Efficacy Of Pulmonary Rehabilitation Research Articles

The Beneficial Impact of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Review of the Current Literature.

Idiopathic pulmonary fibrosis (IPF) is a chronic and irreversible fibrotic disease whose natural history is characterised by a progressive worsening of the pulmonary function, exertional dyspnoea, exercise intolerance, reduced physical activity, and health-related quality of life (HRQOL) impairment. Pulmonary rehabilitation (PR) is a comprehensive, multi-disciplinary programme that uses a combination of strength training, teaching, counselling, and behaviour modification techniques to reduce symptoms and optimise functional capacity in patients with chronic lung disease. Based on the well-documented effectiveness of PR in chronic obstructive pulmonary disease (COPD), over the years supportive evidence of its benefits for other respiratory diseases has been emerging. Although the latest rehabilitation guidelines recognised PR's efficacy for interstitial lung disease (ILD) and IPF in particular, this comprehensive approach remains underused and under-resourced. In this review, we will discuss the advantages and beneficial effects of PR on IPF, analysing its impact on exercise capacity, disease-related symptoms, cardiovascular outcomes, body composition, and HRQOL.

The pulmonary rehabilitation effect on long covid-19 syndrome: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to evaluate the efficacy of pulmonary rehabilitation (PR) in improving dyspnea, fatigue, physical activity, quality of life, anxiety and depression in patients with Long COVID-19 (LC). The impact of PR on LC and a comparison of face-to-face and telerehabilitation approaches was explored. This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. A literature search included PubMed, Web of Science, and Cochrane Library until January 2023. No language filters were applied. Randomized controlled trials, non-randomized controlled trials, and observational studies were included. The risk of bias was assessed using appropriate tools. Descriptive analysis and meta-analysis were performed. Forest plots presented results. Statistical analyses were conducted using the Metafor Package in R v.3.4.2. This systematic review and meta-analysis included 16 studies on PR in LC patients. A total of 1027 adults were included. The studies varied in design, with seven observational studies, three quasi-experimental studies, and six randomized controlled trials. Dyspnea, physical function, quality of life, psychological state, and fatigue were assessed as outcomes. The review found that pulmonary rehabilitation had a significant positive effect on dyspnea, physical function, quality of life (both global and physical domain), anxiety, and depression. However, the effect on fatigue was not significant. Heterogeneity was observed in some analyses, and publication bias was found in certain outcomes. Age and study design were identified as potential moderators. Both face-to-face and telerehabilitation interventions improved the studied outcomes, with only differences in the physical domain of quality of life favoring the face-to-face group. PR improved dyspnea, physical function, quality of life, and psychological state in LC patients, but not fatigue. Face-to-face and telerehabilitation have similar effects, except for physical quality of life.

Safety and Efficacy of Pulmonary Rehabilitation for Long COVID Patients Experiencing Long-Lasting Symptoms.

Due to the high prevalence and persistence of long COVID, it is important to evaluate the safety and efficacy of pulmonary rehabilitation (PR) for patients who experience long-lasting symptoms more than six months after initial COVID-19 onset. Enrolled patients were admitted for a four-week in-patient-PR due to long COVID symptoms (n = 47). The safety of PR was confirmed by the absence of adverse events. Symptom-related outcomes were evaluated pre- and post-PR with significant score changes for: 6 min walking distance (61 [28 to 103] m), quality of life (mental Short Form-12: 10 [6 to 13], and physical: 9 [6 to 12]), Montreal Cognitive Assessment (1 [0 to 3]), fatigue (MFI-20: -19 [-28 to -8]), dyspnea (DYSPNEA-12: -7 [-9 to -2] and mMRC; -1 [-1 to 0]), Nijmegen questionnaire (-8 [-11 to -5]), anxiety and depression (HADS:-4 [-5 to -2] and -2 [-4 to -1], respectively) and posttraumatic stress disorder checklist scale (-8 [-12 to -4]). At the individual level, the percentage of symptomatic patients for each outcome decreased, with a high response rate, and the number of persistent symptoms per patient was reduced from six at PR initiation to three at the end of the program. Our results show that in-PR is safe and efficient at decreasing long-lasting symptoms experienced by long COVID patients at more than six months after initial disease onset.

Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis

IntroductionPrevious systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to...

Clinical effect of pulmonary rehabilitation in patients with mechanical ventilation: A meta-analysis.

To systematically evaluate the clinical efficacy of pulmonary rehabilitation in patients with mechanical ventilation in an intensive care unit (ICU). Relevant studies were identified in the PubMed, Web of Science, National Library of Medicine, China National Knowledge Infrastructure and Wanfang databases. A meta-analysis was performed after screening based on the inclusion and exclusion criteria, data extraction and literature quality evaluation. In total, 19 studies involving 2181 participants were included. The results of the meta-analysis revealed that compared with patients with conventional rehabilitation measures, patients with pulmonary rehabilitation measures had a higher offline success rate (relative risk (RR) = 1.16; 95% confidence interval (CI): 1.09, 1.24; p < 0.00001) and higher arterial oxygen partial pressure levels (mean difference (MD) = 8.96; 95%CI: 5.98, 11.94; p < 0.0001) and these measures significantly shortened the duration of mechanical ventilation (standardised MD (SMD) = -1.08; 95%CI: -1.58, -0.59; p < 0.0001) and ICU stay (SMD = -1.41; 95%CI: -1.94, -0.88; p < 0.0001). Aspiration significantly reduced the incidence of ventilator-associated pneumonia (RR = 0.35; 95%CI: 0.24, 0.51; p < 0.00001) and deep vein thrombosis (RR = 0.32; 95%CI: 0.13, 0.76; p = 0.01) in ICU patients with mechanical ventilation. Pulmonary rehabilitation measures can improve the success rate of weaning from mechanical ventilation in ICU patients, shorten the time of mechanical ventilation and ICU hospitalisation and reduce the incidence of related adverse reactions, but the impact on mortality requires further study.

Efficacy of pulmonary rehabilitation plus chest physiotherapy versus chest physiotherapy alone in patients with bronchiectasis

Abstract Context Bronchiectasis is a chronic airway disease characterized by cough, dyspnoea, expectoration, and poor quality of life. Besides medical treatment, regular chest physiotherapy and Pulmonary rehabilitation (PR) may be an effective approach for bronchiectasis. Aims To compare the effects of PR and chest physiotherapy with chest physiotherapy alone in bronchiectasis. Settings and design This randomized controlled trial observational research enrolled 40 cases with bronchiectasis who were categorized into two groups: (group I); 20 cases received PR and chest physiotherapy in addition to medical treatment, (group II): 20 cases received chest physiotherapy in addition to medical treatment. Methods and material Cases were assessed with modified borg scale, 6-minute walk test (6-MWT), arterial blood gases, Spirometry and underwent PR program. Statistical analysis used The same group’s quantitative data were compared using the paired Student’s t-test. The frequency and percentage (%) of qualitative characteristics were displayed. Results In (group I), there was a statistically notable improvement in modified Borg Scale, 6-MWT, arterial oxygen pressure (PaO2), partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation, FEV1 (actual and predicted %values), FVC (actual and predicted %values), FEV1/FVC actual value, sputum volume and training intensity. In (group II) there was a statistically notable improvement in 6-MWT, PaO2, PaCO2, FEV1 (actual and predicted %values), FVC (actual and predicted %values), FEV1/FVC actual value, and sputum volume. The percentage of improvement in all parameters was significantly higher among group (I). Conclusions PR in addition to chest physiotherapy is superior to chest physiotherapy alone in the improvement of symptoms and exercise tolerance in bronchiectasis.

Functional capacity and quality of life improvement in stable chronic obstructive pulmonary disease (COPD) patients following physical exercise and chicken egg white supplementation.

The pillars of comprehensive pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD) patients include physical exercise and good nutrition. The aim of this study was to evaluate the efficacy of pulmonary rehabilitation, which included physical exercise and chicken egg white supplementation, on the quality of life (QoL) and functional capacity among patients with stable COPD. The COPD patients were enrolled prospectively in this quasi-experimental study and completed a 12-week smartphone-guided home-based physical exercise program that comprised strength and resistance training three times per week for 30 minutes each session. Participants were divided into two groups: the control group who underwent physical exercise only, and the intervention group who had physical exercise and chicken egg white supplementation as a protein source. Patient characteristics including sex, age, nutritional status, comorbidities, smoking status, and obstruction severity, were evaluated. The COPD assessment test (CAT) score and six-minute walk test (6MWT) were used as the parameters to evaluate QoL and functional capacity, respectively. Of the total 50 patients included in the study, 12 were excluded due to follow-up and adherence problems. Our data indicated there were significant CAT score reduction and 6MWT improvement in both control and intervention groups after 12 weeks compared to baseline data. However, reduction of mean CAT score was higher in intervention compared to control group (-13.47±6.49 vs -5.42±5.07, p<0.001). In addition, the improvement of 6MWT was also higher in intervention group compared to control group (145.47±69.2 vs 32.42±17.3 meters, p<0.001). In conclusion, chicken egg white supplement to male patients with stable COPD who exercise with resistance and strength training could improve the QoL and functional capacity.

Effects of whey protein complex combined with low-intensity exercise in elderly inpatients with COPD at a stable stage.

Previous literature mostly has demonstrated the efficacy of pulmonary rehabilitation (PR) combined with whole nutrition powder in patients with chronic obstructive pulmonary disease (COPD). However, the benefits of whey protein as an oral nutritional supplement (ONS) during PR are not clear. It took 12 weeks to complete the trial, we divided 90 elderly patients with stable-stage COPD into a low-intensity exercise group (n= 30, PR group), PR plus whey proteins complex group (n= 30, PRWP group), and a control group (n= 30) randomly, and assessed index such as exercise capacity, mental health status, lung function, and body composition. Eventually, 84 people persisted until the end of the trial. Compared with the control group, hand grip strength (HGS)(1.4 ± 0.6 kg, and 1.0 ± 0.2 kg respectively, p< 0.05) in the PRWP and PR group, 6 minutes of walking distance (6MWD)(14.1 ± 3.8m, p< 0.05) in PRWP group improved. Furthermore, compared with the PR group, Medical Research Council Dyspnea Scale (MRC)(-0.2 ± 0.1, p< 0.01), anxiety score (-1.2 ± 0.4, p< 0.01), and body weight (2.0 ± 0.8kg, p< 0.05) improved in the PRWP group. There were no inter-group differences in a fat-free mass index or appendicular skeletal muscle mass index. Muscle strength could be enhanced in both intervention models. Adding whey protein complex was additionally successful in rectifying dyspnea, anxiety, and weight loss caused by exercise. This rehabilitation pattern might be valuable in elderly patients with COPD.

Benefits of a 12-week pulmonary rehabilitation programme in interstitial lung diseases: 1 year post completions

Objectives Evidence on the efficacy of Pulmonary Rehabilitation in the management of ILD is growing. Despite studies reporting benefits, few studies have investigated the long-term effects in such patients, resulting in a call for such research. Therefore, this study aimed to evaluate the effectiveness of a 12-week PR programme on exercise tolerance, quality of life and physical activity, 6- and 12-months post completion. Design An observational, prospective, quasi experimental type of study. Setting Out-Patient Physiotherapy Department. Participants 60 participants diagnosed with Interstitial Lung Disease. Intervention A 12week PR programme was delivered with outcome measures assessed throughout the programme and at the 28th and 52nd week. Main Outcome Measures 6-min walking distance test, Dyspnoea Borg Scale, St George’s Respiratory Questionnaire and Hospital Anxiety and Depression Score were measured. Results Maintenance of effects was noted in SGRQ scores p = 0.005 on completion of the 12week programme, depression scores (p = 0.038 at week 28 and p = 0.008 at week 52) and BODE index resulting in a statistically significant improvement at the 52nd week (p = 0.017). Benefits of in the 6MWT were maintained at 28week but had a statistically significant decline at 52weeks post completion (p = 0.013). Dyspnoea scores increased post completion of the 12week PR programme at both the 28th week (p = 0.008) and 52nd week (p = 0.005). Conclusion Improvements were maintained up to 1 year post completion in most outcome measures or else showed benefits till the 52week.

Efficacy of Pulmonary Rehabilitation in Post-COVID-19: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis examines how pulmonary rehabilitation impacts in patients suffering from subacute and long COVID-19 infections, gauging enhancements in of dyspnea, physical function, quality of life, psychological state (anxiety and depression), and fatigue. Three electronic databases (PubMed, Web of Science, Cochrane Library) were systematically searched for full-text articles published from inception to January 2023. Randomized, quasi-experimental, and observational studies were included, with adults diagnosed with subacute or long COVID-19 who received pulmonary rehabilitation as intervention. Outcomes related to dyspnea, physical function, quality of life, fatigue, and psychological status were included. Risk of bias was assessed with Cochrane Risk of Bias Tool for Randomized Controlled Trials and Risk of bias in non-randomized studies of intervention. The review was registered before starting in PROSPERO (CRD: 42022373075). Thirty-four studies were included, involving 1970 patients with subacute and long COVID-19. The meta-analysis demonstrated moderate to large effects on dyspnea, physical function, quality of life, and depressive symptoms compared to usual care intervention. No significant differences were found in fatigue compared to usual care, nor in anxiety levels after pulmonary rehabilitation intervention. Pulmonary rehabilitation has the potential to improve health outcomes in patients with subacute and long COVID-19. However, due to the high risk of bias of included studies, conclusions should be taken with caution.

Baseline dependent minimally important differences for clinical outcomes of pulmonary rehabilitation in people with COPD

IntroductionMinimally important differences (MIDs) for common outcomes of pulmonary rehabilitation are well documented for people with chronic obstructive pulmonary disease (COPD). It is not known whether MIDs differ based on COPD disease characteristics. This study aimed to estimate MIDs for clinical outcomes of pulmonary rehabilitation dependent upon baseline characteristics. MethodsA database containing 2791 people with COPD was split into derivation (n=2245; age 66±9 years; 50% males; FEV1 47±20% predicted) and comparator (n=546; age 66±9 years; 47% males; FEV1 46±21% predicted) cohorts. MIDs were estimated using 0.5 x SD (symmetrically distributed) or 0.5 x IQR (non-symmetrically distributed) for: 6-minute walk test (6MWT), constant work rate test (CWRT), COPD assessment test (CAT), St. George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), and fat-free mass index (FFMI). MIDs were estimated based on baseline outcome scores, lung function, modified medical research council (mMRC) grade and FFMI. ResultsMID estimates were comparable to previously reported values. MIDs for SGRQ domains (Symptom=8.7 points, Activity=7.1 points, Impact=8.1 points) and FFMI were produced (0.36kg/m2). There was greater variation of change in 6MWT, SGRQ-activity, SGRQ-impact, HADS and FFMI on which the MIDs were determined when categorising for baseline values (all, p<0.05). Greater variation of change in 6MWT on which the MIDs were determined was evident with COPD disease severity grouping (p<0.05). The magnitude of change in 6MWT, CAT, CWRT, SGRQ-activity, and FFMI with baseline mMRC score categorisation resulted in greater variation on which the MIDs were determined (all, p<0.05). Baseline stratification for FFMI resulted in greater variation of change in CWRT (p<0.001) and HADS-depression (p = 0.043) on which MIDs were determined. DiscussionFindings suggest that baseline presentation should be considered for people with COPD when assessing the efficacy of pulmonary rehabilitation. However, clinical significance of the variation underpinning MIDs is yet to be determined.

Efficacy of pulmonary rehabilitation in patients with post-acute COVID-19.

The most important cause of mortality and morbidity of COVID-19 is lung involvement. In this study, the effects of pulmonary rehabilitation (PR) in the post-acute COVID-19 period on lung functions, functional capacity, dyspnea, quality of life, and psychiatric state were investigated. Patients were admitted to a PR program after discharge when their general condition had stabilized. The patients' scores of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), peripheral arterial oxygen saturation (PaO2), 6-minute walking distance (6MWD), Medical Research Council Dyspnea Scale (MRC), St. George Respiratory Questionnaire (SGSA), and Hospital Anxiety and Depression Scale (HADS) before and after pulmonary rehabilitation were compared. The patients were divided into three groups, mild, moderate, and severe, according to their thorax CT findings. A total of 52 patients [mean age: 46.7 ± 12.5 (range: 19-76) years] were included in the study. Nineteen patients were in the mild group, 16 in the moderate group, and 17 patients comprised the severe group. Comparing the parameters before and after PR, significant improvement was observed in all three groups in the evaluation parameters after treatment including FVC, FEV1, FEV1/FVC, 6MWD, and MRSC; SGSA symptoms, activity, effects and total scores; HADS depression, anxiety, and total scores (p<0.05 for all). PR is a beneficial treatment for patients with COVID-19 with lung involvement for improving lung functions, eliminating dyspnea, and improving functional capacity, psychological status, and life quality of the patient.

The Efficacy of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis

Background: This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) on functional performance, exercise-related oxygen saturation, and health-related quality of life among patients with idiopathic pulmonary fibrosis (IPF). Methods: A total of 25 patients with IPF (13 in the PR group and 12 in the non-PR group) were enrolled between August 2019 and October 2021 at Haeundae-Paik Hospital in the Republic of Korea. A cardiopulmonary exercise test (CPET), six-minute walk test (6MWT), pulmonary function test (PFT), Saint George's Respiratory Questionnaire (SGRQ), muscle strength test, and bioelectrical impedance analysis were performed in each group at baseline and after eight weeks of PR. Results: The mean age was 68 years of age and most subjects were male. Baseline characteristics were similar between the two groups. The distance during 6MWT after PR was significantly improved in the PR group (inter-group p-value = 0.002). VO2max and VE/VCO2 slopes showed a significant difference after eight weeks only in the PR group, but the rate of change did not differ significantly from the non-PR group. Total skeletal muscle mass, PFT variables, and SGRQ scores did not differ significantly between the groups. Conclusions: PR improved exercise capacity, as measured using CPET and 6 MWT. Further studies in larger samples are needed to evaluate the long-term efficacy of PR in IPF patients.

Efficacy of Pulmonary Rehabilitation in Pulmonary Tuberculosis Sequelae with Cystic Bronchiectasis and Pulmonary Hypertension

Cystic bronchiectasis, also known as saccular bronchiectasis (a severe type of bronchiectasis), is a condition that occurs as a complication and sequelae after pulmonary Tuberculosis (TB). There is chronic permanent dilation of bronchi that occurs after destructive changes in elastic and muscular layers of bronchial walls which further leads to the ballooning of bronchi and difficulty in clearing secretions with recurrent infection of the respiratory tract. Pulmonary hypertension is another major complication after bronchiectasis which affects pulmonary circulation. A 44-year-old female reported to the physiotherapy department with cystic bronchiectasis and pulmonary hypertension. The positive symptoms were chronic cough with mucoid sputum, low-grade fever, chest pain, breathlessness (modified Medical Research Council (mMRC) grade III), and easy fatiguability. The goals were set and inpatient Pulmonary Rehabilitation (PR) started with the aim of reducing burdening of symptoms and promoting the Quality of Life (QoL). The therapeutic interventions were splinted coughing techniques, deep breathing exercises, thoracic expansions, postural correction exercises, dyspnoea relieving positions, strength training, and pacing techniques. After rehabilitation the ventilation along with strength improved, dyspnoea was reduced, and exercise tolerance was increased.

The efficacy of pulmonary rehabilitation exercise training on complications and mortality after lung cancer resection: a systematic review and meta-analysis.

BackgroundThe efficacy of pulmonary rehabilitation exercise training for patients after lung cancer resection has been controversial. We sought to evaluate the efficacy of pulmonary rehabilitation on the incidence of complications and mortality in patients after lung cancer resection.MethodsSearch English databases PubMed, EMBASE, Medline to obtain literature. The literature compared the effect of pulmonary rehabilitation exercise training intervention or not on the efficacy of patients after lung cancer resection, and the outcomes included postoperative complications and mortality. The quality of the included literature was assessed according to the Cochrane risk of bias assessment work. The chi-square test was used to test for heterogeneity. When there is heterogeneity, a random effect model is used; when there is no heterogeneity, a fixed effect model is used.ResultsA total of 9 prospective clinical studies (comprising 1,338 patients) were included in this meta-analysis. Among the patients, there were 571 cases in the rehabilitation group and 767 cases in the control group. The incidence of postoperative complications in the rehabilitation group was lower than that in the control group. The odds ratio (OR) value was 0.66 and 95% confidence interval (CI) was 0.47–0.94 (P=0.02). There was no heterogeneity among studies and no publication bias. The incidence of postoperative pulmonary complications in the rehabilitation group was lower than that in the control group, OR =0.33 (95% CI: 0.22–0.50) (P<0.00001). There was no heterogeneity among studies and no publication bias. There was no significant difference in postoperative mortality between the 2 groups (OR =0.77; 95% CI: 0.26–2.30; P=0.65). There was no heterogeneity among studies and no publication bias.DiscussionImplementing pulmonary rehabilitation significantly reduced postoperative complications and the risk of pulmonary complications in lung cancer patients, but had no significant effect on mortality. Pulmonary rehabilitation exercise training is recommended for patients undergoing lung cancer resection.

Long-term efficacy of pulmonary rehabilitation with maintenance programs in patients with chronic obstructive pulmonary disease: a meta-analysis

Long-term efficacy of pulmonary rehabilitation with maintenance programs in patients with chronic obstructive pulmonary disease: a meta-analysis

Hypnosis for the management of COPD-related anxiety and dyspnoea in pulmonary rehabilitation: rationale and design for a cluster-randomised, active-control trial (HYPNOBPCO_2).

Complementary psychological care is recommended for COPD, as it significantly reduces anxiety and boosts the pulmonary rehabilitation efficacy. In a precedent trial (HYPNOBPCO_1, ISRCTN10029862), administering a single hypnosis session was linked to reduced anxiety and improved breathing mechanics in intermediate and advanced COPD patients. However, whether hypnosis could improve self-management of anxiety and dyspnoea in COPD during pulmonary rehabilitation is yet to be investigated.This is the protocol for HYPNOBPCO_2, a 2-arm, cluster-randomised, statistician-blinded superiority monocentre trial (NCT04868357). Its aim is to assess the efficacy of hypnosis as a tool to manage anxiety and dyspnoea during a pulmonary rehabilitation programme (PRP). Clusters of COPD patients eligible for the conventional hospital-based PRP at the Centre Hospitalier de Bligny (CHB) will be randomised and evenly allocated into two parallel arms: “Hypnosis” (treatment) and “Relaxation” (active control). “Hypnosis” will consist of the CHB's conventional 4-week group PRP, supplemented by two educational sessions for teaching self-hypnosis. “Relaxation” will be identical, except standard relaxation exercises will be taught instead. Primary end-point will consist of assessing weekly changes in anxiety throughout the PRP, additional to total anxiety change after treatment completion. Anxiety will be determined by the six-item version of the State-Trait Anxiety Inventory (STAI-6). Secondary outcomes will include change in the 6-min walk test and the COPD assessment test (CAT). Further follow-up outcomes will include CAT and STAI-6 retests, re-hospitalisation rate, action plan use and persistence in self-hypnosis use, throughout the 12 weeks ensuing PRP completion.

Saudi Physicians' Awareness and Practice of Pulmonary Rehabilitation for Post-COVID-19 Syndrome Patients

Background: The coronavirus disease (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, has resulted in considerable mortality, morbidity, and unprecedented strain on healthcare systems throughout the world. As the pandemic evolves, one of those challenges has become increasingly common - the post-COVID-19 syndrome. Approximately 10-20% of SARS-CoV-2 patients who experienced an acute symptomatic phase are still experiencing some effects beyond 12 weeks. To assess knowledge, awareness and practice about effectiveness and benefits of pulmonary rehabilitation for post-covid-19 syndrome patients and their practical barriers and opportunities, and education and training needs among Saudi physicians.&#x0D; Methodology: A cross-sectional online survey was held among healthcare providers in Saudi Arabia. Department of internal medicine, Heraa General Hospital, between January 2021 and November 2021. The questionnaire was sent to Saudi physicians from data collectors face-to-face through smartphone apps. The questionnaire covered the talk about pulmonary rehabilitation knowledge and familiarity among Saudi physicians, support and practice, barriers to pulmonary rehabilitation integration, and interest in learning more about pulmonary rehabilitation programs.&#x0D; Results: A total of 1111 responded to the survey. The mean age of the participants was 33 years old, with mean years of experience of about 6.95 years. The majority of respondents (n=949) (85.4%) work in urban areas and come from various regions, including the west (n=407) (36.6%), east (n=195) (17.6%), north (n=150) (13.5%), south (n=150) (13.5%) and central region (n=209) (18.8%). More than half of the respondents were physicians (n=750) (67.5%) from different specialties, and the mean number of covid-19 patients seen by physicians was 5.68% per day.&#x0D; Conclusion: Participants in this study showed a positive attitude toward pulmonary rehabilitation. They believe their patients would benefit from Pulmonary rehabilitation, are interested in referring post-covid-19 patients to rehabilitation providers and co-managing their care, and would like more educational opportunities in order to increase their knowledge of the safety and efficacy of pulmonary rehabilitation.

Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and COPD: A Propensity-Matched Real-World Study

BackgroundThe adherence to and clinical efficacy of pulmonary rehabilitation in idiopathic pulmonary fibrosis (IPF), particularly in comparison with COPD, remains uncertain. The objectives of this real-world study were to compare the responses of patients with IPF with a matched group of patients with COPD undergoing the same supervised, outpatient pulmonary rehabilitation program and to determine whether pulmonary rehabilitation is associated with survival in IPF.Research QuestionDo people with IPF improve to the same extent with pulmonary rehabilitation as a matched group of individuals with COPD, and are noncompletion of or nonresponse to pulmonary rehabilitation, or both, associated with 1-year all-cause mortality in IPF?Study Design and MethodsUsing propensity score matching, 163 patients with IPF were matched 1:1 with a control group of 163 patients with COPD referred for pulmonary rehabilitation. We compared between-group pulmonary rehabilitation completion rates and response. Survival status in the IPF cohort was recorded over 1 year after pulmonary rehabilitation discharge. Cox proportional hazards regression explored the association between pulmonary rehabilitation status and all-cause mortality.ResultsSimilar pulmonary rehabilitation completion rates (IPF, 69%; COPD, 63%; P = .24) and improvements in exercise response were observed in both groups with no significant mean between-group differences in incremental shuttle walk test (ISWT) change (mean, 2 m [95% CI, –18 to 22 m]). Pulmonary rehabilitation noncompletion (hazard ratio [HR], 5.62 [95% CI, 2.24-14.08]) and nonresponse (HR, 3.91 [95% CI, 1.54-9.93]) were associated independently with increased 1-year all-cause mortality in IPF.InterpretationThis real-word study demonstrated that patients with IPF have similar completion rates and magnitude of response to pulmonary rehabilitation compared with a matched group of patients with COPD. In IPF, noncompletion of and nonresponse to pulmonary rehabilitation were associated with increased all-cause mortality. These data reinforce the benefits of pulmonary rehabilitation in patients with IPF.

Benefits of pulmonary rehabilitation in COPD patients with mild cognitive impairment – A pilot study

BackgroundCognitive impairment might interfere with the efficacy of Pulmonary Rehabilitation (PR) in Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify differential responses to PR between cognitively impaired (CI) and cognitively normal (CN) COPD patients by assessing health status and exercise capacity. MethodsSixty patients (FEV1: 47 ± 15%) were classified as CI or CN according to the Montreal Cognitive Assessment (MoCA ≤25points) and completed a 3-week inpatient PR program. Cognitive function (neuropsychological battery), health-status (36-Item Short Form Survey [SF-36]), and exercise capacity (6-min walk test [6MWT], cycle-endurance test [CET]) were assessed before and after PR. Responsiveness to PR was estimated by mean change (delta-value [Δ]) and the d-Effect Size (ES). ResultsTwenty-five COPD patients (42%) presented evidence of mild CI prior to PR. Both, CI and CN patients significantly improved global cognitive function, health status (the majority of SF-36 components), and exercise capacity (6MWT and cycle endurance) in response to PR. Compared to CN, CI patients did not improve SF-36 subdomains of “role emotional” and “bodily pain”, and demonstrated a lower magnitude of improvement in 6MWT ([Δ]: 25 m; ES: 0.21) compared to CN ([Δ]: 46 m; ES: 0.54). ConclusionsPR has favorable effects on global cognitive function, health status, and exercise capacity in both CI and CN COPD patients. There was no concrete evidence to indicate interference of cognitive impairment to PR effectiveness.