Most inspiratory muscle training (IMT) interventions in patients with chronic obstructive pulmonary disease (COPD) have been implemented as fully supervised daily training for 30 minutes with ...controlled training loads using mechanical threshold loading (MTL) devices. Recently, an electronic tapered flow resistive loading (TFRL) device was introduced that has a different loading profile and stores training data during IMT sessions.
The aim of this study was to compare the efficacy of a brief, largely unsupervised IMT protocol conducted using either traditional MTL or TFRL on inspiratory muscle function in patients with COPD.
Twenty patients with inspiratory muscle weakness who were clinically stable and participating in a pulmonary rehabilitation program were randomly allocated to perform 8 weeks of either MTL IMT or TFRL IMT.
Participants performed 2 daily home-based IMT sessions of 30 breaths (3-5 minutes per session) at the highest tolerable intensity, supported by twice-weekly supervised sessions. Adherence, progression of training intensity, increases in maximal inspiratory mouth pressure (Pimax), and endurance capacity of inspiratory muscles (Tlim) were evaluated.
More than 90% of IMT sessions were completed in both groups. The TFRL group tolerated higher loads during the final 3 weeks of the IMT program, with similar effort scores on the 10-Item Borg Category Ratio (CR-10) Scale, and achieved larger improvements in Pimax and Tlim than the MTL group.
A limitation of the study was the absence of a study arm involving a sham IMT intervention.
The short and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups and is an alternative to traditional IMT protocols in this population. Participants in the TFRL group tolerated higher training loads and achieved larger improvements in inspiratory muscle function than those in the MTL group.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Pulmonary rehabilitation (PR) is effective in improving exercise capacity and health-related quality of life (HRQOL) in patients with moderate-to-very-severe COPD. Quadriceps strength and HRQOL can ...be impaired in patients with mild COPD, therefore, patients at this grade may already benefit from PR. However, the impact of PR in patients with mild COPD remains unestablished. Thus, this systematic review assessed the impact of PR on exercise capacity, HRQOL, health-care resource use and lung function in patients with mild COPD.
The Web of Knowledge, EBSCO, MEDLINE, and SCOPUS databases were searched up to April 2013. Reviewers independently selected studies according to the eligibility criteria.
Three studies with different designs (retrospective, one group pretest-posttest, and randomized controlled trial) were included. Out-patient PR programs were implemented in two studies, which included mainly aerobic, strength, and respiratory muscle training. The randomized controlled trial compared a PR home-based program, consisting of 6 months of walking and participating in ball games, with standard medical treatment. Significant improvements in exercise capacity (effect size ES 0.87-1.82) and HRQOL (ES 0.24-0.86) were found when comparing pretest-posttest data and when comparing PR with standard medical treatment. In one study, a significant decrease in hospitalization days was found (ES 0.38). No significant effects were observed on the number of emergency department visits (ES 0.32), number of hospitalizations (ES 0.219), or lung function (ES 0.198).
Most of the PR programs had significant positive effects on exercise capacity and HRQOL in patients with mild COPD; however, their effects on health-care resource use and lung function were inconclusive. This systematic review suggests that patients with mild COPD may benefit from PR; however, insufficient evidence is still available. Studies with robust designs and with longer follow-up times should be conducted.
PURPOSE:Pulmonary rehabilitation (PR) is effective in patients with moderate to severe chronic obstructive pulmonary disease (COPD). However, the effects of PR in patients with mild COPD have not yet ...been established. Thus, this study investigated the short- and long-term effects of PR in patients with mild COPD in comparison with patients with moderate to severe disease.
METHODS:A total of 32 patients with mild (group 1) and 29 with moderate to severe (group 2) COPD completed the study. Both groups participated in a 12-week PR program with exercise training and psychosocial support and education. Outcome measures at baseline, 3 (post-PR), 6, and 9 months later included 6-minute walk test (6MWT); Modified Medical Research Council Dyspnea Scale; 1-repetition maximum chest press and knee extension; a brief physical activity assessment; the number of exacerbations in the past 3 months and the St. George Respiratory Questionnaire (SGRQ).
RESULTS:Improvements in the 6MWT, chest press, knee extension, and physical activity were observed post-PR (P < .001), with no differences between the 2 groups. Reduction in the number of exacerbations (P < .001) and improvements in the SGRQ total (P < .001) were also observed, however, with greater magnitude in group 2 (P = .029 and P < .001, respectively). Except for peripheral muscle strength (P < .002), all the achieved benefits were sustained at 6 and 9 months (P > .05).
CONCLUSIONS:Pulmonary rehabilitation improves exercise tolerance, muscle strength, physical activity, and health-related quality of life and reduces exacerbations in patients with mild COPD as it does in patients with moderate to severe COPD. Moreover, most of these benefits were maintained at 9-month follow-up, suggesting that PR could be part of the management of mild COPD.
Purpose: This systematic literature review aimed to (1) summarize and explain the concept of Burden of Treatment (BoT) using the International Classification of Functioning, Disability and Health ...(ICF) terminology, and (2) inform the development of a future Comprehensive ICF Core Set for BoT.
Method: Searches on EMbase, Medline, CINAHL and PsycINFO were conducted. Only qualitative studies were considered for inclusion. The screening and data extraction stages were followed by a "Best-fit" framework synthesis and content analysis, using the established ICF linking rules. Screening, data extraction, quality appraisal and data analysis were performed by two independent researchers.
Results: Seventeen studies were included in this review. The "Best-fit" framework synthesis generated 179 subthemes which identified that BoT impacts negatively on body functions and structures, restricts valued activities and participation and influences contextual factors through life roles, self-identify and relationships. The identified subthemes were linked to 77 ICF categories.
Conclusions: This study is part of the preparatory phase of a Comprehensive ICF Core Set for BoT and our findings will inform the further needed studies on this phase. The use of ICF terminology to describe BoT provides an accessible route for understanding this complex concept, which is pivotal for rethinking clinical practice.
Implications for rehabilitation
Health professionals applying the ICF should consider the negative impact of interventions on patient's life roles and self-identity, body functions and structures and on valued activities and participation.
Health professionals who may be concerned about the treatment burden being experienced by their patients can now use the ICF terminology to discuss this with the multidisciplinary team.
Poor adherence to rehabilitation programs may be explained by an increased BoT. This phenomenon can now be mapped to the ICF, and coded using a framework well known by multidisciplinary teams.
BACKGROUND Involving family as part of the patient's rehabilitation plan of care might enhance the management of COPD. The primary aim of this study was to investigate the impact of a family-based ...pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. METHODS Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional (control) PR. Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength, and health-related quality of life were also measured. All measures were collected pre/post-program. RESULTS Forty-two dyads participated (patients: FEV1 , 70.4% ± 22.1% predicted). Patients ( P = .048) and family members ( P = .004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships ( P = .026) and in psychologic distress ( P = .033) compared with the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength, and health-related quality of life after intervention ( P < .001). CONCLUSIONS This research supports family-based PR programs to enhance coping and psychosocial adjustment to illness of the family system. TRIAL REGISTRY ClinicalTrials.gov ; No.: NCT02048306; URL: www.clinicaltrials.gov
There is a need to develop simple, noninvasive, and sensitive outcome measures for respiratory therapy. Adventitious respiratory sounds (ie, crackles and wheezes) can be objectively characterized ...with computerized respiratory sound analysis (CORSA) and have been shown to contribute for diagnosis purposes; however, their potential for use as outcome measures is unknown. Thus, this systematic review synthesizes the evidence on the use of computerized adventitious respiratory sounds as outcome measures.
The Web of Knowledge, MEDLINE, EMBASE, and SCOPUS databases were searched. Reviewers independently selected studies according to the eligibility criteria. Effect sizes and 95% CIs were computed.
Twelve studies with different designs (observational, n = 3; quasi-experimental n = 7; and randomized controlled trial, n = 2) were included. Eight studies were conducted with adults, and 4 studies with children. Most studies explored only one type of adventitious respiratory sound. For wheezes, the occupation rate seemed to be the most promising parameter to be used as an outcome measure, with high/medium effect sizes (0.62-1.82). For crackles, the largest deflection width showed high effect sizes (1.31 and 1.04); however, this was explored in only one study. Crackle number and 2-cycle duration presented conflicting information, with high/poor effect sizes depending on the study.
Specific variables of each adventitious respiratory sound detected and characterized by CORSA showed high effect sizes and, thus, the potential to be used as outcome measures. Further research with robust study designs and larger samples (both of children and adult populations), and following CORSA guidelines is needed to build evidence-based knowledge on this topic.
We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, ...observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (
= 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (
= 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (
= 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (
= 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (
< 0.001). Class 3 (
= 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (
= 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
Pulmonary rehabilitation (PR) is a core component of the management of patients with moderate-to-very-severe COPD. However, as impairments in quadriceps muscle strength and health-related quality of ...life (HRQOL) are already present in patients with mild COPD, there is a need to investigate whether PR could also be beneficial to these patients. Thus, this study assessed the impact of PR on patients with mild COPD.
A quasi-experimental study was conducted. Twenty-six participants (67.8 ± 10.3 years old; FEV1 83.8 ± 6.4% of predicted) enrolled in a 12-week PR program with exercise training and psychoeducation. Lung function was assessed by spirometry, dyspnea with the Modified Medical Research Council questionnaire, functional balance with the Timed Up and Go test, muscle strength with 10-repetition maximum testing, exercise tolerance with the 6-min walk test, emotional state with the Depression Anxiety Stress Scales, and HRQOL with the St George Respiratory Questionnaire (SGRQ).
Significant effects were observed on participants' dyspnea (P = .003, effect size ES = 0.7), functional balance (P < .001, ES = 0.8), shoulder flexor/knee extensor strength (P < .001, ES = 1.2-1.3), and exercise tolerance (P < .001, ES = 0.5). With the exception of the SGRQ impact score, the symptom (P < .001, ES = 0.6), activity (P = .02, ES = 0.4), and total (P = .005, ES = 0.3) scores improved significantly after PR. The PR program had no significant effect on participants' lung function and emotional state.
Patients with mild COPD benefit from PR and could therefore be routinely included in these programs. Studies with more robust designs and with long-term follow-ups are needed to inform guidelines for PR in mild COPD.
Patients with asthma often consider their symptomatology a barrier to exercise, leading to a reduced physical activity level. This study aims to determine whether the effect of a Nordic walking (NW) ...training program plus education and usual care is superior to educational and usual care only, in terms of exercise tolerance and other health-related outcomes in patients with asthma. The second aim is to explore the patients' experience with the NW program.
A randomized controlled trial will be conducted with 114 adults with asthma recruited in sanitary area of A Coruña, Spain. Participants will be randomized to NW or control groups in blocks of six and in the same proportion in each group. Participants in the NW group will enrol in supervised sessions during eight weeks, three times/week. All participants will receive three educational sessions on asthma self-management plus usual care (S1 Appendix). Outcomes such as exercise tolerance (primary outcome), physical activity level, asthma-related symptoms and asthma control, dyspnea, lung function, handgrip strength, health related quality of life, quality of sleep, treatment adherence and healthcare resources use will be measured pre and postintervention, and at three and six months of follow-up. Participants in the NW group will additionally participate in focus groups.
This is the first study analysing the effect of NW in patients with asthma. NW combined with education and usual care is expected to improve exercise tolerance, but also asthma-related outcomes. If this hypothesis is confirmed, a new community-based therapeutic approach will be available for patients with asthma.
Study registered in ClinicalTrials.gov with number of register NCT05482620.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Computerized respiratory sound analysis provides objective information about the respiratory system and may be useful to monitor patients with chronic obstructive pulmonary disease (COPD) ...and detect exacerbations early. For these purposes, a thorough understanding of the typical computerized respiratory sounds in patients with COPD during stable periods is essential. This review aimed to systematize the existing evidence on computerized respiratory sounds in stable COPD. A literature search in the Medline, EBSCO, Web of Knowledge and Scopus databases was performed. Seven original articles were included. The maximum frequencies of normal inspiratory sounds at the posterior chest were between 113 and 130Hz, lower than the frequency found at trachea (228 Hz). During inspiration, the frequency of normal respiratory sounds was found to be higher than expiration (130 vs. 100Hz). Crackles were predominantly inspiratory (2.9-5 vs. expiratory 0.73-2) and characterized by long durations of the variables initial deflection width (1.88-2.1 ms) and two cycle duration (7.7-11.6 ms). Expiratory wheeze rate was higher than inspiratory rate. In patients with COPD normal respiratory sounds seem to follow the pattern observed in healthy people and adventitious respiratory sounds are mainly characterized by inspiratory and coarse crackles and expiratory wheezes. Further research with larger samples and following the Computerized Respiratory Sound Analysis (CORSA) guidelines are needed.
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