1,721,506 research outputs found
Are crackles an appropriate outcome measure for airway clearance therapy?
Full text linkBACKGROUND: There is an urgent need to develop new outcome measures for respiratory therapy, to evaluate its effectiveness. Adventitious sounds generated from the lungs (crackles and wheezes), can now be quantified and characterized objectively with computer technology. To our knowledge, this is the first reported study designed to assess any change in lung crackles before and after a single session of airway clearance therapy.METHODS: Twenty-three stable bronchiectasis patients were recruited from United Kingdom out-patient clinics and treated with a single session of airway clearance therapy, using the active cycle of breathing technique. Sound recordings were made before and after the session at 7 anatomical chest locations. Computerized lung sound analysis was used to measure crackle parameters: 2-cycle deflection width (2CD), and crackle number per breath cycle (nBC). Perceived breathlessness, lung function, and oxygen saturation data were also recorded.RESULTS: Crackle mean 2CD and mean nBC increased post intervention. Sixteen participants (70%) showed a statistically significant difference in mean crackle 2CD before and after the session at ? 1 chest location. Thirteen (57%) participants had a difference between mean crackle 2CD before and after the intervention > 1 Smallest Real Difference (SRD, mean SRD = 2.23 ms) at ? 1 chest location. Differences in mean crackle nBC before and after the intervention did not exceed the SRD (mean SRD = 32 crackles per breath cycle) in any participant. Perceived breathlessness was significantly reduced post intervention; no significant changes were observed in either lung function or oxygen saturation.CONCLUSIONS: Crackle duration (2CD) was found to change after a single session of airway clearance therapy, and shows promise as a new outcome measure for respiratory therapy interventions.<br/
A list of tools is not enough! Professionals’ advice on how to implement a core outcome set in practice
No full textBackground: the number of Core Outcome Sets (COS) has increased in recent years and more methodological research has been published aiming to increase the credibility of COS. However little is yet known about strategies to facilitate COS implementation and promote adherence among professionals and researchers to use COS in practice. Methods: qualitative interviews (n=29) were conducted in the pre-Delphi stage of the development of a COS to evaluate physical activity interventions for people living with dementia. Nine professionals were asked to comment on strategies to implement this COS, once it had been completed. Data generated from the comments were analysed thematically. Results: participants included professionals from a wide range of backgrounds (public, private and voluntary sectors), and from different settings (hospitals, community, nursing and care homes). Their comments on COS implementation in practice can be organised into three themes: 1) “Needing a COS in practice” – participants explained how COS can help to meet the needs of professionals to measure patients’ physical activity interventions and bench mark their results against others and against published research; 2)“Making it work in practice” – participants stressed the need to include feasible measurement tools in COS (low cost and easy to use) but also the need for a “toolkit”, including not only the tools, but when and how to use them; and 3) “Broadcasting it widely” – by presenting at conferences, professionals’ meetings, and promoting COS among professional and governance bodies. Conclusions: professionals recognise the need for COS in practice and would welcome a set of outcomes and tools presented as a “toolkit”. Wide dissemination activities are likely to be necessary to achieve the homogeneity of reporting outcomes aimed by COS developers. <br/
Implications of a qualitative study on Core Outcome Set development
No full textBackground: the use of qualitative methods within Core Outcome Set (COS) development has been recognised as a potentially beneficial methodological innovation. Although preliminary guidance on the use of qualitative methods as a pre-Delphi stage in COS development has been published, additional appraisal on the use of this novel approach is still encouraged. The present study reports on the implications of a qualitative study on the development of a COS to evaluate physical activity interventions for people with dementia, across different stages of the condition and intervention settings. Methods: in-depth qualitative interviews (n=29) were conducted with people with dementia, their family carers and health professionals. Data were analysed thematically and the outcomes identified in the interviews were compared against those reported in a previous literature review. Interview data was also used to define the scope of each outcome domain. Possible implications of this qualitative study on the development of the COS were identified. Results: the present qualitative study generated 10 new outcomes; nine outcomes were identified in previous literature, but not in this qualitative study. A final list of 77 outcomes was generated to be used in the Delphi stage. A glossary was also developed based on these qualitative findings, clearly defining the scope of each domain prior to the Delphi. The large majority of outcomes were mentioned by participants across stages of dementia. Thus the COS protocol was changed from a Delphi survey subdivided per stages of dementia, to a single Delphi survey common to all stages. Conclusions: qualitative studies can generate new outcomes to those generated through literature reviews, and they can be paramount in defining the scope of each outcome pre-Delphi. Qualitative studies can inform the structure of COS, by providing an in-depth understanding of how outcomes can be meaningful across stages of disease progression.<br/
Giving voice to people: experiences during mild to moderate acute exacerbations of COPD
Full text linkAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on health status and disease progression, but their clinical presentation is heterogenous. A comprehensive understanding of people's experience during AECOPD is needed to develop person-centred interventions, such as pulmonary rehabilitation (PR). This study aimed to explore people's experience during mild to moderate AECOPD, and their thoughts on PR during this period.publishe
Outcomes of physical activity for people living with dementia: qualitative study to inform a core outcome set
No full textBackground: the need for a Core Outcome Set to evaluate physical activity interventions for people living with dementia, across stages of disease and intervention settings has been established. This qualitative study precedes the consensus phase of developing this Core Outcome Set and aims to: (i) compare the outcomes identified by patients, carers and professionals to those previously reported in the literature; (ii) and understand “why” certain outcomes are considered important.Design and Methods: in-depth semi-structured interviews were conducted with people living with dementia, family carers and professionals (n = 29). The outcomes identified in the interviews were mapped to a list of outcomes reported in a recent literature review. An in-depth thematic analysis was conducted to understand the importance of physical activity in dementia care.Results: a comprehensive, inductively derived list of 77 outcomes, common across stages of dementia and intervention setting, was put together for the consensus phase of this Core Outcome Set: ten of these were new outcomes generated by this qualitative study. Five themes explained why stakeholders perceived physical activity outcomes as important for people living with dementia: “being well and staying well”, “having a role towards others”, “maintaining identity”, “being connected to the present” and “delivering good quality care”.Conclusion: ten new outcomes of physical activity, not previously reported in recent literature, were identified. Physical activity is considered important to people living with dementia due to its positive impact on multiple health outcomes for both patients and carers
Reliability of computer aided lung sound analysis detecting crackles in bronchiectasis patients: a potential outcome measure for respiratory physiotherapy
No full textThe use of computer aided lung sound analysis to characterise adventitious lung sounds: a potential outcome measure for respiratory therapy
No full textA barrier to assessing the effectiveness of respiratory physiotherapy has been insufficient accurate, reliable and sensitive outcome measures. Lung sounds provide useful, specific information for assessing and monitoring respiratory patients. However, standard auscultation techniques are too subjective to allow them to be used as an outcome measure. In this research, Computer Aided Lung Sound Analysis (CALSA) was used to assess whether adventitious lung sounds’ characteristics could be quantified clinically and used as a new objective, non-invasive, bedside clinical outcome measure for physiotherapy alveolar recruitment and airway clearance techniques. Two experimental studies were conducted incorporating ‘before-and-after’ and ‘repeated measures’ components. Fifty four participants with productive lung disorders (cystic fibrosis and bronchiectasis) were recruited from out-patient clinics. Demographic, anthropometric, lung function, oxygen saturation, breathlessness and lung sound data were collected at baseline and after a single intervention (selfintervention in the first study and intervention applied by a physiotherapist in the second study). The intra-subject reliability of crackle frequency (f) within each session was found to be ‘good’ to ‘excellent’, estimated by the Analysis of Variance, Intraclass Correlation Coefficient, Smallest Real Difference and Bland and Altman 95% limits of agreement. Crackle initial deflection width (IDW) and crackle two cycles deflection width (2CD) were reliable over short time periods. The f of crackles increased in the majority of participants post interventions. Agreement on the number (N) and timing (T) of crackles between CALSA and a physiotherapist‘s auscultatory findings was found to be poor in anterior chest sites, but higher in posterior sites. Conclusion: the use of CALSA to identify the type and f of adventitious lung sounds collected clinically is feasible; crackle IDW and 2CD are both reliable measures but crackle 2CD is more consistent; crackle f was more responsive than the N or T of crackles per breathing cycle to the interventions. In future, CALSA may provide an objective and responsive tool for assessing and monitoring respiratory interventions in clinical settings
Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach
No full textIntroduction: Chronic obstructive pulmonary disease (COPD) is a complex and heterogenous disease that is associated with a range of respiratory and non-respiratory symptoms, which highly contribute to the daily burden of the disease. Symptoms burden remains high despite optimal bronchodilator therapy, but pulmonary rehabilitation (PR) is an effective intervention to improve patients' symptoms. A comprehensive interdisciplinary approach within the framework of a PR program is warranted to tackle these complex symptoms and their consequences. Areas covered: This narrative review describes how symptoms of dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances, and cognitive decline arise in COPD and can contribute to several non-pulmonary manifestations of the disease. It also describes evidence of the effectiveness of interdisciplinary PR programs to counteract these symptoms. A literature search was performed on PubMed and Scopus between June and July 2020. Expert opinion: Respiratory and non-respiratory symptoms are highly prevalent, often not comprehensively assessed, and result in several extra-pulmonary manifestations of the disease (physical, emotional and social). Interdisciplinary PR programs can improve these negative manifestations through different pathways, contributing for an effective symptoms' management. A thorough assessment of symptoms (beyond dyspnea) should be routinely performed and may support the identification of treatable traits, allowing the tailoring of PR interventions and assessment of their real-life impact.publishe
Clinically useful outcome measures for physiotherapy airway clearance techniques: a review
No full textA lack of good outcome measures has been a barrier to the development of an evidence base for all areas of respiratory physiotherapy. Many of the clinically available outcome measures are not specifically related to the physiotherapy intervention employed and may be affected by other factors. In this paper, the outcome measures currently clinically available to UK NHS physiotherapists to assess the response to alveolar recruitment and airway clearance interventions have been reviewed. It is clear that there is an urgent need to increase the accuracy, reliability, and sensitivity of the outcome measures employed, or to develop new measures to assess the effectiveness of respiratory physiotherapy. Lung sounds provide useful, specific information, but standard auscultation is too subjective to allow them to be used as an outcome measure. Computer Aided Lung Sound Analysis (CALSA) is proposed as a new objective, non-invasive, bedside clinical measure with the potential to monitor and assess the effects of airway clearance therapy
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