1,721,021 research outputs found
Rehabilitation of patients with coexisting COPD and heart failure
No full textChronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) frequently coexist, significantly reducing the patient's quality of life (QoL) and increasing morbidity, disability and mortality. For both diseases, a multidisciplinary disease-management approach offers the best outcomes and reduces hospital readmissions. In both conditions, muscle dysfunction may dramatically influence symptoms, exercise tolerance/performance, health status and healthcare costs. The present review describes muscular abnormalities and mechanisms underlying these alterations. This review also discusses studies on training programs for patients with COPD, CHF and, where available, combined COPD-CHF diagnosis. Dyspnea, peripheral muscles and activities of daily living (ADL) represent a potential starting point for improving patients' functioning level and quality of life in COPD and CHF. A synergy of the combined diagnostic, pharmacological and rehabilitation treatment interventions is also essential. Integration between exercise training, drug therapy and nutritional care could be a valid, synergic and tailored approach for patients presenting with both diseases, and may have a positive impact on the exercise performance
An implementation protocol for noninvasive ventilation prescription: the physiotherapist's role in an Italian hospital
No full textFor patients with chronic respiratory failure or sleep breathing disorders, adaptation and training are important prerequisites for successful home noninvasive ventilation (NIV) and CPAP. In Europe, management of NIV/CPAP is sometimes performed by physiotherapists (PTs). However, their role within the NIV/CPAP management team is not well defined
Does quadriceps contractile fatigue influence rehabilitation outcomes in COPD-chronic respiratory failure patients?
Full text linkBackground: In patients with moderate COPD, response to pulmonary rehabilitation including exercise training varies according to the presence of peripheral muscle fatigue (pMF) of quadriceps. This study investigates the role of pMF in predicting pulmonary rehabilitation outcomes in more severe COPD patients who have already developed chronic respiratory failure (COPD-CRF). Methods: A post hoc analysis of a prospective randomised controlled trial was performed at Istituti Clinici Scientifici Maugeri Lumezzane (Brescia, Italy), involving 30 COPD-CRF patients undergoing a pulmonary rehabilitation programme comprising 20 endurance training sessions. Pre-to-post assessment included a 6-min walk test (6MWT), Fatigue Severity Scale (FSS), Barthel dyspnoea index, and quality-of-life questionnaires. We assessed the contractile pMF of quadriceps via electrical nerve stimulation pre-to-post a cycling fatiguing task, using the change in potentiated quadriceps twitch for pMF. Results: At baseline, 12 (40%) patients developed pMF (pMF group), while 18 (60%) did not (no-pMF group). The pMF group had a lower baseline 6-min walk distance (6MWD) with greater FSS and lower quadriceps thickness. After pulmonary rehabilitation, no change in contractile pMF was found in the overall group, but pMF ameliorated only in the pMF group. The pMF group had a greater increase in 6MWD (71.67±53.64 m versus 35.28±36.01 m, p<0.05) and was more likely to exceed the minimal clinically important difference in 6MWD (OR 6.25, 95% CI 1.05-37.07; p=0.044). Other pulmonary rehabilitation outcomes improved similarly between groups. Conclusion: Baseline quadriceps pMF predicted greater improvement in the 6MWT in COPD-CRF patients, suggesting it may be a new target for predicting pulmonary rehabilitation outcomes and optimising training protocols
Strategies targeting the NO pathway to counteract extra-pulmonary manifestations of COPD: a systematic review and meta-analysis
No full textThe clinical symptoms of chronic obstructive pulmonary disease (COPD) disease are accompanied by severely debilitating extra-pulmonary manifestations, including vascular dysfunction and hypertension. This systematic review evaluated the current evidence for several therapeutic interventions, targeting the nitric oxide (NO) pathway on hemodynamics and, secondarily, exercise capacity in patients with COPD. A comprehensive search on COPD and NO donors was performed on online databases. Of 934 initially found manuscripts, 27 were included in the review, and 16 in the meta-analysis. The analysis indicated inconsistent effects of dietary nitrate supplementation on exercise tolerance in COPD patients. Dietary nitrate supplementation decreased systolic (-3.7 ± 4.3 mmHg; p = 0.10) and diastolic blood pressure (BP; -2.6 ± 3.2 mmHg; p = 0.05) compared with placebo. When restricted to acute studies, a clinically relevant BP lowering effect of nitrate supplementation during diastole was observed (-4.7 ± 3.2 mmHg; n = 5; p = 0.05). In contrast, inhaled NO (iNO) at doses <20 ppm (+9.2 ± 11.3 mmHg) and 25-40 ppm (-5±2 mmHg) resulted in inconsistent effects on PaO2 (p = 0.48). Data on the effect of iNO on exercise capacity were too limited and inconsistent, but preliminary evidence suggests a possible benefit of iNO on pulmonary vascular resistance during exercise in severe COPD patients. Overall, the effects of acute dietary nitrate supplementation on BP may be of clinical relevance as an adjunct therapy and deserve further investigation in large sample size studies of COPD patients with and without cardiovascular comorbidities. iNO exerted inconsistent physiological effects, with the use of high doses posing safety risks
Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
No full textOBJECTIVE: To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD). DESIGN: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ). RESULTS: Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897-98.927); standardized mean difference, 3.86 (95% CI, 2.04-5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, -8.041 (95% CI, -15.273 to -0.809); standardized mean difference, -1.23 (95% CI, -2.14 to -0.31)]. CONCLUSIONS: Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed
Is There Any Additional Effect of Tele-Assistance on Long-Term Care Programmes in Hypercapnic COPD Patients? A Retrospective Study
No full textThe evidence for tele-assistance (TA) in hypercapnic chronic obstructive pulmonary disease (COPD) patients on long-term oxygen therapy (LTOT) is scarce. The aim of this study was to evaluate the effects of addition of long-term TA to LTOT with or without non-invasive ventilation (NIV) in these patients. Retrospective analysis of a previous randomised study of patients on LTOT. According to the care programme patients were divided into Group 1: LTOT; Group 2: LTOT + NIV; Group 3: LTOT + TA and Group 4: LTOT + NIV+TA. Primary outcomes: time to first exacerbation and hospitalisation during 12 months of long-term care. Risk of exacerbation was statistically different among groups (p = 0.0002). TA addition to NIV significantly reduced exacerbation risk when compared with that to all groups. Hospitalisation risk was statistically different among groups (p = 0.049). Addition of TA to LTOT but not to NIV significantly reduced hospitalisation risk when compared to Group 1 (p = 0.013). Risk of mortality did not differ among groups (p = 0.074). In chronically hypercapnic COPD patients on LTOT, 1. TA alone and with greater efficacy when combined with NIV may reduce the frequency of exacerbations and 2. TA added to LTOT, but not to NIV, may reduce the frequency of hospitalisations
A Pulmonary Rehabilitation Decisional Score to Define Priority Access for COPD Patients
Full text linkThis retrospective study aimed to evaluate, through an ad hoc 17-item tool, the Pulmonary Rehabilitation Decisional Score (PRDS), the priority access to PR prescription by respiratory specialists. The PRDS, scoring functional, clinical, disability, frailty, and participation parameters from 0 = low priority to 34 = very high priority for PR access, was retrospectively calculated on 124 specialist reports sent to the GP of subjects (aged 71 ± 11 years, FEV1% 51 ± 17) consecutively admitted to our respiratory outpatient clinic. From the specialist's report the final subject's allocation could be low priority (LP) (>60 days), high priority (HP) (30-60 days), or very high priority (VHP) (<30 days) to rehabilitation. The PRDS calculation showed scores significantly higher in VHP versus LP (p < 0.001) and significantly different between HP and VHP (p < 0.001). Comparing the specialist's allocation decision and priority choice based on PRDS cut-offs, PR prescription was significantly more appropriate in VHP than in HP (p = 0.016). Specialists underprescribed PR in 49% of LP cases and overprescribed it in 46% and 30% of the HP and VHP prescriptions, respectively. A multicomprehensive score is feasible being useful for staging the clinical priorities for PR prescription and facilitating sustainability of the health system
Impact of Clinical and Quality of Life Outcomes of Long-Stay ICU Survivors Recovering From Rehabilitation on Caregivers' Burden
No full textThe objective of this work was to evaluate the time course of clinical and health-related quality of life outcomes of long-stay ICU survivors' and caregivers' burden
A two-year longitudinal study on strain and needs in caregivers of advanced ALS patients
No full textOur objective was to explore strain and needs in caregivers of advanced ALS patients and correlate this burden with patient's clinical condition and caregiver's sociodemographic status. Fifty-eight caregivers completed the Family Strain Questionnaire-short form (FSQ-SF) and Caregiver Needs Assessment (CNA) during patients' hospitalization (T0); 39 caregivers were reassessed at 6-12 months (T1) and 13 caregivers at 18-24 months (T2) follow-up. FSQ-SF and CNA total scores (CNA-T), including the CNA subscores 'Emotional/Social Support Needs' (CNA-E) and 'Information/Communication Needs' (CNA-I), were compared to patients' clinical condition (measured by ALSFRS-R and FVC %) and caregivers' sociodemographic status. Results showed that high strain level was found in 80% of caregivers and persisted over time. At T0, CNA-T was moderate and was not correlated to site of ALS onset, patients' clinical variables, or caregiver's sociodemographic characteristics; CNA-I subscore was significantly correlated to bulbar onset. CNA-T and CNA-I were significantly reduced at T1 (both, p < 0.01). Caregivers' parental relationship to patient (filial) and working status influenced caregivers' needs. After a longer follow-up (T2), CNA-E significantly decreased vs. T0 score (p < 0.02). In conclusion, over time, caregivers of advanced ALS patients show persisting high strain while needs decline, although the level still remains high. Further studies are needed to propose the most appropriate support
Does 6-Month Home Caregiver-Supervised Physiotherapy Improve Post-Critical Care Outcomes?: A Randomized Controlled Trial
No full textObjective This study aims to determine whether a 6-month home physiotherapy program can improve outcomes in critical care survivors. Design Forty-eight consecutive patients were randomized. The treatment group underwent 2 sessions/day of breathing retraining and bronchial hygiene, physical activity (mobilization, sit-to-stand gait, limb strengthening), and exercise re-conditioning whereas controls underwent standard care. Maximum inspiratory/expiratory pressures (MIP/MEP), forced volumes, blood gases, dyspnea, respiratory rate, disability, peripheral force measurements, perceived health status (Euroquol-5D), patient adherence/satisfaction, safety, and costs were assessed. Results Outcomes of treatment versus controls: MIP 14 ± 17 vs. -0.2 ± 14 cm H2O, MEP 27 ± 27 vs. 6 ± 21 cm H2O both P < 0.03; in addition, quality of life (Euroquol-5D) (P = 0.04), FEV 1 (P = 0.03), dyspnea (P = 0.002), and respiratory rate (P = 0.009) were significantly improved for treated cardiorespiratory patients only. Eighty-three percent of the treated patients were decannulated versus 14% of controls (P = 0.01). Compliance was high (74 ± 25%) and there were no side effects. The majority (87.4%) expressed satisfaction with the program. Treatment cost was 459€/patient/month. Conclusions Carrying over regular bronchial hygiene techniques, physical activity, and exercise into the home after long critical care stays is safe and has a beneficial effect on respiratory muscles, decannulation, pulmonary function, and quality of life. © 2016 Wolters Kluwer Health, Inc
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