1,721,377 research outputs found
Alternative Modes of Delivery in Pulmonary Rehabilitation
No full textPurpose:This review presents an overview of the safety and efficacy of alternative modes of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD).Review Methods:We identified recently published systematic reviews, meta-analyses, and guidelines, as well as relevant studies, exploring the safety and effectiveness of community-based PR, home-based PR, telerehabilitation, and web-based rehabilitation in people with COPD. A narrative summary of the main findings is presented.Summary:Although evidence suggests that community-based PR, home-based PR, telerehabilitation, and web-based rehabilitation are effective alternatives to center-based PR, it requires a careful interpretation as several of these programs do not comply with PR definition and have been compared with center-based PR programs that do not reach the minimal clinically important differences. Moreover, there is a huge heterogeneity among programs, and the confidence and quality of the evidence is mostly low. Hence, these novel modes of PR and center-based PR are not interchangeable. Instead, these are alternative modes aiming to increase access to PR. Questions remain regarding the most efficient way of implementing each PR mode, level of access, reimbursement policies, and data privacy in the use of technology. Standard protocols on how to set up each alternative PR mode need to be developed. Future research needs to explore how to use the treatable traits approach in combination with individual preferences and needs, program availability, safety, social support network, digital literacy, and health system context to identify the optimal PR program for each patient
COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force
Full text linkBACKGROUND: Patients with coronavirus disease 2019 (COVID-19) or post-COVID-19 will probably have a need for rehabilitation during and directly after the hospitalisation. Data on safety and efficacy are lacking. Healthcare professionals cannot wait for published randomised controlled trials before they can start these rehabilitative interventions in daily clinical practice, as the number of post-COVID-19 patients increases rapidly. The Convergence of Opinion on Recommendations and Evidence process was used to make interim recommendations for rehabilitation in the hospital and post-hospital phases in COVID-19 and post-COVID-19 patients, respectively. METHODS: 93 experts were asked to fill out 13 multiple-choice questions. Agreement of directionality was tabulated for each question. ≥70% agreement on directionality was necessary to make consensus suggestions. RESULTS: 76 (82%) experts reached consensus on all questions based upon indirect evidence and clinical experience on the need for early rehabilitation during the hospital admission, the screening for treatable traits with rehabilitation in all patients at discharge and 6-8 weeks after discharge, and around the content of rehabilitation for these patients. It advocates for assessment of oxygen needs at discharge and more comprehensive assessment of rehabilitation needs, including physical as well as mental aspects 6-8 weeks after discharge. Based on the deficits identified, multidisciplinary rehabilitation should be offered with attention on skeletal muscle and functional as well as mental restoration. CONCLUSIONS: This multinational task force recommends early, bedside rehabilitation for patients affected by severe COVID-19. The model of pulmonary rehabilitation may suit as a framework, particularly in a subset of patients with long-term respiratory consequences.status: Publishe
Motivation and preferences for learning of patients with COPD or asthma and their significant others in pulmonary rehabilitation: a qualitative study
No full textIntroduction: In depth understanding of educational needs from the perspective of the learners in pulmonary rehabilitation (PR) is lacking. To improve learning in PR, understanding of factors that induce or enhance intrinsic motivation in both patients and their significant others is needed
Impact of Surgery on Functional and Patient-reported Outcomes in Patients With Early-stage Non-small Cell Lung Cancer
No full textRationale In patients with early-stage non-small cell lung cancer (NSCLC), the treatment of choice is surgical resection, with or without (neo)adjuvant chemotherapy. As a result of the disease and its treatment, patients have an increased risk for poor functional performances, decreased quality of life and high symptom burden. Current knowledge is mainly based on cross-sectional evaluations after treatment; longitudinal changes have been poorly characterized. Therefore, we aimed to investigate functional and patient-reported outcomes in patients with early-stage NSCLC before treatment and 12 weeks after treatment. Methods Patients with early-stage NSCLC (stage I-IIIB) were assessed before surgery and 12 weeks after treatment initiation. Functional outcome measures were a six-minute walk distance (6MWD), 1-minute sit-to-stand test (1-MSTST), quadriceps muscle strength (QMS; microFET), and handgrip strength (HGS; Jamar). Patient-reported outcome measures were the European Organization for the Research and Treatment of Cancer Questionnaire and lung cancer module (EORTC QLQ-C30-LC13), multidimensional fatigue inventory (MFI-20), and San Diego shortness of breath questionnaire (SOBQ). Analyses were performed using JMP PRO 14.2.0. Paired t-tests and Wilcoxon Signed rank tests were used to compare differences between both timepoints. Results Fifteen patients were included (10 males; age 65±9yrs; 5 with COPD). Patients had NSCLC stage IA (n=10), IB (n=1), IIB (n=2) or IIIA (n=2) and were treated via VATS only (n=11) or VATS and adjuvant chemotherapy (n=4). Results are presented in Figure 1. Twelve weeks after treatment, a significant worsening was found for 1-MSTST (27reps vs. 23reps, p=0.008), HGS (36kg vs. 31kg, p=0.036), and SOBQ score (11 vs. 21, p=0.010). No significant differences were found for the other outcomes. Conclusion In early-stage NSCLC, the treatment mainly affected the performance on the 1-MSTST, peripheral muscle strength, and shortness of breath. In contrast to previous findings, we did not observe a significant decrease in 6MWD, quality of life, and fatigue levels
Impact of Surgery on Functional and Patient-reported Outcomes in Patients With Early-stage Non-small Cell Lung Cancer
No full textRationale In patients with early-stage non-small cell lung cancer (NSCLC), the treatment of choice is surgical resection, with or without (neo)adjuvant chemotherapy. As a result of the disease and its treatment, patients have an increased risk for poor functional performances, decreased quality of life and high symptom burden. Current knowledge is mainly based on cross-sectional evaluations after treatment; longitudinal changes have been poorly characterized. Therefore, we aimed to investigate functional and patient-reported outcomes in patients with early-stage NSCLC before treatment and 12 weeks after treatment. Methods Patients with early-stage NSCLC (stage I-IIIB) were assessed before surgery and 12 weeks after treatment initiation. Functional outcome measures were a six-minute walk distance (6MWD), 1-minute sit-to-stand test (1-MSTST), quadriceps muscle strength (QMS; microFET), and handgrip strength (HGS; Jamar). Patient-reported outcome measures were the European Organization for the Research and Treatment of Cancer Questionnaire and lung cancer module (EORTC QLQ-C30-LC13), multidimensional fatigue inventory (MFI-20), and San Diego shortness of breath questionnaire (SOBQ). Analyses were performed using JMP PRO 14.2.0. Paired t-tests and Wilcoxon Signed rank tests were used to compare differences between both timepoints. Results Fifteen patients were included (10 males; age 65±9yrs; 5 with COPD). Patients had NSCLC stage IA (n=10), IB (n=1), IIB (n=2) or IIIA (n=2) and were treated via VATS only (n=11) or VATS and adjuvant chemotherapy (n=4). Results are presented in Figure 1. Twelve weeks after treatment, a significant worsening was found for 1-MSTST (27reps vs. 23reps, p=0.008), HGS (36kg vs. 31kg, p=0.036), and SOBQ score (11 vs. 21, p=0.010). No significant differences were found for the other outcomes. Conclusion In early-stage NSCLC, the treatment mainly affected the performance on the 1-MSTST, peripheral muscle strength, and shortness of breath. In contrast to previous findings, we did not observe a significant decrease in 6MWD, quality of life, and fatigue levels
Functional and Patient-reported Outcomes at Diagnosis of Non-small Cell Lung Cancer
No full textRationale Poor functional performance and high symptom burden are frequently observed in patients undergoing treatment for non-small cell lung cancer (NSCLC). Little is known about their health status initiation therapy. We investigated functional and patient-reported outcomes at diagnosis in patients with early-and advanced-stage NSCLC, and compared them to age-matched healthy individuals. Methods A cross-sectional study was conducted in newly diagnosed patients with early-stage (stage IA-IIIA) and advanced-stage (stage IIIB-IVB) NSCLC-before starting treatment-and healthy individuals. Functional outcome measures were maximal inspiratory pressure (MIP; MicroRPM), quadriceps muscle strength (QMS; microFET), handgrip strength (HGS; Jamar), short physical performance battery (SPPB), one-minute sit-to-stand test (1-MSTST), and six-minute walk distance (6MWD). Patient-reported outcome measures were modified Baecke questionnaire, physical activity scale for the elderly questionnaire (PASE), multidimensional fatigue inventory (MFI-20), modified Medical Research Council dyspnea questionnaire (mMRC), San Diego shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS), short-form health survey (SF-12), EuroQoL 5-dimensions (EQ-5D), and instrumental activities of daily living scale (IADLs). One-way ANOVAs and Kruskal-Wallis tests, followed by Tukey-Kramer or Steel-Dwass pairwise comparisons, were performed in JMP PRO 14.2.0 to explore differences between the three groups. Results We recruited 24 patients with early-stage NSCLC (70% male; age 66±9yrs; 33% COPD), 17 patients with advanced-stage NSCLC (65% male; age 64±7yrs; 6% COPD) and 18 healthy individuals (44% male; age 67±10yrs; 0% COPD). Patients with early-and advanced-stage NSCLC presented significant lower 1-MSTST (72%pred vs. 74%pred vs. 89%pred, p=0.010), 6MWD (97%pred vs. 106%pred vs. 128%pred, p<0.0001) and SF-12 mental component score (45 vs. 42 vs. 53, p=0.046) in comparison to healthy individuals. PASE and MFI-20 scores were significantly worse in patients with advanced-stage NSCLC than in healthy controls (56 vs. 108, p=0.005; 58 vs. 42, p=0.027). Compared to patients with early-stage NSCLC, patients with advanced-stage NSCLC had a significantly lower PASE score (88 vs. 56, p=0.049). Detailed results are presented in Table 1. Conclusion Patients with NSCLC scored lower on the 1-MSTST and SF-12 mental score at diagnosis compared to healthy individuals. Patients with advanced-stage NSCLC reported higher fatigue symptoms than healthy individuals, and lower self-reported physical activity levels than patients with early-stage NSCLC and healthy individuals. Although patients with NSCLC scored worse compared to healthy individuals, clinically relevant impairments were not found at diagnosis. To prevent a further decrease, it is important to implement individually tailored interventions to maintain their health status during and after treatment
Determinants Of Peak Aerobic Capacity And Six-Minute Walk Distance In Patients Treated For Lung Cancer
No full text
Functional and Patient-reported Outcomes at Diagnosis of Non-small Cell Lung Cancer
No full textRationale Poor functional performance and high symptom burden are frequently observed in patients undergoing treatment for non-small cell lung cancer (NSCLC). Little is known about their health status initiation therapy. We investigated functional and patient-reported outcomes at diagnosis in patients with early-and advanced-stage NSCLC, and compared them to age-matched healthy individuals. Methods A cross-sectional study was conducted in newly diagnosed patients with early-stage (stage IA-IIIA) and advanced-stage (stage IIIB-IVB) NSCLC-before starting treatment-and healthy individuals. Functional outcome measures were maximal inspiratory pressure (MIP; MicroRPM), quadriceps muscle strength (QMS; microFET), handgrip strength (HGS; Jamar), short physical performance battery (SPPB), one-minute sit-to-stand test (1-MSTST), and six-minute walk distance (6MWD). Patient-reported outcome measures were modified Baecke questionnaire, physical activity scale for the elderly questionnaire (PASE), multidimensional fatigue inventory (MFI-20), modified Medical Research Council dyspnea questionnaire (mMRC), San Diego shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS), short-form health survey (SF-12), EuroQoL 5-dimensions (EQ-5D), and instrumental activities of daily living scale (IADLs). One-way ANOVAs and Kruskal-Wallis tests, followed by Tukey-Kramer or Steel-Dwass pairwise comparisons, were performed in JMP PRO 14.2.0 to explore differences between the three groups. Results We recruited 24 patients with early-stage NSCLC (70% male; age 66±9yrs; 33% COPD), 17 patients with advanced-stage NSCLC (65% male; age 64±7yrs; 6% COPD) and 18 healthy individuals (44% male; age 67±10yrs; 0% COPD). Patients with early-and advanced-stage NSCLC presented significant lower 1-MSTST (72%pred vs. 74%pred vs. 89%pred, p=0.010), 6MWD (97%pred vs. 106%pred vs. 128%pred, p<0.0001) and SF-12 mental component score (45 vs. 42 vs. 53, p=0.046) in comparison to healthy individuals. PASE and MFI-20 scores were significantly worse in patients with advanced-stage NSCLC than in healthy controls (56 vs. 108, p=0.005; 58 vs. 42, p=0.027). Compared to patients with early-stage NSCLC, patients with advanced-stage NSCLC had a significantly lower PASE score (88 vs. 56, p=0.049). Detailed results are presented in Table 1. Conclusion Patients with NSCLC scored lower on the 1-MSTST and SF-12 mental score at diagnosis compared to healthy individuals. Patients with advanced-stage NSCLC reported higher fatigue symptoms than healthy individuals, and lower self-reported physical activity levels than patients with early-stage NSCLC and healthy individuals. Although patients with NSCLC scored worse compared to healthy individuals, clinically relevant impairments were not found at diagnosis. To prevent a further decrease, it is important to implement individually tailored interventions to maintain their health status during and after treatment
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