Change in V˙O in Response to Aerobic Exercise Training and the Relationship With Exercise Prescription in People With COPD: A Systematic Review and Meta-analysis.
Ward Thomas J C,Plumptre Charles D,Dolmage Thomas E,Jones Amy V,Trethewey Ruth,Divall Pip,Singh Sally J,Lindley Martin R,Steiner Michael C,Evans Rachael A
BACKGROUND:Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O with aerobic training. RESEARCH QUESTION:The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O in COPD. STUDY DESIGN AND METHODS:A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome. RESULTS:A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in V˙O (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in V˙O was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in V˙O was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect V˙O. Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O (P < .001). INTERPRETATION:Overall, people with COPD achieved moderate improvements in V˙O through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population. CLINICAL TRIAL REGISTRATION:PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/.
Scope, background and definition of pulmonary rehabilitation.
Nici L,Zuwallack R
European journal of physical and rehabilitation medicine
The optimal therapy of an individual with chronic respiratory disease usually requires a combination of pharmacologic and non-pharmacologic therapies. A case of a 68-year-old man with advanced chronic obstructive pulmonary disease is given to illustrate this point. He is a recent ex-smoker with severe chronic obstructive pulmonary disease by spirometric criteria, frequent exacerbations of this disease, considerable recent health care utilization, dyspnea with minimal activities, severe functional status limitation, prominent systemic effects of the disease (e.g., weight loss) and substantial comorbidities. The primary respiratory disease cannot be isolated from and treated independently of these important factors. Pulmonary rehabilitation is an important therapeutic option in situations like this, providing a mode of integrating care, complementing otherwise standard medical therapy, and producing significant gains across multiple outcome areas of importance to the patient. Pulmonary rehabilitation has been defined by the American Thoracic Society and European Respiratory Society as: "an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease". Its components include comprehensive assessment, education, exercise training, and psychosocial intervention. Outcomes assessment is usually performed for quality assessment. Pulmonary rehabilitation produces the greatest improvements of any available therapy in dyspnea, exercise capacity, and health-related quality of life. These gains are realized despite the fact that pulmonary rehabilitation has no direct effect on lung function. It works primarily through reducing the impact of the systemic manifestations of the disease and frequent comorbidity. Pulmonary rehabilitation also leads to substantial reductions in subsequent health care utilization, possibly through collaborative self-management strategies emphasized in the program. Although pulmonary rehabilitation has been utilized by astute clinicians for many years, its science has been developed over the past two decades.
Influence of COPD Assessment Text (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of COPD patients.
Liu Jing,Meng Guangju,Ma Yi,Zhang Xia,Chen Dongmei,Chen Mengting
Open medicine (Warsaw, Poland)
The study aimed to evaluate the influence of the COPD Assessment Test (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of patients with chronic obstructive pulmonary disease (COPD). Forty-five patients with COPD admitted from Nov. 2012 to Nov. 2013 were treated with combined bronchodilators and inhaled corticosteroids. Thirty-five patients admitted from Nov. 2012 to Nov. 2013 and classified as a study group received rehabilitation education guidance on the basis of the treatment of the control group to compare the quality-of-life-scale score, dyspnea index score, and motor function of the two groups of patients after 48 weeks of treatment. After treatment, the CAT score of both groups of patients was significantly lowered. After 48 weeks of treatment, the respiratory function of both groups was significantly improved, but the Medical Research Council (MRC) scale for the study group after treatment was significantly lower than that for the control group. After 48 weeks of rehabilitation exercises, the 6-minute walk test (6MWT) for patients with COPD was significantly prolonged, but the test results were significantly higher for the study group after treatment than for the control group. After receiving CAT rehabilitation education, COPD patients had significantly improved life quality and significantly enhanced exercise tolerance. The treatment mode may be gradually introduced in future clinic and nursing work.
The role of hope for health professionals in rehabilitation: A qualitative study on unfavorable prognosis communication.
Amati Mirjam,Grignoli Nicola,Rubinelli Sara,Amann Julia,Zanini Claudia
BACKGROUND:The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients. METHODS:Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis. RESULTS:The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery. CONCLUSIONS:The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.
[Demands for cardiac rehabilitation information in patients with coronary atherosclerotic heart disease and influential factors].
Xiao Jing,Huang Lingzhi,Li Lezhi
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences
OBJECTIVE:To investigate the demands for cardiac rehabilitation information in patients with coronary atherosclerotic heart disease (CHD) and influential factors.
Methods: Information demands for cardiac rehabilitation in CHD patients were surveyed by questionnaire and the influential factors were analyzed by one-way ANOVA and multi-factor analysis of variance.
Results: The score of demands for cardiac rehabilitation information in CHD patients was 3.86±0.53. Among them, the most urgent top 5 items were: drug knowledge, diagnosis and treatment, basic knowledge of the heart, emergency and safety and nutrition knowledge. The top 3-demand modes were: communication with medical workers, movies or videos to take home, and lectures. The score of demands for cardiac rehabilitation information was different in different age groups. The highest score was in the patients with age less than 60. There were different demands in different characteristic groups.
Conclusion: The most urgent need and mode are drug knowledge and communication with medical workers, respectively. With the age increase, the demands for patients' cardiac rehabilitation information decrease. An individualized health education strategy should be developed according to the characteristics of CHD patients.
Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR): A Logic Model.
Gill Simone V,Khetani Mary A,Yinusa-Nyahkoon Leanne,McManus Beth,Gardiner Paula M,Tickle-Degnen Linda
American journal of physical medicine & rehabilitation
In a patient-centered care era, rehabilitation can benefit from researcher-clinician collaboration to effectively and efficiently produce the interdisciplinary science that is needed to improve patient-centered outcomes. The authors propose the use of the Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR) logic model to provide guidance to rehabilitation scientists and clinicians who are committed to growing their involvement in interdisciplinary rehabilitation research. We describe the importance and key characteristics of the FAIRR model for conducting interdisciplinary rehabilitation research.
A patient-centered care ethics analysis model for rehabilitation.
Hunt Matthew R,Ells Carolyn
American journal of physical medicine & rehabilitation
There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes.
[The recovery model: One paradigm, two conceptions].
Garber-Epstein Paula,Roe David
Vertex (Buenos Aires, Argentina)
In recent decades, new models of recovery have been developed in the feld of mental health, based on the transfer of hospital treatment to the community. Community mental health became the standard of care and treatment, and people with mental illness were able to freely congregate and support each other. The new recovery model includes broad aspects of the person and recovery became the "guiding vision" of mental health services. New defnitions of recovery were developed that focus on the difference between recovering from an illness and being in recovering, or in other words, "clinical recovery" versus "personal recovery." This important development represents a huge challenge for policy makers and planners of modern mental health systems. As is clear from this article, efforts to implement a recovery-oriented perspective that will produce a more consumerbased mental health system have just begun. The urgent need to investigate these efforts, taking into account the complexity and many meanings of "recovery", begins to manifest itself in mental health research agendas. Recovery-oriented treatments focus on preparing and training the person with mental disorders to acquire the knowledge necessary to manage their own disease and recovery process, and thus improve overall functioning, health and quality of life.