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    Development and Validation of the Tele-Pulmonary Rehabilitation Acceptance Scale. Almojaibel Abdullah A,Munk Niki,Goodfellow Lynda T,Fisher Thomas F,Miller Kristine K,Comer Amber R,Bakas Tamilyn,Justiss Michael D Respiratory care BACKGROUND:Using telehealth in pulmonary rehabilitation (telerehabilitation) is a new field of health-care practice. To successfully implement a telerehabilitation program, measures of acceptance of this new type of program need to be assessed among potential users. The purpose of this study was to develop a scale to measure acceptance of using telerehabilitation by health-care practitioners and patients. METHODS:Three objectives were met (a) constructing a modified scale of the technology acceptance model, (b) judging the items for content validity, and (c) judging the scale for face validity. Nine experts agreed to participate and evaluate item relevance to theoretical definitions of domains. To establish face validity, 7 health-care practitioners and 5 patients were interviewed to provide feedback about the scale's clarity and ease of reading. RESULTS:The final items were divided into 2 scales that reflected the health-care practitioner and patient responses. Each scale included 3 subscales: perceived usefulness, perceived ease of use, and behavioral intention. CONCLUSIONS:The 2 scales, each with 3 subscales, exhibited evidence of content validity and face validity. The 17-item telerehabilitation acceptance scale for health-care practitioners and the 13-item telerehabilitation acceptance scale among patients warrant further psychometric testing as valuable measures for pulmonary rehabilitation programs. 10.4187/respcare.06432
    The effects of core stabilization training on dynamic balance and pulmonary parameters in patients with asthma. Develi Elif,Subasi Feryal,Aslan Goksen K,Bingol Zuleyha Journal of back and musculoskeletal rehabilitation BACKGROUND:In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. OBJECTIVE:To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. METHODS:The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. RESULTS:The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01). CONCLUSIONS:The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma. 10.3233/BMR-191803
    The effect of lung-conduction exercise in chronic obstructive pulmonary disease: Randomized, assessor-blind, multicenter pilot trial. Lee Su Won,Park Jae Jun,Lyu Yee Ran,Lee Eun Jung,Kim Si Yeon,Kang Weechang,Son Ji Woong,Jung In Chul,Park Yang Chun Medicine BACKGROUND:Pulmonary rehabilitation (PR) is a management modality that improves the quality of life of patients with chronic obstructive pulmonary disease (COPD); however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed easily without any limitations. The purpose of this randomized, assessor-blind, multicenter pilot trial was to compare the effects of LCE with PR and standard care (SC) in COPD patients. METHODS:Twenty-five participants who met the eligibility criteria were randomly allocated to the SC group (only medication, n = 9), LCE group (medication + LCE, 5 times a week, n = 8), or PR group (medication + PR, 5 times a week, n = 8). The 6-minute walk distance (6WMD), pulmonary function test, modified Medical Research Council dyspnea scale, COPD assessment test (CAT), and St. George Respiratory Questionnaire (SGRQ) survey were carried out before starting the trial and after 4 and 8 weeks to determine motor performance, lung function, and dyspnea. RESULTS:After 8 weeks, the pulmonary function test scores were the same. The 6MWD (PR, 28.3 ± 38.5; LCE, 14.5 ± 53.1; SC, 11.5 ± 20.5; P = .984), modified Medical Research Council dyspnea scale (PR, 0.8 ± 1.0; LCE, 0.8 ± 0.8; SC, 0.3 ± 0.5; P = .772), CAT (PR, 7.3 ± 6.2; LCE, 4.2 ± 5.2; SC, 1.0 ± 2.2; P = .232), and SGRQ scores (PR, 11.5 ± 15.4; LCE, 5.5 ± 13.1; SC, 4.8 ± 5.1; P = .358 [PR vs LCE], P = .795 [PR vs SC]) had improved in order of PR, LCE, and SC group. Although there were no statistically significant differences in the outcome measures between the groups, there were clinically significant improvements in the CAT and SGRQ scores. CONCLUSIONS:In this trial, PR showed more improvement in symptoms and quality of life than SC alone. To seek a more precise use of LCE, further full-sized studies with a long duration and additional outcome measures such as psychological assessment tools and cost-effectiveness ratio should be conducted. TRIAL REGISTRATION:KCT0004724. 10.1097/MD.0000000000028629
    Inter-rater and intra-rater reliability of the Brief-BESTest in people with chronic obstructive pulmonary disease. Leung Regina Wai Man,Alison Jennifer A,McKeough Zoe J Clinical rehabilitation OBJECTIVE::To investigate the inter-rater and intra-rater reliability of the Brief Balance Evaluation System Test (Brief-BESTest) in people with chronic obstructive pulmonary disease and its correlation between the Brief-BESTest score and lung function, functional exercise capacity, functional lower limb strength, and fear of falling. DESIGN::Prospective, single-group, observational study. SETTING::Outpatient pulmonary rehabilitation program. SUBJECTS::People with chronic obstructive pulmonary disease who were attending a pulmonary rehabilitation program. INTERVENTION::Participants performed three Brief-BESTests on two separate days, assessed by two independent physiotherapists. Participants also performed a lung function test, two 6-minute walk tests, the five sit-to-stand test and completed the Fall Efficacy Scale International questionnaire. RESULTS::Thirty participants (mean (SD) age was 72 (7), forced expiratory volume in 1 second % predicted was 47 (16%), and baseline 6-minute walk distance was 427 (90) meters) completed the study. The interclass coefficients of the inter-rater and intra-rater reliability were 0.86 and 0.96, respectively. The Brief-BESTest score was moderately correlated with the 6-minute walk distance ( r = 0.49, P < 0.01) and the five sit-to-stand test time ( r =-0.54, P < 0.01). No adverse events were reported after the completion of 90 tests in this study. CONCLUSION::The Brief-BESTest was shown to have good inter- and intra-rater reliability for measuring balance in people with chronic obstructive pulmonary disease. A moderate correlation was demonstrated between the Brief-BESTest balance score with functional exercise capacity and functional lower limb strength in this population. 10.1177/0269215518792044
    Effects of home-based prescribed pulmonary exercise by patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial. Liu Xiaodan,Li Peijun,Xiao Lu,Lu Yufan,Li Ning,Wang Zhengrong,Duan Hongxia,Li Jian,Wu Weibing Trials BACKGROUND:Chronic obstructive pulmonary disease (COPD) not only affects pulmonary function but also leads to skeletal muscle dysfunction. The various characteristics of different forms of traditional Chinese exercise lead to inconsistent clinical effects in COPD patients. Hence, the present study carefully combined and rearranged liuzijue, wuqinxi, baduanjin, and yijinjing into a pulmonary exercise program targeting COPD patients. METHODS/DESIGN:This study is a single-blind, randomized controlled trial. A random number table will be generated by an independent person. Each number will be placed in a sealed opaque envelop to blind assignment. All outcome assessors will be blinded to group assignment. COPD patients between 40 and 80 years of age, with stable medical treatment and no regular participation in regular exercise in the last 6 months will be included. All participants will be recruited from the Respiratory Medicine Department of Yue-Yang Integrative Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. All participants will continue to follow their medical treatment. They will be randomly assigned to one of four groups in a 1:1:1:1 ratio: (1) usual care (control group, CG), (2) pulmonary exercise group (PG), (3) resistance exercise group (RG), or (4) combined pulmonary exercise and resistance exercise group (PRG). CG participants will receive medical treatment only. PG participants will perform 60 min of exercise twice a day 7 days a week for 3 months, with 1 day's exercise per week at hospital under guidance and supervision. RG participants will perform 60 min of resistance exercise once a day, three times a week for 3 months, with 1 day's exercise per week at hospital under guidance and supervision. PRG participants will perform 60 min of prescribed pulmonary exercise combined with resistance exercise for 3 months. The outcomes include the isokinetic strength of peripheral skeletal muscle, surface electromyography, 6-min walking distance, 30-s arm curl test, pulmonary function, respiratory muscle strength, dyspnea, body composition, physical activity, quality of life, and Chronic Disease Self-Efficacy Scale. DISCUSSION:The results of this study will compensate for the current inadequate understanding of prescribed pulmonary exercise and may provide a new, simple, convenient, and effective home-based exercise intervention for COPD patients. TRIAL REGISTRATION:Chinese Clinical Trial Registry, ChiCTR-1800017405 . Registered on 28 July 2018. 10.1186/s13063-018-3149-7
    Functional Electrical Stimulation Changes Muscle Oxygenation in Patients with Chronic Obstructive Pulmonary Disease During Moderate-Intensity Exercise: A Secondary Analysis. Prieur Guillaume,Combret Yann,Bonnevie Tristan,Gravier Francis-Edouard,Robledo Quesada Aurora,Quieffin Jean,Lamia Bouchra,Medrinal Clement COPD We previously showed that functional electrical stimulation during cycle ergometry (FES-cycling) increased oxygen consumption (VO), indicating that metabolism during exercise was increased. However, the effects on muscle oxygenation have never been studied. The aim of this secondary analysis was to analyse changes in muscle oxygenation during an FES-cycling session. Eight patients with chronic obstructive pulmonary disease who were participating in a pulmonary rehabilitation programme were enrolled. Each participant carried out 30 minutes of cycle ergometry with a constant load at 50% of peak oxygen uptake, either (i) with FES or (ii) without (Placebo-FES). Oxygenation of the vastus lateralis (VL) muscle over time was measured using near-infrared spectroscopy (NIRS) during both sessions. External power output on the cycle ergometer was the same in both conditions. There were no differences in dyspnoea between the groups, although the concentrations of deoxygenated haemoglobin and myoglobin (deoxy(Hb + Mb)) in the VL were significantly greater during Placebo-FES than FES-Cycling (respectively +212 ± 65% vs. +84 ± 29%;  < 0.001), as was the decrease in muscle oxygen saturation (StO) ( < 0.001). When adjusted for VO, there was a greater increase over time in the deoxy(Hb + Mb)/VO ratio during Placebo-FES than FES-cycling ( < 0.0001). FES-cycling could be a useful strategy to decrease muscular deoxy(Hb + Mb) and limit decreases in muscle StO, however this should be confirmed in larger studies. 10.1080/15412555.2018.1560402
    Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Hanania Nicola A,O'Donnell Denis E International journal of chronic obstructive pulmonary disease Dyspnea is a distressing, debilitating, and near-ubiquitous symptom affecting patients with COPD. In addition to the functional consequences of dyspnea, which include activity limitation and reduced exercise tolerance, it is important to consider its psychological impact on patients with COPD, such as onset of depression or anxiety. Moreover, the anticipation of dyspnea itself can have a significant effect on patients' emotions and behavior, with patients frequently self-limiting physical activity to avoid what has become the hallmark symptom of COPD. Dyspnea is, therefore, a key target for COPD treatments. Pharmacologic treatments can optimize respiratory mechanics, provide symptom relief, and reduce patients' increased inspiratory neural drive to breathe. However, it is important to acknowledge the value of non-pharmacologic interventions, such as pulmonary rehabilitation and patient self-management education, which have proven to be invaluable tools for targeting the affective components of dyspnea. Furthermore, it is important to encourage maintenance of physical activity to optimize long-term patient outcomes. Here, we review the physiological and psychological consequences of activity-related dyspnea in COPD, assess the efficacy of modern management strategies in improving this common respiratory symptom, and discuss key unmet clinical and research needs that warrant further immediate attention. 10.2147/COPD.S188141
    Study design for a randomised controlled trial to explore the modality and mechanism of Tai Chi in the pulmonary rehabilitation of chronic obstructive pulmonary disease. Fu Juan-Juan,Min Jie,Yu Peng-Ming,McDonald Vanessa M,Mao Bing BMJ open INTRODUCTION:Although pulmonary rehabilitation (PR) is associated with significant clinical benefits in chronic obstructive pulmonary disease (COPD) and has been recommended by guidelines, PR with conventional exercise training has not been widely applied in the clinic because of its inherent limitations. Alternative exercise such as Tai Chi has been investigated and the results are promising. However, the strengths and weaknesses of the exercise modality of Tai Chi, conventional PR and a combination of Tai Chi and conventional PR and the possible mechanisms underlying Tai Chi exercise remain unclear. This study aims to address the above research gaps in a well-designed clinical trial. METHODS AND ANALYSIS:This study is a single-blind, randomised controlled trial. Participants with stable COPD will be recruited and randomly assigned to one of four groups receiving Tai Chi exercise, conventional PR using a total body recumbent stepper (TBRS), combined Tai Chi and TBRS, or usual care (control) in a 1:1:1:1 ratio. Participants will perform 30 min of supervised exercise three times a week for 8 weeks; they will receive sequential follow-ups until 12 months after recruitment. The primary outcome will be health-related quality of life as measured by the St George's Respiratory Questionnaire. Secondary outcomes will include 6 min walking distance, pulmonary function, the modified Medical Research Council Dyspnoea Scale, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, the Berg Balance Scale, exacerbation frequency during the study period, and systemic inflammatory and immune markers. ETHICS AND DISSEMINATION:Ethics approval has been granted by the Clinical Trial and Biomedical Ethics Committee of West China Hospital of Sichuan University (No TCM-2015-82). Written informed consent will be obtained from each participant before any procedures are performed. The study findings will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER:ChiCTR-IOR-15006874; Pre-results. 10.1136/bmjopen-2016-011297
    Web-based support for self-management strategies versus usual care for people with COPD in primary healthcare: a protocol for a randomised, 12-month, parallel-group pragmatic trial. BMJ open INTRODUCTION:The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) may increase the level of physical activity (PA), improve health-related quality of life (HRQoL) and reduce healthcare use. Whether web-based support in addition to prompts (email and SMS) could be used to promote self-management strategies to facilitate behaviour change in people with COPD is not clear. This clinical trial aims to generate evidence on the effect of a web-based solution, the COPD Web, in a cohort of people with COPD in a primary healthcare context. METHODS AND ANALYSIS:The overall design is a pragmatic randomised controlled trial with preassessments and postassessments (3 and 12 months) and an implementation and user experience evaluation. People with a diagnosis of COPD, treated in primary healthcare will be eligible for the study. A total of 144 participants will be enrolled through advertisment or by healthcare professionals at included primary healthcare units and, after fulfilled baseline assessment, randomised to either control or intervention group. All participants will receive usual care, a pedometer and a leaflet about the importance of PA. Participants in the intervention will, in addition, get access to the COPD Web, an interactive self-managed website that aims to support people with COPD in self-management strategies. They will also continuously get support from prompts with a focus on behaviour change.The effect on participants' PA, dyspnoea, COPD-related symptoms, HRQoL and health economics will be assessed using accelerometer and questionnaires. To identify enablers and barriers for the use of web-based support to change behaviour, semistructured interviews will be conducted in a subgroup of participants at the 3 months follow-up. ETHICS AND DISSEMINATION:Ethical approval has been received from the Regional Ethical Review Board in Umeå, Sweden. Dnr 2018-274 and dnr 2019-05572. Findings will be presented at conferences, submitted for publication in peer-reviewed journals and presented to the involved healthcare professionals, participants and patient organisations. TRIAL REGISTRATION NUMBER:NCT03746873. 10.1136/bmjopen-2019-030788
    A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial. Boer Lonneke,Bischoff Erik,van der Heijden Maarten,Lucas Peter,Akkermans Reinier,Vercoulen Jan,Heijdra Yvonne,Assendelft Willem,Schermer Tjard JMIR mHealth and uHealth BACKGROUND:Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. OBJECTIVE:This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. METHODS:In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. RESULTS:Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. CONCLUSIONS:This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. TRIAL REGISTRATION:ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096. 10.2196/14408
    Effects of Home-Based Breathing Exercises in Subjects With COPD. Lu Yufan,Li Peijun,Li Ning,Wang Zhengrong,Li Jian,Liu Xiaodan,Wu Weibing Respiratory care BACKGROUND:We sought to investigate the effects of home-based breathing exercises on pulmonary function, respiratory muscle strength, exercise capacity, dyspnea, and health-related quality of life in patients with COPD. METHODS:All randomized, controlled trials involving the use of home-based breathing exercises as an intervention in patients with COPD were searched on PubMed, Embase, Web of Science, EBSCO, CNKI, and Wangfang Data databases from January 1, 2008, to December 31, 2018. Two researchers independently extracted data and assessed the quality of the literature that met the inclusion criteria. RESULTS:A total of 13 studies were included, with a total of 998 subjects. The intervention methods consisted of diaphragmatic breathing, yoga breathing, breathing gymnastics, and singing. Meta-analysis showed that, compared with the control group, home-based breathing exercises had significant effects on the percent of predicted FEV (mean difference = 3.26, 95% CI 0.52-5.99, = .02), FEV/FVC (mean difference = 2.84, 95% CI 1.04-4.64, = .002), maximum inspiratory pressures (mean difference = 20.20, 95% CI 11.78-28.61, < .001), maximum expiratory pressures (mean difference = 26.35, 95% CI 12.64 to 40.06, < .001), 6-min walk distance (mean difference = 36.97, 95% CI 25.06-48.89, < .001), the modified Medical Research Council dyspnea scale (mean difference= -0.80, 95% CI -1.06 to -0.55, < .001), and the St George Respiratory Questionnaire (mean difference= -8.62, 95% CI -13.09 to -4.16, < .001). CONCLUSIONS:As an alternative method of home-based pulmonary rehabilitation program, breathing exercises can improve pulmonary function, respiratory muscle strength, exercise capacity, dyspnea, health-related quality of life in patients with COPD. 10.4187/respcare.07121
    Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD. Lavoie Kim L,Sedeno Maria,Hamilton Alan,Li Pei-Zhi,De Sousa Dorothy,Troosters Thierry,Maltais François,Bourbeau Jean ERJ open research This study explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial. A 12-week, four-group, randomised, partially double-blind, placebo-controlled, parallel-group trial of SMBM in addition to tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, tiotropium/olodaterol 5/5 µg plus ExT, or placebo was conducted in 304 patients. Outcomes included anxiety (Hospital Anxiety and Depression Scale (HADS)-A), depression (HADS-D and Patient-Health Questionnaire (PHQ)-9) and cognitive function (Montreal Cognitive Assessment (MoCA)). All outcomes showed statistically and clinically significant improvements after 12 weeks independent of treatment group. However, greater improvements in HADS-A and MoCA were seen in patients who exhibited greater increases in physical activity and exercise capacity, respectively, whereas greater improvements in HADS-D and PHQ-9 were seen in patients who exhibited increases in either physical activity or exercise capacity. The results indicate that SMBM with/without bronchodilators or ExT was associated with improved psychological and cognitive functioning. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD. 10.1183/23120541.00013-2019
    Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis. Armstrong Matthew,Winnard Andrew,Chynkiamis Nikolaos,Boyle Spencer,Burtin Chris,Vogiatzis Ioannis European respiratory review : an official journal of the European Respiratory Society The aim of this study was to examine the use of pedometers as a tool to promote daily physical activity levels in patients with COPD.A systematic review meta-analysis of pedometer physical activity promotion in patients with COPD was conducted. Medline/PubMed, Cochrane Library, Web of Science and CINAHL were searched from inception to January 2019. The search strategy included the following keywords: physical activity promotion, pulmonary rehabilitation and daily physical activity. The eligibility criteria for selecting studies were randomised controlled trials reporting pedometer physical activity promotion in patients with COPD.Improvements in steps per day were found with pedometer physical activity promotion either standalone (n=12, mean 0.53 (95% CI 0.29-0.77); p=0.00001) or alongside pulmonary rehabilitation (n=7, 0.51 (0.13-0.88); p=0.006). A subgroup analysis reported significant differences in the promotion of physical activity based on baseline physical activity levels and the type of instrument used to assess levels of physical activity.Future trials should consider the way in which pedometers are used to promote physical activity to inform clinical practice in the setting of pulmonary rehabilitation. 10.1183/16000617.0039-2019
    Facilitators and barriers to clinicians' use of COPD action plans in self-management support: A qualitative study. Feiring Eli,Friis Tori Patient education and counseling OBJECTIVE:Written action plans for patients with chronic obstructive pulmonary disease (COPD) aim at early recognition of exacerbations and self-initiation of interventions. Previous research suggest underuse of COPD action plans. We wanted to 1) examine which factors clinicians in specialist healthcare perceived as influencing clinicians' use of written action plans in COPD-self management support and 2) propose a framework for understanding the factors affecting clinicians' use of action plans in routine practice. METHODS:We performed a theory-driven retrospective qualitative study. Documentary data were collected to describe the COPD action plan in context. In-depth interviews with clinicians (n = 8) were carried out. Interview data were thematically analyzed, using a predetermined model for understanding behavior. RESULTS:Our study revealed that a number of factors influenced clinicians' use of action plans, including their capabilities (knowledge and skills to identify "the right patient" and to individualize the plan template) and motivations (beliefs, reinforcements, and emotions s.a. frustration, fear, and distrust), together with organizational and social opportunities (resources, patient, and GP preferences). CONCLUSION:A multilevel understanding of factors that affect clinicians' use of action plans in self-management support is needed. PRACTICE IMPLICATION:The proposed framework can be used to guide future initiatives to promote targeted self-management support. 10.1016/j.pec.2019.11.002
    The effect of a nurse-led self-management program on outcomes of patients with chronic obstructive pulmonary disease. Wang Lian Hong,Zhao Yan,Chen Ling Yun,Zhang Li,Zhang Yong Mei The clinical respiratory journal PURPOSE:To examine the effectiveness of a nurse-led self-management program on outcomes of patients with chronic obstructive pulmonary disease (COPD). DESIGN:A randomized controlled, single-blind trial, carried out from October 2017 to December 2018, included 154 participants admitted with COPD to the Affiliated Hospital of Zunyi Medical University in Guizhou, (randomized into intervention (n = 77) and control groups (n = 77)). MATERIALS AND METHODS:Participants in the intervention group underwent a nurse-led self-management program in addition to routine care, and participants of the control group received only routine care. The main outcome measures were COPD-related readmission and emergency department visits, the 6-minute walk distance (6MWD) test for measurement of exercise capacity, the St George Respiratory Questionnaire (SGRQ) for measurement of health-related quality of life, and the COPD Transitional Care Patient Satisfaction Questionnaire (CTCPSQ) for measurement of satisfaction. Data collection was conducted at baseline (T1) and after 3 (T2), 6 (T3) and 12 mo (T4). Findings Compared to the control group, participants in the intervention group showed significantly fewer COPD-related hospital admissions (P = 0.03) and emergency department visits (P = 0.001) and higher total CTCPSQ scores (P = 0.001) at 12 mo. Meanwhile, analysis of variance showed a significantly greater improvement in exercise capacity and health status over time in the nurse-led program group than in the control group, P < 0.001. CONCLUSIONS:This study demonstrated that the nurse-led self-management program was effective in decreasing hospital readmissions and emergency department visits and improving exercise capacity, health-related quality of life and satisfaction for patients with COPD. 10.1111/crj.13112
    Physical Activity in Patients with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy: A Cross-Sectional Study. Paneroni Mara,Ambrosino Nicolino,Simonelli Carla,Bertacchini Laura,Venturelli Massimo,Vitacca Michele International journal of chronic obstructive pulmonary disease Background and aim:There are few studies evaluating physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). Aim:To assess PA in hypoxemic COPD patients on LTOT. Methods:In this cross-sectional study, we compared lung function, arterial blood gases, respiratory and peripheral muscle strength, 6-min walking distance (6MWD), daily energy expenditure and steps, and health-related quality of life (HRQL) in COPD patients on LTOT (LTOT group) versus two groups of control patients not needing LTOT: with (HYPOX) and without (COPD) exercise-induced desaturations. Results:Groups did not differ as regards demographics, anthropometrics, peripheral or respiratory muscle strength. Compared to the other groups, LTOT patients had more severe airway obstruction and lung hyperinflation, greater number and severity of comorbidities, shorter 6MWD, as well as lower mean SpO during 6MWD and worse quality of life. LTOT patients had a lower daily energy expenditure, shorter time spent > 3.0 METs and longer sedentary time compared to the COPD group, and less daily steps compared to the other groups. No significant difference in any parameter of PA was found between COPD and HYPOX. In LTOT patients, daily steps showed a strong correlation with 6MWD, and a moderate correlation with airway obstruction, level of oxygenation, comorbidities and quality of life but not with peripheral and respiratory muscle strength. In COPD and HYPOX patients, daily steps were strongly correlated with 6MWD and level of oxygenation as assessed by PaO/FiO. There was no significant correlation between mean SpO and 6MWD in any group. Conclusion:COPD patients on LTOT perform less physical activity than patients not needing LTOT, both with and without exercise-induced desaturations. Patients with exercise-induced desaturations do not perform less physical activity than those without. 10.2147/COPD.S228465
    Clinical Effects Of Acupuncture On The Pathophysiological Mechanism Of Chronic Obstructive Pulmonary Disease During Exercise. Maekura Tomonori,Miki Keisuke,Miki Mari,Kitada Seigo,Maekura Ryoji International journal of chronic obstructive pulmonary disease Purpose:Pharmacological therapy and pulmonary rehabilitation are useful for exertional dyspnoea in patients with chronic obstructive pulmonary disease (COPD); however, several patients have no meaningful improvements. Although acupuncture significantly improves exercise intolerance and dyspnoea, the pathophysiological mechanism of these effects is unknown; therefore, we evaluated this mechanism using cardiopulmonary exercise testing in a single-arm, open experimental study. Patients and methods:Sixteen patients with COPD underwent acupuncture once a week for 12 weeks. Primary outcomes were exercise performance parameters, including peak oxygen uptake in the incremental exercise tests (IETs) and the time to the limit of tolerance measured in constant work rate exercise tests (CWRETs) at 70% peak work-rate of the IET. IETs and CWRETs were performed at baseline and at weeks 12, 16, and 24. Results:During the time course, there were significant increases in peak oxygen uptake (p = 0.018) and minute ventilation (V̇, p = 0.04) in the IETs. At 12 weeks, the endurance time significantly increased (810 ± 470 vs 1125 ± 657 s, p < 0.001) and oxygen uptakes at terminated exercise were significantly lower (771 ± 149 mL/min, p < 0.05) than those at baseline (822 ± 176 mL/min) in CWRETs. The significant decreases in oxygen uptake and minute ventilation and improvements in Borg scale scores were also observed during CWRETs after acupuncture. The decreases at isotime in the Borg scale (r = -0.789, p = 0.0007) and V̇ (r = -0.6736, p = 0.0042) were significantly correlated with the improvement of endurance time. Conclusion:The positive effects of acupuncture on exertional dyspnoea were associated with increased endurance time influenced by improved oxygen utilisation and reduced ventilation during exercise. Acupuncture may be a new intervention for COPD in addition to conventional maintenance therapies. 10.2147/COPD.S225694
    Effect of Using a Wheeled Walker on Physical Activity and Sedentary Time in People with Chronic Obstructive Pulmonary Disease: A Randomised Cross-Over Trial. Hill Kylie,Ng L W Cindy,Cecins Nola,Formico Vittoria R,Cavalheri Vinicius,Jenkins Sue C Lung PURPOSE:To determine the effects of providing a wheeled walker (WW) for use in the home and community, on daily physical activity (PA) and sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD). METHODS:A randomised cross-over study in which participants with COPD characterised by a 6-min walk distance ≤ 450 m, who had recently finished pulmonary rehabilitation, completed two 5-week phases. During one phase, participants were provided a WW to use, whereas during the other phase, the WW was not available. The order of the phases was randomised. For the final week of each phase, measures of PA and ST were collected using wearable devices and health-related quality of life was measured using the Chronic Respiratory Disease Questionnaire (CRDQ). Wheeled walker use was also measured using an odometer attached to the device. RESULTS:17 participants [FEV = median (interquartile range) 33 (25) % pred; ten males] aged mean (SD) 73 (9) years completed the study. Comparing the data collected when the WW was not available for use, the daily step count was greater (mean difference [MD] 707 steps/day (95% confidence interval [CI] 75 to 1340) and participants tended to report less dyspnoea during daily life (MD 0.5 points per item, 95% CI - 0.1 to 1.0) when WW was available. No differences were observed for ST, upright time or stepping time. The WW was used over 4504 m/week (95% CI 2746 to 6262). CONCLUSION:These data demonstrated that, when provided to selected patients with COPD, WWs increased daily step count. CLINICAL TRIAL REGISTRATION NUMBER:ACTRN12609000332224. 10.1007/s00408-019-00297-2
    The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error. Fonseca Fernanda Rodrigues,Biscaro Roberta Rodolfo Mazzali,de Rê Alexânia,Junkes-Cunha Maíra,Reis Cardine Martins Dos,Bahl Marina Mônica,Yohannes Abebaw Mengistu,Maurici Rosemeri Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia OBJECTIVE:To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. METHODS:We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. RESULTS:The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, -2.24 to 1.96 and -2.65 to 2.69. CONCLUSIONS:In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error. 10.1590/1806-3713/e20180397
    Diaphragmatic motor cortex hyperexcitability in patients with chronic obstructive pulmonary disease. Elnemr Rehab,Sweed Rania Ahmad,Shafiek Hanaa PloS one BACKGROUND AND OBJECTIVES:Respiratory muscles dysfunction has been reported in COPD. Transcranial magnetic stimulation (TMS) has been used for assessing the respiratory corticospinal pathways particularly of diaphragm. We aimed to study the cortico-diaphragmatic motor system changes in COPD using TMS and to correlate the findings with the pulmonary function. METHODS:A case control study recruited 30 stable COPD from the out-patient respiratory clinic of Main Alexandria University hospital- Egypt and 17 healthy control subjects who were subjected to spirometry. Cortical conduction of the diaphragm was performed by TMS to all participants followed by cervical magnetic stimulation of the phrenic nerve roots. Diaphragmatic resting motor threshold (DRMT), cortical motor evoked potential latency (CMEPL), CMEP amplitude (CMEPA), peripheral motor evoked potential latency (PMEPL), PMEP amplitude (PMEPA) and central motor conduction time (CMCT) were measured. RESULTS:66.7% of COPD patients had severe and very severe COPD with median age of 59 (55-63) years. There was statistically significant bilateral decrease in DRMT, CMEPA and PMEPA in COPD group versus healthy subjects and significant increase in CMEPL and PMEPL (p <0.01). Left CMCT was significantly prolonged in COPD group versus healthy subjects (p <0.0001) but not right CMCT. Further, there was significant increase in CMEPL and CMCT of left versus right diaphragm in COPD group (p = 0.003 and 0.001 respectively) that inversely correlated with FEV1% and FVC% predicted. Right and left DRMT were insignificantly different in COPD group (p >0.05) but positively correlated with FEV1/FVC, FEV1% and FVC% predicted. CONCLUSION:Central cortico-diaphragmatic motor system is affected in COPD patients with heterogeneity of both sides that is correlated with pulmonary function. SIGNIFICANCE:Coticospinal pathway affection could be a factor for development of diaphragmatic dysfunction in COPD patients accordingly its evaluation could help in personalization of COPD management especially pulmonary rehabilitation programs. 10.1371/journal.pone.0217886
    Convergent Validity and Minimal Clinically Important Difference of the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the Chronic Obstructive Pulmonary Disease-Specific Health-Related Quality of Life questionnaire (VQ11). Coquart Jérémy B,Heutte Natacha,Terce Gaelle,Grosbois Jean-Marie International journal of chronic obstructive pulmonary disease Purpose:Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients. Patients and methods:Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30-45 mins/week for 8 weeks, including a weekly session supervised by a team member). Results:PR improved all measured variables ( < 0.0001). The correlations were significant ( < 0.0001) between VSRQ and MRF-28 (r = -0.685 at baseline and r = -0.686 after the PR program), and between VSRQ and VQ11 (r = -0.691 at baseline and r = -0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated ( < 0.0001) to changes in score of MRF-28 (r = -0.372) and VQ11 (r = -0.423). Last, we calculated MCID of -5.2 and -2.0 units for MRF-28 and VQ11, respectively. Conclusion:The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of -5.2 and -2.0, respectively. 10.2147/COPD.S222165
    Inspiratory muscle strength and walking capacity in patients with COPD. Kofod Linette Marie,Hage Tine,Christiansen Lene Houmann,Skalkam Karin,Martinez Gerd,Godtfredsen Nina Skavlan,Molsted Stig European clinical respiratory journal : It has been suggested that patients with inspiratory muscle weakness could benefit from specific inspiratory muscle training (IMT). We aimed to examine the frequency of patients with inspiratory muscle weakness in a Danish hospital-based outpatient pulmonary rehabilitation program, and to evaluate the association between inspiratory muscle strength and peripheral muscle strength and walking capacity. : Maximal Inspiratory Pressure (MIP) was assessed in 97 patients with COPD (39 men, 58 women, mean age years 70 ± 9, forced expiratory volume in 1 s ((FEV) = 35 ± 10% pred.). The impact of MIP on knee-extension strength, walking distance, and symptom burden was evaluated using multiple linear regression analyses. : The MIP of the patients with COPD was 63 (95% CI 59; 67) cmHO and it was significantly reduced compared to gender and age-matched reference values 76 (95% CI 73; 79) cmHO (p < 0.001). Seven patients (7.2%) were under the lower limit of normal. MIP was negatively correlated with increasing age, female gender, decreasing knee-extension strength and lower FEV% pred. Walking distance was associated with knee-extension strength and it was not associated with MIP. : Maximal inspiratory pressure was reduced in patients with COPD but only a few patients had a weak MIP. Whilst MIP was associated with leg muscle strength, it was not associated with walking distance or symptoms. 10.1080/20018525.2019.1700086
    Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews. Dobson Rosie,Herbst Pauline,Candy Sarah,Brott Tamzin,Garrett Jeffrey,Humphrey Gayl,Reeve Julie,Tawhai Merryn,Taylor Denise,Warren Jim,Whittaker Robyn JMIR formative research BACKGROUND:Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. OBJECTIVE:The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. METHODS:A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. RESULTS:Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. CONCLUSIONS:These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population. 10.2196/15466
    Patient and carer survey of remote vital sign telemonitoring for self-management of long-term conditions. Walkden Julie-Ann,McCullagh Paul Joseph,Kernohan W George BMJ health & care informatics BACKGROUND:Home-based self-monitoring has failed to show intended savings to healthcare budgets yet it continues to emerge and gain popularity. OBJECTIVE:We set out to verify stakeholders' perspectives of remote vital sign telemonitoring. DESIGN:An observational design was adopted by devising a survey for distribution to service users and their informal carers. SAMPLE:Service users in South Eastern Health and Social Care Trust were included. A total of 274 questionnaires were issued. Data from 97 patients (35% response rate) and 49 carers were analysed. Of these, 81 patients and 48 of their carers experienced a monitoring service known as TF3 and 16 patients and 1 carer experienced a service known as U-Tell. The cohorts comprised people living with a number of long-term conditions: diabetes, hypertension after stroke, chronic heart failure, chronic obstructive pulmonary disorder, bronchiectasis and those requiring anticoagulation using warfarin. RESULTS:Analysis showed that respondents were supportive of the technology with 90.7% of patients agreeing or strongly agreeing with the statement: . The patients liked the technology largely because it provided empowerment and control for self-management and allowed them to continue with their lives without major disruption. These views were independent of the technology used and not associated with the patient's long-term conditions, gender or age. There were no reported adverse incidents. CONCLUSION:As self-monitoring becomes more relevant to healthcare delivery, the technology will be accepted by many in the population with long-term conditions. 10.1136/bmjhci-2019-100079
    Effects of a Digital Self-care Intervention in Adults with COPD: A Pilot Study. Bugajski Andrew,Frazier Susan K,Cousin Lakeshia,Rechenberg Kaitlyn,Brown Jaelyn,Lengerich Alexander J,Moser Debra K,Lennie Terry A Western journal of nursing research Self-care improves quality of life, and reduces exacerbations and mortality risk in people with chronic obstructive pulmonary disease (COPD). The purpose of this report is to describe the development and testing of the feasibility and acceptability of a digital, educational self-care intervention designed to improve self-care ability, adherence, knowledge, somatic symptoms, anxiety, and depressive symptoms.This pilot study was a quasi-experimental, repeated measures design. Self-care behaviors were identified, and educational modules were developed and built into a web-based platform. Twenty participants were enrolled to determine feasibility, acceptability, and preliminary efficacy.The intervention was deemed acceptable and feasible as evidenced by > 95% completion rates and high degree of participation. Overall, the intervention was well received and is feasible for future home-based interventions in those with COPD. Results included significant improvements in adherence and knowledge, and significant associations between self-care ability, adherence, and depressive symptoms. 10.1177/0193945919892282