Standard Pulmonary Rehabilitation Research Articles

Does mild chronic obstructive pulmonary disease need a standard pulmonary rehabilitation program? A case report

Background: Patients with mild chronic obstructive pulmonary disease (COPD) are usually not recommended for a standard pulmonary rehabilitation (PR)program based on the GOLD guideline in mild COPD GOLD A classification. Especially, the scientific evidence on exercise capacity that can be identified for recruitment in PR programs has been less reported. Thus, a preliminary case study to identify the exercise capacity under cardiopulmonary responses by aerobic exercise testing among patients in mild COPD GOLD A classification was the aim of this study. Objective: To evaluate the cardiopulmonary responses from exercise capacity testing in individual COPD patients with mild COPD GOLD A Classification. Materials and methods: Four participants with mild COPD GOLD A performed an exercise endurance capacity test at home using Spot Marching Exercise Test (SMT), marching on the spot with high hip and arm raising. The load of SMT was indicated by a controlled stepping rate at 70, 80, 90, 100, and 110 steps/min. Every participant performed Incremental SMT (ISMT) with every 3 min incremental load, and the Constant SMT (CSMT) at the peak load. Both exercise tests were terminated at symptom limit. Resting time between ISMT and CSMT was at least 30 minutes. Cardiopulmonary exercise responses, Borg perceived breathlessness (RPB) and exertion (RPE) were monitored every minute during the exercise test. The duration of exercises was recorded. Results: Peak exercise capacity using ISMT was low with the end exercise load at 70, 80, 80, and 90 steps/min which is equivalent to moderate to high intensity at 81%, 62%, 65% and 93% of age-predicted maximum heart rate (HRmax). The exercise test was stopped by breathlessness at RPB 7, 8, 6, and 5. Respiratory rates (RR) were 36, 26, 38, and 38 breaths/min. With CSMT, the results showed very short exercise duration 1.78, 4.60, 2.15, and 2.47 mins with RPB 7, 8, 5, and 5 and RR of 33, 27, 34, and 41 breaths/min respectively. Conclusion: This preliminary report reveals that all four mild COPD GOLD A show low exercise capacity and very poor exercise endurance that should identify the appropriated standard PR program in the future.

EXAMINING THE EFFECTS OF CONNECTIVE TISSUE MASSAGE ON PAIN AFTER THORACOTOMY - RANDOMIZED CONTROLLED TRIAL

Purpose: The objective was evaluate the effect of a connective tissue massage on pain, applied analgesic amounts and length of hospitalization of the patients. Method: The study was a prospective, randomized, controlled clinical trial and conducted at a thoracic surgery department of university hospital. The patients were randomly allocated to 1 of 2 groups: a control group (n=27) and the experimental group (n=27). Standard medical treatment, care and pulmonary rehabilitation program were applied to both groups. In addition, a total of 5 sessions of connective tissue massage were applied to the experimental group. Pain level of the patients was evaluated at every 24 hours as of the zeroth postoperative day. VAS was used as a one-dimensional scale for pain assessment. Totally applied analgesic amounts and length of hospitalization of the patients were recorded. Results: There was no statistically significant difference between the experimental and control groups on the postoperative 0th and 1st days. A statistically significant difference was found between VAS averages on postoperative 2nd, 3rd, 4th, 5th, 6th and 7th days (p

Wound healing rates in COPD patients undergoing traditional pulmonary rehabilitation versus tailored Wound-Centric interventions.

This comparative cross-sectional study, conducted at Shanghai Pulmonary Hospital, aimed to evaluate the efficacy of tailored wound-centric interventions (TWCI) versus traditional pulmonary rehabilitation (TPR) in enhancing wound healing in patients with chronic obstructive pulmonary disease (COPD). Enrolling 340 patients with confirmed COPD, the study randomly assigned participants to either the TWCI or TPR group for a 12-week programme. The primary outcome measured was the rate of wound healing, with secondary outcomes including changes in pulmonary function tests (PFTs) and quality of life (QoL) scores. The TWCI group received a customized programme integrating standard pulmonary rehabilitation with specific wound care strategies, such as enhanced oxygen therapy, nutritional supplementation, and infection control measures. In contrast, the TPR group underwent a conventional pulmonary rehabilitation programme without targeted wound care interventions. Wound healing rates, PFTs, and QoL scores were assessed at the end of the intervention and 3 months post-intervention. The TWCI group demonstrated a statistically significant improvement in wound healing rates compared with the TPR group. The TWCI group had a 15% higher rate of reduction in wound size, a 10% rise in complete healing rates, and a 20% drop in infection rates (p < 0.05). Specifically, TWCI group exhibited higher rates of wound size reduction, complete healing, and decreased infection rates. Additionally, long-term pulmonary function and overall quality of life improvements were more pronounced in the tailored group, underscoring the benefits of a personalized approach to managing COPD and wound care. The study concluded that integrating wound-specific care strategies with pulmonary rehabilitation significantly enhances health outcomes in COPD patients with wounds. These findings supported the adoption of customized, multidisciplinary care plans, suggesting that tailored interventions can offer a comprehensive solution to the complex needs of COPD patients, potentially redefining best practices in chronic disease management.

Pulmonary Rehabilitation Associated with Noninvasive Ventilation on Physical Capacity and Quality of Life in Post-COVID-19: A Randomized Controlled Double-Blinded Clinical Trial Protocol.

The coronavirus disease-2019 (COVID-19) pulmonary rehabilitation (PR) seems to be a better choice to improve physical and functional capacity after acute infection. However, there is a lack of evidence regarding the effects of different strategies to optimize post-acute phase rehabilitation and reduce long COVID-19 physical deteriorations. To compare the use of a noninvasive ventilation (NIV) plus aerobic exercise strategy during PR program with to a standard PR (without NIV) on physical capacity and quality of life outcomes in post-COVID-19. Double-blinded randomized controlled clinical trial. A total of 100 individuals discharged from hospital in a post-acute phase of severe COVID-19 will be randomized into two groups: PR + NIV (Group 1) and PR (Group 2). Inclusion criteria include participants who present symptomatic dyspnea II and III by the modified Medical Research Council, aged 18 years or older. Both groups will receive aerobic and resistance exercise, and inspiratory muscle training. However, group 1 will perform aerobic training with bilevel NIV. Cardiopulmonary exercise test will assess the O2 peak uptake, 6-minute walk test will assess the walking distance and short-form 36 will assess the quality of life before and after 8 weeks (after 24 PR sessions). Moreover, patients will be contacted by telephone every 3 months for one year to record possible adverse events, hospitalizations, and death. All data will be registered in RedCap, and analyses will be performed in the STATA v13 software. RBR-3t9pkzt.

Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial

BackgroundEvidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation.MethodsThis is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers.DiscussionThis randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated.Trial registrationClinicalTrials.gov NCT04387318. Registered on May 13, 2020.

Factors Associated With Persistence of Dyspnea and Change in Health-Related Quality of Life in Patients With COVID-19 After Discharge.

Introduction Coronavirus disease 2019 (COVID-19) is a deadly virus affecting multiple organ systems, predominantly the respiratory system. Dyspnea along with the deterioration of health-related quality of life (HRQoL) is common in COVID-19 patients discharged from a dedicated Coronavirus disease (COVID) hospital. Very few studies in India used HRQoL for the assessment of COVID-19 patients after discharge. Our article aims to assess the factors associated with the persistence of dyspnea and HRQoL in discharged patients of COVID-19. Methods A total of 48 patients were included in this prospective observational study. Ethical approval from Institutional Ethics Committee was obtained before the enrolment of patients. Patients having dyspnea at exertion and during discharge were selected for this study. Modified Medical Research Council (mMRC) scale and modified Borg scale were used for assessing dyspnea on activity, and Saint George's Respiratory Questionnaire (SGRQ) was used to assess HRQoL. Data were collected on the day of discharge (D0) and after 60 days (D60) post-discharge. The significance of changes in parameters from D0 to D60 was evaluated by paired t-test. Results The mean mMRC, modified Borg, and SGRQ scores at D0 were 2.38±0.98, 3.15±2.12, and 45.36±27.32, respectively, which were improved to 0.94±0.86, 0.94±1.27, and 19.22±18.96 at D60. Age showed significant positive correlations with initial modified Borg (r=0.292, p=0.044) and SGRQ (r=0.332, p=0.021) scores. Body mass index showed significant positive correlations with initial mMRC (r=0.352, p=0.014) and SGRQ (r=0.419, p=0.003) scores. Conclusion Our study showed that on discharge, many COVID patients have impaired HRQoL. Many of them also have dyspnea on exertion. With the early institution of standard pulmonary rehabilitation protocol, symptoms and HRQoL improves rapidly in a month. Different influencing factors were identified. Long-term follow-up with a bigger sample size is needed to formulate a management strategy for these patients.

Pulmonary rehabilitation in subterranean chambers combined with neuro-orthopedic activity-dependent plasticity therapy influences patients’ quality of life – A preliminary study

ObjectiveThe aim of the study was to evaluate if Neuro-orthopedic Activity-dependent Plasticity (N.A.P.) therapy combined with standard subterranean pulmonary rehabilitation (SPR) conducted in the salt mine influences the health-related quality of life (HRQoL) and chest mobility in patients with asthma or chronic upper respiratory tracts diseases. Methods54 patients enrolled for the study completed a 3-week SPR. The 15D questionnaire, chest mobility and back scratch flexibility tests were conducted before and after SPR. In the study group (N = 23,16 women, 7 men) the N.A.P. therapy was added to SPR, while the control group (N = 31, 21 women and 10 men) completed the SPR program. ResultsAfter the SPR statistically significant improvements were observed on the 15D dimensions of breathing and vitality dimensions, in the chest mobility and back flexibility in both groups.With the baseline gender distribution, age, generic 15D score, chest mobility and back scratch adjusted, the change in the 15D score was 0.068 greater in the study group than in the control group. This difference is clinically important and statistically significant (p = 0.022). There was no statistically significant difference in the chest mobility and back scratch flexibility between the groups. ConclusionsAdding N.A.P. therapy techniques to the SPR program in the underground part of the ‘Wieliczka’ Salt Mine Health Resort results in a statistically significant and clinically important improvement in the subjects' HRQoL.

High intensity interval training versus moderate intensity continuous training for people with interstitial lung disease: protocol for a randomised controlled trial

BackgroundInterstitial lung disease is a debilitating condition associated with significant dyspnoea, fatigue, and poor exercise tolerance. Pulmonary rehabilitation is an effective and key intervention in people with interstitial lung disease. However, despite the best efforts of patients and clinicians, many of those who participate are not achieving clinically meaningful benefits. This assessor-blinded, multi-centre, randomised controlled trial aims to compare the clinical benefits of high intensity interval exercise training versus the standard pulmonary rehabilitation method of continuous training at moderate intensity in people with fibrotic interstitial lung disease.MethodsEligible participants will be randomised to either a standard pulmonary rehabilitation group using moderate intensity continuous exercise training or high intensity interval exercise training. Participants in both groups will undertake an 8-week pulmonary rehabilitation program of twice-weekly supervised exercise training including aerobic (cycling) and strengthening exercises. In addition, participants in both groups will be prescribed a home exercise program.Outcomes will be assessed at baseline, upon completion of the intervention and at six months following the intervention by a blinded assessor. The primary outcome is endurance time on a constant work rate test. Secondary outcomes are functional capacity (6-min walk distance), health-related quality of life (Chronic Respiratory Disease Questionnaire (CRQ), St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis specific version (SGRQ-I), breathlessness (Dyspnoea 12, Modified Medical Research Council Dyspnoea Scale), fatigue (fatigue severity scale), anxiety (Hospital Anxiety and Depression Scale), physical activity level (GeneActiv), skeletal muscle changes (ultrasonography) and completion and adherence to pulmonary rehabilitation.DiscussionThe standard exercise training strategies used in pulmonary rehabilitation may not provide an optimal exercise training stimulus for people with interstitial lung disease. This study will determine whether high intensity interval training can produce equivalent or even superior changes in exercise performance and symptoms. If high intensity interval training proves effective, it will provide an exercise training strategy that can readily be implemented into clinical practice for people with interstitial lung disease.Trial registration ClinicalTrials.gov Registry (NCT03800914). Registered 11 January 2019, https://clinicaltrials.gov/ct2/show/NCT03800914Australian New Zealand Clinical Trials Registry ACTRN12619000019101. Registered 9 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376050&isReview=true

Feasibility, tolerance and effects of adding impact loading exercise to pulmonary rehabilitation in people with chronic obstructive pulmonary disease: study protocol for a pilot randomised controlled trial

BackgroundChronic obstructive pulmonary disease (COPD) is a disorder linked with a multitude of extra pulmonary manifestations (also known as treatable traits), including low bone mineral density (BMD). To date, no specific guidelines exist for the management of BMD in this population. Impact loading exercise has been identified as an intervention that improves or maintains BMD in other populations. However, the feasibility of and tolerance to impact loading exercise has not been tested in people with COPD. The aim of the proposed study will be to investigate the feasibility and tolerance of adding impact loading exercise to a standard pulmonary rehabilitation programme (PRP) in people with COPD and report its effects on bone health, balance and falls risk.MethodsThis is a protocol for a pilot feasibility and tolerance randomised controlled trial (RCT). Fifty-eight people with COPD will be randomly allocated, on a 1:1 ratio, to either the experimental or control group. Initially, participants in both groups will complete a standard 8-week (twice-weekly) PRP followed by a 32-week period of maintenance exercises. Over the initial 8-week period, participants allocated to the experimental group will also undertake targeted lower limb resistance exercises and commence a programme of impact loading exercises (e.g. bounding and drop jumps). On completion of the initial 8-week PRP, in addition to the standard maintenance exercises, participants in the experimental group will continue with home-based impact loading exercises, four times a week, for the extra 32 weeks. The primary outcome of this study is feasibility of and tolerance to impact loading exercises. Feasibility will be measured using data collected pertaining to recruitment, withdrawal and completion. Adherence to the exercises will be collected using exercise logs. Tolerance to the exercises will be determined using outcomes to assess pain, recording any adverse effects such as a fall and feedback from the participants in semi-structured interviews on completing of the trial. The effects of the 40-week experimental intervention on bone health, balance and falls risk will be reported.DiscussionThis pilot RCT will test the feasibility and tolerance of an intervention that has never been trialed in people with COPD. It will also provide initial information regarding the size of the effect this intervention has on outcomes such as BMD, balance and falls risk. These data will be critical when designing a definitive RCT to advance this area of research.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR): 12620001085965 (20/10/2020)

Reflexive thematic analysis exploring stakeholder experiences of virtual pulmonary rehabilitation (VIPAR)

IntroductionTo enable greater availability of pulmonary rehabilitation (PR), video-conferencing technology was employed to link a community site to a standard outpatient PR service to deliver the programme closer to those...

Long-Term Benefits of Adding a Pedometer to Pulmonary Rehabilitation for COPD: The Randomized Controlled STAR Trial

PurposeThis Stay Active after Rehabilitation (STAR) study examined the effects of a pedometer-based behavioral intervention for individuals with COPD during three weeks of inpatient pulmonary rehabilitation (PR) on patients’ physical activity levels six weeks and six months after PR, including steps (primary outcome), moderate-intensity physical activity, and sedentary time as well as patient quality of life, symptoms, and other psychological and clinical variables.Patients and MethodsRehabilitation patients with COPD wore a triaxial accelerometer (ActiGraph wGT3X) for seven days two weeks before (T0) as well as six weeks (T3) and six months (T4) after PR. In addition to the three-week inpatient PR (control group, CG), the randomly allocated intervention group (IG) received a brief pedometer-based behavioral intervention with the application of the following behavior-change techniques: performing the behavior, individual goal-setting, self-monitoring, and feedback. The effects were analyzed using analysis of covariance with an intention-to-treat approach.ResultsA total of 327 patients (69% male, age: 58 years, FEV1 (%): 53.5, six-minute walk distance: 447.8 m) were randomly allocated to either the IG (n = 167) or CG (n = 160). Although both groups increased their daily steps after PR (IG: MT3-T0 = 1152, CG: MT3-T0 = 745; IG: MT4-T0 = 795, CG: MT4-T0 = 300), the slightly higher increases in daily steps in the IG compared to the CG at T3 (Δ388 steps, d = 0.16) and T4 (Δ458 steps, d = 0.15) were not statistically significant (p > 0.05 for all). Patients in both groups showed moderate to high pre-post-changes in terms of secondary outcomes, but no advantage favoring the IG was found.ConclusionThe results show that adding a pedometer-based behavioral intervention to standard German three-week inpatient PR for COPD patients did not result in more physical activity in terms of steps and moderate-intensity physical activity or less sedentary time. However, both groups (IG and CG) showed remarkably enhanced physical activity levels six weeks and six months after PR, as well as improvements in other secondary outcomes (eg, quality of life).

The Accessibility, Feasibility, and Safety of a Standardized Community-based Tele-Pulmonary Rehab Program for Chronic Obstructive Pulmonary Disease: A 3-Year Real-World Prospective Study.

Rationale: Few individuals with chronic obstructive pulmonary disease (COPD) are able to access pulmonary rehabilitation (PR) despite its importance. Barriers include increased travel time and lack of resources. Tele-PR has been proposed as a novel solution to overcome such barriers and improve access. Objectives: Our study aimed to provide information on implementing a novel province-wide standardized community-based tele-PR program and determine its accessibility, feasibility, and safety. Secondary objectives examined the effectiveness of tele-PR compared with standard PR and if clinical improvements were sustained over time. Methods: We conducted a concurrent prospective study of people with COPD enrolled in either standard PR or community-based tele-PR at satellite centers between January 2017 and January 2020. To determine accessibility and feasibility, we recorded the number of participating centers meeting eligibility criteria, centers remaining in the program over 3 years, number of delivered programs, and major adverse events. Participants had a 6-minute walk test (6MWT) and COPD assessment test (CAT) at baseline, immediately after PR and at 1, 3, 6, and 12 months. Descriptive analysis was performed for accessibility, feasibility, and safety. Mixed-effects random models were used to estimate change in 6MWT and CAT. Results: Seven tele-sites were recruited into the tele-PR program, with six continuing to participate at 3 years, delivering a total of 58 programs for 177 individuals with COPD. During that same period, the standard PR site delivered 15 programs for 89 individuals with COPD. Over 70% of participants completed each program, and no major adverse events were reported. There were significant improvements in the 6MWT and CAT scores in both groups immediately after PR with no between-group differences. Participants in both programs had persistent 6MWT improvement at 1, 3, 6, and 12 months after PR. Participants in tele-PR, but not those in standard PR, had persistent improvements of CAT scores beyond 1 month after PR. Conclusions: This study provides real-world evidence demonstrating successful implementation of tele-PR. The Canadian standardized tele-PR program is an accessible, feasible, safe, and effective model for delivering PR.

Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL.

Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.

Experiences in responders and non-responders to pulmonary rehabilitation among people with chronic obstructive pulmonary disease: a clinical study with convergent mixed analysis

Purpose This study aims to investigate the experienced and measured development in physical capacity in people with Chronic Obstructive Pulmonary Disease (COPD) undergoing a standard pulmonary rehabilitation programme with a focus on the diverging experiences of responders and non-responders. Methods Twenty-one participants in standard pulmonary rehabilitation were included in the study. We measured the participants’ change in the six-minute walk test (6MWT) during rehabilitation participation. We investigated their experiences of the changes in their physical capacity by combined participant observations and interviews. A convergent mixed analysis was conducted of the coherent data. Results Standard pulmonary rehabilitation had a different physical impact on people with COPD. Responders were delighted by a positive physical change, which improved their daily functioning and capability of fulfilling personal priorities. However, non-responders experienced decreased capacity and a lack of trust in their future. All participants found it challenging to exercise and achieve sustainable exercise habits. Conclusion In this qualitative study, we found that absence of expected improvement to pulmonary rehabilitation seems to confer distress and feelings of hopelessness. The achievement of sustainable change in daily exercise behaviour appears yet to be insufficient. Thus, new and more individualized models of physiotherapists’ guidance in exercise are imperative. Implications for rehabilitation It is vital to acknowledge differential response to people with the chronic obstructive pulmonary disease following eight-week standard pulmonary rehabilitation. Especially noteworthy feelings of distress and hopelessness are prominent to non-responders because of the absence of the promised improvements. Both responders and non-responders require intensive physiotherapist guidance to exercise. It is recommended to ensure individualised support to people with chronic obstructive pulmonary disease in rehabilitation programmes.

Effectiveness of Continuous Chest Wall Vibration With Concurrent Aerobic Training on Dyspnea and Functional Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

ObjectiveTo investigate the effects of continuous chest wall vibration with concurrent aerobic training in addition to a 4-week pulmonary rehabilitation program on dyspnea and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DesignRandomized, single-blind, placebo-controlled trial. SettingThe Cardiopulmonary Rehabilitation Unit of a tertiary referral subacute rehabilitation center. ParticipantsA sample of 146 consecutive patients with COPD (Global Initiative for Chronic Obstructive Lung Disease II-III-IV) were assessed for eligibility. The final sample of 40 patients (N=40) was randomized into 3 groups (intervention, sham intervention, control). InterventionsAll groups carried out 5 sessions per week for 4 weeks of standard pulmonary rehabilitation treatment. The 2 daily 30-minute sessions included aerobic training and resistance training or airway clearance techniques. The intervention group performed the aerobic training with the addition of continuous chest wall vibration applied during cycling, whereas the sham intervention group received continuous chest wall vibration as a placebo during cycling. Main Outcome MeasuresSix-minute walk distance (6MWD) and Barthel Index based on dyspnea (BID). ResultsA total of 36 participants completed the study (69±7 years; forced expiratory volume in 1 second percentage of predicted, 40.15%±15.97%). Intention to treat analysis showed no significant differences between groups for 6MWD and BID. However, the increase in 6MWD was a clinically important difference in the intervention group (42.57±43.87m, P=.003), with a moderate effect size (d=0.58). ConclusionsContinuous chest wall vibration with concurrent aerobic training in addition to a standard pulmonary rehabilitation program might improve functional exercise capacity compared with usual care, but there were no effects on dyspnea, respiratory muscle function, or quality of life in patients with COPD.

12-months follow-up of pulmonary tele-rehabilitation versus standard pulmonary rehabilitation: A multicentre randomised clinical trial in patients with severe COPD

Between March 2016 and October 2017, we randomised 134 patients with severe COPD from 8 hospitals in the Capital Region of Denmark to participate in either standardised, outpatient pulmonary rehabilitation (control group) or on-line, supervised and home-based tele-rehabilitation (intervention group). We found no difference between the groups in the primary outcome: six minutes walking distance (6MWD) after completion of the programme. The current study presents results from the 12-month follow-up with assessment of the 6MWD and analyses of hospitalisation and mortality. There were no significant differences between or within the groups in the 6MWD one year after completion of the programme.

Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study.

BackgroundTelehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices.ObjectiveThe objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study.MethodsUsability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions.ResultsDuring usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements.ConclusionsUsability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions.

Experiences of individuals using a novel web-based rehabilitation programme: Self-management Programme of Activity Coping and Education (SPACE) for chronic obstructive pulmonary disease

Background/Aims The Self-management Programme of Activity Coping and Education (SPACE) for chronic obstructive pulmonary disease has been integrated into an online programme for patients to pursue at home with the support of health care professionals. This study aimed to identify barriers and facilitators to participation in the web-based programme and to guide further development of the website. Methods This nested qualitative study was part of a feasibility study comparing web-based rehabilitation with standard pulmonary rehabilitation. Framework analysis was performed to identify themes. Results Four overarching themes were identified: programme content and reported gains; embedding the programme into daily routines; barriers to participating in the programme; and support. These themes describe benefits of the programme including improved activity levels, exercise intensity and knowledge of the condition, as well as the incorporation of exercise into daily routine. Both completers and non-completers acknowledged the importance of motivation and self-discipline when following the programme and that the flexibility of the programme could help or hinder engagement. Support from healthcare professionals was important and used for encouragement, to obtain health advice and technical support. Conclusions The experiences of chronic obstructive pulmonary disease patients using this web-based rehabilitation programme illustrate how patients can benefit from such a resource and integrate it into their daily lifestyle.

Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients.

BackgroundThe appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR).MethodsWe retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes.ResultsCompared to the category of individuals with 6MWD >350 meters, those patients with 201–350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased.ConclusionThis study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.

Balance Training in Pulmonary Rehabilitation to Reduce Fall Risk

Purpose: To determine the efficacy of a balance training program for fall risk reduction in outpatient pulmonary rehabilitation (PR). Methods: Forty-nine participants in an outpatient PR program participated in a balance training program in addition to the standard PR exercises. Balance was assessed with the Activities-Specific Balance Confidence (ABC) scale, Mini-BESTest (MBT), and Short Physical Performance Battery (SPPB). Gait speed, 5 times sit to stand test (5TSTS), and Timed Up and Go (TUG) data were extracted for analysis. Progressive lower-extremity strengthening and balance specific exercises were performed during each PR session. Results: Over 90% of participants presented with at least one balance assessment that indicated an increased fall risk and 81% had mobility limitations based on an SPPB score &lt;10. During the final assessment, only 16.2% of the participants were at fall risk and 13.5% had mobility limitations. Significant improvements (P &lt; .001) were seen in the mean differences from baseline to final in the ABC scale 31.6% (95% CI [24.8, 38.5]), MBT 9.3 (95% CI [7.6, 11.0]), SPPB 4.1 (95% CI [3.4, 4.7]), gait speed 0.37 m/s (95% CI [0.29, 0.46]), 5TSTS −7.8 seconds (95% CI [−10.5, −5.0]), and TUG −4.7 seconds (95% CI [−5.7, −3.7]). Conclusions: Incorporating a balance training program into a PR program may help to decrease fall risk and increase balance confidence in functional activities.