correcting for potential confounders. Of the 53 participants with a mean age of 73 (SD:8) years 38 (72%) were frail. The mean 6MWD and V'O2peak increased in frail and no frail patients during pulmonary rehabilitation and declined after its completion, while CAT score showed a steep decline during the training, and a mild decline later. Frailty showed a significant interaction with time in terms of 6MWD variation during (β adj:43.6 meters, p-value:0.01) and after (β adj:-47 meters, p-value:0.02) pulmonary rehabilitation; no significant interaction was found in terms of V'O2peak and CAT score variation. In conclusion, frail COPD patients have a higher potential to benefit from pulmonary rehabilitation, but a higher risk to have a steeper decline later.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1967915 .
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Affiliation(s)
- Panaiotis Finamore
- Department of Medicine and Surgery, Campus Bio-Medico di Roma University, Unit of Geriatrics, Rome, Italy
| | - Simone Scarlata
- Department of Medicine and Surgery, Campus Bio-Medico di Roma University, Unit of Geriatrics, Rome, Italy
| | | | | | - Raffaele Antonelli Incalzi
- Department of Medicine and Surgery, Campus Bio-Medico di Roma University, Unit of Geriatrics, Rome, Italy
| | - Alice Laudisio
- Department of Medicine and Surgery, Campus Bio-Medico di Roma University, Unit of Geriatrics, Rome, Italy
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36
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Malaguti C, Dal Corso S, Janjua S, Holland AE. Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2021; 8:CD013569. [PMID: 34404111 PMCID: PMC8407510 DOI: 10.1002/14651858.cd013569.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease (COPD), but gains are not maintained over time. Maintenance pulmonary rehabilitation has been defined as ongoing supervised exercise at a lower frequency than the initial pulmonary rehabilitation programme. It is not yet known whether a maintenance programme can preserve the benefits of pulmonary rehabilitation over time. Studies of maintenance programmes following pulmonary rehabilitation are heterogeneous, especially regarding supervision frequency. Furthermore, new maintenance models (remote and home-based) are emerging. OBJECTIVES To determine whether supervised pulmonary rehabilitation maintenance programmes improve health-related quality of life (HRQoL), exercise performance, and health care utilisation in COPD patients compared with usual care. Secondly, to examine in subgroup analyses the impact of supervision frequency and model (remote or in-person) during the supervised maintenance programme. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PEDro, and two additional trial registries platforms up to 31 March 2020, without restriction by language or type of publication. We screened the reference lists of all primary studies for additional references. We also hand-searched conference abstracts and grey literature through the Cochrane Airways Trials Register and CENTRAL. SELECTION CRITERIA We included only randomised trials comparing pulmonary rehabilitation maintenance for COPD with attention control or usual care. The primary outcomes were HRQoL, exercise capacity and hospitalisation; the secondary outcomes were exacerbation rate, mortality, direct costs of care, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts, extracted data, and assessed the risk of bias. Results data that were similar enough to be pooled were meta-analysed using a random-effects model, and those that could not be pooled were reported in narrative form. Subgroup analyses were undertaken for frequency of supervision (programmes offered monthly or less frequently, versus more frequently) and those using remote supervision (e.g. telerehabilitation versus face-to-face supervision). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 21 studies (39 reports) with 1799 COPD patients. Participants ranged in age from 52 years to 88 years. Disease severity ranged from 24% to 88% of the predicted forced expiratory volume in one second. Programme duration ranged from four weeks to 36 months. In-person supervision was provided in 12 studies, and remote supervision was provided in six studies (telephone or web platform). Four studies provided a combination of in-person and remote supervision. Most studies had a high risk of performance bias due to lack of blinding of participants, and high risk of detection, attrition, and reporting bias. Low- to moderate-certainty evidence showed that supervised maintenance programmes may improve health-related quality of life at six to 12 months following pulmonary rehabilitation compared to usual care (Chronic Respiratory Questionnaire total score mean difference (MD) 0.54 points, 95% confidence interval (CI) 0.04 to 1.03, 258 participants, four studies), with a mean difference that exceeded the minimal important difference of 0.5 points for this outcome. It is possible that supervised maintenance could improve six-minute walk distance, but this is uncertain (MD 26 metres (m), 95% CI -1.04 to 52.84, 639 participants, 10 studies). There was little to no difference between the maintenance programme and the usual care group in exacerbations or all-cause hospitalizations, or the chance of death (odds ratio (OR) for mortality 0.73, 95% CI 0.36 to 1.51, 755 participants, six studies). Insufficient data were available to understand the impact of the frequency of supervision, or of remote versus in-person supervision. No adverse events were reported. AUTHORS' CONCLUSIONS This review suggests that supervised maintenance programmes for COPD patients after pulmonary rehabilitation are not associated with increased adverse events, may improve health-related quality of life, and could possibly improve exercise capacity at six to 12 months. Effects on exacerbations, hospitalisation and mortality are similar to those of usual care. However, the strength of evidence was limited because most included studies had a high risk of bias and small sample size. The optimal supervision frequency and models for supervised maintenance programmes are still unclear.
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Affiliation(s)
- Carla Malaguti
- Department of Cardiorespiratory Physiotherapy and Skeletal Muscle, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Simone Dal Corso
- Graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Anne E Holland
- Physiotherapy, Alfred Health, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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Lopez D, Cecins N, Cockram J, Collins A, Landers H, Sanfilippo F, Briffa T, Brims F, Geelhoed E, Murray K, Phillips K, Preen D, Jenkins S. Maintaining quality of life in patients with chronic obstructive pulmonary disease (COPD) by extending the maintenance phase of community-based pulmonary rehabilitation: protocol for a randomised controlled trial (ComEx3 Study). BMJ Open Respir Res 2021; 7:7/1/e000548. [PMID: 32209643 PMCID: PMC7206909 DOI: 10.1136/bmjresp-2019-000548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Pulmonary rehabilitation is a core component of the treatment of people with chronic obstructive pulmonary disease (COPD); however, the benefits gained diminish in the ensuing months. The optimal strategy for maintaining the benefits is unclear with weekly supervised maintenance exercise programmes proposed as one strategy. However, the long-term future of maintenance programs is dependent on quality evidence. Methods and analysis The ComEx3 randomised controlled trial will investigate the efficacy of extending a weekly supervised maintenance programme for an additional 6 months following an initial 10-week maintenance programme (intervention) by comparing with a control group who receive the same 10-week maintenance programme followed by 6 months of usual care. 120 participants with COPD will be recruited. Primary objective is to determine health-related quality of life over 12 months. Secondary objectives are to determine functional exercise capacity trajectory and to perform an economic evaluation of the intervention to the health system. Outcomes will be analysed for superiority according to intention-to-treat and per-protocol approaches. Ethics and dissemination Approval has been received from the relevant ethics committees. Findings will be disseminated in peer-reviewed journals and conferences, targeting those involved in managing people with COPD as well as those who develop policies and guidelines. Clinical trial registration ANZCTR 12618000933257
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Affiliation(s)
- Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Nola Cecins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Joanne Cockram
- Community Physiotherapy Services, Perth, Western Australia, Australia
| | - Anna Collins
- Community Physiotherapy Services, Perth, Western Australia, Australia
| | - Holly Landers
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Frank Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Fraser Brims
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, Curtin University, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Elizabeth Geelhoed
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | | | - David Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Susan Jenkins
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Moy ML, Wayne PM, Litrownik D, Beach D, Klings ES, Davis RB, Pinheiro A, Yeh GY. Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD. ERJ Open Res 2021; 7:00025-2021. [PMID: 34262967 PMCID: PMC8273295 DOI: 10.1183/23120541.00025-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022] Open
Abstract
Mind-body modalities are promising strategies to maintain the benefits gained after completion of conventional pulmonary rehabilitation in persons with COPD. In this pilot randomised controlled study we examined Tai Chi in persons with COPD after completing pulmonary rehabilitation. Participants were randomised 2:2:1 to Tai Chi (TC), usual care (UC) or group walking (GW) for 24 weeks. We assessed feasibility; primary outcome was exercise capacity measured by 6-min walk test (6MWT) distance at 24 weeks. Secondary outcomes included health-related quality of life measured by Chronic Respiratory Questionnaire (CRQ), dyspnoea, mood, stress, social support, self-efficacy, physical activity and exercise engagement. Effect size estimates and estimates from generalised estimating equations were calculated. Ninety-one persons (36 TC, 37 UC, 18 GW) were enrolled, with mean age 69±6 years, 59% male, and forced expiratory volume in 1 s % predicted (FEV1 % pred) 48±19%. There was no difference in adherence and adverse events between groups. There was a small between-group effect size (ES=0.25) in change in 6MWT distance favouring TC compared to UC; 24-week comparison was nonsignificant (p=0.10). There were no differences in secondary outcomes. In exploratory analyses, there was a greater percentage of participants in TC who improved 6MWT distance at 24 weeks, compared to UC, 64% versus 39%, p=0.05. There were higher percentages of participants in TC who improved CRQ Fatigue (59% versus 31%, p=0.02) and CRQ Mastery (47% versus 20%, p=0.01) domain scores, compared to UC. For GW, there were no differences compared with TC. Tai Chi may be a feasible option to maintain the benefits gained after completing conventional pulmonary rehabilitation.
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Affiliation(s)
- Marilyn L. Moy
- Pulmonary, Sleep, and Critical Care Medicine Section, Dept of Medicine, Veterans Administration Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Corresponding author: Marilyn L. Moy (E-mail: )
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Litrownik
- Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Douglas Beach
- Division of Pulmonary, Sleep and Critical Care Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Roger B. Davis
- Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Adlin Pinheiro
- Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Gloria Y. Yeh
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
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39
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Blervaque L, Préfaut C, Forthin H, Maffre F, Bourrelier M, Héraud N, Catteau M, Pomiès P, Jaffuel D, Molinari N, Hayot M, Gouzi F. Efficacy of a long-term pulmonary rehabilitation maintenance program for COPD patients in a real-life setting: a 5-year cohort study. Respir Res 2021; 22:79. [PMID: 33691702 PMCID: PMC7948332 DOI: 10.1186/s12931-021-01674-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnea in chronic obstructive pulmonary disease (COPD) patients. Maintenance programs can sustain the benefits for 12 to 24 months. Yet, the long-term effects (> 12 months) of pragmatic maintenance programs in real-life settings remain unknown. This prospective cohort study assessed the yearly evolution in the outcomes [6-min walking distance (6MWD), HRQoL, dyspnea] of a supervised self-help PR maintenance program for COPD patients followed for 5 years. The aim was to assess the change in the outcomes and survival probability for 1 to 5 years after PR program discharge in COPD patients following a PR maintenance program supported by supervised self-help associations. METHODS Data were prospectively collected from 144 COPD patients who followed a pragmatic multidisciplinary PR maintenance program for 1 to 5 years. They were assessed yearly for 6MWD, HRQol (VQ11) and dyspnea (MRC). The 5-year survival probability was compared to that of a control PR group without a maintenance program. A trajectory-based cluster analysis identified the determinants of long-term response. RESULTS Maintenance program patients showed significant PR benefits at 4 years for 6MWD and VQ11 and 5 years for MRC. The 5-year survival probability was higher than for PR patients without PR maintenance. Two clusters of response to long-term PR were identified, with responders being the less severe COPD patients. CONCLUSIONS This study provides evidence of the efficacy of a pragmatic PR maintenance program in a real-life setting for more than 3 years. In contrast to short-term PR, long-term PR maintenance appeared more beneficial in less severe COPD patients.
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Affiliation(s)
- Léo Blervaque
- PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier University, Montpellier, France
| | | | | | | | | | - Nelly Héraud
- Direction de la recherche clinique et de l'innovation en santé - KORIAN SANTE, 34700, Lodève, France
| | - Matthias Catteau
- PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier University, Montpellier, France
| | - Pascal Pomiès
- PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier University, Montpellier, France
| | - Dany Jaffuel
- Department of Pneumology, Montpellier University Hospital, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Fares Gouzi
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France.
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Give a Little or Give a Lot?: The Question of Long-term Maintenance After Pulmonary Rehabilitation. Chest 2021; 159:893-894. [PMID: 33678267 DOI: 10.1016/j.chest.2020.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
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Habib GMM, Rabinovich R, Divgi K, Ahmed S, Saha SK, Singh S, Uddin A, Uzzaman MN, Pinnock H. Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings. NPJ Prim Care Respir Med 2020; 30:52. [PMID: 33214560 PMCID: PMC7677536 DOI: 10.1038/s41533-020-00210-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.
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Affiliation(s)
- G M Monsur Habib
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Roberto Rabinovich
- ELEGI/Colt Laboratory, Centre for Inflammation Research, QMRI, The University of Edinburgh and Respiratory Department, Royal Infirmary Edinburgh, Edinburgh, UK
| | | | - Salahuddin Ahmed
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
- Johns Hopkins University-Bangladesh, Projahnmo, Dhaka, Bangladesh
| | | | - Sally Singh
- Pulmonary and Cardiac Rehabilitation, Department of Respiratory Medicine (Acute Division), University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Aftab Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Nazim Uzzaman
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.
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Butler SJ, Desveaux L, Lee AL, Beauchamp MK, Brusco NK, Wang W, Goldstein RS, Brooks D. Randomized controlled trial of community-based, post-rehabilitation exercise in COPD. Respir Med 2020; 174:106195. [PMID: 33171390 DOI: 10.1016/j.rmed.2020.106195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Although pulmonary rehabilitation (PR) improves function in people with chronic obstructive pulmonary disease (COPD), a community-based exercise program may be necessary to maintain functional capacity. We aimed to determine the effectiveness of a post-rehabilitation, community-based maintenance program on exercise tolerance, functional capacity and quality of life. METHODS Patients with COPD who completed PR were randomized to receive a community-based maintenance program (intervention) or usual care (control). The primary outcome was 6-min walk distance (6MWD), measured immediately post-PR, 6 months and 12 months later. Secondary outcomes included self-reported functional capacity, health-related quality of life, self-efficacy, program cost, and lower extremity muscle strength. RESULTS Ninety-seven patients (69 ± 9 years) were enrolled. There was a non-significant trend of an intervention effect on 6MWD over time (β = 42, 95% CI: 0.06 to 83.93, p = 0.053). There was no significant impact of group on any of the secondary outcomes. Restricting the analysis to those who attended ≥50% of the exercise sessions showed a significant intervention effect for 6MWD (β = 69.19, 95% CI = 10.16 to 128.22, p = 0.03). The cost of participating in the community maintenance program for the intervention group was $374.77 (SD 142.12) and membership renewal was highest at community centres offering twice weekly, supervised exercise classes. CONCLUSIONS A post rehabilitation, community-based exercise program, will maintain exercise capacity in people with COPD who attend at least 50% of available sessions over one year. An increased focus on factors that determine adherence would help inform improvements in maintenance program design.
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Affiliation(s)
- Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Desveaux
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Marla K Beauchamp
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Wei Wang
- Cabrini Health, Malvern, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Abstract
Pulmonary rehabilitation (PR) is an essential intervention in the management of patients with chronic obstructive pulmonary disease. To guide health care professionals in the implementation and evaluation of a PR program, this article discusses the current key concepts regarding exercise testing, prescription, and training, as well as self-management intervention as essential parts of PR and post-rehabilitation maintenance. Moreover, new approaches (alternative forms of organization and delivery, tele-rehabilitation, exercise adjuncts) and unique and challenging situations (patients experiencing acute exacerbations, advanced disease) are thoroughly reviewed. Finally, validated point-of-care resources and online tools are provided.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montréal, Québec H4A 3S5, Canada.
| | - Sebastien Gagnon
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montréal, Québec H4A 3S5, Canada
| | - Bryan Ross
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montréal, Québec H4A 3S5, Canada
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Efficiency of High-Flow Nasal Cannula on Pulmonary Rehabilitation in COPD Patients: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7097243. [PMID: 33083481 PMCID: PMC7556103 DOI: 10.1155/2020/7097243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/04/2020] [Accepted: 08/05/2020] [Indexed: 01/04/2023]
Abstract
Introduction The clinical benefit of high-flow nasal cannula (HFNC) on factors related to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients remains unclear. This meta-analysis aimed at synthesizing the available evidence on the efficacy of HFNC on exercise capacity, lung function, and other factors related to pulmonary rehabilitation in COPD patients. Methods Electronic databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science) were searched for randomized trials comparing with conventional oxygen therapy (COT) or noninvasive ventilation (NIV). Primary outcomes were respiratory rate, FEV1, tidal volume, oxygen partial pressure, total score of St. George's respiratory questionnaire, 6-minute walk test, and exercise endurance time. Results Ten trials met the criteria for inclusion. Combined data from six studies showed that HFNC showed a lower respiratory rate in COPD patients [mean difference -1.27 (95% CI: -1.65–(-0.89)]. Combined data from three studies showed a lower forced expiratory volume in one second (FEV1) in the group of HFNC. No difference in tidal volume was showed between the HFNC and control groups in COPD patients. No significant oxygen improvement between the HFNC groups and control groups. The total score of St. George's respiratory questionnaire was improved by the subgroup analysis of HFNC versus COT but no NIV. Two multicenter RCTs showed the six-minute walk test, and statistical results showed that the length of the six-minute walk capacity was increased after usage of HFNC compared to the control group [mean difference -8.65 (95% CI: -9.12–(-8.19)]. No increase of exercise capacity after usage of HFNC (mean difference -12.65). Conclusion In the first meta-analysis of the area, the current evidence did not show so much positive effect on tidal volume or oxygen improvement in COPD patients. Length of the six-minute walk capacity was increased after using HFNC, while other pulmonary rehabilitation parameters, namely, the score of St. George's respiratory questionnaire and exercise capacity show no increase in the group of HFNC. The variance in the quality of the evidence included in this meta-analysis highlights the need for this evidence to be followed up with further high-quality and more randomized trials.
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Arnold MT, Dolezal BA, Cooper CB. Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked. Tuberc Respir Dis (Seoul) 2020; 83:257-267. [PMID: 32773722 PMCID: PMC7515680 DOI: 10.4046/trd.2020.0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease receive a range of treatments including but not limited to inhaled bronchodilators, inhaled and systemic corticosteroids, supplemental oxygen, and pulmonary rehabilitation. Pulmonary rehabilitation is a multidisciplinary intervention that seeks to combine patient education, exercise, and lifestyle changes into a comprehensive program. Programs 6 to 8 weeks in length have been shown to improve health, reduce dyspnea, increase exercise capacity, improve psychological well-being, and reduce healthcare utilization and hospitalization. Although the use of pulmonary rehabilitation is widely supported by the literature, controversy still exists regarding what should be included in the programs. The goal of this review was to summarize the evidence for pulmonary rehabilitation and identify the areas that hold promise in improving its utilization and effectiveness.
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Affiliation(s)
- Michael T Arnold
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christopher B Cooper
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Ahmed I, Haji G. COVID-19 - Is It Time for Exercise Clinicians to Prehabilitate "High Risk" Respiratory Patients? Curr Sports Med Rep 2020; 19:281-283. [PMID: 32769662 DOI: 10.1249/jsr.0000000000000737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Irfan Ahmed
- Barts Health NHS Trust, Public Health Department, The Royal London Hospital, London, UNITED KINGDOM
| | - Gulam Haji
- Imperial College Healthcare NHS Trust, London, UNITED KINGDOM
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Dawson S, Kunonga P, Beyer F, Spiers G, Booker M, McDonald R, Cameron A, Craig D, Hanratty B, Salisbury C, Huntley A. Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely discharge and improve patient well-being? A mixed method meta-review of systematic reviews. F1000Res 2020; 9:857. [PMID: 34621521 PMCID: PMC8482050 DOI: 10.12688/f1000research.25277.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being. Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy was developed: eight bibliographic medical and social science databases were searched, and references of included studies checked. Searches were restricted to OECD countries and to systematic reviews published between January 2013-March 2018. Data extraction and quality appraisal was undertaken by one reviewer with a random sample screened independently by two others. Results: Searches retrieved 21,233 records; using data mining techniques, we identified 8,720 reviews. Following title and abstract and full-paper screening, 71 systematic reviews were included: 62 quantitative, seven qualitative and two mixed methods reviews. There were 52 reviews concerned with healthcare interventions and 19 reviews concerned with social care interventions. This meta-review summarises the evidence and evidence gaps of nine broad types of health and social care interventions. It scrutinises the presence of research in combined health and social care provision, finding it lacking in both definition and detail given. This meta-review debates the overlap of some of the person-centred support provided by community health and social care provision. Research recommendations have been generated by this process for both primary and secondary research. Finally, it proposes that research recommendations can be delivered on an ongoing basis if meta-reviews are conducted as living systematic reviews. Conclusions: This meta-review provides evidence of the effect of health and social care interventions for the community-dwelling older population and identification of evidence gaps. It highlights the lack of evidence for combined health and social care interventions and for the impact of social care interventions on health care outcomes. Registration: PROSPERO ID CRD42018087534; registered on 15 March 2018.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Patience Kunonga
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Gemma Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Matthew Booker
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Ailsa Cameron
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Dawn Craig
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, UK, Newcastle, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Gu R, Xu S, Li Z, Gu Y, Sun Z. The safety and effectiveness of rehabilitation exercises on COVID-19 patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21373. [PMID: 32756125 PMCID: PMC7402771 DOI: 10.1097/md.0000000000021373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Corona Virus Disease 2019 (COVID-19) is spreading fast starting late 2019. It mainly affects the human respiratory system. Many reports revealed that rehabilitation exercise can improve respiratory function and relieve the pressure from diseases, but there is no evidence to prove its effects on COVID-19. This protocol of systematic review and meta-analysis will clarify the safety and effectiveness of rehabilitation exercises on different COVID-19 patients. METHODS AND ANALYSIS Related studies will be retrieved from Web of Science, Cochrane Library, PubMed, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, Wan fang Database, ClinicalTrials, WHO Trials, and Chinese Clinical Trial Registry. Pre-defined inclusion and exclusion criteria will be used by two researchers independently for extracting data from literatures. Clinical recovery time and effective rates will be assessed as the primary outcomes. Changes of patient's condition, pulmonary function, respiratory function and activity of daily living will be assessed as the secondary outcomes. Fixed effect model will be used for evaluating efficiency. Considering clinical heterogeneity, random effect model will be used for continuous outcomes. Funnel charts, subgroup analysis and sensitivity analysis will be used to explore sources of heterogeneity. Endnote X9.3 will be used to manage data screening. The statistical analysis will be completed by RevMan5.2 and Stata/SE 15.1 software. RESULT This study will assess effects and safety for practicing rehabilitation exercises on COVID-19 patients. CONCLUSION The conclusion of this study will provide evidence to prove the safety and effectiveness of rehabilitation exercises on COVID-19 patients.
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Affiliation(s)
- Renjun Gu
- The First School of Clinical Medicine
| | - Senlei Xu
- School of Acupuncture and Tuina, School of Regimen and Rehabilitation
| | - Ziyun Li
- The Third School of Clinical Medicine
| | - Yihuang Gu
- School of Acupuncture and Tuina, School of Regimen and Rehabilitation
| | - Zhiguang Sun
- The Second School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
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Pulmonary Rehabilitation Can Improve the Functional Capacity and Quality of Life for Pneumoconiosis Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6174936. [PMID: 32802860 PMCID: PMC7411485 DOI: 10.1155/2020/6174936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) for pneumoconiosis. We systematically searched PubMed, Embase, The Cochrane Library, Web of Science, SinoMed, CNKI, VIP databases and Wanfang Data from their inception to June 1, 2019. A systematic review and meta-analysis of randomized controlled trials (RCTs) of PR for pneumoconiosis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently screened literature, extracted data, and assessed bias risk. All statistical analyses were performed using the RevMan software. Sixteen RCTs with 1307 subjects were ultimately included for analysis. Compared with routine treatment, PR was able to improve the 6-minute walking distance (mean difference (MD) 69.10, 95% confidence interval (CI) 61.95–76.25); the 36-Item Short Form Health Survey total score (MD 17.60, 95% CI 13.59–21.61); physical function score (MD 15.45, 95% CI 3.20–27.69); role physical score (MD 17.87, 95% CI 12.06–23.69); body pain score (MD 14.34, 95% CI 10.33–18.36); general health score (MD 20.86, 95% CI 16.87–24.84); vitality score (MD 11.66, 95% CI 0.18–23.13); social function score (MD 9.67, 95% CI 1.27–18.08); mental health score (MD 20.60, 95% CI 13.61–27.59); forced vital capacity (FVC) (MD 0.20, 95% CI 0.12–0.29); forced expiratory volume in 1 s (FEV1) (MD 0.23, 95% CI 0.09–0.38); FEV1% (MD 5.19, 95% CI 1.48–8.90); maximal voluntary ventilation (MD 4.47, 95% CI 1.14–7.81); reduction in the St. George's Respiratory Questionnaire score (MD -9.60, 95% CI -16.40 to -2.80); and the modified Medical Research Council Scale score. Furthermore, PR did not increase the FEV1/FVC (MD 3.61, 95% CI -3.43 to 10.65), nor the emotional score (MD 6.18, 95% CI -23.01 to 35.38) compared with the control. We found no reports of adverse events associated with PR. Thus, to some extent, PR can improve functional capacity and quality of life in patients with pneumoconiosis. However, these results should be interpreted with caution because of high heterogeneity. This trial is registered with registration number CRD42018095266.
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