RÉSUMÉ
BACKGROUND: Pulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials. METHODS: This was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned. RESULTS: Ten outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study. CONCLUSIONS: We identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.
Sujet(s)
Chutes accidentelles , Équilibre postural , Broncho-pneumopathie chronique obstructive , Humains , Broncho-pneumopathie chronique obstructive/rééducation et réadaptation , Broncho-pneumopathie chronique obstructive/diagnostic , Broncho-pneumopathie chronique obstructive/épidémiologie , Chutes accidentelles/prévention et contrôle , Études rétrospectives , Incidence , Résultat thérapeutique , Études multicentriques comme sujet , Plan de recherche , Essais contrôlés randomisés comme sujet , Traitement par les exercices physiques/méthodes , Facteurs tempsRÉSUMÉ
INTRODUCTION: This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD. METHODS: A structured search strategy (2000-2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14â days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored. RESULTS: 34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22-4.80, 95% PI -4.60-9.63), Timed Up and Go (TUG) test (mean -1.12â s, 95% CI -1.69-â -0.55â s, 95% PI -2.78-0.54â s), Single-Leg Stance (SLS) test (mean 3.25â s, 95% CI 2.72-3.77â s, 95% PI 2.64-3.86â s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41-14.58%, 95% PI -8.92-25.92%). Effect on falls remains unknown. Treatment effects were larger in male versus mixed-sex groups for the ABC scale and SLS test, and in balance training versus other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2). CONCLUSION: Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.
Sujet(s)
Chutes accidentelles , Traitement par les exercices physiques , Équilibre postural , Broncho-pneumopathie chronique obstructive , Humains , Chutes accidentelles/prévention et contrôle , Broncho-pneumopathie chronique obstructive/physiopathologie , Broncho-pneumopathie chronique obstructive/thérapie , Broncho-pneumopathie chronique obstructive/diagnostic , Traitement par les exercices physiques/méthodes , Mâle , Résultat thérapeutique , Femelle , Sujet âgé , Facteurs de risque , Adulte d'âge moyen , Récupération fonctionnelle , Poumon/physiopathologieRÉSUMÉ
BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. METHODS: In a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures - Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test - were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. RESULTS: Among 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88-0.97) and moderate convergent validity (r = 0.34-0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. CONCLUSION: Though all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.
Sujet(s)
Chutes accidentelles , Vie autonome , Équilibre postural , Broncho-pneumopathie chronique obstructive , Humains , Chutes accidentelles/prévention et contrôle , Sujet âgé , Broncho-pneumopathie chronique obstructive/physiopathologie , Broncho-pneumopathie chronique obstructive/diagnostic , Femelle , Équilibre postural/physiologie , Mâle , Reproductibilité des résultats , Études longitudinales , Appréciation des risques/méthodes , Sujet âgé de 80 ans ou plus , Adulte d'âge moyen , Dépistage de masse/méthodes , Études prospectives , Facteurs de risqueRÉSUMÉ
Assessment of self-conscious emotions is important to develop tailored interventions for people with chronic obstructive pulmonary disease (COPD). Previous instruments have largely been developed for mental health populations. The Self-Conscious Emotions in COPD Questionnaire was the first instrument to assess self-conscious emotions in people with COPD, but it was only available in English. The aim was to translate the Self-Conscious Emotions in COPD Questionnaire into Swedish and to evaluate its psychometric properties and internal structure in a Swedish context. The translation process included forward and backward translation, a multidisciplinary meeting, assessment of content validity, and cognitive interviews. The translated instrument was tested in a sample of 173 people with COPD between September 2021 and September 2022. Parallel analysis (PA), exploratory factor analysis (EFA), and test-retest reliability was performed. The content validity index (CVI) for the instrument was 0.88. Based on the PA, an EFA with a two-factor solution was conducted, with a high Cronbach's alpha (0.786-0.821), and one item about self-blame was excluded. The two factors were labelled: The burden of living with a disability and The desire to hide vulnerability. Test-retest reliability showed no difference between scale scores on factor or item level, except for one item. The Swedish Self-Conscious Emotions in COPD showed good validity and reliability. One item was excluded from the two subscales, indicating that the instrument needs to be further developed to cover the concept of self-blame. The instrument is expected to be a valuable tool for assessing self-conscious emotions in people with COPD.
Sujet(s)
Émotions , Psychométrie , Broncho-pneumopathie chronique obstructive , Traductions , Humains , Broncho-pneumopathie chronique obstructive/psychologie , Broncho-pneumopathie chronique obstructive/physiopathologie , Psychométrie/méthodes , Suède , Enquêtes et questionnaires , Mâle , Femelle , Sujet âgé , Reproductibilité des résultats , Adulte d'âge moyen , Analyse statistique factorielleRÉSUMÉ
People with chronic obstructive pulmonary disease (COPD) have a higher prevalence of pain and a greater risk of falls than their healthy peers. As pain has been associated with an increased risk of falls in older adults, this study investigated the association between pain and falls in people with COPD compared to healthy controls. Data from the English Longitudinal Study of Ageing were used to establish an association between pain and falls when modelled with a generalised ordinal logistic regression and adjusted for sex, age, wealth, and education (complete case analysis only; n = 806 COPD, n = 3898 healthy controls). The odds were then converted to the predicted probabilities of falling. The predicted probability of falling for people with COPD was greater across all pain categories than for healthy controls; for COPD with (predicted probability % [95%CI]), no pain was 20% [17 to 25], with mild pain was 28% [18 to 38], with moderate pain was 28% [22 to 34] with severe pain was 39% [30 to 47] and for healthy controls with no pain was 17% [16 to 18], mild pain 22% [18 to 27], moderate pain 25% [20 to 29] and severe pain 27% [20 to 35]. The probability of falling increased across pain categories in individuals with COPD, with the most severe pain category at a nearly 40% probability of falling, indicating a potential interaction between COPD and pain.
Sujet(s)
Chutes accidentelles , Broncho-pneumopathie chronique obstructive , Sujet âgé , Humains , Vieillissement , Études longitudinales , Douleur/épidémiologie , Douleur/complications , Broncho-pneumopathie chronique obstructive/complications , Broncho-pneumopathie chronique obstructive/épidémiologie , Mâle , FemelleRÉSUMÉ
People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a "frailty rehabilitation paradox" whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.
Sujet(s)
Fragilité , Troubles respiratoires , Maladies de l'appareil respiratoire , Téléréadaptation , Humains , États-Unis , Sujet âgé , Téléréadaptation/méthodes , Soins palliatifsRÉSUMÉ
OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) is complicated by chronic pain. People with COPD report higher pain prevalence than the general population. Despite this, chronic pain management is not reflected in current COPD clinical guidelines and pharmacological treatments are often ineffective. We conducted a systematic review that aimed to establish the efficacy of existing non-pharmacological and non-invasive interventions on pain and identify behaviour change techniques (BCTs) associated with effective pain management. METHODS: A systematic review was conducted with reference to Preferred Reporting Items for Systematic Review (PRISMA) [1], Systematic review without Meta analysis (SWIM) standards [2] and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines [3]. We searched 14 electronic databases for controlled trials of non-pharmacological and non-invasive interventions where the outcome measure assessed pain or contained a pain subscale. RESULTS: Twenty-nine studies were identified involving 3,228 participants. Seven interventions reported a minimally important clinical difference in pain outcomes, although only two of these reached statistical significance (p < 0.05). A third study reported statistically significant outcomes, but this was not clinically significant (p = 0.0273). Issues with intervention reporting prevented identification of active intervention ingredients (i.e., BCTs). CONCLUSIONS: Pain appears to be a meaningful issue for many individuals with COPD. However, intervention heterogeneity and issues with methodological quality limit certainty about the effectiveness of currently available non-pharmacological interventions. An improvement in reporting is required to enable identification of active intervention ingredients associated with effective pain management.
Sujet(s)
Douleur chronique , Broncho-pneumopathie chronique obstructive , Humains , Douleur chronique/thérapie , Broncho-pneumopathie chronique obstructive/complications , Broncho-pneumopathie chronique obstructive/thérapie , Thérapie comportementale , Qualité de vieRÉSUMÉ
BACKGROUND: Talking about breathlessness can be emotionally challenging. People can feel a sense of illegitimacy and discomfort in some research contexts. Comic-based illustration (cartooning) offers an opportunity to communicate in a more creative and inclusive way. We used cartooning in patient and public involvement and engagement (PPIE) work to explore symptoms of breathlessness and their impact on peoples' everyday lives. MAIN BODY: Five, 90-min cartooning workshops were delivered online to members of Breathe Easy Darlington (UK). The workshop series involved 5-10 Breathe Easy members and were facilitated by a professional cartoonist supported by three researchers. The experience of living with breathlessness was represented via illustrations of cartoon characters and ideas explored in subsequent conversations. Cartooning was fun and the majority found it a nostalgic experience. Sharing the experience helped the research team develop new understandings of breathlessness and fostered relationships with the Breathe Easy members. The illustrations showed characters leaning against objects, sweating and sitting down, demonstrating living with the sensation of not being in control. CONCLUSION: Comic-based art, as a fun and innovative PPIE approach. It facilitated the research team becoming embedded in an existing group who will act as PPIE members on a long-term research programme. Illustrations enabled storytelling and fostered novel insights into the lived experiences of people with breathlessness including sensations of a loss of control, disorientation, and unsteadiness. This will impact on work investigating balance in people with chronic obstructive pulmonary disease. This model has potential to be applied in a range of PPIE and research contexts.
Talking about breathlessness can be difficult and cause feelings of anxiety. Involving people with breathlessness in research activities can also be challenging. Research contexts can make people feel uncomfortable as they may struggle to understand and feel like they don't belong. Comic-based illustration (cartooning) offers an opportunity to communicate in a different way. Cartooning was used with members of Breathe Easy Darlington, a support group for people with breathlessness, as a way of helping the research team understand how breathlessness impacts daily lives. Five 90-min cartooning workshops were delivered online and involved 510 Breathe Easy members per session. The sessions were led by a professional cartoonist whilst the research team facilitated discussions about breathlessness and related issues. The experience of living with breathlessness was illustrated via cartoon characters and ideas were explored through conversations about the illustrations. People found cartooning fun and sharing the experience with the research team helped them to become part of an existing group who will support a long-term research project directly impacting research investigating balance in people with lung disease. The Breathe Easy members were able to tell their stories via illustrations allowing the research team an insight into different aspects of living with breathlessness. The illustrations showed characters leaning against trees and chairs, sweating and sitting down. The need for physical support caused embarrassment, while people struggled to appear "normal". Conversations about the illustrations revealed that the idea of "balance" aligns with a loss of control, disorientation, and unsteadiness which causes intense fear and shame.
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BACKGROUND: Limited research assessed the validity of the Activities-specific Balance Confidence, ABC) Scale in individuals with chronic obstructive pulmonary disease, COPD) at risk of falls. We report on the scale's construct and criterion validity. METHODS: Construct validity was established by assessing known groups, convergent, and divergent validity. A receiver operating characteristic, (ROC) curve and logistic regression examined the criterion validity of the scale. RESULTS: In 223 individuals with COPD, the ABC Scale significantly, (p < 0.001) discriminated between groups, with lower scores for females [Mean difference (MD) = 10%], rollator use [MD = 13%], and fallers [MD = 12%], and had a strong association [r = 0.58, p < 0.001] with Berg Balance Scale. The scale distinguished fallers from non-fallers with a cutoff value of 58% [Area Under the Curve = 0.64, 95% CI = 0.57-0.72, p < 0.001] and significantly identified fall status [B, SE = -0.03, 0.01, p < 0.001] with an odds ratio of 0.97 [95%CI = 0.96-0.99]. The sensitivity, specificity, and test accuracy were: 61, 58, and 60%, respectively. CONCLUSION: The ABC Scale showed evidence for known groups, convergent, and divergent validity and can assist in identifying fall status in individuals with COPD.
Sujet(s)
Équilibre postural , Broncho-pneumopathie chronique obstructive , Chutes accidentelles/prévention et contrôle , Femelle , Humains , Broncho-pneumopathie chronique obstructive/diagnostic , Courbe ROC , Facteurs de risqueRÉSUMÉ
OBJECTIVES: Symptoms associated with lung cancer and thoracic surgery might increase fall risk. We aimed to investigate: 1) balance, gait and functional status in people post-thoracic surgery compared to healthy controls; 2) perceptions of balance, gait and functional status. METHODS: Recruitment targeted older adults (≥50 years) who had undergone thoracic surgery for a diagnosis of lung cancer in the previous 3 months, and healthy age-matched controls. Dynamic and static balance, gait velocity, knee-extension strength and physical activity levels were assessed using the BESTest, Kistler force plate, GAITRite system, Biodex System 3 and CHAMPS questionnaire, respectively. Two-part semi-structured interviews were conducted post-surgery. RESULTS: Individuals post-surgery (n = 15) had worse dynamic balance and gait, and lower levels of moderate/vigorous physical activity (MVPA) (all p<0.05) versus healthy controls (n = 15). Strength did not differ between groups (p > 0.05). No associations between BESTest and strength or physical activity existed post-surgery (p > 0.05). Three themes were identified: 1) Symptoms affect daily activities; 2) Functional assessments alter perceptions of balance ability and 3) Open to supervised rehabilitation. CONCLUSION: Balance, gait and MVPA are impaired post-thoracic surgery, yet balance was not viewed to be important in enabling activities of daily living. However, supervised rehabilitation was considered acceptable.
Sujet(s)
Tumeurs du poumon , Chirurgie thoracique , Chutes accidentelles , Activités de la vie quotidienne , Sujet âgé , Démarche , Humains , Tumeurs du poumon/chirurgie , Équilibre posturalRÉSUMÉ
Purpose: Guidelines for pulmonary rehabilitation (PR) include balance training but lack specific parameters. After a knowledge translation project at our site, clinicians modified the physiotherapy programme to facilitate the sustainability of balance training as part of PR. The purpose of this study was to explore whether the modified programme resulted in improved balance and balance confidence. A secondary aim was to provide information on the way in which balance training was operationalized as part of PR for clinicians wanting to incorporate it into an existing PR programme. Method: We conducted a retrospective study of patients with chronic obstructive pulmonary disease, enrolled in a 4- to 6-week inpatient PR programme over a 1-year period. Balance training was provided biweekly with a staff-to-patient ratio of 2:11. Participants completed the brief Balance Evaluation Systems Test (brief-BESTest) and Activities-Specific Balance Confidence (ABC) scale at the beginning and end of PR. Results: The 85 participants had a mean age of 69.5 (SD 9.0) years. After completing an average of 7.6 balance sessions (min-max 2-13), participants showed improvements in brief-BESTest (mean difference 3.2 [95% CI: 2.5, 3.9] points) and ABC (mean difference 7.8 [95% CI: 4.1, 11.5] percent). Conclusions: A staff-to-patient ratio of 2:11 and a training frequency of twice per week for 4-6 weeks improved balance. This result will inform how we incorporate balance training into existing PR programmes.
Objectif : les directives relatives à la réadaptation pulmonaire (RP) incluent l'entraînement à l'équilibre, mais ne sont pas liées à des paramètres précis. Après un projet d'application des connaissances à l'établissement des cliniciens, ceux-ci ont apporté des modifications pour favoriser la pérennité de l'entraînement à l'équilibre en RP. La présente étude visait à explorer si le programme modifié améliorait l'équilibre et la confiance en l'équilibre. Un objectif secondaire consistait à fournir de l'information sur l'opérationnalisation de l'entraînement à l'équilibre dans le cadre de la RP chez les cliniciens qui désirent l'intégrer à des programmes de RP en place. Méthodologie : étude rétrospective des patients atteints d'une maladie pulmonaire obstructive chronique qui ont participé à un programme de RP de quatre à six semaines sur une période d'un an. L'entraînement à l'équilibre avait lieu deux fois par semaine selon un ratio de deux membres du personnel pour 11 patients. Les participants ont rempli le bref test sur les systèmes d'évaluation de l'équilibre (brief-BESTest) et l'échelle de confiance entre des activités précises et l'équilibre (ABC) au début et à la fin de la RP. Résultats : les 85 participants avaient un âge moyen de 69,5 ans (ÉT 9,0). Après avoir effectué en moyenne 7,6 séances d'équilibre (minimum de deux et maximum de 13), les participants se sont améliorés au brief-BESTest (différence moyenne de 3,2 points [IC à 95 % : 2,5, 3,9]) et à l'échelle ABC (différence moyenne de 7,8 % [IC à 95 % : 4,1, 11,5]). Conclusion : un ratio de deux membres du personnel pour 11 patients et une fréquence de deux entraînements par semaine pendant quatre à six semaines ont amélioré l'équilibre. Ce résultat éclairera l'intégration de l'entraînement de l'équilibre aux programmes de RP existants.
RÉSUMÉ
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterised by shortness of breath, cough and recurrent exacerbations. People with COPD often live with one or more co-existing long-term health conditions (comorbidities). People with more severe COPD often have a higher number of comorbidities, putting them at greater risk of morbidity and mortality. OBJECTIVES: To assess the effectiveness of any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention for people with COPD and one or more common comorbidities (quantitative data, RCTs) in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To assess the effectiveness of an adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more common comorbidities (quantitative data, RCTs) compared to usual care in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To identify emerging themes that describe the views and experiences of patients, carers and healthcare professionals when receiving or providing care to manage multimorbidities (qualitative data). SEARCH METHODS: We searched multiple databases including the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, and CINAHL, to identify relevant randomised and qualitative studies. We also searched trial registries and conducted citation searches. The latest search was conducted in January 2021. SELECTION CRITERIA: Eligible randomised controlled trials (RCTs) compared a) any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention, or b) any adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more comorbidities, compared to usual care. We included qualitative studies or mixed-methods studies to identify themes. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods for analysis of the RCTs. We used Cochrane's risk of bias tool for the RCTs and the CASP checklist for the qualitative studies. We planned to use the Mixed Methods Appraisal tool (MMAT) to assess the risk of bias in mixed-methods studies, but we found none. We used GRADE and CERQual to assess the quality of the quantitative and qualitative evidence respectively. The primary outcome measures for this review were quality of life and exacerbations. MAIN RESULTS: Quantitative studies We included seven studies (1197 participants) in the quantitative analyses, with interventions including telemonitoring, pulmonary rehabilitation, treatment optimisation, water-based exercise training and case management. Interventions were either compared with usual care or with an active comparator (such as land-based exercise training). Duration of trials ranged from 4 to 52 weeks. Mean age of participants ranged from 64 to 72 years and COPD severity ranged from mild to very severe. Trials included either people with COPD and a specific comorbidity (including cardiovascular disease, metabolic syndrome, lung cancer, head or neck cancer, and musculoskeletal conditions), or with one or more comorbidities of any type. Overall, we judged the evidence presented to be of moderate to very low certainty (GRADE), mainly due to the methodological quality of included trials and imprecision of effect estimates. Intervention versus usual care Quality of life as measured by the St George's Respiratory Questionnaire (SGRQ) total score may improve with tailored pulmonary rehabilitation compared to usual care at 52 weeks (mean difference (MD) -10.85, 95% confidence interval (CI) -12.66 to -9.04; 1 study, 70 participants; low-certainty evidence). Tailored pulmonary rehabilitation is likely to improve COPD assessment test (CAT) scores compared with usual care at 52 weeks (MD -8.02, 95% CI -9.44 to -6.60; 1 study, 70 participants, moderate-certainty evidence) and with a multicomponent telehealth intervention at 52 weeks (MD -6.90, 95% CI -9.56 to -4.24; moderate-certainty evidence). Evidence is uncertain about effects of pharmacotherapy optimisation or telemonitoring interventions on CAT improvement compared with usual care. There may be little to no difference in the number of people experiencing exacerbations, or mean exacerbations with case management compared with usual care (OR 1.09, 95% CI 0.75 to 1.57; 1 study, 470 participants; very low-certainty evidence). For secondary outcomes, six-minute walk distance (6MWD) may improve with pulmonary rehabilitation, water-based exercise or multicomponent interventions at 38 to 52 weeks (low-certainty evidence). A multicomponent intervention may result in fewer people being admitted to hospital at 17 weeks, although there may be little to no difference in a telemonitoring intervention. There may be little to no difference between intervention and usual care for mortality. Intervention versus active comparator We included one study comparing water-based and land-based exercise (30 participants). We found no evidence for quality of life or exacerbations. There may be little to no difference between water- and land-based exercise for 6MWD (MD 5 metres, 95% CI -22 to 32; 38 participants; very low-certainty evidence). Qualitative studies One nested qualitative study (21 participants) explored perceptions and experiences of people with COPD and long-term conditions, and of researchers and health professionals who were involved in an RCT of telemonitoring equipment. Several themes were identified, including health status, beliefs and concerns, reliability of equipment, self-efficacy, perceived ease of use, factors affecting usefulness and perceived usefulness, attitudes and intention, self-management and changes in healthcare use. We judged the qualitative evidence presented as of very low certainty overall. AUTHORS' CONCLUSIONS: Owing to a paucity of eligible trials, as well as diversity in the intervention type, comorbidities and the outcome measures reported, we were unable to provide a robust synthesis of data. Pulmonary rehabilitation or multicomponent interventions may improve quality of life and functional status (6MWD), but the evidence is too limited to draw a robust conclusion. The key take-home message from this review is the lack of data from RCTs on treatments for people living with COPD and comorbidities. Given the variation in number and type of comorbidity(s) an individual may have, and severity of COPD, larger studies reporting individual patient data are required to determine these effects.
Sujet(s)
Broncho-pneumopathie chronique obstructive/thérapie , Sujet âgé , Biais (épidémiologie) , Prise en charge personnalisée du patient , Cause de décès , Comorbidité , Intervalles de confiance , Évolution de la maladie , Études d'évaluation comme sujet , Exercice physique , Humains , Adulte d'âge moyen , Odds ratio , Broncho-pneumopathie chronique obstructive/épidémiologie , Broncho-pneumopathie chronique obstructive/mortalité , Broncho-pneumopathie chronique obstructive/rééducation et réadaptation , Qualité de vie , Essais contrôlés randomisés comme sujet , Indice de gravité de la maladie , Télémédecine , Facteurs temps , Test de marcheRÉSUMÉ
Interview with @EarlyCareerERS Awardee 2020 @burtin_chris, and a preview of #LungScienceConference and #SleepandBreathing 2021 https://bit.ly/3fUXs1M.
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This study aimed to investigate (a) the association between psychological flexibility and engagement in pulmonary rehabilitation within 8 weeks following hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and (b) how psychological (in)flexibility presents in this context. A mixed-methods study was conducted. Psychological flexibility during an AECOPD was assessed using The Acceptance and Action Questionnaire-II (AAQ-II) (n = 41) and the Engaged Living Scale (ELS) (n = 40). Engagement in post-AECOPD pulmonary rehabilitation was then recorded. Twenty-three patients also participated in cognitive interviews. Psychological flexibility was associated with a greater chance of accepting a pulmonary rehabilitation referral following an AECOPD. Small numbers prohibited analysis on attendance or completion. An AAQ-II score of 11 translated to a 60 (37-82)% probability of accepting a referral to pulmonary rehabilitation and an ELS score of 73 was associated with a 68 (46-91)% probability of accepting. Four themes were extracted from interviews: (1) family values, (2) self as abnormal, (3) 'can't do anything' versus 'I do what I can' and (4) disability, and related emotions, as barriers to action. Randomised clinical trials are needed to evaluate interventions designed to increase psychological flexibility (i.e. acceptance and commitment therapy) to support acceptance of pulmonary rehabilitation post-AECOPD.
Sujet(s)
Adaptation psychologique , Participation des patients/psychologie , Broncho-pneumopathie chronique obstructive/psychologie , Broncho-pneumopathie chronique obstructive/rééducation et réadaptation , Maladie aigüe , Sujet âgé , Personnes handicapées/psychologie , Évolution de la maladie , Émotions , Femelle , Humains , Entretiens comme sujet , Mâle , Adulte d'âge moyen , Concept du soi , Enquêtes et questionnairesRÉSUMÉ
Rationale: Current international guidelines for prevention of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) recommend enrolment and participation in a pulmonary rehabilitation (PR) program within 4 weeks of hospital discharge. However, there is poor uptake of these programs as well as low adherence and completion rates.Objectives: The objectives of this study were to explore the views of patients and healthcare professionals (HCPs) on PR after AECOPD and how participation could be enhanced.Methods: A qualitative study was undertaken, and data were analyzed using deductive thematic analysis. A total of 13 patients who had experienced an AECOPD in the previous 6 months and 11 HCPs experienced in the management of COPD participated in face-to-face, semistructured interviews. Patients and HCPs were recruited from both rehabilitation and acute hospital settings.Results: Four main themes were identified: 1) uncertainty about timing of PR-most HCPs endorsed the professional guidelines that advocate for PR programs to begin within 4 weeks of an AECOPD; patients, however, varied drastically in their view of the ideal timing to start a PR program, anywhere from before an exacerbation (perhaps preventing one) and up to 6-8 weeks after exacerbation; 2) tailored and flexible manner to deliver PR programs with a gradual start-patients and HCPs talked about individually tailored programs with a gradual introduction of exercise and teaching sessions; some HCPs advocated allowing patients to pick and choose which elements would help them the most; 3) education for all-patients would like HCPs to be more informed and informative about the PR programs available in their neighborhoods, and HCPs focused on how they could educate patients about their disease and how better to manage it; and 4) logistical, disease-related, and psychological barriers-barriers to PR were discussed by both HCPs and patients; these fell into two categories: a) delivery issues (i.e., transportation and location of PR); and b) patient-specific issues (too sick or too well, high levels of anxiety).Conclusions: Our findings lay the foundation for the development of a flexible, stepped-care approach to delivering PR after AECOPD, which should be tailored according to the needs and preferences of the individual.
Sujet(s)
Traitement par les exercices physiques/méthodes , Participation des patients/psychologie , Broncho-pneumopathie chronique obstructive/rééducation et réadaptation , Sujet âgé , Sujet âgé de 80 ans ou plus , Attitude du personnel soignant , Évolution de la maladie , Femelle , Connaissances, attitudes et pratiques en santé , Humains , Entretiens comme sujet , Mâle , Adulte d'âge moyen , Recherche qualitative , Qualité de vie , QuébecRÉSUMÉ
Pulmonary rehabilitation (PR) is recommended for all individuals living with a lung condition and chronic breathlessness. This article considers how adopting an interdisciplinary, medical humanities approach to the term 'pulmonary rehabilitation' might unpack some of the misconceptions, misrepresentations or negative connotations surrounding it, which have been largely overlooked in explanations of the low uptake of this programme. Taking key insights from Wellcome Trust-funded Life of Breath project, including ethnographic research in community fitness groups in North East England and the 'Breath Lab' special interest group, this article outlines how the whole-body approach of PR is not easily understood by those with lung conditions; how experience can inform breath perception through the pacing of everyday life; and how stigma can impact rehabilitation. This article highlights the value of medical humanities in working through communicative challenges evident in the translation of PR between patient and clinical contexts and sets out two arts-based approaches (Singing for Lung Health and dance movement) as potential options that could be included in the PR referral. Finally, the article outlines the need for collaborative research exploring the communication and meaning of healthcare strategies and experiences at the interface of the arts, humanities and medical practice.
Sujet(s)
Thérapie par la danse , Dyspnée/rééducation et réadaptation , Communication sur la santé , Maladies pulmonaires/rééducation et réadaptation , Participation des patients , Thérapie respiratoire , Chant , Terminologie comme sujet , Attitude envers la santé , Maladie chronique , Sciences humaines , Humains , Stigmate socialRÉSUMÉ
OBJECTIVES: To identify clusters of chronic obstructive pulmonary disease (COPD) patients with distinct beliefs about their illness in terms of symptoms, health-related quality of life (HRQoL), self-efficacy, and daily life physical activity (DLPA). METHODS: This cross-sectional study included 150 COPD outpatients. The patients' illness perceptions, clinical control, HRQoL, self-efficacy, and DLPA (accelerometry) were evaluated. A cluster analysis was conducted using data from the Illness Perceptions Questionnaire - Revised to establish groups of patients with distinct illness perceptions. Differences between clusters were tested using a T-test or a Mann-Whitney U test. RESULTS: The cluster analysis revealed two groups: distressed ( n = 95) and coping ( n = 55). Despite the fact that both clusters presented similar pulmonary function, between-cluster differences were observed in their self-efficacy, dyspnea, HRQoL, clinical control ( p < 0.001), and educational level ( p = 0.002). The levels of DLPA did not differ between the clusters. DISCUSSION: We observed that clinically stable COPD patients who displayed higher emotional representations and less coherence had heightened symptoms, poorer HRQoL, worse self-efficacy, and lower educational levels. These results emphasize the need to routinely evaluate illness perceptions in COPD patients to target and tailor the proper treatment to improve these important health outcomes.