Chronic Respiratory Questionnaire Mastery Research Articles

Cost-Effectiveness of a Specialized Breathlessness Service Versus Usual Care for Patients With Advanced Diseases

ObjectivesThe Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal perspective. MethodsData included generic (5-level version of EQ-5D) health-related quality of life and disease-specific CRQ Mastery. Quality-adjusted life years (QALYs) were calculated based on 5-level version of EQ-5D utilities valued with German time trade-off. Direct medical costs and productivity loss were calculated based on standardized unit costs. Incremental cost-effectiveness ratios (ICER) and cost-effectiveness–acceptance curves were calculated using adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) and performing 1000 simultaneous bootstrap replications. Potential gender differences were investigated in stratified analyses. ResultsBetween March 2014 and April 2019, 183 eligible patients were enrolled. MBS intervention demonstrated significantly better effects regarding generic (AMD of QALY gains of 0.004, 95% confidence interval [CI] 0.0003 to 0.008) and disease-specific health-related quality of life at nonsignificantly higher costs (AMD of €605 [95% CI −1109 to 2550]). At the end of the intervention, the ICER was €152 433/QALY (95% CI −453 545 to 1 625 903) and €1548/CRQ Mastery point (95% CI −3093 to 10 168). Intervention costs were on average €357 (SD = 132). Gender-specific analyses displayed dominance for MBS in males and higher effects coupled with significantly higher costs in females. ConclusionsOur results show a high ICER for MBS. Considering dominance for MBS in males, implementing MBS on approval within the German health care system should be considered.

Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD.

Mind–body modalities are promising strategies to maintain the benefits gained after completion of conventional pulmonary rehabilitation in persons with COPD.In this pilot randomised controlled study we examined Tai Chi in persons with COPD after completing pulmonary rehabilitation. Participants were randomised 2:2:1 to Tai Chi (TC), usual care (UC) or group walking (GW) for 24 weeks. We assessed feasibility; primary outcome was exercise capacity measured by 6-min walk test (6MWT) distance at 24 weeks. Secondary outcomes included health-related quality of life measured by Chronic Respiratory Questionnaire (CRQ), dyspnoea, mood, stress, social support, self-efficacy, physical activity and exercise engagement. Effect size estimates and estimates from generalised estimating equations were calculated.Ninety-one persons (36 TC, 37 UC, 18 GW) were enrolled, with mean age 69±6 years, 59% male, and forced expiratory volume in 1 s % predicted (FEV1 % pred) 48±19%. There was no difference in adherence and adverse events between groups. There was a small between-group effect size (ES=0.25) in change in 6MWT distance favouring TC compared to UC; 24-week comparison was nonsignificant (p=0.10). There were no differences in secondary outcomes. In exploratory analyses, there was a greater percentage of participants in TC who improved 6MWT distance at 24 weeks, compared to UC, 64% versus 39%, p=0.05. There were higher percentages of participants in TC who improved CRQ Fatigue (59% versus 31%, p=0.02) and CRQ Mastery (47% versus 20%, p=0.01) domain scores, compared to UC. For GW, there were no differences compared with TC.Tai Chi may be a feasible option to maintain the benefits gained after completing conventional pulmonary rehabilitation.

Adherence to walking exercise prescription during pulmonary rehabilitation in COPD with a commercial activity monitor: a feasibility trial

BackgroundRegular exercise is important in the management of COPD. Pulmonary rehabilitation (PR) facilitates a more physically active lifestyle through exercise participation, ideally without compromising non-exercise physical activity (PA). During PR patients are advised to perform exercise defined by duration and intensity. The extent to which PR attendees participate in unsupervised exercise bouts and their adherence to the exercise prescription provided during PR is unclear. Commercially available devices have the potential to support patients to exercise at their individually prescribed intensity. Study aims were to (1) assess how adherent patients are to their prescribed walking intensity; (2) examine the pattern of overall PA and walking exercise during the course of PR; (3) determine the feasibility of prescribing exercise to PR attendees using an activity monitor; and (4) explore the relationship between exercise and non-exercise PA with routine PR outcome measures.Methods19 patients wore an activity monitor during routine walking tests and 6 weeks of PR, recording in a diary when they exercised. Exercise intensity (cadence) was prescribed from the Endurance Shuttle Walk Test. Patients completed questionnaires, walking tests and a lower limb strength test before and after PR. Repeated ANOVA compared changes in outcomes between weeks 1–6.ResultsPatients wore the monitor every day during PR (median 42 days). Exercise steps increased by 56% (Δ332 [95% CI 54–611] steps/day, p = 0.009) between weeks 1 and 6, with no significant change in non-exercise steps (Δ79 [95% CI − 22 to − 179] steps/day, p = 0.13). Patients reported exercising on 70% of days. Adherence to prescribed cadence was achieved 55% of time spent exercising, and did not change across the 6 weeks (p = 0.907). Change in total daily steps was associated with improved dyspnea (p = 0.027), Chronic Respiratory Questionnaire (CRQ) Dyspnea domain (p = 0.019), CRQ Emotional Functioning domain (p = 0.001) and CRQ Mastery domain scores (p = 0.001) but not with exercise capacity or lower limb muscle strength.ConclusionsImprovements in exercise participation, not at the expense of non-exercise PA, throughout a PR course was observed in attendees provided with a commercially available activity monitor. Wearable technology may be able to support effective remote walking exercise prescription and participation during PR.Trial registration (retrospectively registered): http://www.isrctn.com/ISRCTN15892972.

Openness Personality Trait Associated With Benefit From a Nonpharmacological Breathlessness Intervention in People With Intrathoracic Cancer: An Exploratory Analysis

ContextBreathlessness is common in people with lung cancer. Nonpharmacological breathlessness interventions reduce distress because of and increase mastery over breathlessness. ObjectivesIdentify patient characteristics associated with response to breathlessness interventions. MethodsExploratory secondary trial data analysis. Response defined as a one-point improvement in 0–10 Numerical Rating Scale of worst breathlessness/last 24 hours (response—worst) or a 0.5-point improvement in the Chronic Respiratory Questionnaire (CRQ) mastery (response—mastery) at four weeks. Univariable regression explored relationships with plausible demographic, clinical, and psychological variables followed by multivariable regression for associated (P < 0.05) variables. ResultsAbout 158 participants with intrathoracic cancer (mean age 69.4 [SD 9.35] years; 40% women) were randomized to one or three breathlessness training sessions. About 91 participants had evaluable data for response—worst and 107 for response—mastery. In the univariable analyses, the personality trait openness was associated with response—worst (odds ratio [OR] 1.99 [95% CI 1.08–3.67]; P = 0.028) and response—mastery (OR 1.84 [95% CI 1.04–3.23]; P = 0.035). Higher CRQ—fatigue (OR 0.61 [95% CI 0.41–0.91]; P = 0.015), CRQ—emotion (OR 0.68 [95% CI 0.47–0.96]; P = 0.030), and worse CRQ—mastery (OR 0.61 [95% CI 0.42–0.88]; P = 0.008), and the presence of metastases and fatigue were associated with reduced odds of response—mastery. In the adjusted response—mastery model, only openness remained (OR 1.73 [95% CI 0.95–3.15]; P = 0.072). ConclusionWorse baseline health, worse breathlessness mastery, but not severity, and openness were associated with a better odds of response. Breathlessness services must be easy to access, and patients should be encouraged and supported to attend.

Behavioural correlates of an experimental hippocampal epileptiform syndrome in rats.

Experiments are reported describing assessment of abnormal behaviour of rats in which a chronic epileptiform syndrome has been induced by the injection of tetanus toxin bilaterally into their hippocampi. The abnormal behaviour included hyper-reactivity to a novel environment, intermittent aggression on handling, and abnormally passive response to a strange rat introduced into their home cage. In animals with unilateral injection of toxin, electrical records from the hippocampi have been obtained. They illustrated bilaterally simultaneous discharges and also some independence between the two hippocampi. The discharges were accompanied by overt signs of complex partial seizures during the first few weeks of the syndrome but later occurred without motor signs. In this later stage the rats were somewhat resistant to the convulsant effects of pentylenetetrazol.