RESUMEN
STUDY OBJECTIVE: To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe COPD. DESIGN: A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis. SETTING: A tertiary-care respiratory service. PATIENTS: Forty patients (mean age, 65 +/- 8 years [+/- SD]) with severe chronic flow limitation (FEV(1), 35 +/- 13%) without respiratory failure (Pao(2), 72 +/- 9 mm Hg; Paco(2), 42 +/- 5 mm Hg) were randomized either to a control group or to a PR group (PRG). INTERVENTIONS: Sixteen weeks of PR that included breathing retraining and exercise. MEASUREMENTS: At baseline and 16 weeks, we evaluated psychosocial morbidity using two questionnaires (the Millon Behavior Health Inventory [MBHI] and the Revised Symptom Checklist [SCL-90-R]) and measured 6-min walk distance (6WMD) and HRQL using the Chronic Respiratory Questionnaire (CRQ). RESULTS: We found differences in favor of the PRG in the following MBHI domains: introversive, forceful, and sensitive personality styles (all p = 0.05) and chronic tension (p = 0.01). Results of the depression, hostility, global severity, positive symptom distress index (all p = 0.01), somatization, anxiety, psychoticism, and positive symptom (all p = 0.05) domains of the SCL-90-R favored the PRG. We also found statistically and clinically significant differences between groups in 6MWD (85 m; p < 0.01) and in two domains of the CRQ: dyspnea (1.0; p < 0.01) and mastery (0.6; p < 0.05). The other two domains of CRQ showed strong trends in favor of PRG: 0.7 for both fatigue and emotional function (minimal important difference, 0.5). CONCLUSIONS: PR may decrease psychosocial morbidity in COPD patients even when no specific psychological intervention is performed. Findings from this study also confirm the positive impact of PR on functional exercise capacity and HRQL.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Anciano , Ejercicios Respiratorios , Ejercicio Físico , Tolerancia al Ejercicio , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pruebas Psicológicas , Calidad de Vida , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Correction of exercise hypoxemia in advanced lung diseases is crucial and often challenging. However, oxygen-conserving devices have been introduced in the market with limited evidence of effectiveness. In the present study the efficacy of 2 oxygen-conserving devices, a pulse demand oxygen delivery (DOD) system and pendant reservoir cannula (PRC), were evaluated in subjects with COPD and interstitial lung disease (ILD). METHODS: A cross-sectional, crossover study included 28 COPD and 31 ILD subjects with oxygen desaturation on the 6-min walk test (average S(pO2) < 88%). Each subject underwent 3 walk tests with DOD, PRC, and continuous oxygen flow by standard nasal cannula (CFNC), in random order, taking average S(pO2) ≥ 90% as the resaturation criterion. RESULTS: Exercise desaturation was corrected in 79%, 79%, and 86% of COPD subjects with CFNC, DOD, and PRC, respectively, and in 77%, 61%, and 81% of ILD subjects with CFNC, DOD, and PRC, respectively. When compared to CFNC, the oxygen-conserving devices showed similar efficacy, except a lower performance for the DOD in the ILD subjects (P = .01). CONCLUSIONS: Although these oxygen-conserving devices corrected exercise hypoxemia in most COPD and ILD subjects, correction was not achieved in about 20% of the severe COPD subjects, regardless of the device, and in nearly 40% of the ILD subjects with the DOD device. These findings underscore that individualized adjustment of oxygen flow is needed for optimal correction of exercise hypoxemia, especially with a DOD in an ILD patient. (ClinicalTrials.gov NCT01086891).
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Ejercicio Físico/fisiología , Hipoxia/prevención & control , Enfermedades Pulmonares/terapia , Terapia por Inhalación de Oxígeno/instrumentación , Oxígeno/farmacología , Anciano , Estudios Cruzados , Estudios Transversales , Diseño de Equipo , Prueba de Esfuerzo/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Hipoxia/etiología , Hipoxia/metabolismo , Masculino , Consumo de Oxígeno , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: The interviewer-administered chronic respiratory questionnaire (CRQ-IA) is widely used and has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS) in Spanish has not been validated. The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SAS in patients with COPD. MATERIAL AND METHODS: We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs. IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 questionnaire, pulmonary function tests, and six-minute walk test. RESULTS: The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a range of correlations, for the change scores, between 0.46 (P=.05) and 0.71 (P=.01). Regarding sensitivity to change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [P=.02], emotional factor 0.62 [P=.04], control of the disease 0.83 [P=.06]). CONCLUSIONS: The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. The correlations of the CRQ-SAS with other tools provide construct validity and show good sensitivity to change.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Femenino , Humanos , Lenguaje , Masculino , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Introducción: El cuestionario de la enfermedad respiratoria crónica con entrevistador (CRQ-IA) ha demostradoexcelentes propiedades de medida de la calidad de vida relacionada con la salud (CVRS) en pacientescon enfermedad pulmonar obstructiva crónica (EPOC). La validación en español de la versión estandarizadaautoadministrada (CRQ-SAS) no se ha realizado. El objetivo de este estudio fue evaluar la validez yla sensibilidad a los cambios, de la versión española del CRQ-SAS en pacientes con EPOC.Pacientes y métodos: Aleatorizamos a 40 pacientes con EPOC (33 en tratamiento con rehabilitación respiratoriay 7 con oxígeno líquido) a uno de los dos métodos de administración del CRQ (SAS vs. IA) antesy 8 semanas después de la intervención. Los pacientes completaban el cuestionario SF-36, pruebas defunción pulmonar y prueba de los 6 min de marcha.Resultados: El CRQ-SAS ha demostrado una buena validez de constructo longitudinal en todas las áreascon un rango de correlaciones, para las puntuaciones del cambio, entre 0,46 (p = 0,05) y 0,71 (p = 0,01).En cuanto a la sensibilidad a los cambios, se observa un cambio mínimo clínicamente significativo en lamayoría de áreas (fatiga 0,71 [p = 0,02], factor emocional 0,62 [p = 0,04], control de la enfermedad 0,83[p = 0,06]).Conclusiones: La versión española del CRQ-SAS resulta ser válida para evaluar la CVRS de los pacientescon EPOC. Las correlaciones con otros instrumentos aportan validez de constructo y se demuestra unabuena sensibilidad a los cambios(AU)
Introduction: The interviewer-administered chronic respiratory questionnaire (CRQ-IA) is widely usedand has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patientswith chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS)in Spanish has not been validated.The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SASin patients with COPD.Material and methods: We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs. IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 questionnaire, pulmonary function tests, and six-minute walk test. Results: The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a rangeof correlations, for the change scores, between 0.46 (P=.05) and 0.71 (P=.01). Regarding sensitivityto change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [P = .02],emotional factor 0.62 [P=.04], control of the disease 0.83 [P=.06]).Conclusions: The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. Thecorrelations of the CRQ-SAS with other tools provide construct validity and show good sensitivity tochange(AU)