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Engel RM, Gonski P, Vemulpad S, Graham PL. The Long-Term Benefit of Exercise With and Without Manual Therapy for Mild Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. J Cardiopulm Rehabil Prev 2024:01273116-990000000-00151. [PMID: 38870023 DOI: 10.1097/hcr.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is characterized by decreasing exercise capacity and deteriorating quality of life (QoL). Recent evidence indicates that combining exercise with manual therapy (MT) delivers greater improvements in exercise capacity than exercise alone in moderate COPD. The aim of this study was to investigate whether this combination delivers similar results in mild COPD. METHODS A total of 71 participants aged 50-65 yr with mild COPD were randomly allocated to two groups: exercise only (Ex) or MT plus exercise (MT + Ex). Both groups received 16 wk of exercise with the MT + Ex group also receiving 8 MT sessions. Lung function (forced vital capacity [FVC] and forced expiratory volume in the 1st sec [FEV1]), exercise capacity (6-min walk test [6MWT]), and QoL (St George's Respiratory Questionnaire [SGRQ] and Hospital Anxiety and Depression Scale [HADS]) were measured at baseline, 4, 8, 16, 24, 32, and 48 wk. RESULTS Although there was no difference in the mean effect over time between groups for lung function (FEV1, P= .97; FVC, P= .98), exercise capacity (6MWT, P= .98), and QoL (SGRQ, P= .41; HADS anxiety, P= .52; and HADS depression, P= .06), there were clinically meaningful improvements at 48 wk for 6MWT (30 m; 95% CI, 10-51 m; P< .001), SGRQ (6.3 units; 95% CI, 2.5-10.0; P< .001), and HADS anxiety (1.5 units; 95% CI, 0.3-2.8 units; P= .006) across the entire cohort. CONCLUSIONS While adding MT to Ex did not produce any additional benefits, exercise alone did deliver sustained modest improvements in exercise capacity and QoL in mild COPD.
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Affiliation(s)
- Roger Mark Engel
- Author Affiliations: Department of Chiropractic, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia (Dr Engel); Southcare, Sutherland Hospital, Sydney, Australia (Associate Professor Gonski); Department of Natural Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, Australia (Associate Professor Vemulpad); School of Mathematical and Physical Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, Australia (Associate Professor Graham)
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Auyeung T, Jiang O, Taylor M, Chang V, Kwan B. A pilot study on the effectiveness of a language-specific (Chinese) pulmonary rehabilitation programme for individuals with chronic pulmonary disease: a 2-year prospective cohort study in Sydney, Australia. Intern Med J 2024; 54:274-282. [PMID: 37548152 DOI: 10.1111/imj.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS Pulmonary rehabilitation (PR) improves dyspnoea, fatigue and healthcare-related quality of life (QoL) in patients with chronic lung disease (CLD). Non-English-speaking background (NESB) patients face language and cultural barriers that hinder their access to PR programmes, contributing to health disparities. Our trial aimed to demonstrate the effectiveness and feasibility of a Chinese language-specific PR programme on lung function, functional exercise capacity and QoL measures. METHODS A prospective cohort study was conducted over a 2-year period. Participants were enrolled in an 8-week PR programme with biweekly sessions conducted by Chinese-speaking physiotherapists. Baseline and post-rehabilitation testing included pulmonary function testing, 6-min walk test (6MWT), St. George Respiratory Questionnaire (SGQR) and Short Form Health Survey (SF-36). RESULTS We enrolled 76 patients (58% male) with a median age of 77 years (interquartile range (IQR) 68-81) and achieved a completion rate of 86.8% (n = 66). CLD included chronic obstructive pulmonary disease (42%), asthma (15%) and interstitial lung disease (3%). Baseline median forced expiratory volume in 1 s (FEV1) was 1.63 L (IQR 1.17-2.05), and the median 6MWT was 282 m (IQR 232-332). Post-intervention median 6MWT increased to 332 m (IQR 290-390), and the median FEV1 was 1.99 L (IQR 1.3-2.1). Both QoL measures (SGQR and SF-36) showed significant improvement after intervention (P < 0.05). CONCLUSION Our study demonstrates that a language-specific PR programme is feasible, improving outcomes in NESB patients with CLD. The improvement in 6MWT and QoL measures was comparable to English-based programmes. Ensuring equal access to healthcare programmes, regardless of cultural background or language barriers, is crucial in promoting health equity.
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Affiliation(s)
- Titus Auyeung
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- South Eastern Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Osborn Jiang
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mitchell Taylor
- Functional Lungs Physiotherapy, Sydney, New South Wales, Australia
| | - Vicky Chang
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Benjamin Kwan
- Department of Respiratory Medicine, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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3
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Rea J, Babek JT, Anderson RM, Bacani R, Staggs J, Vassar M. The Current State of Health Inequities in COPD. Respir Care 2024; 69:238-249. [PMID: 37848254 PMCID: PMC10898466 DOI: 10.4187/respcare.10553] [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: 10/19/2023]
Abstract
An understanding of the health inequities that surround the treatment and prevention of COPD is required to address the barriers that hinder improvement of care for underserved populations. This scoping review was conducted to identify the existing evidence of social factors that affect the health, health-care access, and health-care quality of patients with COPD within the United States, and to identify gaps in knowledge to help direct future research. We followed the guidelines from the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta Analyses Extension for Scoping Reviews. In July 2022, a literature search by using Ovid (Embase) and MEDLINE (PubMed) databases was conducted to identify articles on COPD, published between 2016 and 2021, written in English, and that investigated at least one health inequity as defined by the National Institutes of Health. All studies were screened for inclusion criteria and were extracted in a masked, duplicate manner. Each health inequity was investigated, extracted, and summarized. Thirty articles were screened in full text, and 19 were found to meet inclusion criteria. Common social factors investigated in the COPD literature included race/ethnicity, income, and education. Since the implementation of the National Institutes of Health's sex and gender minority category in 2016, only one study within our sample examined LGBTQ+ (lesbian, gay, bisexual, transgender, queer [or sometimes questioning], and others) patients with COPD. The least commonly investigated social factors that affect patients with COPD were rural/under-resourced (geography), sex and gender, and LGBTQ+ affiliation. In addition, occupational status was not investigated by any included studies in our sample. Our scoping review underlines the lack of research with regard to inequities that affect patients with COPD. We propose researching hormone replacement therapy's impact on lung function in transgender and nonbinary patients with COPD. Implementation science studies are suggested to enhance intervention for COPD medication adherence among racial/ethnic minority groups, given the intersectionalities of social factors that disproportionately affect this population. We, also recommend developing telemedicine pulmonary rehabilitation technology for rurally located patients with COPD.
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Affiliation(s)
- Jack Rea
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma.
| | - Jay Tyler Babek
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Reece M Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Rigel Bacani
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Jordan Staggs
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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del Valle MF, Valenzuela J, Bascour-Sandoval C, Marzuca-Nassr GN, del Sol M, Díaz Canales C, Escobar-Cabello M, Lizama-Pérez R, Valenzuela-Aedo F, Muñoz-Cofré R. Effects of a pulmonary rehabilitation program on pulmonary function, exercise performance, and quality of life in patients with severe COVID-19. Ther Adv Respir Dis 2024; 18:17534666231212431. [PMID: 38660953 PMCID: PMC11047239 DOI: 10.1177/17534666231212431] [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: 04/20/2023] [Accepted: 10/19/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Severe coronavirus 2019 disease (COVID-19) causes acute hypoxemic respiratory failure requiring invasive mechanical ventilation (IMV). Once these symptoms are resolved, patients can present systemic deterioration. OBJECTIVE The two objectives of this study were as follows: to describe the results of a pulmonary rehabilitation program (PRP), which is divided into three groups with different numbers of sessions (12, 24, and 36), and to associate the variables of pulmonary function, exercise performance, and functionality with the number of sessions and functional improvement. DESIGN Prospective, observational study. METHODS PRP consisted of aerobic + strength + flexibility exercises under the supervision and individualized into 12, 24, or 36 sessions (12s, 24s, and 36s), depending on the evolution of each patient. At the beginning of the study and immediately after the intervention, forced vital capacity (FVC), maximal inspiratory pressure, 6-minute walk test (6MWT), sit-to-stand test (STS), maximal handgrip strength (HGS), Fatigue Assessment Scale, Post-COVID-19 Functional Status (PCFS), and health-related quality of life (HRQoL) were measured. RESULTS The proposed PRP demonstrated a positive effect on pulmonary function, exercise performance, and HRQoL, regardless of the number of sessions. A higher score on the PCFS and more days on IMV were associated with the increased likelihood of needing more sessions, whereas more meters on the 6MWT in the initial evaluation was associated with a reduced likelihood of needing more sessions. Finally, more repetitions on the STS and less distance covered on the initial 6MWT were associated with a greater improvement in exercise performance evaluated with the 6MWT. CONCLUSION Supervised and individualized PRP for patients with severe post-COVID-19 improves pulmonary function, exercise performance, functionality, and quality of life. Functionality, distance covered on the 6MWT, and the days on IMV are central to the scheduling of the number of sessions for these patients.
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Affiliation(s)
| | - Jorge Valenzuela
- Servicio de Medicina Física y Rehabilitación, Hospital el Carmen, Maipú, Chile
| | - Claudio Bascour-Sandoval
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Gabriel Nasri Marzuca-Nassr
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Mariano del Sol
- Centro de Excelencia en Estudios Morfológicos y Quirúrgicos, Universidad de La Frontera. Temuco, Chile
- Doctorado en Ciencias Morfológicas, Universidad de La Frontera. Temuco, Chile
| | | | - Máximo Escobar-Cabello
- Laboratorio de Función Disfunción Ventilatoria, Departamento de Kinesiología, Universidad Católica del Maule, Talca, Chile
| | - Rodrigo Lizama-Pérez
- Department of Physical Education and Sport, Faculty of Sport Science, University of Granada, Granada, Spain
| | - Fernando Valenzuela-Aedo
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Doctorado en Ciencias Morfológicas, Universidad de La Frontera. Temuco, Chile
| | - Rodrigo Muñoz-Cofré
- Posdoctorado en Ciencias Morfológicas, Universidad de La Frontera, Av. Francisco Salazar 01145, Temuco 4811230, Chile
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LaMarca A, Tse I, Keysor J. Rehabilitation Technologies for Chronic Conditions: Will We Sink or Swim? Healthcare (Basel) 2023; 11:2751. [PMID: 37893825 PMCID: PMC10606667 DOI: 10.3390/healthcare11202751] [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: 08/17/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Chronic conditions such as stroke, Parkinson's disease, spinal cord injury, multiple sclerosis, vestibular disorders, chronic pain, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease are leading causes of disability among middle-aged and older adults. While evidence-based treatment can optimize clinical outcomes, few people with chronic conditions engage in the recommended levels of exercise for clinical improvement and successful management of their condition. Rehabilitation technologies that can augment therapeutic care-i.e., exoskeletons, virtual/augmented reality, and remote monitoring-offer the opportunity to bring evidence-based rehabilitation into homes. Successful integration of rehabilitation techniques at home could help recovery and access and foster long term self-management. However, widespread uptake of technology in rehabilitation is still limited, leaving many technologies developed but not adopted. METHODS In this narrative review, clinical need, efficacy, and obstacles and suggestions for implementation are discussed. The use of three technologies is reviewed in the management of the most prevalent chronic diseases that utilize rehabilitation services, including common neurological, musculoskeletal, metabolic, pulmonary, and cardiac conditions. The technologies are (i) exoskeletons, (ii) virtual and augmented reality, and (iii) remote monitoring. RESULTS Effectiveness evidence backing the use of technology in rehabilitation is growing but remains limited by high heterogeneity, lack of long-term outcomes, and lack of adoption outcomes. CONCLUSION While rehabilitation technologies bring opportunities to bridge the gap between clinics and homes, there are many challenges with adoption. Hybrid effectiveness and implementation trials are a possible path to successful technology development and adoption.
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Affiliation(s)
- Amber LaMarca
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA 02129, USA;
| | - Ivy Tse
- Doctor of Physical Therapy Program, MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Julie Keysor
- School of Health Care Leadership, MGH Institute of Health Professions, Boston, MA 02129, USA
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Miravitlles M, Bhutani M, Hurst JR, Franssen FME, van Boven JFM, Khoo EM, Zhang J, Brunton S, Stolz D, Winders T, Asai K, Scullion JE. Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Adv Ther 2023; 40:4236-4263. [PMID: 37537515 PMCID: PMC10499689 DOI: 10.1007/s12325-023-02609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Discharge bundles, comprising evidence-based practices to be implemented prior to discharge, aim to optimise patient outcomes. They have been recommended to address high readmission rates in patients who have been hospitalised for an exacerbation of chronic obstructive pulmonary disease (COPD). Hospital readmission is associated with increased morbidity and healthcare resource utilisation, contributing substantially to the economic burden of COPD. Previous studies suggest that COPD discharge bundles may result in fewer hospital readmissions, lower risk of mortality and improvement of patient quality of life. However, evidence for their effectiveness is inconsistent, likely owing to variable content and implementation of these bundles. To ensure consistent provision of high-quality care for patients hospitalised with an exacerbation of COPD and reduce readmission rates following discharge, we propose a comprehensive discharge protocol, and provide evidence highlighting the importance of each element of the protocol. We then review care bundles used in COPD and other disease areas to understand how they affect patient outcomes, the barriers to implementing these bundles and what strategies have been used in other disease areas to overcome these barriers. We identified four evidence-based care bundle items for review prior to a patient's discharge from hospital, including (1) smoking cessation and assessment of environmental exposures, (2) treatment optimisation, (3) pulmonary rehabilitation, and (4) continuity of care. Resource constraints, lack of staff engagement and knowledge, and complexity of the COPD population were some of the key barriers inhibiting effective bundle implementation. These barriers can be addressed by applying learnings on successful bundle implementation from other disease areas, such as healthcare practitioner education and audit and feedback. By utilising the relevant implementation strategies, discharge bundles can be more (cost-)effectively delivered to improve patient outcomes, reduce readmission rates and ensure continuity of care for patients who have been discharged from hospital following a COPD exacerbation.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital/Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- International Primary Care Respiratory Group, Leicester, UK
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - Daiana Stolz
- Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tonya Winders
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Osaka Metropolitan University, Osaka, Japan
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7
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Liu Y, Lin Y, Sun Y, Thekkur P, Cheng C, Li Y, Shi Y, Jiang J, Liao J, Nie C, Sun W, Liang C, Zhang X, Liu S, Ma Y, Berger SD, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R, Golub JE, Li L, Harries AD. Managing Comorbidities, Determinants and Disability at Start and End of TB Treatment under Routine Program Conditions in China. Trop Med Infect Dis 2023; 8:341. [PMID: 37505637 PMCID: PMC10383887 DOI: 10.3390/tropicalmed8070341] [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: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
Many patients with tuberculosis (TB) have comorbidities, risk determinants and disability that co-exist at diagnosis, during and after TB treatment. We conducted an observational cohort study in 11 health facilities in China to assess under routine program conditions (i) the burden of these problems at the start and end of TB treatment and (ii) whether referral mechanisms for further care were functional. There were 603 patients registered with drug-susceptible TB who started TB treatment: 84% were symptomatic, 14% had diabetes, 14% had high blood pressure, 19% smoked cigarettes, 10% drank excess alcohol and in 45% the 6 min walking test (6MWT) was abnormal. Five patients were identified with mental health disorders. There were 586 (97%) patients who successfully completed TB treatment six months later. Of these, 18% were still symptomatic, 12% had diabetes (the remainder with diabetes failed to complete treatment), 5% had high blood pressure, 5% smoked cigarettes, 1% drank excess alcohol and 25% had an abnormal 6MWT. Referral mechanisms for the care of comorbidities and determinants worked well except for mental health and pulmonary rehabilitation for disability. There is need for more programmatic-related studies in other countries to build the evidence base for care of TB-related conditions and disability.
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Affiliation(s)
- Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Ave, Tongzhou, Beijing 101149, China; (Y.L.); (Y.S.); (L.L.)
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
| | - Yuxian Sun
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Ave, Tongzhou, Beijing 101149, China; (Y.L.); (Y.S.); (L.L.)
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Changhao Cheng
- Wuhan Pulmonary Hospital, No. 28 Baofengyilu, Qiaokou, Wuhan 430000, China;
| | - Yuecui Li
- The First People’s Hospital of Yongkang, No. 599 Jinshan West Road, Yongkang 321300, China;
| | - Yunzhen Shi
- Dongyang People’s Hospital, No. 60 Wuning West Road, Dongyang 322100, China;
| | - Jun Jiang
- The Third People’s Hospital of Yichang City, No. 32 Gangyaolu, Yichang 443000, China;
| | - Jiong Liao
- The People’s Hospital of Laiban, No. 159 Pangudadao, Laiban 546100, China;
| | - Chuangui Nie
- Xiangyang Institute of Tuberculosis Control and Prevention, No. 20 Xinhuala, Xiangyang 441000, China;
| | - Wenyan Sun
- Ezhou Third Hospital, No. 16 Minxin West Road, Ezhou 436000, China;
| | - Chengyuan Liang
- Baise City People’s Hospital, No. 8 Chengxianglu, Youjiang, Baise 533000, China;
| | - Xiaojuan Zhang
- Zhongwei People’s Hospital, Gulouxijie, Zhongwei 755000, China;
| | - Sang Liu
- Guangxi Chest Hospital, No. 8 Yangjiaoshanlu, Yufeng, Liuzhou 545000, China;
| | - Yan Ma
- The People’s Hospital of Tongxin, Xueyuanlu, Tongxi, Yuhaizhen 751100, China;
| | - Selma Dar Berger
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India
| | - Mohammed Khogali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), Avenue Appia 20, 1211 Geneva, Switzerland;
| | - Jonathan E. Golub
- Johns Hopkins Center for Tuberculosis, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Ave, Tongzhou, Beijing 101149, China; (Y.L.); (Y.S.); (L.L.)
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Abstract
There have been an estimated 100 million people diagnosed with COVID-19 in the United States, with a majority of patients reporting persistent symptoms expressed as long COVID. The 2 most frequently reported long COVID symptoms are shortness of breath and fatigue. Exercise training during pulmonary rehabilitation (PR) is a successful strategy for improving the lives of people with persistent respiratory symptoms caused by a variety of lung diseases. This narrative review assessed the impact of exercise interventions on functional exercise capacity measures and related symptoms (dyspnea, fatigue) in people with long COVID over the last year. Articles were accessed through electronic databases including PubMed, Embase, CINAHL Plus with full text (EBSCO), and LitCovid. Findings for this Year in Review revealed that exercise interventions and PR show promise for improving functional exercise capacity, dyspnea, and fatigue in people with long COVID. This review supports the need for more rigorous scientific studies on the benefits of structured PR in people with long COVID who have respiratory-related symptoms.
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Affiliation(s)
- Dave M Burnett
- University of Kansas Medical Center, Department of Respiratory Care and Diagnostic Sciences, Kansas City, Kansas
| | - Cheryl E Skinner
- University of Kansas Medical Center, Department of Respiratory Care and Diagnostic Sciences, Kansas City, Kansas.
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9
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Nyberg A, Sondell A, Lundell S, Marklund S, Tistad M, Wadell K. Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis. JMIR Hum Factors 2023; 10:e43269. [PMID: 36995743 PMCID: PMC10131608 DOI: 10.2196/43269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/13/2022] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management. OBJECTIVE The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice. METHODS This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach. RESULTS The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis. CONCLUSIONS This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis. TRIAL REGISTRATION ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.
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Affiliation(s)
- André Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Sondell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sara Lundell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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10
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study. Chron Respir Dis 2023; 20:14799731231221820. [PMID: 38126966 DOI: 10.1177/14799731231221820] [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: 12/23/2023] Open
Abstract
BACKGROUND Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults. METHOD The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2). RESULTS Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively). CONCLUSIONS Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
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11
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Ghaben SJ, Mat Ludin AF, Mohamad Ali N, Beng Gan K, Singh DKA. A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review. Digit Health 2023; 9:20552076231191014. [PMID: 37599901 PMCID: PMC10437210 DOI: 10.1177/20552076231191014] [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: 02/25/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.
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Affiliation(s)
- Suad J Ghaben
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Al Azhar University, Gaza, Palestine
| | - Arimi Fitri Mat Ludin
- Faculty of Health Sciences, Biomedical Science Programme & Center for Healthy Ageing and Wellness (H=CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazlena Mohamad Ali
- Institute of Visual Informatics (IVI), Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Kok Beng Gan
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Devinder Kaur Ajit Singh
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Clark LA, Reed R, Corazzini KN, Zhu S, Renn C, Jennifer Klinedinst N. COPD-Related Fatigue: A Scoping Review. Clin Nurs Res 2022; 32:914-928. [PMID: 36540028 DOI: 10.1177/10547738221141224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Millions of people worldwide have chronic obstructive pulmonary disease (COPD), and one of the most common and troublesome symptoms that must be managed is fatigue. While there are existing interventions to address COPD-related fatigue, not all patients experience benefit. A better understanding of the factors associated with COPD-fatigue could elucidate new approaches to address COPD-related fatigue, thereby offering relief to a greater number of patients. The purpose of this review was to identify the physiologic, psychologic, and situational factors associated with COPD-related fatigue. A total of four databases, PubMed, CINAHL, Scopus, and Google Scholar, were searched. Those that were peer reviewed, in English, and published between 2000 and 2021, were included in the review. A total of 25 articles were included in this scoping review. The following factors were related to fatigue in COPD: dyspnea, pain, anxiety, depression, and sleep. Fatigue is a debilitating symptom with factors influential to the symptom and outcomes. Research is indicated to explore targeted and personalized interventions addressing the factors related to fatigue to mitigate this widespread symptom.
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Affiliation(s)
- Lindsey A. Clark
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Robert Reed
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Cynthia Renn
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Aldhahir AM, Alqahtani JS, AlDraiwiesh IA, Alghamdi SM, Alsulayyim AS, Alqarni AA, Alhotye M, Alwafi H, Siraj R, Alrajeh A, Aldabayan YS, Alzahrani EM, Hakamy A. Healthcare providers' attitudes, beliefs and barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in Saudi Arabia: a cross-sectional study. BMJ Open 2022; 12:e063900. [PMID: 36302583 PMCID: PMC9621177 DOI: 10.1136/bmjopen-2022-063900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral. DESIGN A cross-sectional online survey consisting of nine multiple-choice questions. SETTINGS Saudi Arabia. PARTICIPANTS 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists. PRIMARY OUTCOME MEASURES HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia. RESULTS Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was 'mobility affected by breathlessness' (64%), while the 'availability of PR centres' (61%), the 'lack of trained HCPs' (52%) and the 'lack of authority to refer patients' (44%) were the most common barriers to referral. CONCLUSION PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers.
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Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Respiratory Care Program, College of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah S Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Rayan Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Ahmed Alrajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Yousef S Aldabayan
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Eidan M Alzahrani
- Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ali Hakamy
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
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Sanchez-Ramirez DC, Pol M, Loewen H, Choukou MA. Effect of telemonitoring and telerehabilitation on physical activity, exercise capacity, health-related quality of life and healthcare use in patients with chronic lung diseases or COVID-19: A scoping review. J Telemed Telecare 2022:1357633X221122124. [PMID: 36045633 PMCID: PMC9434200 DOI: 10.1177/1357633x221122124] [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: 03/08/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19. METHODS A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment. RESULTS This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups' exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results. CONCLUSION Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.
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Affiliation(s)
- Diana C Sanchez-Ramirez
- Department of Respiratory Therapy, Rady
Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Margriet Pol
- Department of Occupational Therapy,
Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied
Sciences, The Netherlands
| | - Hal Loewen
- Neil John Maclean Health Sciences
Library, University of Manitoba, Canada
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy,
Rady Faculty of Health Science, University of Manitoba, Canada
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15
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Singh P. Clinician's Commentary on O'Hoski et al. 1. Physiother Can 2022; 74:265-266. [PMID: 37325215 PMCID: PMC10262835 DOI: 10.3138/ptc-2020-0081-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Prashna Singh
- Certified Respiratory Educator; Pulmonary Rehabilitation Program Coordinator; Queensway Health Centre, Trillium Health Partners;
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16
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Matarese M, Lyons KS, Piredda M, De Marinis MG. Disease-related knowledge in people with chronic obstructive pulmonary disease and their informal caregivers: A multilevel modelling analysis. J Clin Nurs 2022. [PMID: 35765175 DOI: 10.1111/jocn.16433] [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: 02/06/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the level of chronic obstructive pulmonary disease (COPD)-related knowledge within patient and informal caregiver dyads, and to identify factors influencing the knowledge level considering the interdependence within the dyads. BACKGROUND Patients with COPD and their informal caregivers present poor disease knowledge and different characteristics are associated with their level of knowledge. Disease knowledge and related characteristics have been assessed separately in patients and informal caregivers, without considering possible influence within the dyads. DESIGN Cross-sectional study. METHODS A convenience sample of dyads was recruited in outpatient and inpatient settings in Central and South Italy. The Bristol COPD Knowledge Questionnaire was used to measure disease knowledge. Sociodemographic, clinical and caregiving characteristics, self-efficacy and depression were measured in patients and caregivers. Multilevel modelling was used to analyse COPD knowledge at the level of the dyad to control for interdependency between patients and informal caregivers. The STROBE guidelines for cross-sectional studies were followed for study reporting. RESULTS We recruited 133 dyads. The total level of correct knowledge shared by dyads was 32.89%. Dyads presented higher levels of correct knowledge about disease symptoms, smoking cessation and vaccination, and lower about COPD treatment. Younger patients with greater self-efficacy, who attended pulmonary rehabilitation and were cared for by a spouse/partner with low levels of depression, and informal caregivers who were patients' spouse/partner were more likely to have higher levels of disease-related knowledge. CONCLUSIONS Our study advances dyadic research in COPD. Future studies should investigate the effects of shared knowledge and incongruent knowledge (where one member knows more than the other) on patient self-care and caregiver contribution to patient self-care. RELEVANCE TO CLINICAL PRACTICE Our study shows what knowledge nurses should provide in educational programmes directed at patients and caregivers, and which dyads have greater knowledge deficits, to whom offer targeted educational interventions.
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Affiliation(s)
- Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Michela Piredda
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
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Spielmanns M, Gloeckl R, Jarosch I, Leitl D, Schneeberger T, Boeselt T, Huber S, Kaur-Bollinger P, Ulm B, Mueller C, Bjoerklund J, Spielmanns S, Windisch W, Pekacka-Egli AM, Koczulla AR. Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial. Thorax 2022; 78:442-450. [PMID: 35450945 PMCID: PMC10176348 DOI: 10.1136/thoraxjnl-2021-218338] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Evidence suggests that patients with COPD struggle to maintain improved physical activity (PA) after completing pulmonary rehabilitation (PR). Smartphone applications (apps) providing a comprehensive training programme have conferred healthy benefits. This study was conducted to determine whether regular usage of an app maintains PA following PR. METHODS Patients with stage II-IV COPD were enrolled in a 6-month trial following PR. After the screening period, participants were randomised into the Kaia COPD app group (intervention group (IG)) or the control group (CG). The primary outcome was PA (daily steps), measured using an activity tracker. Secondary outcomes included the COPD Assessment Test (CAT), the Chronic Respiratory Disease Questionnaire (CRQ) and the 1 min Sit-to-Stand Test (STST). RESULTS Sixty participants completed the study. The median steps from baseline to 6 months were significantly different between the groups, in favour of the IG (-105.3, IQR -1970.1 to 2105.8, vs CG -1173.0, IQR -3813.1 to -93.8; p=0.007). CAT was significantly decreased in the IG (15.1±8.6 vs 19.7±6.4, p=0.02), whereas the CRQ subdomains for dyspnoea (4.5±1.7 vs 3.7±1.3, p=0.033) and fatigue (4.5±1.4 vs 3.5±1.3, p=0.028) improved significantly in the IG. The STST at 6 months was not significant. Sleep duration and sleep efficiency showed no significant differences between the two groups at any time. CONCLUSIONS A comprehensive program by using the Kaia app following PR maintained PA and improved symptoms in patients with COPD at 6 months. The app might be an important accessory tool for enhanced COPD care. TRIAL REGISTRATION NUMBER DRKS00017275.
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Affiliation(s)
- Marc Spielmanns
- Pulmonary Medicine, Zuercher RehaZentren Klinik Wald, Wald, Switzerland .,Faculty of Health, Department for Pulmonary Medicine, University Witten Herdecke, Witten, Germany
| | - Rainer Gloeckl
- Pulmonary Rehabilitation, Philipps-Universität Marburg, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Pulmonary Rehabilitation, Philipps-Universität Marburg, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Leitl
- Pulmonary Rehabilitation, Philipps-Universität Marburg, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Tessa Schneeberger
- Pulmonary Rehabilitation, Philipps-Universität Marburg, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Tobias Boeselt
- Pulmonary Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | | | | | - Bernhard Ulm
- Unabhaengige Statistische Beratungen Bernhard Ulm, Munich, Bavaria, Germany
| | | | | | - Sabine Spielmanns
- Pulmonary Medicine, Zuercher RehaZentren Klinik Wald, Wald, Switzerland
| | - Wolfram Windisch
- Faculty of Health, Department for Pulmonary Medicine, University Witten Herdecke, Witten, Germany.,Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Koeln, Koeln, Germany
| | | | - Andreas Rembert Koczulla
- Pulmonary Rehabilitation, Philipps-Universität Marburg, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
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18
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Sanchez-Ramirez DC. Impact of Pulmonary Rehabilitation Services in Patients with Different Lung Diseases. J Clin Med 2022; 11:407. [PMID: 35054101 PMCID: PMC8780231 DOI: 10.3390/jcm11020407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND the effect of pulmonary rehabilitation (PR) services, beyond research contexts, on patients with lung diseases other than COPD requires further study. OBJECTIVES to (i) assess the impact of a publicly funded PR on patients' exercise capacity, self-efficacy, and health-related quality of life (HRQoL), and (ii) explore whether the effects vary across lung diseases. METHODS this retrospective pre-post study analyzed data from the Winnipeg Regional Health Authority PR program between 2016 and 2019. RESULTS 682 patients completed the full PR program. Pooled analyses found significant improvements in the patients' exercise capacity (six-minute walk test (6MWT) (13.6%), fatigue (10.3%), and dyspnea (6.4%)), Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD6) (11.6%), and HRQoL (Clinical COPD Questionnaire (CCQ) (18.5%) and St George's Respiratory Questionnaire (SGRQ) (10.9%)). The analyses conducted on sub-groups of patients with chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, interstitial lung diseases (ILDs), other restrictive lung diseases (e.g., obesity, pleural effusion, etc.), lung cancer, and pulmonary hypertension (PH) indicated that, except for patients with PH, all the patients improved in the 6MWT. Fatigue decreased in patients with COPD, ILDs, and other restrictive lung diseases. Dyspnea decreased in patients with COPD, asthma, and lung cancer. SEMCD6 scores increased in COPD, ILDs and PH patients. CCQ scores decreased in all lung diseases, except lung cancer and PH. SGRQ scores only decreased in patients with COPD. CONCLUSION PR services had a significant impact on patients with different lung diseases. Therefore, publicly funded PR should be available as a critical component in the management of patients with these diseases.
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Affiliation(s)
- Diana C Sanchez-Ramirez
- Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Room 334-771 McDermot Ave, Winnipeg, MB R3E 0T6, Canada
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