Home Pulmonary Rehabilitation Research Articles

Meaning in Life: A Novel Factor for Promoting Wellbeing in COPD.

Research evidence indicates that meaning in life (MIL) is a meaningful outcome in individuals living with chronic illness, but evidence is lacking for chronic obstructive pulmonary disease (COPD). We hypothesized that MIL is independently associated with clinically meaningful outcomes for patients with COPD. We performed cross sectional analysis from a large cohort with moderate - severe COPD that participated in a home pulmonary rehabilitation study. MIL was measured using the Meaning in Life Questionnaire (MLQ), with domains of Presence and Search. The study included 340 participants: mean age 69 y/o (SD 9.4), 55.3% female, FEV1% 44.3% (SD 19.4) and mMRC dyspnea scale of 2.69 (SD 0.84). Patients with high MLQ Presence (vs low score) had meaningfully better scores (beyond the MCID) across all Chronic Respiratory Questionnaire domains Dyspnea, Fatigue, Emotions and Mastery (p ≤ 0.02), self-management (p ≤ 0.001), social support (p ≤ 0.001); anxiety (p ≤ 0.001) and depression (p ≤ 0.01) scores. When adjusting for age, sex, FEV1, mMRC, social support, and anxiety, MLQ Presence was independently associated with CRQ domains Fatigue, Emotions, and self-management (p ≤ 0.01). MLQ Search was independently associated with CRQ Dyspnea, Fatigue, and Mastery (p < 0.05). In patients with COPD, the perception that life has meaning or the willingness to search for MIL, is associated with the outcomes that patients consider most important. Our results are novel as MIL is a potentially modifiable outcome that could complement person-centered conversations during clinical visits, pulmonary rehabilitation, and health coaching.

Does virtual professional support improve the effectiveness of home pulmonary rehabilitation?Authors' ReplyEffects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors a randomized controlled clinical studyCorrect use of repeated measures analysis of variance.

Does virtual professional support improve the effectiveness of home pulmonary rehabilitation?Authors' ReplyEffects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors a randomized controlled clinical studyCorrect use of repeated measures analysis of variance.

Effects of exercise-based home pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: An overview of systematic review.

Clinical research on exercise-based home pulmonary rehabilitation (HPR) effectiveness in chronic obstructive pulmonary disease (COPD) treatment is rising, as are associated systematic reviews/meta-analyses (SRs/MAs). However, different SRs/MAs vary in outcome indicators, analysis methodologies, literature quality, and findings. This overview aimed to describe the findings of these SRs/MAs and assess their methodological quality. From inception until April 2022, we searched PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), and Wan Fang. Two researchers searched these SRs/MAs separately, collected the data, and cross-checked it using predetermined rules. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) was used to evaluate the methodological quality of each contained SR/MA. The evidence was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 (PRISMA-2009). The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to determine the validity of the results. A total of 433 records were found, with 44 chosen for full-text review. There were 11 SRs/MAs that matched the inclusion criteria. Our overview included studies published from 2010 to 2022. According to the AMSTAR 2 tool, one had low methodological quality, while the other 10 SRs/MAs had very low quality. The PRISMA statement revealed a low rate of complete reporting for eight items. The GRADE tool, on the other hand, revealed that the evidence quality for most outcomes was very low to moderate. According to current research, exercise-based HPR may benefit COPD patients. Nevertheless, this finding is restricted by the low quality of the included SRs/MAs. And more high-quality and large-sample studies are needed in the future. ID: CRD42022322768. https://www.crd.york.ac.uk/prospero/#recordDetails.

Telerehabilitation Using Fitness Application in Patients with Severe Cystic Fibrosis Awaiting Lung Transplant: A Pilot Study.

Purpose The purpose of this study was to pilot a home-based pulmonary rehabilitation (PR) program administered via a telemedicine approach using a combination of fitness application and self-selected activity in lung transplant candidates with cystic fibrosis (CF). Methods We recruited adult patients with CF. The main outcome was adherence, measured by number of sessions completed in 12 weeks. Secondary outcomes were adverse events, six-minute walk distance (6MWD), and dyspnea. Participants were provided a personalized exercise program and equipment including a fitness application that provided exercise videos, recorded exercise time, and corresponding heart rate. We reviewed data daily and provided text messages with feedback. We compared our study outcomes to a retrospective data set of CF patients who participated in a 24-session outpatient hospital-based PR program. Data presented as mean ± standard deviation. Results Eleven patients participated in the home PR program, 45% female, age 33 ± 7 years, FEV1 27 ± 5% predicted. Sessions completed were 19 ± 12 home-based PR vs. 9 ± 4 hospital-based PR, p = .03. Fifty percent of the home-based group completed ≥24 sessions in 12 weeks versus 0% of the hospital-based patients (p = .03). There were no adverse events during exercise. Completers of the home-based program demonstrated a clinically meaningful lower decline in 6 MWD than noncompleters (6MWD −7 ± 15 vs. −86 ± 108 meters). Only one participant performed a post 6 MWD in the hospital-based PR. Conclusion Patients with severe CF demonstrated adherence to home PR delivered using fitness application and self-selected activity with no adverse events. This program style may be a viable solution for telerehabilitation in severe CF and is particularly relevant in the COVID era.

СУЧАСНІ ПІДХОДИ ДО ЛЕГЕНЕВОЇ РЕАБІЛІТАЦІЇ ХВОРИХ НА ХОЗЛ

V. L. Poberezhets, A. V. Demchuk, Y. M. Mostovoy Abstract Pulmonary rehabilitation (PR) is an effective method to improve the health and quality of life of patients with chronic respiratory diseases. The indications and requirements for performing PR are regulated at the legislative level in conciliatory international and national documents. PR is an integrated approach to the management of COPD patients based on a thorough patient assessment followed by therapy, which includes three components - exercise, education and correction of habits, behavior, and is designed to improve the physical and psychological state of patients with COPD, long-term adherence to a healthy lifestyle. The implementation of PR leads to decrease in symptoms and the frequency of exacerbations of the disease, its systemic manifestations, depression and social isolation of seriously ill patients. For the proper conduct of PR, a multidisciplinary team of specialists is formed which, after a thorough examination of the patient, creates an individual rehabilitation program, teaches him the correct implementation of its components. Modern digital technologies make it possible to carry out PR not only at a rehabilitation center but remotely as well, which makes it more accessible and increases its efficiency. With purpose to assess the adherence of patients with COPD to PR at home and its effectiveness, 72 men with COPD of groups C and D, mean age (68.4 ± 10.3) years, were examined, who were offered to perform PR for 8 weeks at home with a frequency of workouts once a day. We found low adherence of patients with COPD to PR at home (20.8 %). Lung function and the state of skeletal muscles are the determining factors for the successful implementation of PR. Home PR helps improve symptoms in patients with COPD. Key words: COPD, pulmonary rehabilitation.

Evaluating an Intervention Program Using WeChat for Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.

BackgroundThe application of telemedicine in home pulmonary rehabilitation interventions for the management of patients with chronic obstructive pulmonary disease (COPD) has achieved promising results.ObjectiveThis study aimed to develop a WeChat official account (Pulmonary Internet Explorer Rehabilitation [PeR]) based on social media. It further evaluated the effect of PeR on the quality of life, symptoms, and exercise self-efficacy of patients with COPD.MethodsThe functional modules of PeR were developed by a multidisciplinary team according to the electronic health–enhanced chronic care model (eCCM) components. A total of 106 patients were randomly selected (53 in the PeR group and 53 in the outpatient face-to-face group [FtF]). Pulmonary rehabilitation intervention was conducted for 3 months, and the outcome was observed for 3 months. The primary outcome was patient quality of life measured with the COPD assessment test (CAT). The secondary outcomes were evaluated using the modified Medical Research Council scale (mMRC), exercise self-regulatory efficacy scale (Ex-SRES), and St George’s Respiratory Questionnaire (SGRQ).ResultsThe intention-to-treat analysis was used in the study. A total of 94 participants completed the 6-month pulmonary rehabilitation program. No statistically significant differences were observed in CAT (F1,3=7.78, P=.001), Ex-SRES (F1,3=21.91, P<.001), and mMRC scores (F1,3=29.64, P<.001) between the two groups with the variation in time tendency. The Ex-SRES score had a significant effect on the CAT score (P=.03). The partial regression coefficient of Ex-SRES to CAT was 0.81, and Exp (B) was 2.24.ConclusionsThe telemedicine technology was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy. Pulmonary rehabilitation at home through PeR and FtF could improve the sense of self-efficacy and quality of life and alleviate symptoms in patients with COPD.Trial RegistrationChinese Clinical Trial Registry ChiCTR1900022770; https://tinyurl.com/tmmvpq3

The impact of home-based pulmonary rehabilitation on people with mild chronic obstructive pulmonary disease: A randomised controlled trial.

People with mild chronic obstructive pulmonary disease (COPD) experience exercise intolerance, dyspnoea and poor quality of life. However, the role of pulmonary rehabilitation (PR) in this group is unclear. This randomised controlled trial aimed to explore the effects of home-based PR in people with mild COPD. People with mild COPD (FEV1 /FVC<70%; FEV1 >80%predicted) with a smoking history of ≥10 packet years were randomised to either 8 weeks of home-based PR (one home visit and seven once-weekly telephone calls) or standard care (weekly social telephone calls). Six minute walk distance (6MWD), and Modified Medical Research Council Dyspnoea Scale (mMRC) and Chronic Respiratory Disease Questionnaire (CRQ) scores were compared. A total of 58 participants (34 males, mean age 68 (SD 9) years, FEV1 %predicted 90 (7), 6MWD 496 (105)m) were included with 31 participants randomised to home-based PR. Participants attended an average of 6.8 of the 8 scheduled sessions, ranging from 3 to 8sessions. Both groups showed improvements in exercise capacity, symptoms and health-related quality of life (HRQoL) over time, however there was no difference in 6MWD at end-intervention (mean difference -3m, 95% confidence interval (CI) -64 to 58) or 6months (7m, 95% CI -59 to 72). At 6 months home-based PR participants were more likely to have clinically important improvements in CRQ emotional function (50% of home PR vs 0% control, P<0.001) and CRQ total score (45% vs 17%, P=0.05). For people with mild COPD, home-based PR did not improve exercise capacity more than standard care. The trial was registered at the Australia New Zealand clinical trial registry (https://www.anzctr.org.au, Trial ID: ACTRN12616000965404).

Comparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

ABSTRACTBackground: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients.Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables.Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity (p = 0.003), quality of life (p = 0.045), FEV1 (p = 0.001), lower pack-year smoking (p < 0.001) than outpatient PR.After home PR, exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea(p < 0.05), anxiety (p < 0.001), depression (p < 0.001) were improved except endurance shutte test. Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar.Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.

Effect of information-motivation-behavioral skill model in home pulmonary rehabilitation of stable COPD patients

Objective To explore the application effect of information-motivation-behavioral skills model theory in home pulmonary rehabilitation of patients with stable chronic obstructive pulmonary disease (COPD). Methods Convenient sampling method was used to select 80 stable COPD patients meeting the exclusion criteria as the research object, and the random number table method was used to divide them into two groups, 40 cases each group.Patients in the control group received routine discharge guidance and telephone follow-up.The patients in the experimental group received the home care model based on the information-motivation-behavioral skills model, including providing information support for patients with COPD pulmonary rehabilitation exercise, conducting motivational interviews with patients and their families, and using information technology or family follow-up to provide patients with pulmonary rehabilitation exercise skills intervention for 3 months.The changes of COPD home health knowledge, symptom management behavioral compliance, lung function, quality of life of the two groups were observed. Results At discharge, there were no statistically significant differences between the two groups in COPD home health knowledge, symptom management behavior compliance, lung function, and quality of life(P>0.05). After 3 months of intervention, patients in the experimental group were significantly better than those in the control group in terms of home health knowledge, symptom management behavior compliance, lung function and quality of life, with statistically significant differences(P<0.05). Conclusion Application of information-motivation-behavioral skills model theory in COPD patients with pulmonary rehabilitation at home can establish an effective home-based pulmonary rehabilitation program for patients with COPD, which effectively improves patients' knowledge of home health and their compliance with symptom management behaviors, thus improving their pulmonary function and quality of life. Key words: Chronic obstructive pulmonary disease (COPD); Stability; Information-motivation-behavior skill model; Pulmonary rehabilitation; Lung function

Does pulmonary rehabilitation reduce peripheral blood pressure in patients with chronic obstructive pulmonary disease?

Pulmonary rehabilitation (PR) can improve aerobic exercise capacity, health-related quality of life and dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Recent studies have suggested that exercise training may improve blood pressure and arterial stiffness, albeit in small highly selected cohorts. The aim of the study was to establish whether supervised outpatient or unsupervised home PR can reduce peripheral blood pressure. Resting blood pressure was measured in 418 patients with COPD before and after outpatient PR, supervised by a hospital-based team (HOSP). Seventy-four patients with COPD undergoing an unsupervised home-based programme acted as a comparator group (HOME). Despite significant improvements in mean (95% confidence interval) exercise capacity in the HOSP group (56 (50-60) m, p < 0.001) and HOME group (30 (17-42) m, p < 0.001) systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) did not change in either the HOSP (SBP: p = 0.47; DBP: p = 0.06; MAP: p = 0.38) or HOME group (SBP: p = 0.67; DBP: p = 0.38; MAP: p = 0.76). Planned subgroup analysis of HOSP patients with known hypertension and/or cardiovascular disease showed no impact of PR upon blood pressure. PR is unlikely to reduce blood pressure, and by implication, makes a mechanism of action in which arterial stiffness is reduced, less likely.

Home pulmonary rehabilitation in respiratory care and management

Home pulmonary rehabilitation in respiratory care and management

Home vs Hospital-Based Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease: A Spanish Multicenter Trial

To compare the effects of a simple home pulmonary rehabilitation program and an intensive hospital-based program in terms of the exercise tolerance and health-related quality of life (HRQL) of patients with severe chronic obstructive pulmonary disease (COPD). Patients in this prospective, multicenter trial were randomized to 2 groups to receive hospital or home pulmonary rehabilitation. Patients in both groups attended 2 informative sessions about the disease and 4 physical therapy sessions. Patients in the hospital group then carried out a structured exercise program while home group patients performed low intensity exercises at home without supervision. Twenty-eight patients were randomized to the hospital rehabilitation group and 23 to the home group. Both groups showed a similar improvement on the 6-minute walk test (mean difference, 8.7 m; P=.61). HRQOL measured with the Chronic Respiratory Questionnaire also improved in both groups, but the change was greater on the emotional function domain in the hospital rehabilitation group (mean difference between groups, 0.58 on a scale for which the smallest clinically relevant difference is 0.5 points). The benefits were maintained in both groups 6 months after the programs ended. This study demonstrates that the improvement in exercise tolerance achieved by COPD patients with an unsupervised home pulmonary rehabilitation program is similar to the gains of patients in an intensive hospital-based program. However, the hospital program afforded greater benefit on the HRQOL emotional function domain.

Development of the Home-Based Pulmonary Rehabilitation Program for Patients with Chronic Lung Disease

【Background : Even though it is well known that pulmonary rehabilitation (PR) improves exercise capacity, and the quality of life, in patients with chronic lung diseases, not many patients can attend hospital based intensive PR in Korea. The purpose of this study was to develop a method for a home-based PR program, and study its effectiveness. Materials and Methods : Twenty patients with chronic lung diseases were randomly divided into two groups : a home PR group comprising of 10 male patients, with a mean age of 70 years, and a control group comprising of 10 male patients, with a mean age of 65 years. We developed exercise programs, depending on the exercise capacity of each patient, which were easy to do at home. The PR program consisted of a 12 week period of enforced aerobic (mostly walking) and muscle strengthening exercises, as prescribed by the exercise specialist, in accordance with the functional capacity of the patient. In addition to the education, nutritional and psychiatric consultation was undertaken, and respiratory muscle training arranged. Patients visited hospital every 2 weeks for evaluation and exercise prescription. Results : All patients finished the 12 week course of therapy. Following the home PR, the endurance times and work capacity of the upper and lower extremities were significantly increased in the treatment group in comparison to the controls. The six minute working (Eds note:should) 'working' read walking?) distance was increased from $465{\pm}60m$ to $508{\pm}37m$ and the maximal inspiratory pressure from $72.8{\pm}27.2cmH_2O$ to $91.4{\pm}30.9cmH_2O$ . The quality of life, as assessed by St Georges Respiratory Questionnaire (SGRQ), was also improved following PR. (Eds note:do you have figures for before and after, and a reference for the SGRQ?i.e. for the main paper.) Conclusion : The home PR program we developed seemed to be applicable, and effective, to most of the patients with chronic lung diseases in this study.】