Social Participation and Associated Factors in Individuals with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy.

Long-term oxygen therapy (LTOT) reduces hypoxaemia and mitigate systemic alterations in chronic obstructive pulmonary disease (COPD), however, it is related to inactivity and social isolation. Social participation and its related factors remain underexplored in individuals on LTOT. This study investigated social participation in individuals with COPD on LTOT and its association with dyspnoea, exercise capacity, muscle strength, symptoms of anxiety and depression, and quality of life. The Assessment of Life Habits (LIFE-H) assessed social participation. The modified Medical Research Council dyspnoea scale, the 6-Minute Step test (6MST) and handgrip dynamometry were used for assessments. In addition, participants responded to the Hospital Anxiety and Depression Scale (HADS) and the Chronic Respiratory Questionnaire (CRQ). Correlation coefficients and multivariate linear regression analyses were applied. Fifty-seven participants with moderate to very severe COPD on LTOT were included (71 ± 8 years, FEV1: 40 ± 17%predicted). Social participation was associated with dyspnoea (rs=-0.46, p < 0.01), exercise capacity (r = 0.32, p = 0.03) and muscle strength (r = 0.25, p = 0.05). Better participation was also associated with fewer depression symptoms (rs=-0.40, p < 0.01) and a better quality of life (r = 0.32, p = 0.01). Dyspnoea was an independent predictor of social participation (p < 0.01) on regression models. Restricted social participation is associated with increased dyspnoea, reduced muscle strength and exercise capacity. Better participation is associated with fewer depression symptoms and better quality of life in individuals with COPD on LTOT.

Upper limb function of individuals hospitalized in intensive care: A 6-month cohort study.

BACKGROUND: Impaired physical function is a common complication in intensive care unit (ICU) patients. However, specific upper limb (UL) function is still poorly studied in this population. OBJECTIVE: To evaluate UL function at discharge and after a 6-month follow-up of individuals hospitalized in the ICU. METHODS: This was a longitudinal prospective 6-month multicentre cohort study with forty-six individuals hospitalized in the ICU undergoing mechanical ventilation for ≥ 48 h (ICU Group) and forty-six healthy individuals matched by sex, age, and socioeconomic status (control Group). The primary outcomes were measurements of UL disability using the Jebsen-Taylor Hand Function Test (JTT) and the Nine Hole Peg Test (NHPT). Secondary outcomes were physical function (Barthel index), muscle strength (Medical Research Council scale and hand grip strength), and quality of life (EuroQol-5 Dimension). All measurements were assessed after ICU discharge and at a 6-month follow-up. RESULTS: The JTT performance time in the ICU group after discharge was worse than that in the control group [121 s (86-165) vs. 54 s (49-61), median (IQR), p<0,001] and was reduced after 6 months [62 s (54-81), p<0,01]. The NHPT performance time at discharge in the ICU group was worse than that in the controls [39 s (33-59) vs. 21 s (20-23), p<0,001] and was reduced after 6 months of follow-up [24 s (21-27), p<0,01]. Physical function, muscle strength and quality of life were reduced after ICU discharge. CONCLUSION: Individuals hospitalized in the ICU presented with reduced UL function at discharge and at the 6-month follow-up.

Pulmonary expansion manoeuvres compared to usual care on ventilatory mechanics, oxygenation, length of mechanical ventilation and hospital stay, extubation, atelectasis, and mortality of patients in mechanical ventilation: A randomized clinical trial.

Pulmonary expansion manoeuvres are therapeutic techniques used to prevent and reverse atelectasis; however, no randomized controlled trials have provided evidence supporting the use of this intervention among individuals on mechanical ventilation. OBJECTIVE: To evaluate the effects of chest compression-decompression and chest block manoeuvres compared to usual care among patients on mechanical ventilation. METHODS: The current study was a randomized clinical trial of adult subjects on mechanical ventilation for 12 to 48 hours. The control group received usual care (passive or active mobilization, manoeuvres for airway clearance and tracheal aspiration). The intervention group received usual care plus two lung expansion manoeuvres, i.e., chest decompression and chest block, while remaining on mechanical ventilation. Assessments were performed before and after usual care, immediately after the intervention and 30 minutes after the intervention. The primary outcome was static compliance. The secondary outcomes were the incidence of atelectasis, dynamic compliance, airway resistance, driving pressure, oxygenation, duration of mechanical ventilation, extubation success, length of hospital and ICU stay, and mortality. RESULTS: Fifty-one participants (67±15 years old, 53% men, 26 in the control group and 25 in the intervention group) were evaluated. No differences in static compliance were observed between groups (intervention minus control) before and after expansion manoeuvres [3.64 ml/cmH2O (95% CI: -0.36-7.65, p = 0.074)]. Peripheral oxygen saturation differed between groups before and after expansion manoeuvres, with more favourable outcome observed in the control group [-1.04% (95% CI: -1.94 --0.14), p = 0.027]. No differences were found in other outcomes. CONCLUSION: Chest compression-decompression and chest block manoeuvres did not improve ventilatory mechanics, the incidence of atelectasis, oxygenation, the duration of mechanical ventilation, the length of stay in the ICU and hospital, or mortality in individuals on mechanical ventilation. The findings of this study can be valuable for guiding evidence-based clinical practice and developing a therapeutic approach that provides real benefits for this population.

Perceptions of individuals regarding barriers to participation in a pulmonary rehabilitation program after hospitalization due to COVID-19: A qualitative study.

INTRODUCTION: Several individuals with post-COVID-19 syndrome referred for pulmonary rehabilitation did not participate. This study aimed to explore individuals' barriers to participating in posthospitalization COVID-19 rehabilitation. MATERIALS AND METHODS: This was a qualitative, multicenter study performed using semistructured interviews. This study included 20 individuals hospitalized for COVID-19 who refused to participate in a pulmonary rehabilitation program at a university hospital. RESULTS: Individuals reported difficulties accessing the rehabilitation center, mainly due to distance, transport costs and conditions, and lack of companions. Health problems (e.g., surgeries, pain, and mobility difficulties) and lack of time due to work, commuting, and household work were also reported. Another reported theme was not perceiving the need for rehabilitation due to feeling well. Minor themes included the need for more information about rehabilitation and a lack of interest, motivation, and medical encouragement. CONCLUSION: Individuals hospitalized for COVID-19 faced several barriers to participating in a pulmonary rehabilitation program. These barriers included difficulties in accessing the rehabilitation center, health problems, lack of time, and the perception that rehabilitation was unnecessary. There is a need for actions to overcome these barriers to make the program available to a larger number of individuals.

Step tests are feasible, safe, and can be used to evaluate exercise capacity at home after hospitalization for COVID-19 / Os testes do degrau são viáveis, seguros e podem ser utilizados para avaliar a capacidade de exercício no domicílio após hospitalização por COVID-19

Abstract Introduction: Step-based tests are commonly utilized to assess the exercise capacity of individuals with respiratory diseases. However, the feasibility and safety of the step tests have not yet been studied in individuals after COVID-19. Objective: To investigate the feasibility and safety of the six-minute step test (6MST) and the modified incremental step test (MIST) in assessing exercise capacity at home in individuals after hospitalization for COVID-19, and to identify factors associated with performance in these tests. Methods: Cross-sectional multicenter study with individuals hospitalized for COVID-19 fifteen days after hospital discharge. Participants performed spirometry, 6MST, and MIST during a single home visit. Adverse events were registered during and immediately after the tests. Results: Sixty-five participants were studied (50 ± 10 years old, 55% male). The feasibility was 96.9% and the incidence of adverse events was 13.8% in 6MST and 6.2% in MIST. The individuals performed 76.9% of the predicted on the 6MST, with 40% of the participants reaching 80% of the maximum HR and 31% presenting exercise-induced oxygen desaturation. In the MIST, the individuals performed 20% of the predicted, 23% of the participants reached 80% of the maximum heart rate, and 17% presented exercise-induced oxy-gen desaturation. Length of hospital stay and the use of mechanical ventilation were associated with test performance. Conclusion: 6MST and MIST are feasible, safe, and can be used to assess exercise capacity in a home environment in individuals after hospitalization for COVID-19. The performance in these tests was associated with a prolonged hospital stay and the use of mechanical ventilation.

Resumo Introdução: Testes baseados em degraus são comumente utilizados para avaliar a capacidade de exercício de indivíduos com doenças respiratórias. No entanto, a viabilidade e segu-rança dos testes de degrau ainda não foram estudadas em indivíduos após hospitalização por COVID-19. Objetivo: In-vestigar a viabilidade e segurança do teste do degrau de seis minutos (TD6) e do teste do degrau incremental modificado (TDIM) na avaliação da capacidade de exercício no domicílio em indivíduos após hospitalização por COVID-19, e identificar fatores associados ao desempenho nesses testes. Métodos: Estudo transversal multicêntrico com indivíduos internados por COVID-19 quinze dias após a alta hospitalar. Os participantes realizaram espirometria, TD6 e TDIM durante uma única visita domiciliar. Eventos adversos foram registrados durante e ime-diatamente após os testes. Resultados: Foram estudados 65 participantes (50 ± 10 anos, 55% do sexo masculino). A via-bilidade foi de 96,9% e a incidência de eventos adversos foi de 13,8% no 6MST e 6,2% no TDIM. Os indivíduos realizaram 76,9% do previsto no TD6, sendo que 40% dos participantes atingiram 80% da frequência cardíaca máxima e 31% apresen-taram dessaturação de oxigênio induzida pelo exercício. No TDIM, os indivíduos realizaram 20% do previsto, 23% dos participantes atingiram 80% da frequência cardíaca máxima e 17% apresentaram dessaturação de oxigênio induzida pelo exercício. O tempo de internação e o uso de ventilação mecâni-ca estiveram associados ao desempenho do teste. Conclusão: O TD6 e o TDIM são viáveis, seguros e podem ser usados para avaliar a capacidade de exercício em ambiente domiciliar em indivíduos após hospitalização por COVID-19. O desempenho nesses testes esteve associado ao tempo prolongado de internação e ao uso de ventilação mecânica.

Validity of the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) in individuals with Chronic Obstructive Pulmonary Disease in Brazil / Validación de la Escala de Fatiga, Functional Assessment Of Chronic Illness Therapy Fatigue Scale (FACIT-F) en individuos con enfermedad pulmonar obstructiva crónica en Brasil / Validade da Escala de Fadiga, Functional Assessment Of Chronic Illness Therapy Fatigue Scale (FACIT-F) em indivíduos com Doença Pulmonar Obstrutiva Crônica no Brasil

ABSTRACT Fatigue is one of the most prevalent symptoms in individuals with Chronic Obstructive Pulmonary Disease (COPD), but it is poorly evaluated. The Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) is one of the main instruments used to measure fatigue. However, this instrument has not yet been validated for the Brazilian population with COPD. This study aimed to investigate the validity of the FACIT-F fatigue scale in individuals with COPD. In a cross-sectional study, the impact of symptoms (COPD Assessment Test - CAT), dyspnea (modified Medical Research Council - MRC scale), functional capacity (six-minute step test - 6MST), exertional fatigue (Borg modified scale at the end of 6MST), and the FACIT-F scale to assess multidimensional fatigue were evaluated. Concurrent validity was assessed by associating the FACIT-F with the CAT, and convergent validity by associating it with the number of steps, perceived exertional fatigue, and dyspnea. Discriminant validity was assessed by comparing fatigue with the dyspnea severity strata. In total, 92 participants were studied (69.9±8.8 years, FEV1: 48.4% of predicted). The FACIT-F presented an average of 30.1±10.9 points, strong concurrent validity with the CAT (r=-0.80), strong convergent validity with dyspnea (r=−0.66), and low with exercise capacity (r=0.40) and fatigue on exertion (r=-0.44). FACIT-F was effective in discriminating groups with different intensities of dyspnea. Conclusion: The FACIT-F is a valid tool for assessing fatigue in the Brazilian population with COPD.

RESUMEN La fatiga es uno de los síntomas más frecuentes en los individuos con enfermedad pulmonar obstructiva crónica (EPOC), pero su evaluación sigue siendo deficiente. Uno de los principales instrumentos utilizados para medir la fatiga es la Functional assessment of chronic illness therapy fatigue scale (FACIT-F). Sin embargo, este instrumento aún no ha sido validado para la población con EPOC en Brasil. En este contexto, el objetivo de este estudio fue investigar la validez de la escala de fatiga FACIT-F en individuos con EPOC. El estudio transversal evaluó el impacto de los síntomas (COPD Assessment Test -CAT), de la disnea (escala modificada del Consejo de Investigación Médica -MRC), de la capacidad funcional (prueba de pasos de seis minutos -6MST), de la fatiga de esfuerzo (escala modificada de Borg al final de la 6MST) y de la escala FACIT-F para evaluar la fatiga multidimensional. La validez concurrente se evaluó asociando la escala con el CAT, y la validez convergente la asoció con el número de pasos, la fatiga al esfuerzo percibida y la disnea. La validez discriminante se evaluó comparando la fatiga con los estratos de gravedad de la disnea. Se estudió a 92 participantes (69,9±8,8 años, VEF1: 48,4% del predicho). La FACIT-F tuvo una puntuación media de 30,1±10,9, fuerte validez concurrente con el CAT (r=-0,80), fuerte validez convergente con la disnea (r=-0,66) y baja con la capacidad de ejercicio (r=0,40) y con la fatiga de esfuerzo (r=-0,44). La FACIT-F fue eficaz para distinguir grupos con diferentes intensidades de disnea, por lo que muestra ser un instrumento válido para evaluar la fatiga en la población brasileña con EPOC.

RESUMO A fadiga é um dos sintomas mais prevalentes nos indivíduos com Doença Pulmonar Obstrutiva Crônica (DPOC), porém, ainda é pouco avaliada. Um dos principais instrumentos utilizados para mensurar a fadiga é a functional assessment of chronic illness therapy fatigue scale (Facit-F). Entretanto, este instrumento ainda não foi validado para a população com DPOC no Brasil. Dessa forma, o objetivo deste estudo foi investigar a validade da escala de fadiga Facit-F em indivíduos com DPOC. Em um estudo transversal, foram avaliados o impacto dos sintomas (COPD Assessment Test - CAT), a dispneia (escala do Medical Research Council - MRC modificada), a capacidade funcional (teste do degrau de seis Minutos - TD6), a fadiga no esforço (escala de Borg modificada ao final do TD6) e a escala Facit-F para avaliar a fadiga multidimensional. A validade concorrente foi avaliada pela associação da escala com o CAT, e a validade convergente pela associação desta com o número de degraus, percepção de fadiga no esforço e a dispneia. A validade discriminante foi avaliada comparando a fadiga com os estratos da gravidade da dispneia. Foram estudados 92 participantes (69,9±8,8 anos, VEF1: 48,4% do previsto). A Facit-F apresentou uma média de 30,1±10,9 pontos, validade concorrente forte com o CAT (r=-0,80), validade convergente forte com a dispneia (r=-0,66) e baixa com a capacidade de exercício (r=0,40) e com a fadiga ao esforço (r=-0,44). A Facit-F foi eficaz em discriminar grupos com diferentes intensidades de dispneia, portanto é um instrumento válido para a avaliação da fadiga na população brasileira com DPOC.