Background and objective
The benefits of pulmonary rehabilitation (PR) are now firmly established. However, less is known about the provision and efficacy of PR immediately after an acute ...exacerbation of chronic obstructive pulmonary disease (COPD). The study aimed to explore the effectiveness of a short outpatient PR programme and the impact upon readmission rates.
Methods
One hundred sixty (87 males) patients, mean (SD) age 70.35 (8.59) years, forced expiratory volume in 1 s 0.99 (0.44) litres were assessed for a 7‐week PR programme following a hospital admission for an acute exacerbation of COPD. Patients were assessed and commenced PR within 4 weeks of discharge from hospital. Outcome measures included: Incremental Shuttle Walking Test (ISWT), Endurance Shuttle Walk Test (ESWT), Chronic Respiratory Questionnaire Self‐Reported (CRQ‐SR). Patients were assessed at baseline and at 7 weeks (after the 4‐week supervised and 3‐week unsupervised components). Readmission data were collected retrospectively for the 12 months pre and post admission (n = 155).
Results
Statistically significant improvements were found in the ISWT, ESWT and CRQ‐SR at discharge (P < 0.05). The number of admission was significantly less in the 12‐month post‐pulmonary rehabilitation compared to the previous 12 months.
Conclusions
A short course of PR showed improvements in exercise capacity and health status in patients who have had an acute exacerbation of COPD. The number of readmissions was also significantly lower in the year following PR.
This is the largest cohort of post‐acute exacerbation rehabilitation to date. Statistically significant improvements were found in exercise capacity and health‐related quality of life. The number of hospital readmissions reduced significantly in the 12 months following PR.
See Editorial, page 1039
Pulmonary rehabilitation (PR) in patients with COPD has consistently been shown to produce benefits in exercise capacity, symptoms, and health status. The data surrounding survival following PR are ...less clear. Our aims were to compare the long-term survival in two cohorts of patients referred for PR; those who successfully completed PR, and a comparator group constructed from patients who either did not complete PR or did not start the program. Additionally, we compared survival between those people who were able to achieve a clinically meaningful improvement in exercise capacity (incremental shuttle walking test) following PR with those who were not.
A retrospective longitudinal analysis of clinical service outcomes was conducted to compare the long-term survival in "completers" and "non-completers" of rehabilitation at two hospitals within the University Hospitals of Leicester NHS Trust from January 1, 2000 to February 23, 2012. For "completers", we also analyzed survival in those meeting (and not meeting) the desired level of change in the incremental shuttle walking test (≥50 m vs <50 m).
We present to you the largest dataset on this topic (n=1,515). Survival data were ascertained for 823 (54.3%) patients with COPD who had completed a course of PR and for 692 (45.7%) patients who dropped out. Survival time was significantly greater in "completers" compared to "non-completers" of PR (
<0.001). In addition, PR success (≥50 m change in walking distance) was also associated with improved survival (
<0.05).
The data show an association between completion of PR and survival. In addition, PR success (>50 m change in walking distance) was also associated with improved survival.
Background and objective
Patients with interstitial lung disease (ILD) are increasingly being referred to pulmonary rehabilitation (PR) where exercise capacity is measured, often by an incremental ...shuttle walk test (ISWT). These patients are frequently limited by severe dyspnoea and exertional desaturation. Available guidelines suggest two ISWT are needed; however, this is time consuming and it has not been reported whether a practice ISWT is necessary in ILD. We aimed to investigate if a practice ISWT is needed for patients with ILD referred to PR.
Methods
Patients with ILD who attended a PR assessment performed two ISWT as per standard protocol. Hospital notes were retrieved and relevant data extracted and validated. Endurance shuttle walk test (ESWT) level was calculated at 85% VO2 peak as estimated from the first ISWT (ISWT 1) and second ISWT (ISWT 2).
Results
Forty‐three patients were included (18 with idiopathic pulmonary fibrosis). There was a mean change of 28.84 (31.71) m between the two ISWT (P < 0.001) with 72.1% of patients walking further on ISWT 2. A Bland–Altman plot showed good agreement between the ISWTs; however, the limits of agreement were wide. There was a significant difference in ESWT levels (P < 0.001) when calculated from ISWT 1 and ISWT 2. ISWT 1 distance, post‐ISWT 1 heart rate and baseline Borg breathlessness score were significant variables (P < 0.05) in linear regression, but this only explained 42.6% of the variance (R2 0.426).
Conclusions
A practice ISWT is necessary to accurately assess exercise capacity. It was not possible to predict which patients did not need to complete two ISWT.
We investigated if a practice ISWT is necessary for PR in patients with ILD. There was a mean change of 28.84 (31.71) m between the two ISWT (P < 0.001); 72.1% of patients walked further on ISWT 2. A practice ISWT is necessary to accurately assess exercise capacity.
Care bundles may be an effective tool to standardise care for patients admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). However, it is unclear how care bundles can be ...implemented without the need for additional resources. We redeployed a respiratory early discharge service (REDS) to deliver a COPD discharge bundle. We audited the effect of this service redesign on length of stay (LOS) and uptake of referrals to smoking cessation and pulmonary rehabilitation services. Of 1,742 patients with COPD, 1,170 received the discharge care bundle. Mean LOS for patients who received the discharge care bundle was 6.17 days versus 7.08 days for patients who did not. Smoking cessation and pulmonary rehabilitation referrals increased during the project year. A COPD discharge care bundle can be implemented on a large scale by redeploying a REDS without an increase on hospital LOS.
There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management ...manual for individuals with COPD.
Participants with a confirmed diagnosis of COPD were recruited from primary care.
A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks.
The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23-1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47-443.03, P < 0.001).
This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care.
Introduction and objectives
There are various recommendations for physical activity (PA). However agreement between all of these measures has not been established. Furthermore, given the challenges ...of measuring PA there is interest in evaluating whether a measure of exercise performance can be used as a surrogate measure to identify who is likely to achieve the recommendations.
Methods
A total of 184 people with COPD were recruited, 128 of which had complete data for these analyses. Participants wore the SenseWear Armband for 7 consecutive days and all performed an incremental shuttle walk test (ISWT). We extracted moderate to vigorous physical activity (MVPA) in bouts of ≥10 min using a 3 metabolic equivalent (MET) threshold and an individually prescribed MET threshold (based on performance on the ISWT). Average daily step count and the physical activity level were also calculated.
Results
There was poor agreement between the four PA recommendations, with agreement on all four achieved in only 30 participants. People were least likely to be active using MVPA in ≥10 min bouts using 3 MET threshold (21.1% active), and most likely to be active using MVPA in ≥10 min bouts using an individually prescribed threshold (64.9% active). It was not possible to identify a threshold on the ISWT that would reliably predict those that achieved any of the four recommendations.
Conclusion
Agreement between various physical activity recommendations is poor. This should be considered when measuring and describing physical activity adherence. The ISWT cannot be used to reliably predict adherence to physical activity guidelines.
The Canadian Occupational Performance Measure (COPM) is now a widely used and accepted outcome measure for clients with chronic conditions. The aim of this study was to examine the reproducibility of ...the COPM in clients with chronic obstructive pulmonary disease (COPD). Test-retest reliability of the performance and satisfaction scores has yet to be established in this population. The reasons for examining reliability are discussed.
Fifteen clinically stable clients (eight men and seven women, mean age 67.1 years) were interviewed by an occupational therapist and their COPM performance and satisfaction scores recorded. A reassessment of the performance and satisfaction scores then took place about 7 days later. The scores were analysed using the mean difference, 95% confidence intervals and correlation coefficients.
The results were as follows: performance score 1 and performance score 2: mean difference = 0.14 (95% CI: −0.39 to 0.68); and satisfaction score 1 and satisfaction score 2: mean difference = 0.42 (95% CI: −0.18 to 1.01). The intraclass correlation coefficients between test 1 and test 2 were high (r = 0.92 for performance and r = 0.90 for satisfaction). This study indicates that the COPM is a reliable tool in clients with COPD.
This thesis examines the effect of an individually targeted exercise programme when compared to a general exercise programme in patients with Chronic Obstructive Pulmonary Disease (COPD). The effect ...of these programmes upon domestic function and daily activity is also examined.;Initially, the test-retest reliability of the primary measure of domestic function, the Canadian Occupational Performance Measure (COPM) was examined. The COPM was completed in 15 patients with stable COPD. The intra class correlation coefficients were high indicating that the COPM is a reliable measure in patients with COPD.;A large randomised prospective trial was then completed. 185 patients with stable COPD referred for seven-week hospital based, outpatient pulmonary rehabilitation programme, were recruited. A third of these patients (n=61) were initially assigned to a pre treatment group in order to establish the variability of all outcome measures.;Patients were randomly assigned to either a general exercise programme (GEP) (n=90) or an individually targeted exercise programme (ITEP) (n=90). Functional targets for patients in the ITEP were identified using the COPM. Activity monitors measured daily activity. Exercise performance was measured using the Incremental Shuttle Walking Test and the Endurance Shuttle Walk Test and measures of health status were also employed. Both treatment groups made statistically significant improvements in domestic function, exercise performance and health status. However there were no statistically significant differences between the GEP and the ITEP. This study demonstrated that general exercise training is as effective as more complex individually targeted training.;ITEP is no more effective at prolonging the benefits of pulmonary rehabilitation when compared the GEP.
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