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1.
Ther Umsch ; 76(6): 323-327, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762415

RESUMO

Pulmonary Rehabilitation Abstract. Pulmonary rehabilitation is a comprehensive therapeutic approach for patients with advanced chronic lung diseases which leads to a decline of dyspnea, an increase of exercise capacity and an increase of quality of life. Further effects are a reduction of frequency of hospitalisations and an increase of physical activity, if a self management education program is integrated. Pulmonary rehabilitation incorporates an individualised training program with focus on endurance, strength and mobility, further a disease specific education with the goal to improve self efficacy and self management of the patients, specially with the goal to improve their daily physical activity. Due to the good evidence of pulmonary rehabilitation, the accredited programs are accepted and paid by the swiss insurances.


Assuntos
Terapia por Exercício , Pneumopatias , Doença Pulmonar Obstrutiva Crônica , Dispneia/etiologia , Dispneia/prevenção & controle , Exercício , Humanos , Pneumopatias/reabilitação , Resistência Física , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(38): e17129, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567952

RESUMO

BACKGROUND: Pulmonary rehabilitation (PR) is an indispensable component in the nonpharmacological management of patients with chronic obstructive pulmonary disease (COPD) with significant improvements in quality of life and exercise capacity. It is strongly supported by systematic reviews (SR) as part of the treatment of these patients. However, it is not known which PR components are essential, such as duration, ideal locations, type and intensity of training, degree of supervision, adherence, cost-effectiveness challenge, and how long the program effects last. This overview aims to evaluate and describe different pulmonary rehabilitation interventions for individuals with COPD. METHODS: Only systematic reviews of randomized controlled trials (RCTs) published in the Cochrane Database of Systematic Reviews will be included. The following results were analyzed: health-related quality of life, functional capacity, mortality, dyspnea, cost-effectiveness, and adverse events. The risk of bias will be assessed by the Risk of Bias in Systematic Reviews (ROBIS). The methodological quality will be analyzed through the Assessment of Multiple Systematic Reviews (AMSTAR-2). We will use the evaluations of the Classification of Recommendations, Evaluation, Development and Evaluation (GRADE) of the authors of the included systematic reviews. The screening of systematic reviews, eligibility evaluation, data extraction, methodological quality, and quality of evidence will be performed in pairs by independent reviewers. The results that have been reported in the included reviews will be summarized in an "Overview of Reviews" table. The main conclusions about the effects of the interventions studied in the included reviews will be summarized and organized in clinically meaningful categories. RESULTS: The article in this overview will be submitted for publication in a peer-reviewed journal. The results will also be included in a doctoral thesis and disclosed in medical conferences. CONCLUSIONS: We expect to compile evidence from multiple systematic reviews of pulmonary rehabilitation in people with COPD in an accessible and useful document. REGISTRATION NUMBER PROSPERO: CRD42019111564.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-31505861

RESUMO

Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to these patients. To expand useful knowledge in the field, more sophisticated telerehabilitation interventions must be developed and appraised, but first and foremost, thoroughly described. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the >C☺PD-Life>> programme, within the bounds of the checklist of Template for Intervention Description and Replication (TIDieR). Approach: >C☺PD-Life>> is a telerehabilitation programme for COPD patients delivered as a study intervention by an interprofessional team of clinicians collaborating from both the hospital and the municipal healthcare system. Making use of two-way audio and visual communication software, 15 patients participated in the intervention via a tablet computer from their private setting. The programme was a six-month-long empowerment-based rehabilitation that aimed to support COPD patients in leading a satisfactory and confident life with appropriate physical activity and high disease management. Conclusions: A long-term interprofessional cross-sectoral telerehabilitation programme has been justified and described. The intervention was tested in 2017-2018 and the qualitative appraisal, along with an analysis of case-based measurements of development in physical capacity, COPD Assesment Test, and health management, is currently under production.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida/psicologia , Telerreabilitação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Doença Pulmonar Obstrutiva Crônica/psicologia , Autoimagem
5.
BMC Complement Altern Med ; 19(1): 239, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484521

RESUMO

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is one global disease. Lung function gradually declines. Medication does not fully reverse the airflow limitation. Qigong's role in COPD rehabilitation has been assessed. We aimed to assess the effects of Qigong practised by COPD patients. METHODS: Eligible articles were obtained through a systematic search. The databased were search on October 8, 2017, and the date range of the searches in the electronic databases had no upper limit. The Cochrane risk-of-bias tool was used to evaluate the quality of the eligible studies. Mean differences with 95% confidence intervals were utilized to analyse the results. RESULTS: Ten included studies contained 993 participants. Statistical improvements occurred in the 6-min walk distance (6MWD) (MD, 30.57 m; 95% CI, 19.61-41.53 m; P < 0.00001); forced expiratory volume in 1 s (FEV1) (MD, 0.32 L; 95% CI, 0.09-0.56 L; P < 0.001); forced vital capacity rate of 1 s (FEV1/FVC) (MD, 2.66%; 95% CI, 1.32-2.26%; P = 0.0001); forced expiratory volume in 1 s/predicted (FEV1/pre) (MD, 6.04; CI, 2.58-9.5; P = 0.006); Monitored Functional Task Evaluation (MD, 0.88; 95% CI, 0.78-0.99; P < 0.00001); COPD Assessment Test for exercise (MD, - 5.54; 95% CI, - 9.49 to - 1.59; P = 0.006); Short Form-36 Health Quality Survey (SF-36)-General Health (MD, 5.22; 95% CI, 3.65-6.80; P < 0.00001); and Short Form-36 Health Quality Survey (SF-36)-Mental Health (MD, - 1.21; 95% CI, - 2.75 to 0.33; P = 0.12). CONCLUSIONS: In this meta-analysis of RCTs between ten included studies, we found that Qigong can improve COPD patients in lung function, exercise capacity and quality of life who were in the stable stage.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Qigong , Idoso , Humanos , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Teste de Caminhada , Caminhada/fisiologia
6.
Fisioter. Pesqui. (Online) ; 26(3): 275-284, jul.-set. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039892

RESUMO

ABSTRACT This study sought to quantify and qualitatively analyze the perception of physical therapists about facilitators and the challenges in the use of different types of tools for resistance training in chronic obstructive pulmonary disease (COPD) patients. This was a mixed-model study with qualitative analysis developed in a rehabilitation center. Six physical therapists who performed a randomized clinical trial were interviewed. The protocol consisted of the evaluation of three types of resistance training: elastic tubes, elastic bands, and training with conventional weight machines. After completion of the randomized trial, therapists were invited to participate in a focus group to collect qualitative data. Physical therapists also answered a quantitative questionnaire containing closed questions. The main outcome measures were the opinion of physical therapists about the advantages and disadvantages in clinical practice of each of the analyzed tools. The focus group analysis resulted in eight themes: Insecurities regarding load and handling tools, implementation of home-based treatment, improvements of tools, advantages and disadvantages of tools, incidence of injuries with elastic tools, patient's preferences, and particularities of the tools. Physical therapists pointed out different challenges and facilitators for resistance training. Characteristics of the tools such as costs, portability, handling and practicality were cited as factors that influence clinical practice. In the quantitative analysis, no differences were observed when comparing the scores of each instrument. The three tools analyzed are applicable and feasible in the clinical practice of physical therapists; moreover, they present different characteristics and particularities that should be considered, such as cost, clinical applicability, portability and perception of the patient and therapists.


RESUMO O objetivo do estudo foi quantificar e analisar qualitativamente a percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com doença pulmonar obstrutiva crônica (DPOC). O método utilizado foi desenvolvido em um centro de reabilitação. Seis fisioterapeutas que participaram como terapeutas de um ensaio clínico randomizado foram entrevistados. O protocolo consistiu na avaliação de três ferramentas para treinamento resistido: tubos elásticos, bandas elásticas e treinamento convencional com equipamentos de musculação. Depois da finalização do ensaio clínico randomizado, os fisioterapeutas foram convidados a participar de um grupo focal para análise qualitativa e responder questionário fechado para análise quantitativa. Os profissionais opinaram sobre vantagens e desvantagens de cada uma das três ferramentas na prática clínica. A análise do grupo focal resultou em oito temas: insegurança em relação à carga e manuseio das ferramentas; implementação de tratamento domiciliar; melhorias para ferramentas; vantagens e desvantagens das ferramentas; incidência de lesões com ferramentas elásticas; preferência dos pacientes; e particularidades de cada ferramenta. Fisioterapeutas apontaram diferentes barreiras e facilitadores para o treinamento resistido. Características das ferramentas - como custo, portabilidade, manuseio, praticidade e percepção do paciente e fisioterapeuta - foram citadas como fatores que influenciam a prática clínica. Na análise quantitativa, nenhuma diferença foi observada quando comparados os escores para cada instrumento. As três ferramentas são aplicáveis na prática clínica do fisioterapeuta. Adicionalmente, as características e particularidades de cada uma delas devem ser consideradas.


RESUMEN El objetivo del estudio fue cuantificar y analizar cualitativamente la percepción de fisioterapeutas sobre facilitadores y barreras en el uso de diferentes herramientas de entrenamiento de resistencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). El método utilizado fue desarrollado en un centro de rehabilitación. Seis profesionales que participaron como terapeutas en un ensayo clínico aleatorizado fueron entrevistados. El protocolo consistió en la evaluación de tres herramientas de entrenamiento de resistencia: tubos elásticos, bandas elásticas y entrenamiento convencional con equipo de entrenamiento con pesas. Después del ensayo clínico aleatorizado, se invitó a los fisioterapeutas a participar en un grupo focal para análisis cualitativo y a responder un cuestionario cerrado para análisis cuantitativo. Los profesionales opinaron sobre las ventajas y desventajas de cada una de las tres herramientas en la práctica clínica. El análisis del grupo resultó en ocho temas: falta de fiabilidad en lo referente a la carga y al manejo de las herramientas; puesta en práctica del tratamiento domiciliario; mejoras en las herramientas; ventajas y desventajas de las herramientas; incidencia de lesiones con las herramientas elásticas; preferencia de los pacientes; particularidades de cada herramienta. Los fisioterapeutas señalaron diferentes barreras y facilitadores para el entrenamiento de resistencia. Características de la herramienta - como costo, portabilidad, manejo, practicidad y percepción del paciente y del fisioterapeuta - fueron mencionadas como factores que influyen en la práctica clínica. En el análisis cuantitativo no se observaron diferencias de puntaje entre los instrumentos. Las tres herramientas son aplicables en la práctica clínica del fisioterapeuta. Además, se deben considerar las características y particularidades de cada una de ellas.


Assuntos
Humanos , Adulto , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Inquéritos e Questionários , Pesquisa Qualitativa , Treinamento de Resistência , Fisioterapeutas
7.
Tuberk Toraks ; 67(2): 116-123, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414642

RESUMO

Introduction: Pulmonary rehabilitation (PR) is well-proven approach on improving dyspnea, exercise intolerance which are two components of BODE index. But, PR is known to have minimal effect on pulmonary function which is another component of BODE index. There are few studies evaluating PR efficacy by using i-BODE index. Our aim was to evaluate efficacy of PR in patients with chronic obstructive pulmonary disease (COPD) with i-BODE index and to investigate changes in i-BODE index according to GOLD 2011 combined assessment. Materials and Methods: A total of 228 stable COPD patients who completed a comprehensive 8 week duration PR program were enrolled into this retrospective study. Result: The patients were with mean age of 63.3 ± 8.6 years and mean FEV1% was 38.6 ± 16.2%. According to combined assessment of COPD, 23 patients were group A, 30 patients were B, 31 patients were C and 144 patients were D. Baseline i-BODE scores correlated with body compositions, pulmonary function, dyspnea, exercise capacity, psychological status, quality of life, and age. i-BODE index score decreased from 4.7 ± 2.2 to 3.5 ± 1.8 after PR (p<0.001), improved by 26%. Significant improvements were found in dyspnea, quality of life and i-BODE index in more symptomatic patients (group B and D). Conclusions: This study highlights that changes in i-BODE scores after PR significantly correlated with improvements in dyspnea, exercise capacity and quality of life. i-BODE score could be a better predictor of efficacy of PR than some individual variables such as BMI or FEV1. Significant improvements in dyspnea sensation, quality of life and i-BODE index could be seen symptomatic patients in after PR.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Índice de Gravidade de Doença , Fatores Etários , Idoso , Composição Corporal , Índice de Massa Corporal , Dispneia/fisiopatologia , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários
8.
Arq Bras Cir Dig ; 32(2): e1439, 2019 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460599

RESUMO

BACKGROUND: Abdominal disorders can alter respiratory function and increase the morbidity and mortality of patients with chronic obstructive pulmonary disease. AIM: To improve the physiotherapeutic and muscular capacity in chronic obstructive pulmonary muscular inspiration in the preoperative preparation in abdominal surgeries. METHOD: Retrospective and documentary study using SINPE © , clinical database software of patients with chronic obstructive pulmonary disease and candidates to abdominal operation. The sample consisted of 100 men aged 55-70 years, all with chronic obstructive pulmonary disease who underwent preoperative physiotherapeutic treatment. They were divided into two groups of 50 individuals (group A and group B). In group A the patients were treated with modern mobility techniques for bronchial clearance and the strengthening of the respiratory muscles was performed with IMT ® Threshold. In group B the treatment performed for bronchial obstruction was with classic maneuvers and for the strengthening of the respiratory muscles for flow incentive was used Respiron ® . RESULTS: Both groups obtained improvement in the values ​​of the PiMáx after the different treatments. Group A obtained greater change in the intervals and a more significant increase of the values of the PiMax in relation to the average pre and post-treatment. However, when analyzing the variance and the standard deviation of the samples, group B presented the best results showing more homogeneity. CONCLUSIONS: The modern and traditional bronchial clearance techniques associated with inspiratory muscle training were equally effective in gaining inspiratory muscle strength with increased Pmax. In this way, the two can be used in the preoperative preparation of patients with chronic obstructive pulmonary disease and referred to abdominal operations.


Assuntos
Exercícios Respiratórios/métodos , Procedimentos Cirúrgicos do Sistema Digestório , Cuidados Pré-Operatórios/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/reabilitação , Testes de Função Respiratória , Estudos Retrospectivos , Software , Espirometria
9.
Respir Res ; 20(1): 166, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340825

RESUMO

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and cardiovascular disease is a major cause of death in COPD. The current literature indicates that changes in cardiovascular risk during pulmonary rehabilitation (assessed using aortic stiffness) are heterogeneous suggesting that there may be sub-groups of patients who do and do not benefit. OBJECTIVES: To investigate the characteristics of COPD patients who do and do not experience aortic stiffness reduction during pulmonary rehabilitation, examine how changes relate to physical activity and exercise capacity, and assess whether changes in aortic stiffness are maintained at 6 weeks following rehabilitation. METHODS: We prospectively measured arterial stiffness (aortic pulse-wave velocity), exercise capacity (Incremental Shuttle Walk Test) and physical activity (daily step count) in 92 COPD patients who started a six week pulmonary rehabilitation programme, 54 of whom completed rehabilitation, and 29 of whom were re-assessed six weeks later. RESULTS: Whilst on average there was no influence of pulmonary rehabilitation on aortic stiffness (pre- vs. post pulse-wave velocity 11.3 vs. 11.1 m/s p = 0.34), 56% patients responded with a significant reduction in aortic stiffness. Change in aortic stiffness (absolute and/or percentage) during rehabilitation was associated with both increased physical activity (rho = - 0.30, p = 0.042) and change in exercise capacity (rho = - 0.32, p = 0.02), but in multivariable analysis most closely with physical activity. 92% of the responders who attended maintained this response six weeks later. CONCLUSION: Elevated aortic stiffness in COPD is potentially modifiable in a subgroup of patients during pulmonary rehabilitation and is associated with increased physical activity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03003208. Registered 26/12/ 2016.


Assuntos
Aorta/fisiopatologia , Exercício/fisiologia , Volume Expiratório Forçado/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Rigidez Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Análise de Onda de Pulso/métodos , Teste de Caminhada/métodos
10.
Int J Nurs Pract ; 25(5): e12745, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31268214

RESUMO

AIM: The review aimed to evaluate the effects of pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: With an increase in published reports on pulmonary rehabilitation, there is a need for a meta-analysis to measure the effects of pulmonary rehabilitation in elderly COPD patients. DESIGN: A systematic review and meta-analysis. DATA SOURCES: The Cochrane library (Issue 4, 2018), Web of Science (1975 to April 2018), Embase (1974 to April 2018), Pubmed (1966 to April 2018), CINAHL (1982 to April 2018), JBI (The Joanna Briggs Institute) (1996 to April 2018), CNKI (China National Knowledge Infrastructure) (1979 to April 2018), CBM (SinoMed) (1982 to April 2018), and Wanfang Data (1900 to April 2018) were searched. REVIEW METHODS: Six outcome indicators were utilized for the effects of pulmonary rehabilitation. Two reviewers selected trials, evaluated the quality, and extracted data. Meta-analysis was performed by using the RevMan 5.3 software. RESULTS: Eight studies recruited 414 elderly patients. Pulmonary rehabilitation resulted in significantly improved exercise capacity and quality of life in elderly people but with no influence on oxygen saturation compared with the control group. CONCLUSION: There is a need to provide more detailed pulmonary rehabilitation programs for elderly patients with COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Tolerância ao Exercício , Volume Expiratório Forçado , Humanos , Oxigênio/sangue , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Capacidade Vital
11.
Medicine (Baltimore) ; 98(27): e16299, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277166

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has the characteristics of high incidence, mortality, disability rate, and heavy economic burden. Symptomatic measures such as anti-inflammatory, antispasmodic and anti-asthmatic are widely used in the treatment of COPD, and pulmonary rehabilitation has not been fully utilized. It is reported that up to 10 different kinds of Traditional Chinese exercises (TCEs) are often used for treating stable COPD. There are many randomized controlled trials (RCTs) and systematic reviews that have evaluated the efficacy of various TCEs for COPD. However, most of these studies were designed in comparison with conventional western medicine or health education. There are rarely studies to compare different TCEs head to head. Therefore, there remains uncertainty regarding the comparative efficacy among different TCEs. Thus, we plan to conduct a systematic review and Network meta-analysis (NMA) to compare the efficacy among 5 different TCEs and rank their benefits relative to each other. It is hoped that the findings of this study will facilitate the management and application of TCEs in the treatment of COPD. METHODS: A systematic and comprehensive literature search will be performed from inception to April 2019 in both English and Chinese databases, involving Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database, and Chongqing VIP information. RCTs related to TCE in the treatment of COPD will be included. Quality of included trials will be assessed according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the certainty of the evidence of estimates derived from NMA. Data analysis will be conducted by using STATA 14.0. RESULTS: This systematic review and NMA aims to summarize the direct and indirect evidence for different kinds of TCEs and to rank these TCEs. The findings of this NMA will be reported according to the PRISMA-NMA statement. The results of the NMA will be submitted to a peer-reviewed journal once completed. CONCLUSION: Using NMA, this study will provide an evidence profile which will be helpful to inform the selection of TCE for treating patients with COPD. The results will inform clinicians, bridge the evidence gaps, and identify promising TCE for future trials. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42019132970.


Assuntos
Terapia por Exercício , Medicina Tradicional Chinesa , Doença Pulmonar Obstrutiva Crônica/reabilitação , China , Humanos
12.
J Cardiothorac Surg ; 14(1): 132, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277671

RESUMO

BACKGROUND: Pulmonary rehabilitation programme for lung surgery patients can reduce the risk of post-operative complications but compliance to programmes can be limited by access to health care. We developed a home-based rehabilitation app and tested its feasibility in patients undergoing lung resection surgery. METHODS: A cohort study was conducted over 18 months at a regional thoracic unit. The Fit 4 Surgery app included ten exercises. Patients were instructed to exercise for at least three minutes for each exercise. Data was transmitted back to the researchers remotely. Data was also collected from a contemporaneous group of surgery patients who attended local outpatient-based Chronic Obstructive Pulmonary Disease rehabilitation classes. Quality of Life and outcomes data in the app group were collected. Patients were also interviewed about their experience of the app. RESULTS: App patients had a shorter wait before surgery compared to patients attending rehabilitation classes (24 vs 45 days) but managed four times as many sessions (2 vs 9), improving incremental shuttle walk test distance by 99 ± 83 (p < 0.05) metres before surgery. Five themes were gathered from the interviews. CONCLUSION: An app based programme of rehabilitation can be delivered in a timely fashion to lung surgery patients with demonstrable physiological benefits; this will need to be confirmed in further clinical trials. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN00061628. Registered 27 May 2011.


Assuntos
Terapia por Exercício , Aplicativos Móveis , Pneumonectomia/reabilitação , Idoso , Biorretroalimentação Psicológica , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/reabilitação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Tempo para o Tratamento , Teste de Caminhada
13.
Int J Chron Obstruct Pulmon Dis ; 14: 1033-1043, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190788

RESUMO

Background: COPD is a common cause of morbidity and mortality. The aim of this study was to explore patients' experiences, self-reported needs, and needs-driven strategies to cope with self-management of COPD. Patients and methods: In this phenomenological study, 10 participants with mild to severe COPD were interviewed 1-2 times, until data saturation was reached. In total, 15 in-depth interviews were conducted, recorded, transcribed, and analyzed. Results: COPD negatively affected participants' physical and psychosocial well-being, their family relationships, and social life. They described their experiences of COPD like fighting a war without weapons in an ever-shrinking world with a loss of freedom at most levels, always fearing possible breathlessness. Fourteen needs were identified and eight clusters of needs-driven strategies that participants used to cope with self-management of COPD. Coping with the reality of COPD, a life-threatening disease, meant coping with dyspnea, feelings of suffocation, indescribable smoking addiction, anxiety, and lack of knowledge about the disease. Reduced participation in family and social life meant loss of ability to perform usual and treasured activities. Having a positive mindset, accepting help and assuming healthy lifestyle was important, as well as receiving continuous professional health care services. The participants' needs-driven strategies comprised conducting financial arrangements, maintaining hope, and fighting their smoking addiction, seeking knowledge about COPD, thinking differently, facing the broken chain of health care, and struggling with accepting support. Procrastination and avoidance were also evident. Finally, the study also found that participants experienced a perpetuating cycle of dyspnea, anxiety, and fear of breathlessness due to COPD which could lead to more severe dyspnea and even panic attacks. Conclusion: COPD negatively affects patients' physical and psychosocial well-being, family relationships and, social life. Identifying patients' self-reported needs and needs-driven strategies can enable clinicians to empower patients by educating them to improve their self-management.


Assuntos
Adaptação Psicológica , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Autocuidado , Idoso , Efeitos Psicossociais da Doença , Relações Familiares , Feminino , Volume Expiratório Forçado , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Participação do Paciente , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Comportamento de Redução do Risco , Fumar/efeitos adversos , Fumar/psicologia , Abandono do Hábito de Fumar , Comportamento Social
14.
BMC Pulm Med ; 19(1): 116, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242944

RESUMO

BACKGROUND: With rising medical costs, stakeholders and healthcare professionals are exploring community-based solutions to relieve the burden of chronic diseases and reduce health care spending. The community health worker (CHW) model is one example that has proven effective in improving patient outcomes globally. We sought to systematically describe the effectiveness of community health worker interventions in improving patient reported outcomes and reducing healthcare utilization in the adult asthma and chronic obstructive pulmonary disease (COPD) populations in the U.S. METHODS: Studies were included if they were a randomized control trial or involved a pre-post intervention comparison with clearly stated disease specific outcomes, targeted adult patients with asthma or COPD, and were performed in the United States. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria and was registered with PROSPERO. RESULT: The search yielded 4013 potential articles, of which 47 were chosen for full-text review and 4 were chosen for inclusion; all focused on asthma and three had a comparison group. CHW interventions demonstrated improvement in asthma-related quality of life, asthma control, home trigger scores, and asthma symptom free days. There were no studies that reported COPD specific outcomes as a result of CHW interventions. CONCLUSION: Emerging evidence suggests CHW interventions may improve some aspects of asthma related disease burden in adults, however additional studies with consistent outcome measures are needed to confirm their effectiveness. Further research is also warranted to evaluate the use of community health workers in the COPD population.


Assuntos
Asma/reabilitação , Serviços de Saúde Comunitária/métodos , Agentes Comunitários de Saúde , Doença Pulmonar Obstrutiva Crônica/reabilitação , Adulto , Asma/economia , Serviços de Saúde Comunitária/organização & administração , Humanos , Medidas de Resultados Relatados pelo Paciente , Doença Pulmonar Obstrutiva Crônica/economia , Qualidade de Vida , Estados Unidos
15.
BMJ ; 365: l2191, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208954

RESUMO

Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.


Assuntos
Reabilitação Cardíaca/economia , Doença Crônica/economia , Doença Crônica/reabilitação , Custos de Cuidados de Saúde , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Humanos , Doença Pulmonar Obstrutiva Crônica/economia , Melhoria de Qualidade , Estados Unidos
16.
Adv Respir Med ; 87(2): 77-82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038717

RESUMO

INTRODUCTION: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. MATERIAL AND METHODS: This three-group randomized controlled clinical trial was conducted in 2017-2018 in Velayat hospital, Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. RESULTS: Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically significant (p > 0.05). CONCLUSION: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitation technique for these patients.


Assuntos
Exercícios Respiratórios/métodos , Terapia por Exercício/métodos , Resistência Física/fisiologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Caminhada/fisiologia , Adulto , Exercício/fisiologia , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Teste de Caminhada
17.
PLoS One ; 14(5): e0217157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31107900

RESUMO

OBJECTIVES: Physical activity is key to improve the prognosis of chronic obstructive pulmonary disease (COPD). To help to tailor future interventions we aimed to identify the baseline characteristics of COPD patients which predict 12-month completion and response to a behavioral physical activity intervention. METHODS: This is a 12-month cohort study of the intervention arm of the Urban Training randomized controlled trial (NCT01897298), an intervention proven to be efficacious to increase physical activity. We considered baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics as potential determinants of completion and response. We defined completion as attending the 12-month study visit. Among completers, we defined response as increasing physical activity ≥1100 steps/day from baseline to 12 months, measured by accelerometer. We estimated the factors independently for completion and response using multivariable logistic regression models. RESULTS: Of a total of 202 patients (m (SD) 69 (9) years, 84% male), 132 (65%) completed the study. Among those, 37 (28%) qualified as responders. Higher numbers of baseline steps/day (OR [95% CI] 1.11 [1.02-1.21] per increase of 1000 steps, p<0.05) and living with a partner (2.77 [1.41-5.48], p<0.01) were related to a higher probability of completion while more neighborhood vulnerability (0.70 [0.57-0.86] per increase of 0.1 units in urban vulnerability index, p<0.01) was related to a lower probability. Among the completers, working (3.14 [1.05-9.33], p<0.05) and having an endocrino-metabolic disease (4.36 [1.49-12.80], p<0.01) were related to a higher probability of response while unwillingness to follow the intervention (0.21 [0.05-0.98], p<0.05) was related to a lower probability. CONCLUSIONS: This study found that 12-month completion of a behavioral physical activity intervention was generally determined by previous physical activity habits as well as interpersonal and environmental physical activity facilitators while response was related to diverse factors thought to modify the individual motivation to change to an active lifestyle.


Assuntos
Terapia Comportamental , Terapia por Exercício , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Idoso , Feminino , Humanos , Estilo de Vida , Masculino , Estudos Prospectivos , Autocuidado
18.
Artigo em Russo | MEDLINE | ID: mdl-31095126

RESUMO

BACKGROUND: The efficiency of the application of normobaric interval hypoxic therapy and enteral oxygen therapy for the treatment of the patients suffering from chronic obstructive pulmonary disease remains to be confirmed. AIM: The objective of the present study was the identification of the pathophysiological mechanisms responsible for the efficiency of normobaric interval hypoxic therapy and enteral oxygen therapy in the patients presenting with a chronic obstructive pulmonary disease. MATERIAL AND METHODS: A total of 230 patients at the age from 45 to 60 years were examined. All of them presented with chronic obstructive pulmonary disease (COPD). 150 patients were given a course of normobaric interval hypoxic therapy and enteral oxygen therapy while the remaining 80 ones constituted the control group. RESULTS: It was shown that the combined application of normobaric interval hypoxic therapy and enteral oxygen therapy provided an effective tool for the correction of the health status in the patients with chronic obstructive pulmonary disease. This method allowed to improve arterial blood supply with oxygen, increase the blood hemoglobin level and its oxygen capacity, augment oxygen tension and content in the arterial blood. The combination of the intake of oxygen cocktails and hypoxic therapy resulted in the improvement of metabolic processes in the lungs manifested as the alteration in the characteristics of the condensate of the exhaled air. The decrease in the content of malondialdehyde gave evidence of the reduction of lipid peroxidation while the enhanced activities of glutathione peroxidase and superoxide dismutase in blood confirmed the activation of the antioxidant system. The improved oxygen supply at all stages of its mass transfer along with the resulting improvement of oxygen utilization by the tissues was responsible for the reduction of hypoxia in the bronchial tree and lung tissue. CONCLUSION: The present study confirmed the high effectiveness of the combined application of normobaric interval hypoxic therapy and enteral oxygen therapy for the rehabilitation of the patients presenting with chronic obstructive pulmonary disease.


Assuntos
Oxigênio/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/reabilitação , Terapia Combinada , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Br J Health Psychol ; 24(3): 515-546, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31033121

RESUMO

PURPOSE: To systematically review the evidence for health coaching as an intervention to improve health-related quality of life (HRQoL) and reduce hospital admissions in people with chronic obstructive pulmonary disease (COPD). METHODS: We systematically searched MEDLINE, EMBASE, PsycINFO, and CINAHL from database inception to August 2018 to identify all randomized controlled trials (RCTs) of health coaching for people with COPD. Eligible health coaching interventions had to include three components: goal setting, motivational interviewing, and COPD-related health education. Data were extracted on study characteristics and the effects of the intervention on HRQoL, hospital admissions, physical activity, self-care behaviour, and mood. Study quality was appraised by two authors using the Cochrane tool for assessing the risk of bias in RCTs. Effect sizes (standardized mean differences [SMD] or odds ratios [OR]) with 95% confidence intervals (CIs) were calculated and pooled using random effects meta-analyses. RESULTS: Of 1578 articles, 10 RCTs were included. Meta-analysis showed that health coaching has a significant positive effect on HRQoL (SMD = -0.69, 95% CI: -1.28, -0.09, p = .02, from k = 4) and leads to a significant reduction in COPD-related hospital admissions (OR = 0.46, 95% CI: 0.31, 0.69, p = .0001, from k = 5), but not in all-cause hospital admissions (OR = 0.70, 95% CI: 0.41-1.12, p = .20, from k = 3). Three of four studies reported significant improvements to self-care behaviours such as medication adherence and exercise compliance. CONCLUSIONS: This is the first systematic review to show that health coaching may be a candidate intervention to improve HRQoL and reduce costly hospital admissions in people with COPD. Statement of contribution What is already known on this subject? COPD is a leading cause of death worldwide and considerably reduces HRQoL. In turn, HRQoL is associated with a range of adverse health outcomes in COPD. Health coaching is a self-management intervention for people with long-term conditions such as COPD. Studies have examined whether health coaching improves HRQOL and other health outcomes in people with COPD, but no systematic review has been conducted. What does this study add? The first systematic review and meta-analysis of RCTs of health coaching for people with COPD. Health coaching may be a candidate intervention for improving HRQoL and reducing COPD-related hospital admissions in people with COPD. The need to establish the most effective health coaching components, delivery modality, and economic impact.


Assuntos
Tutoria , Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Exercício , Promoção da Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(4): 275-278, 2019 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-30955285

RESUMO

Objective: To analyze the implementation and understanding of pulmonary rehabilitation in medical personnel at all levels of medical institutions nationwide. Methods: We used WeChat and e-channels to disseminate e-questionnaires including personal basic information and the implementation of hospital pulmonary rehabilitation (including the setting up of hospital rehabilitation, pulmonary rehabilitation-related treatment, and the composition of pulmonary rehabilitation teams), and awareness of pulmonary rehabilitation (including doctors' understanding of lung rehabilitation status, pathways, prospects, and obstacle factors). Finally, the analysis of the data was performed using SPSS 20.0 for statistical analysis. The frequency distribution and composition ratio were used to describe the distribution of each question item. Comparison among groups according to the unit level of the respondents was performed by chi-square test. P<0.05 was considered statistically significant. Results: A total of 921 medical staff from all over the country completed the survey, covering the entire country including Taiwan Province and a total of 32 provinces, municipalities, autonomous regions, and municipalities directly under the Central Government. 88.1% of medical personnel reported that their hospitals had rehabilitation departments, the difference being statistically significant (P=0.001). Doctors could understand that the most important ways of pulmonary rehabilitation knowledge were the following: expert lectures (559, 60.69%), professional literature (541, 58.74%), professional books (442, 47.99%), pulmonary rehabilitation conference (392, 42.56%), the difference being statistically significant (all P<0.05).Among the factors that impeded the implementation of pulmonary rehabilitation, the top four were lack of talent (690, 74.92%), lack of education (645, 70.03%), lack of policy support (603, 65.47%), and lack of related equipments (578, 62.76%). Conclusions: The lower the level of the hospitals, the poor the implementation and cognitive status of pulmonary rehabilitation. Promoting the training of pulmonary rehabilitation personnel and strengthening the academic exchange of pulmonary rehabilitation were good ways to strengthen the implementation of pulmonary rehabilitation and improve the understanding of pulmonary rehabilitation.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Hospitais de Reabilitação , Doença Pulmonar Obstrutiva Crônica/reabilitação , China , Humanos , Inquéritos e Questionários
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