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Barbosa M, de Melo CA, Torres R. The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: a prospective cohort study. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:68-85. [PMID: 38828206 PMCID: PMC11144029 DOI: 10.29390/001c.117966] [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: 01/04/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
Introduction Pilates exercise may complement traditional pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). The objective was to analyze the effects of adding a six-month Pilates exercise program to a three-month pulmonary rehabilitation for individuals with COPD. Methods Thirty-five participants with COPD (GOLD B) were assigned to the intervention (n=14) or control (n=21) group. Both groups received an initial three months of a pulmonary rehabilitation program. The intervention group further underwent six months of pilates. Participants were evaluated at baseline and at three, six, and nine months. Lung function and strength of respiratory muscles were defined as primary outcomes. Secondary outcomes included cardiac, physical function, and exacerbation episodes. Results There were no consistent statistically significant differences between groups for the lung function outcomes (p\<0.05). Maximal inspiratory and expiratory pressure increased significantly at three months in both groups (p\<0.05). It was significantly superior in the intervention group at nine months for maximal inspiratory pressure (p=0.005) and six and nine months for maximal expiratory pressure (p=0.027 and p\<0.001, respectively). Changes in muscle strength (knee extension and handgrip) were comparable between groups (p>0.05), but exercise-induced fatigue and balance were significantly superior in the intervention group at the six- and nine-month follow-ups (p\<0.05). Discussion Pilates exercise programs may be implemented to augment traditional pulmonary rehabilitation with the goal of improving the strength of respiratory muscles. Conclusion Adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-induced fatigue, and improved balance.
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Affiliation(s)
- Marisela Barbosa
- PhysiotherapyCentro Hospitalar do Baixo Vouga Aveiro - Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal
- PhysiotherapyEscola Superior de Saúde Norte da Cruz Vermelha Portuguesa, Oliveira de Azeméis, Portugal
| | - Cristina A. de Melo
- PhysiotherapySchool of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal (retired)
| | - Rui Torres
- PhysiotherapyCESPU, North Polytechnic Institute of Health, Paredes, Portugal
- PhysiotherapyCIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal
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2
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Liao Y, Yu J, Zhan Y, Liu Y, Zhou Y, Wang H, Liu X, Wang W, Ma Y, Lan F. Motivating factors for physical activity participation among individuals with chronic obstructive pulmonary disease: A qualitative study applying the motivation, opportunity, and ability model. PLoS One 2024; 19:e0303858. [PMID: 38781270 PMCID: PMC11115224 DOI: 10.1371/journal.pone.0303858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE The study aims to explore the driving forces behind physical activity engagement among patients with chronic obstructive pulmonary disease, focusing on motivation, opportunity, and capability. DESIGN A phenomenological qualitative study applied the motivation, opportunity, and capability model, conducted in two respiratory units of a Chinese university hospital. METHODS Participants, selected by age, gender, and illness duration, included inpatients during the interview sessions and those recently discharged within six months. One-on-one semi-structured interviews were recorded, transcribed, and analyzed by the Colaizzi seven-step method. RESULTS Seventeen participants diagnosed with chronic obstructive pulmonary disease for over one year aged between 66 (range: 42-96) participated. Three major themes were identified: Inspiring participation motivation-transitioning from recognizing significance to habit formation; Offering participation opportunities-reiterating demand for personalized strategies and ideal environmental settings; Enhancing participation capability-addressing strategies for overcoming fears, setting goals, ensuring safety, and adjusting activity levels. CONCLUSIONS This research underscores the vital role of inspiring participation motivation, offering opportunities, and enhancing the capability for participation in effective engagement. Advocating increased attention from healthcare departments, fostering interdisciplinary collaboration, improving activity guidance and counseling effectiveness, and considering individual preferences can significantly benefit those patients with chronic obstructive pulmonary disease who hesitate or are unable to participate in physical activities, thereby increasing the dose of non-leisure time physical activity.
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Affiliation(s)
- Yuanyu Liao
- Nursing Department, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jiaohua Yu
- Nursing Department, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yuxin Zhan
- Department of Neurosurgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yunfang Liu
- Department of Thoracic Surgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yaoling Zhou
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- School of Nursing, Huanggang Polytechnic College, Huanggang, Hubei Province, China
| | - Huan Wang
- Department of Thoracic Surgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xinghong Liu
- Department of Cardiovascular Surgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Weiwei Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yu Ma
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fenfen Lan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Toubes-Navarro ME, Gude-Sampedro F, Álvarez-Dobaño JM, Reyes-Santias F, Rábade-Castedo C, Rodríguez-García C, Lado-Baleato Ó, Lago-Fidalgo R, Sánchez-Martínez N, Ricoy-Gabaldón J, Casal-Mouriño A, Abelleira-Paris R, Riveiro-Blanco V, Zamarrón-Sanz C, Rodríguez-Núñez N, Lama-López A, Ferreiro-Fernández L, Valdés-Cuadrado L. A pulmonary rehabilitation program reduces hospitalizations in chronic obstructive pulmonary disease patients: A cost-effectiveness study. Ann Thorac Med 2023; 18:190-198. [PMID: 38058789 PMCID: PMC10697305 DOI: 10.4103/atm.atm_70_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 08/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Although pulmonary rehabilitation (PR) is recommended in patients with chronic obstructive pulmonary disease (COPD), there is a scarcity of data demonstrating the cost-effectiveness and effectiveness of PR in reducing exacerbations. METHODS A quasi-experimental study in 200 patients with COPD was conducted to determine the number of exacerbations 1 year before and after their participation in a PR program. Quality of life was measured using the COPD assessment test and EuroQol-5D. The costs of the program and exacerbations were assessed the year before and after participation in the PR program. The incremental cost-effectiveness ratio (ICER) was estimated in terms of quality-adjusted life years (QALYs). RESULTS The number of admissions, length of hospital stay, and admissions to the emergency department decreased after participation in the PR program by 48.2%, 46.6%, and 42.5%, respectively (P < 0.001 for all). Results on quality of life tests improved significantly (P < 0.001 for the two tests). The cost of PR per patient and the cost of pre-PR and post-PR exacerbations were €1867.7 and €7895.2 and €4201.9, respectively. The PR resulted in a cost saving of €1826 (total, €365,200) per patient/year, and the gain in QALYs was+0.107. ICER was -€17,056. The total cost was <€20,000/QALY in 78% of patients. CONCLUSIONS PR contributes to reducing the number of exacerbations in patients with COPD, thereby slowing clinical deterioration. In addition, it is cost-effective in terms of QALYs.
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Affiliation(s)
| | - Francisco Gude-Sampedro
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago de Compostela, Spain
| | - José Manuel Álvarez-Dobaño
- Interdisciplinary Group of research in Pulmonology, Institute of Sanitary research from Compostela, Spain
- University Clinical Hospital of Santiago de Compostela, Spain
| | - Francisco Reyes-Santias
- Department of Human Resources and General Services, University Clinical Hospital of Santiago de Compostela, Spain
| | - Carlos Rábade-Castedo
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | | | - Óscar Lado-Baleato
- Research Methods Group, Health Research Institute of Santiago de Compostela, Spain
- ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela, Spain
| | - Raquel Lago-Fidalgo
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago de Compostela, Spain
- Mathematics University of Santiago de Compostela, Spain
| | - Noelia Sánchez-Martínez
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago de Compostela, Spain
- Mathematics University of Santiago de Compostela, Spain
| | - Jorge Ricoy-Gabaldón
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Ana Casal-Mouriño
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Romina Abelleira-Paris
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Vanessa Riveiro-Blanco
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Carlos Zamarrón-Sanz
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Adriana Lama-López
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Lucía Ferreiro-Fernández
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
- Interdisciplinary Group of research in Pulmonology, Institute of Sanitary research from Compostela, Spain
| | - Luis Valdés-Cuadrado
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
- Interdisciplinary Group of research in Pulmonology, Institute of Sanitary research from Compostela, Spain
- Medicine University of Santiago de Compostela, Spain
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Morii Y, Abiko K, Osanai T, Takami J, Tanikawa T, Fujiwara K, Houkin K, Ogasawara K. Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients. Cost Eff Resour Alloc 2023; 21:12. [PMID: 36726117 PMCID: PMC9893661 DOI: 10.1186/s12962-023-00421-3] [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: 03/25/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Rehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of 7-days-per-week rehabilitation schedule has been studied in comparison with 5- or 6-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of 7-days-per-week rehabilitation for acute stroke from public health payer's perspective, and public healthcare and long-term care payer's perspective in Japan. METHODS Cost-effectiveness of 7-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a previous study using a Japanese database examining the efficacy of 7-days-per-week rehabilitation. Cost utility analysis was conducted by comparing 7-days-per-week rehabilitation with 5- or 6-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years (QALY). The costs were estimated using the Japanese fee table and from published sources. The time horizon was 5 years, and Markov modeling was used for the analysis. RESULTS The ICER was $6339/QALY from public health payer's perspective, lower than 5,000,000 Yen/QALY (approximately US$37,913), which was the willingness-to-pay used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payer's perspective. The result of sensitivity analysis confirmed the results. CONCLUSION The results indicated that 7-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective.
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Affiliation(s)
- Yasuhiro Morii
- grid.415776.60000 0001 2037 6433Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama Japan ,grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan
| | - Kagari Abiko
- grid.415260.40000 0004 1769 060XDepartment of Rehabilitation Medicine, Sapporo Azabu Neurosurgical Hospital, N22-E1, Higashi-Ku, Sapporo, Hokkaido Japan ,grid.412167.70000 0004 0378 6088Department of Rehabilitation Medicine, Hokkaido University Hospital, N15-W7, Kita-Ku, Sapporo, Hokkaido Japan
| | - Toshiya Osanai
- grid.39158.360000 0001 2173 7691Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-Ku, Sapporo, Hokkaido Japan
| | - Jiro Takami
- Department of Rehabilitation, Nishi Sapporo Hospital, 5-1, Yamanote 3-2, Nishi-Ku, Sapporo, Hokkaido Japan
| | - Takumi Tanikawa
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan ,grid.444700.30000 0001 2176 3638Faculty of Health Sciences, Hokkaido University of Science, 4-1, Maeda 7-15, Teine-Ku, Sapporo, Hokkaido Japan
| | - Kensuke Fujiwara
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan ,grid.444620.00000 0001 0666 3591Graduate School of Commerce, Otaru University of Commerce, 5-21, Midori 3, Otaru, Hokkaido Japan
| | - Kiyohiro Houkin
- grid.39158.360000 0001 2173 7691Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-Ku, Sapporo, Hokkaido Japan
| | - Katsuhiko Ogasawara
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan
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5
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Kushniruk A, Middelweerd A, van Empelen P, Preuhs K, Konijnendijk AAJ, Oude Nijeweme-d'Hollosy W, Schrijver LK, Laverman GD, Vollenbroek-Hutten MMR. A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study. JMIR Hum Factors 2023; 10:e40017. [PMID: 36633898 PMCID: PMC9947918 DOI: 10.2196/40017] [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: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). OBJECTIVE This paper aimed to describe the systematic development of E-Supporter 1.0. METHODS Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. RESULTS The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. CONCLUSIONS The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.
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Affiliation(s)
| | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | | | | | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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Baiardini I, Fasola S, Lorenzi C, Colombo N, Bruno M, La Grutta S, Scognamillo C, Braido F. Might Dog Walking Reduce the Impact of COPD on Patients' Life? Healthcare (Basel) 2022; 10:healthcare10112317. [PMID: 36421641 PMCID: PMC9690207 DOI: 10.3390/healthcare10112317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Low levels of physical activity (PA) lead to a worsening of physical condition and contributes to multimorbidity in Chronic Obstructive Respiratory Disease (COPD). Unsupervised PA related to dog ownership may contribute to reducing sedentary behavior. We aimed to investigate the relationship between dog walking, patient-reported outcomes (PROs) and exacerbations in COPD. A pre-defined sample of 200 COPD patients (dog owners and non-dog owners) with symptomatic COPD was sourced from a database representative of the Italian population. A computer-assisted personal interview was used to assess health status impairment (CAT), fatigue (FACIT), health-related quality of life (HRQoL) (EQ-5D), and PA frequency. In the whole sample, PA was associated with better CAT, EQ-5D, VAS, FACIT scores and reduced number of exacerbation (p < 0.001). Under the same CAT scores, dog-walking duration was associated with a better HRQoL (EQ5D, p = 0.015) and less fatigue (FACIT, p = 0.017). In an adjusted regression model, walking dogs >30 min was associated with lower fatigue (FACIT) than having no dogs and walking dogs <15 min (p = 0.026 and p = 0.009, respectively). Motivation related to dog walking could modify patients’ tendency to focus on symptoms during PA and, therefore, to perceive the fatigue. Dog walking may be effective for increasing and maintaining regular PA, reducing the subjective impact of COPD.
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Affiliation(s)
- Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genova, 16126 Genova, Italy
- Correspondence:
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, 90146 Palermo, Italy
| | - Chiara Lorenzi
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genova, 16126 Genova, Italy
| | - Nicole Colombo
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genova, 16126 Genova, Italy
| | - Matteo Bruno
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genova, 16126 Genova, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, 90146 Palermo, Italy
| | | | - Fulvio Braido
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genova, 16126 Genova, Italy
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Liu J, He X, Wu J. Economic Evaluation of Triple Therapy with Budesonide/Glycopyrrolate/Formoterol Fumarate for the Treatment of Moderate to Very Severe Chronic Obstructive Pulmonary Disease in China Using a Semi-Markov Model. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:743-755. [PMID: 35478081 DOI: 10.1007/s40258-022-00732-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic respiratory disease with considerable clinical and socioeconomic impact. Budesonide/glycopyrrolate/formoterol fumarate (BGF) is a newly approved pharmacotherapy for COPD in China that has been shown to improve lung function and reduce the risk of exacerbations, but the cost-effectiveness of BGF remains unknown. The objective of this study was to evaluate the cost-effectiveness of BGF in patients with moderate to very severe COPD from a Chinese healthcare system perspective. METHODS A semi-Markov model was developed to compare the costs and benefit of treatment with BGF versus a composite comparator of long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) therapies. Clinical inputs for BGF and the composite comparator were based on the KRONOS study (NCT02497001) and a network meta-analysis. Cost inputs were derived from published literature and Chinese government documents, supplemented by expert opinion where necessary. Health-related quality-of-life inputs were also obtained based on the KRONOS study. Lifetime costs, number of exacerbations, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. Costs were measured in 2020 Chinese Yuan (CN¥) and converted into US dollars (US$). Scenario analyses and sensitivity analyses were conducted. RESULTS Over the lifetime horizon, BGF treatment led to fewer moderate and severe exacerbations (4.01 and 0.87, respectively) versus the composite comparator (8.42 and 2.04, respectively), with a base-case ICER of CN¥13,685.94 (US$1983.47) per QALY gained. Scenario analyses considering different population and utilities resulted in ICERs ranging from dominant to CN¥13,673.91 (US$1981.73). Extensive sensitivity analyses indicated robust base-case results since all analyses yielded ICERs below the conservative cost-effectiveness threshold of one times the Chinese per capita gross domestic product (CN¥72,447.00 [US$10,499.57], 2020). CONCLUSION Triple therapy with BGF was predicted to improve outcomes and be a cost-effective treatment option compared with LAMA/LABA therapies for patients with moderate to very severe COPD in China.
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Affiliation(s)
- Jia Liu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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8
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Tian J, Zhou F, Zhang XG, Wang HY, Peng SH, Li X, Cao J, Zhang H. Experience of physical activity in patients with COPD: A systematic review and qualitative meta-synthesis. Geriatr Nurs 2022; 47:211-219. [PMID: 35940039 DOI: 10.1016/j.gerinurse.2022.07.013] [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: 04/30/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically evaluate and integrate the qualitative research on physical activity (PA) experience of patients with chronic obstructive pulmonary disease (COPD). METHODS Web of Science, Cochrane Library, Embase, CINAHL and other databases were searched, and the qualitative research on PA experience of patients with COPD was collected. The systematic review was conducted in line with Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence. RESULTS 12 studies were included and 3 themes were summarized, included: COPD patients experience more barriers while participating in physical activities than facilitators; COPD patients experience more positive effects post-physical activities than negative effects; Guaranteeing safety, goal setting, and establishing a professional support group improve compliance in COPD patients. CONCLUSION Health care professionals should help patients overcome the obstacles of PA, pay attention to the PA experience of patients, adopt diversified PA methods, improve PA participation and compliance, and make patients develop good PA habits.
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Affiliation(s)
- Jing Tian
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Fan Zhou
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Xian Geng Zhang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu, Sichuan 610100, China.
| | - Hong Yan Wang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu, Sichuan 610100, China
| | - Si Han Peng
- Affiliated hospital of Chengdu University of Traditional Chinese Medicine,Chengdu, Sichuan 610032, China
| | - Xin Li
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
| | - Jun Cao
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu, Sichuan 610100, China
| | - Hong Zhang
- College of Nursing,Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China
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9
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Chen ML, Chen LS, Chen YT, Gardenhire DS. The Association of Health-Related Factors with Leisure-Time Physical Activity among Adults with COPD: A Cross-Sectional Analysis. Healthcare (Basel) 2022; 10:249. [PMID: 35206864 PMCID: PMC8872349 DOI: 10.3390/healthcare10020249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the association of health attitudes, health appraisals and affective experience to leisure-time physical activity in adults with chronic obstructive pulmonary disease (COPD). Cross-sectional analyses were conducted with a sample of 274 adults with COPD drawn from the second wave of the Midlife in the United States (MIDUS 2) Study. Chi-square analyses and independent t-tests were used to test the differences between physically active and inactive COPD patients (active group versus inactive group) for all study variables. Multiple logistic regression was used to examine the association of each study variable with leisure-time physical activity. The results showed that there were significant differences between the active and inactive groups in terms of age, education, functional limitations, health attitudes, health appraisals and affective experience. After controlling for socio-demographic variables and functional limitations, beliefs about the importance of physical fitness and strength for a good life and comparative health appraisals were significantly related to physical activity. However, neither negative nor positive affect was associated with physical activity status. Modifiable factors, such as health attitudes toward physical fitness and strength, as well as health appraisals, should be considered for developing effective physical activity promotion interventions among COPD patients.
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Affiliation(s)
- Mei-Lan Chen
- School of Nursing, Georgia State University, Atlanta, GA 30303, USA
| | - Li-Sheng Chen
- Department of Respiratory Therapy, Georgia State University, Atlanta, GA 30303, USA; (L.-S.C.); (D.S.G.)
| | - Yen Tzu Chen
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Douglas S. Gardenhire
- Department of Respiratory Therapy, Georgia State University, Atlanta, GA 30303, USA; (L.-S.C.); (D.S.G.)
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Railey AF, Muller C, Noonan C, Schmitter-Edgecombe M, Sinclair K, Kim C, Look M, Kaholokula JK. Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension. PHARMACOECONOMICS - OPEN 2022; 6:85-94. [PMID: 34389923 PMCID: PMC8807791 DOI: 10.1007/s41669-021-00291-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The aim of this study was to calculate the costs and assess whether a culturally grounded physical activity intervention offered through community-based organizations is cost effective in reducing blood pressure among Native Hawaiian adults with hypertension. METHODS Six community-based organizations in Hawai'i completed a randomized controlled trial between 2015 and 2019. Overall, 263 Native Hawaiian adults with uncontrolled hypertension (≥ 140 mmHg systolic, ≥ 90 mmHg diastolic) were randomized to either a 12-month intervention group of hula (traditional Hawaiian dance) lessons and self-regulation classes, or to an education-only waitlist control group. The primary outcome was change in systolic blood pressure collected at baseline and 3, 6, and 12 months for the intervention compared with the control group. Incremental cost-effectiveness ratios (ICERs) were calculated for primary and secondary outcomes. Non-parametric bootstrapping and sensitivity analyses evaluated uncertainty in parameters and outcomes. RESULTS The mean intervention cost was US$361/person, and the 6-month ICER was US$103/mmHg reduction in systolic blood pressure and US$95/mmHg in diastolic blood pressure. At 12 months, the intervention group maintained reductions in blood pressure, which exceeded reductions for usual care based on blood pressure outcomes. The change in blood pressure at 12 months resulted in ICERs of US$100/mmHg reduction in systolic blood pressure and US$93/mmHg in diastolic blood pressure. Sensitivity analyses suggested that at the estimated intervention cost, the probability that the program would lower systolic blood pressure by 5 mmHg was 67 and 2.5% at 6 and 12 months, respectively. CONCLUSION The 6-month Ola Hou program may be cost effective for low-resource community-based organizations. Maintenance of blood pressure reductions at 6 and 12 months in the intervention group contributed to potential cost effectiveness. Future studies should further evaluate the cost effectiveness of indigenous physical activity programs in similar settings and by modeling lifetime costs and quality-adjusted life-years. TRIAL REGISTRATION NUMBER NCT02620709.
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Affiliation(s)
- Ashley F Railey
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
- Department of Sociology, Indiana University, 1022 E. Third St, Bloomington, IN, 47405-7103, USA.
| | - Clemma Muller
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Ka'imi Sinclair
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Corin Kim
- Kilohana, University of Hawai'i at Hilo, Hilo, HI, USA
| | - Mele Look
- Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA
| | - J Keawe'aimoku Kaholokula
- Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA
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Exacerbations and Changes in Physical Activity and Sedentary Behaviour in Patients with Bronchiectasis after 1 Year. J Clin Med 2021; 10:jcm10061190. [PMID: 33809173 PMCID: PMC7998500 DOI: 10.3390/jcm10061190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic characteristics related to a change in physical activity and sedentary behaviour in patients with bronchiectasis after one year. Methods: This was a prospective observational study during which physical activity measurements were recorded using a SenseWear Armband for one week at baseline and at one year. At each assessment point, patients were classified as active or inactive (measured as steps per day) and as sedentary or not sedentary (measured as sedentary time). Results: 53 patients with bronchiectasis were analysed, and after one year, 18 (34%) had worse activity and sedentary levels. Specifically, 10 patients became inactive and sedentary. Multivariable analysis showed that the number of exacerbations during the follow-up period was the only outcome independently associated with change to higher inactivity and sedentary behaviour (odds ratio (OR), 2.19; 95% CI, 1.12 to 4.28). Conclusions: The number of exacerbations in patients with bronchiectasis was associated with changes in physical activity and sedentary behaviour. Exacerbation prevention may appear as a key factor in relation to physical activity and sedentary behaviour in patients with bronchiectasis.
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Betancourt-Peña J, Ávila-Valencia JC, Assis JK, Escobar-Vidal DA. Clinical and Quality of Life Differences in Patients with COPD With and Without a Background of Hospitalization in the Last Year. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210209111111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading
cause of death worldwide. An upward trend is estimated by 2030. One of the causes of mortality is
the exacerbations of symptoms that result in hospitalizations. These hospitalizations reduce the
quality of life, limit performance in daily life, and increase the costs for the health system and the
patient.
Objective:
This study aimed to determine the differences between hospitalized and non-hospitalized
patients with a medical diagnosis of COPD, considering some sociodemographic and clinical
variables, and survival rates.
Methods:
A cross-sectional study was conducted, which included patients diagnosed with COPD
who initiated pulmonary rehabilitation (PR) from January to September 2018. The patients were divided
into two groups: patients with one or more exacerbations that led to the hospitalization
(COPD-H) and patients without hospitalizations in the last year (COPD-NH).
Results:
There were 128 participants (78 males and 50 females), with a mean age of 71.10±(9.34)
in the COPD-H group and 71.30±(8.91) in the COPD-NH group. When comparing both groups,
COPD-NH had a higher socioeconomic status (p=0.041), reporting a higher FEV1 44.71± (14.97),
p=0.047, and comorbidities according to the COTE index (p<0.001).
Conclusion:
The patients with the highest number of hospitalizations belonged to a lower socioeconomic
stratum and had a higher number of comorbidities. Therefore, it is necessary to identify these
factors at the beginning of PR.
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Affiliation(s)
- Jhonatan Betancourt-Peña
- Faculty of Health and Rehabilitation, Institucion Universitaria Escuela Nacional del Deporte, Cali, Colombia
| | - Juan Carlos Ávila-Valencia
- Faculty of Health and Rehabilitation, Institucion Universitaria Escuela Nacional del Deporte, Cali, Colombia
| | - Jorge Karim Assis
- Clinica de Occidente S.A. Research and Educational, Valle del Cauca, Colombia
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Ney JP, Robinson SA, Richardson CR, Moy ML. Can Technology-Based Physical Activity Programs for Chronic Obstructive Pulmonary Disease Be Cost-Effective? Telemed J E Health 2021; 27:1288-1292. [PMID: 33625893 DOI: 10.1089/tmj.2020.0398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the cost-effectiveness of a technology-based physical activity (PA) intervention for chronic obstructive pulmonary disease (COPD). Design: A secondary data analysis was performed from a randomized controlled trial in COPD of an activity monitor alone or an activity monitor plus a web-based PA intervention. Models estimated cost per quality-adjusted life year (QALY) and incremental cost-effectiveness ratios (ICERs) compared with usual care. Results: The estimated ICER for both groups was below the willingness-to-pay threshold of $50,000/QALY (activity monitor alone = $10,437/QALY; website plus activity monitor intervention = $13,065/QALY). A probabilistic simulation estimated 76% of the activity monitor-alone group and 78% of the intervention group simulations to be cost-effective. Conclusion(s): Both the activity monitor-alone group and the activity monitor plus website group were cost-effective at the base case by using conventional willingness-to-pay thresholds. Further research would benefit from a more direct estimate of health utilities and downstream health care costs. Clinical Trials.gov NCT01102777.
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Affiliation(s)
- John P Ney
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Marilyn L Moy
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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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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