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Introdução: As estratégias atuais para a promoção de atividade física (AF) em pessoas com doença pulmonar obstrutiva crónica (DPOC) têm mostrado resultados inconsistentes. O uso de plataformas digitais para treino (coaching) de AF tem o potencial de acompanhar remotamente o doente e proporcionar feedback regular sem sobrecarregar os serviços de saúde, podendo alcançar um maior número de doentes. A plataforma digital OnTRACK (ref. POCI-01-0145-FEDER-028446) integra uma aplicação móvel, dirigida a doentes, que intercomunica com uma aplicação web, acessível aos profissionais de saúde, para definir metas individualizadas, monitorizar a progressão da AF e dar feedback motivacional. A OnTRACK foi desenvolvida atendendo às necessidades e expectativas dos utilizadores finais para facilitar a sua adesão a longo prazo, porém nunca foi testada em contexto de prática clínica. Objetivo: Avaliar a aceitabilidade e viabilidade (clínica e económica) da intervenção OnTRACK na promoção de AF na DPOC. Métodos: Este é um estudo de métodos mistos. O recrutamento de doentes clinicamente estáveis com DPOC decorrerá durante 2 semanas numa unidade de saúde do Centro. A avaliação inicial incluirá, o estado clínico (e.g., limitação do fluxo aéreo: espirometria, impacto da doença: COPD Assessment Test), desempenho físico (e.g., teste de marcha dos 6 minutos), estadio de mudança (e.g., Questionário de Mudança Comportamental) e AF habitual (acelerómetro Actigraph GT3X+, 7 dias). A média dos dados de AF desses 7 dias servirá de base para estabelecer a meta inicial de AF (passos/dia) através da OnTRACK. Os doentes levarão para casa a aplicação móvel, onde poderão acompanhar a progressão de AF e verificar o (não)cumprimento da meta definida. Semanalmente, receberão um contacto telefónico de um profissional de saúde para definirem a meta da semana seguinte, considerando o nível de autoconfiança do doente [0–10], até um máximo de 10% aumento. Após 6 semanas, os doentes farão uma nova avaliação, que incluirá as medidas da avaliação inicial, um focus group e um questionário de aceitabilidade da intervenção. Serão analisadas taxas de recrutamento e atrito (não-utilização, desistência e motivos), possíveis efeitos adversos (segurança) e custos da intervenção. Discussão: Os dados da aceitabilidade informarão ajustes necessários à intervenção. Conclusão: Este estudo permitirá avaliar a viabilidade e aceitabilidade da intervenção OnTRACK, para posterior implementação num estudo randomizado e controlado. published

The objective of this review is to describe cranial nerve non-invasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS), its use, effects and implications for rehabilitation science in adult populations. Additionally, it will identify how CN-NINM via TLNS is being incorporated into neurological rehabilitation and current gaps in the evidence with respect to this novel technology.

People with chronic respiratory diseases present several physical, psychological and social impairments that contribute to decrease their ability to perform activities of daily living and compromise their independence. Occupational therapy (OT) has been designated as part of the rehabilitation process for disabled individuals with the aim of providing them maximal function and independence to sustain activities of daily living and to improve their ability to cope with working and social behaviours. Thus, OT is strictly linked with the individual’s autonomy, both to manage deficient activities and prevent any further deterioration. Pulmonary rehabilitation (PR) is currently a core component of the management of people with chronic respiratory diseases. While it is widely accepted that PR should be implemented by an interdisciplinary team, less than 40% of PR programs in Canada report having an OT in the team and it is not clear from national and international reports and guidelines what their role and their added value to patients’ outcomes. Thus, the aims of this scoping review is to explore the role of occupational therapy (OT) in pulmonary rehabilitation (PR) programs, the current guidelines for including OT in PR programs, and the estimated prevalence and reported or anticipated effects of OT interventions in PR programs.

Critically ill adults admitted into the intensive care unit (ICU) require continuous monitoring and therapies to prevent disease progression and allow for recovery. Respiratory therapists (RTs) are specialized healthcare providers on the interdisciplinary care team. Their main role in the ICU includes providing interventions to support patients' respiratory or oxygen needs. Additional services they may provide encompass consultations and specialized procedures to aid patients' recovery and mitigate disease progression. However, their overall practice role, regional practice variations and inclusion in the multidisciplinary team are not well reported in the literature. The objective of this scoping review is to describe the roles of RTs in adult critical care, the guidelines for RTs in the critical care team, and the regional differences in RTs’ practice roles across North America (Canada and United States).

Sem resumo disponível. published

Supplemental material, sj-docx-1-jpx-10.1177_23743735221107244 for Patient Priorities for Pulmonary Rehabilitation Research by Sachi O’Hoski, Cindy Ellerton, Lauren Ellerton and Dina Brooks, Roger Goldstein in Journal of Patient Experience

Introdução e objetivos: A força muscular do quadricípite é um forte indicador de morbilidade e mortalidade em pessoas com doença pulmonar obstrutiva crónica (DPOC). Programas de reabilitação respiratória (RR) aumentam a força muscular. Contudo, a interpretação clínica dos resultados da força muscular pós-RR é limitada pela ausência de pontos de corte que identifiquem alterações clinicamente relevantes (i.e., mínima diferença de importância clínica – MDIC). Este estudo teve como objetivo calcular a MDIC para a força muscular isométrica do quadricípite em pessoas com DPOC após um programa de RR. Materiais e Métodos: Realizou-se um estudo observacional prospetivo com pessoas com DPOC, que participaram num programa de RR de 12 semanas. A força isométrica do quadricípite foi recolhida com um dinamómetro handheld. O teste de marcha de 6 minutos (TM6M) e o questionário respiratório de St. George (SGRQ) foram usados como âncoras, caso se verificasse uma correlação entre as diferenças (pré-/pós-RR) na força muscular e a diferença nestes testes > 0.30. A MDIC foi calculada utilizando métodos de âncora (i.e., diferenças entre médias e regressões lineares) e de distribuição (i.e., 0.5*desvio padrão [0.5DP]; erro standard da medida [SEM]; 1.96*ESM [1.96SEM]; mínima diferença detetável [MDC95]). As MDIC foram estabelecidas através do cálculo da média dos valores encontrados com os diferentes métodos. Resultados: 70 pessoas com DPOC foram incluídas (81% homens, 70±7 anos, FEV1 48±17% previsto). Não foram encontradas correlações significativas entre as diferenças na força muscular e no TM6M (r= 0,02; p=0,873) e no SGRQ (r=-0,13; p=0,284), pelo que os métodos de âncora não foram aplicados. Os valores encontrados com os métodos de distribuição foram: 4,1 (0.5DP), 2,9 (SEM), 5,7 (1,96SEM) e 8,1 (MDC95) kgf. A MDIC final foi de 5,2 kgf (min. 2,9 – max. 8,1 kgf). Conclusões: A MDIC encontrada poderá ser usada pelos fisioterapeutas para interpretar os efeitos da RR na força muscular isométrica do quadricípite. Contudo, os resultados devem ser interpretados com cuidado uma vez que apenas métodos de distribuição foram utilizados, o que pode ter contribuído para uma sobrestimação da MDIC encontrada. in publication

No abstract available. published

No abstract available. published

Introdução e objetivos: A tosse é um sintoma prevalente e com grande impacto na qualidade de vida de pessoas com doença pulmonar obstrutiva crónica (DPOC). Contudo, os fatores determinantes da tosse são pouco conhecidos, contribuindo para a identificação tardia de pessoas com tosse crónica e ausência de um tratamento eficaz. Este estudo teve como objetivo explorar os determinantes da sintomatologia e impacto da tosse em pessoas com DPOC. Materiais e Métodos: Realizou-se um estudo observacional e transversal em pessoas com DPOC. A tosse foi avaliada com os domínios “sintomas” e “impacto” da tosse da escala cough and sputum assessment questionnaire (CASA-Q). Os potenciais determinantes da tosse foram selecionados com base na literatura e incluíram: dados sociodemográficos, volume expiratório forçado no 1º segundo (FEV1pp), número de exacerbações no ano anterior, oxigenoterapia de longa duração (OLD), unidade maço/ano, dispneia (modified medical research council dyspnea questionnaire), impacto da doença (COPD assessment questionnaire - CAT) e fadiga (functional assessment of chronic illness therapy –fatigue – FACIT-FS). Foram usadas regressões lineares simples entre os domínios da CASA-Q e cada um dos potenciais determinantes. Variáveis significativas (p

A reabilitação respiratória (RR) é fundamental no tratamento de pessoas com doença respiratória crónica (DRC) e apresenta elevada evidência científica na doença pulmonar obstrutiva crónica (DPOC). Contudo, os seus efeitos noutras DRC, como a doença pulmonar intersticial (DPI), são menos conhecidos. Este estudo comparou os efeitos da RR em pessoas com DPOC e DPI. Realizou-se um estudo observacional retrospetivo em pessoas que participaram num programa de RR de 12 semanas. A dispneia–escala modified Medical Research Council, ansiedade/depressão–Hospital Anxiety and Depression Scale (HADS-A/D), força muscular do quadricípite (FMQ)–hand held dynamometer, funcionalidade–teste de 1-minuto sentar-e-levantar (1STS), tolerância ao esforço–teste de marcha dos 6 minutos (TM6M) e equilíbrio–Brief-Balance Evaluation Systems Test (Brief-BESTest) foram avaliados antes e após o programa. As médias das diferenças (Mdif) pré/pós foram calculadas para cada variável e comparadas entre grupos através de análises de variância de 2 fatores mistos, testes t independentes ou U de Mann-Whitney. Exploraram-se as comparações pré/pós em cada grupo com testes t de amostras emparelhadas ou Wilcoxon Signed Rank. Foram incluídas 105 pessoas: 63 com DPOC (69 [42-85] anos, 49 [78%] homens, FEV1 47 [22-88] %previsto) e 42 com DPI (67 [38-84] anos, 16 [38%] homens, FVC 76 [49-113] %previsto). Após a RR, encontraram-se melhorias significativas em ambos os grupos (0.001

Stephanie Chauvin,1 Renata Kirkwood,1 Dina Brooks,1,2 Roger S Goldstein,2– 4 Marla K Beauchamp1,2,5 1School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; 2Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; 3Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 5Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, Hamilton, Ontario, CanadaCorrespondence: Marla K BeauchampMcMaster University, 1400 Main Street West, Hamilton, ON L8S 1C7, IAHS 430 CanadaTel +1 905 525-9140 x 21732Email beaucm1@mcmaster.caRationale: Chronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention.Methods: A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples t-tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy.Results: Data from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%.Conclusion: The stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.Keywords: BESTest, chronic obstructive pulmonary disease, balance, falls, rehabilitation

No abstract available. published

No abstract available published

Additional file 2. Physiotherapist Interview Guide & Instructions.

Motivators and barriers to exercise participation in women with coronary artery disease remain poorly understood. With evidence suggesting that women with coronary artery disease are less likely to adhere to exercise during cardiac rehabilitation and are more likely to drop out, it is important to understand these factors in order to optimize cardiac rehabilitation programs for women. We contribute to the discussion by presenting findings from a qualitative study using two focus groups with nine women with coronary artery disease sharing their experiences with attending cardiac rehabilitation and exercising in this setting, in addition to their perceived motivators and barriers to performing aerobic interval training. Focus group transcripts were analysed using a deductive thematic approach with Bandura���s Social Cognitive Theory as the guiding conceptual framework. Four themes were identified regarding the attitudes and experiences of attending and exercising at cardiac rehabilitation, while five themes capturing the motivators and barriers for these women to perform aerobic interval training were identified for the first time. These novel themes encompassed the daunting nature of it, the physical discomfort associated with it, and conversely, the potential sense of enjoyment and accomplishment that it could bring. This study demonstrates the complexity of implementation of aerobic interval training into clinical practice, and suggests that further research is warranted to explore this domain.IMPLICATIONS FOR REHABILITATIONDespite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml��kg���1��min���1 in favour of aerobic interval training.The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs.Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient. Despite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml��kg���1��min���1 in favour of aerobic interval training. The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs. Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient.

Supplemental material, Supplemental_material_search_strategy_MEDLINE for Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review by Stacey J Butler, Lauren Ellerton, Andrea S Gershon, Roger S Goldstein and Dina Brooks in Palliative Medicine

Additional file 1. Stroke Participant Interview Guide & Instructions.

Supplemetary_table_1_search_strategy for Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis by Lok Sze Katrina Li, Stacey Butler, Roger Goldstein and Dina Brooks in Chronic Respiratory Disease

Supplementary_table_2_TIDIER_checklist_table_of_studies for Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis by Lok Sze Katrina Li, Stacey Butler, Roger Goldstein and Dina Brooks in Chronic Respiratory Disease

Although currently major contributors to morbidity and mortality, cardiovascular disease (CVD) and chronic respiratory diseases, such as chronic obstructive pulmonary disease, are projected to rank among the top three in global disease burden by 2020. Multimorbidity is a common feature in CVD and chronic respiratory disease, and patients often share the same pathological characteristics including anatomical location of disease, dyspnea and fatigue, among several others. However, patients entering rehabilitation programs for either condition are functionally diverse; therefore, individuals with respiratory comorbidities may not fare as well in cardiac rehabilitation programs. This retrospective cohort study investigated several relevant functional parameters and outcomes., OBJECTIVE: To describe the prevalence and impact of respiratory comorbidities on patients undergoing cardiac rehabilitation (CR). METHODS: A retrospective review of a CR database (1999 to 2004) of patients with ischemic heart disease with ≥10 pack per year (ppy) smoking history and respiratory comorbidities (RC), non-respiratory comorbidities (NRC) and no comorbidities (NC) was performed. Primary outcomes at zero, six and 12 months included peak oxygen uptake (VO2peak), maximum workload, resting heart rate, ventilatory anaerobic threshold and anthropometrics. Analyses were performed on individuals who completed the program, adjusting for age, sex and baseline VO2peak. RESULTS: Of 5922 patients, 1247 had ≥10 ppy smoking history: 77 (6.2%) had RC; 957 (76.7%) had NRC; and 213 (17.1%) had NC. The program completion rate for each group was similar for the RC (46.8%), NRC (55.8%) and NC groups (57.3%) (P=0.26). The RC group had the lowest baseline fitness levels (P

Adnan Wshah,1,2 Sara JT Guilcher,2,3 Roger Goldstein,1,2,4,5 Dina Brooks1,2,5 1Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; 2Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; 3Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; 4Department of Medicine, University of Toronto, Toronto, ON, Canada; 5Department of Physical Therapy, University of Toronto, Toronto, ON, Canada Abstract: The objective of this review was to examine the prevalence of osteoarthritis (OA) in individuals with COPD. A computer-based literature search of CINAHL, Medline, PsycINFO and Embase databases was performed. Studies reporting the prevalence of OA among a cohort of individuals with COPD were included. The sample size varied across the studies from 27 to 52,643 with a total number of 101,399 individuals with COPD recruited from different countries. The mean age ranged from 59 to 76years. The prevalence rates of OA among individuals with COPD were calculated as weighted means. A total of 14 studies met the inclusion criteria with a prevalence ranging from 12% to 74% and an overall weighted mean of 35.5%. Our findings suggest that the prevalence of OA is high among individuals with COPD and should be considered when developing and applying interventions in this population. Keywords: COPD, osteoarthritis, prevalence, comorbidities, pulmonary rehabilitation

Introdução: A doença pulmonar obstrutiva crónica (DPOC) é uma condição que pode levar ao aumento da dependência do doente em relação ao cuidador informal e, consequentemente, promover um aumento do distress associado à sobrecarga deste.1 De acordo com a literatura, na população geral, maiores níveis de atividade física (AF) contribuem para menores níveis de distress2. O objetivo principal deste estudo foi verificar se esta relação se confirma em cuidadores informais de pessoas com DPOC. Metodologia: Foi desenvolvido um estudo observacional transversal, tendo-se realizado a caracterização sociodemográfica da amostra, a recolha de informação sobre o contexto de prestação de cuidados e a aplicação dos questionários: Questionário de Avaliação de Sobrecarga do Cuidador Informal (QASCI), para avaliar o nível de distress associado à sobrecarga, e Habitual Physical Activity Questionnaire (HPAQ), para avaliar o nível de AF. Para a análise de dados foram utilizadas medidas de estatística descritiva, os coeficientes de correlação Pearson e Spearman e regressões lineares (simples e múltiplas). Resultados: Foram incluídos 26 cuidadores (63,1 ± 9,7 anos; 84,6% feminino e 15,4% masculino). A média do QASCI foi de 31,3 ± 22 e a do HPAQ foi de 5,5 ± 1,8. A correlação entre estas variáveis foi moderada negativa (r=-0,535, p=0.01). A variável AF teve a capacidade de predizer o valor do QASCI em 28,7%. Ao adicionar a variável duração de cuidados em anos, foi possível aumentar para 54,6% a capacidade de a equação predizer o valor do QASCI. Conclusões: Os resultados sugerem que existe uma relação entre o aumento do nível da AF e a diminuição do nível de distress nesta população. Estes achados suportam a importância da promoção da prática de AF nos cuidadores informais de indivíduos com DPOC. Estudos longitudinais futuros deverão ser considerados. N/A

Respiratory muscle weakness resulting from conditions such as neuromuscular disease can lead to respiratory infection, hospitalization and serious pulmonary complications. Secretion clearance from the airways is correlated with peak expiratory cough flow, which can be enhanced by physical manoeuvres coupled with manual or mechanical resuscitator devices. Cough-assistance devices, such as the mechanical insufflator-exsufflator, can increase inspiratory lung volumes and peak expiratory cough flows beyond the patient’s spontaneous ability and significantly augment lung secretion clearance. This study was prompted by the lack of data regarding current practices and availability of mechanical insufflator-exsufflator devices in Canada., BACKGROUND: The mechanical insufflator-exsufflator (MIE) is effective in assisting cough and in helping to avoid unplanned hospitalizations, tracheostomy and long-term ventilation in patients with neuromuscular disease or spinal cord injury. Despite this, the availability and usage of the device in Canada is unknown. OBJECTIVE: To investigate practice patterns and availability of the MIE in Ontario hospitals. METHODS: A cross-sectional, self-administered mail survey was sent to a random sample of 400 respiratory therapists practicing in 96 Ontario hospitals. RESULTS: A total of 114 (28%) completed surveys were returned from 62 (65%) hospitals. Twenty (32%) hospitals had a MIE. The respiratory therapist was the predominant health care provider using the MIE. The device was most commonly used in the intensive care unit, and medical/surgical units in patients with neuromuscular diseases or spinal cord injuries. Optimal pressure spans of 35 cmH2O to 40 cmH2O were used by 54% of respondents. Fourteen of the 20 hospitals with an MIE had policies or guidelines in place, and four of these hospitals had established staff competencies. Measurements of peak cough flow, maximal inspiratory/expiratory pressure and vital capacity were reported to be infrequently performed. CONCLUSIONS: The present study demonstrated that the MIE device is not widely available in Ontario hospitals and there are variations in how the devices are applied, possibly resulting in suboptimal therapy. A comprehensive educational program about MIE devices that incorporates best practices and a practical component is recommended for current providers as well as for inclusion in student curricula.

Sem resumo disponível published

Sem resumo disponivel published

Sem resumo disponível published

Chronic obstructive pulmonary disease (COPD) is becoming a critical health concern that affects people living in high-, middle-, and low-income countries. Pulmonary rehabilitation (PR) has been demonstrated to be a clinical and cost-effective approach to minimizing the effects of COPD. Despite global predictions of an increased incidence of COPD, there continues to be an important misalignment between the demand and the supply of PR services. In other words, only a small proportion of individuals with COPD who require, or would benefit from, PR programs are receiving them on the global stage. This issue may be even more pronounced in middle- and low-income countries where the burden of disease is reported to be highest, and where access to health services and trained health professionals appears be to lowest. Given this predicament, we suggest that PR services must be viewed as an effective way in which to generate clinical efficiencies within health systems, and has the potential to relieve pressure on acute care systems. Although implementing PR programs require commitment and financial investment, we argue that such investments would yield important social and aggregated financial cost savings in the long term.

BACKGROUND: Involving family as part of the patient's rehabilitation plan of care might enhance the management of COPD. The primary aim of this study was to investigate the impact of a family-based pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. METHODS: Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional (control) PR. Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength, and health-related quality of life were also measured. All measures were collected pre/post-program. RESULTS: Forty-two dyads participated (patients: FEV1, 70.4% ±22.1% predicted). Patients (P = .048) and family members (P = .004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships (P = .026) and in psychologic distress (P = .033) compared with the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength, and health-related quality of life aft er intervention (P

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individuals with COPD; however, current international guidelines do not include balance training and fall prevention strategies. Objective: The primary aim of this trial is to determine the effects of PR with balance training compared to PR with no balance training on the 12-month rate of falls in individuals with COPD. Secondary aims are to determine the effects of the intervention on balance, balance confidence, and functional lower body strength, and to estimate the cost-effectiveness of the program. Methods: A total of 400 individuals from nine PR centers across Canada, Europe, and Australia will be recruited to participate in a randomized controlled trial. Individuals with COPD who have a self-reported decline in balance, a fall in the last 2 years, or recent near fall will be randomly assigned to an intervention or control group. The intervention group will undergo tailored balance training in addition to PR and will receive a personalized home-based balance program. The control group will receive usual PR and a home program that does not include balance training. All participants will receive monthly phone calls to provide support and collect health care utilization and loss of productivity data. Both groups will receive home visits at 3, 6, and 9 months to ensure proper technique and progression of home exercise programs. The primary outcome will be incidence of falls at 12-month follow-up. Falls will be measured using a standardized definition and recorded using monthly self-report fall diary calendars. Participants will be asked to record falls and time spent performing their home exercise program on the fall diary calendars. Completed calendars will be returned to the research centers in prepaid envelopes each month. Secondary measures collected by a blinded assessor at baseline (pre-PR), post-PR, and 12-month follow-up will include clinical measures of balance, balance confidence, functional lower body strength, and health status. The cost-effectiveness of the intervention group compared with the control group will be evaluated using the incremental cost per number of falls averted and the incremental cost per quality-adjusted life years gained. Results: Recruitment for the study began in January 2017 and is anticipated to be complete by December 2019. Results are expected to be available in 2020. Conclusions: Findings from this study will improve our understanding of the effectiveness and resource uses of tailored balance training for reducing falls in individuals with COPD. If effective, the intervention represents an opportunity to inform international guidelines and health policy for PR in individuals with COPD who are at risk of falling. Trial Registration: ClinicalTrials.gov NCT02995681; https://clinicaltrials.gov/ct2/show/NCT02995681 (Archived by WebCite at http://www.webcitation.org/6ukhxgAsg) [JMIR Res Protoc 2017;6(11):e228]

Samantha L Harrison,1 Roger Goldstein,1 Laura Desveaux,1 Verity Tulloch,1 Dina Brooks2 1Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; 2Department of Medicine Physical Therapy, University of Toronto, Toronto, ON, Canada Abstract: Though the guidelines for the optimal management of chronic obstructive pulmonary disease (COPD) following an acute exacerbation (AE) are well established, issues associated with poor adherence to nonpharmacological interventions such as self-management advice and pulmonary rehabilitation will impact on hospital readmission rates and health care costs. Systems developed for clinically stable patients with COPD may not be sufficient for those who are post-exacerbation. A redesign of the manner in which such interventions are delivered to patients following an AECOPD is necessary. Addressing two or more components of the chronic care model is effective in reducing health care utilization in patients with COPD, with self-management support contributing a key role. By refining self-management support to incorporate the identification and treatment of psychological symptoms and by providing health care professionals adequate time and training to deliver respiratory-specific advice and self-management strategies, adherence to nonpharmacological therapies following an AE may be enhanced. Furthermore, following up patients in their own homes allows for the tailoring of advice and for the delivery of consistent health care messages which may enable knowledge to be retained. By refining the delivery of nonpharmacological therapies following an AECOPD according to components of the chronic care model, adherence may be improved, resulting in better disease management and possibly reducing health care utilization.Keywords: acute exacerbation, chronic obstructive pulmonary disease, pulmonary rehabilitation, self-management, physical activity, oxygen, adherence, chronic care model

Introduction: Self-report physical activity (PA) measures are often used to assess changes before/after chronic obstructive pulmonary disease (COPD) rehabilitation, as they are easy to employ and more feasible than objective measures. However, the ability of self-report measures to detect intervention-related changes in PA should be determined. published

Despite the well-recognised benefits of regular physical activity (PA) in COPD, a large number of patients are inactive. Previous research has highlighted that family support may affect PA levels of healthy people. However, the influence of family members on PA levels of patients with COPD has never been explored. published

Chronic Obstructive Pulmonary Disease (COPD) places a high burden on patients and their family. The World Health Organization has recommended family integration in rehabilitation interventions. However, Pulmonary Rehabilitation (PR) programmes for COPD typically focus on patients, neglecting the family. This study aimed to explore the needs and expectations of patients with COPD and respective family carers and assess their perspectives about their participation in a PR programme. Nine patients with COPD (70±8yrs; FEV169±25%pred) and their family carers (64±11yrs) were recruited in primary care. Individual interviews were conducted to explore their needs and expectations about PR programmes. Focus groups were conducted after their participation in a PR programme. Data were audio-recorded, transcribed and submitted to content analysis. Patients and carers identified the need for more information about COPD (nP=7; nC=5) and emotional support (nP=2; nC=3), and expected PR programmes to improve their skills to manage the disease (nP=9; nC=2). A PR programme with psychoeducation and exercise training was implemented, considering these findings. Participants reported that the programme helped them to cope better with the disease and patients found their carers to be less worried and living happier (n=3). The majority of carers reported self-benefits (n=6) and stressed the importance of on-going support to help themselves and their care receivers (n=2). PR programmes inclusive of carers have the potential to enhance the skills of the whole family to manage COPD and, therefore, to promote a healthy adjustment to the disease. Future research should explore the impact of PR programmes within the family unit. published

W Darlene Reid,1,2 Cristiane Yamabayashi,1 Donna Goodridge,3 Frank Chung,4 Michael A Hunt,1 Darcy D Marciniuk,5 Dina Brooks,6 Yi-Wen Chen,1 Alison M Hoens,1,7 Pat GCamp1,21Department of Physical Therapy, University of British Columbia, Vancouver, 2Institute of Heart and Lung Health, University of British Columbia, Vancouver, 3College of Nursing, University of Saskatchewan, 4Physiotherapy, Burnaby Hospital, Fraser Health, British Columbia, 5Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, 6Department of Physical Therapy, University of Toronto, Toronto, ON, 7Providence Health Care, Vancouver, BC, CanadaIntroduction: The prescription of physical activity for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be complicated by the presence of comorbidities. The current research aimed to synthesize the relevant literature on the benefits of exercise for people with multimorbidities who experience an AECOPD, and ask: What are the parameters and outcomes of exercise in AECOPD and in conditions that are common comorbidities as reported by systematic reviews (SRs)?Methods: An SR was performed using the Cochrane Collaboration protocol. Nine electronic databases were searched up to July 2011. Articles were included if they (1) described participants with AECOPD, chronic obstructive pulmonary disease (COPD), or one of eleven common comorbidities, (2) were an SR, (3) examined aerobic training (AT), resistance training (RT), balance training (BT), or a combination thereof, (4) included at least one outcome of fitness, and (5) compared exercise training versus control/sham.Results: This synthesis examined 58 SRs of exercise training in people with AECOPD, COPD, or eleven chronic conditions commonly associated with COPD. Meta-analyses of endurance (aerobic or exercise capacity, 6-minute walk distance – 6MWD) were shown to significantly improve in most conditions (except osteoarthritis, osteoporosis, and depression), whereas strength was shown to improve in five of the 13 conditions searched: COPD, older adults, heart failure, ischemic heart disease, and diabetes. Several studies of different conditions also reported improvements in quality of life, function, and control or prevention outcomes. Meta-analyses also demonstrate that exercise training decreases the risk of mortality in older adults, and those with COPD or ischemic heart disease. The most common types of training were AT and RT. BT and functional training were commonly applied in older adults. The quality of the SRs for most conditions was moderate to excellent (>65%) as evaluated by AMSTAR scores.Conclusion: In summary, this synthesis showed evidence of significant benefits from exercise training in AECOPD, COPD, and conditions that are common comorbidities. A broader approach to exercise and activity prescription in pulmonary rehabilitation may induce therapeutic benefits to ameliorate clinical sequelae associated with AECOPD and comorbidities such as the inclusion of BT and functional training.Keywords: pulmonary disease, chronic obstructive, comorbidity, exercise, physical fitness

OBJECTIVES: To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.METHODS: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.RESULTS: Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.CONCLUSIONS: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.

BackgroundHip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown. ObjectiveThe objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture. MethodsThe search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods. ResultsThis review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture. ConclusionsThe aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.

3R protocol schedule of enrolment, interventions and outcomes (adapted from original table1). A table with an overview of enrolment, intervention and outcomes to be assessed in each time point in the study. (DOCX 23 kb)

3R protocol schedule of enrolment, interventions and outcomes (adapted from original table1). A table with an overview of enrolment, intervention and outcomes to be assessed in each time point in the study. (DOCX 23 kb)

BACKGROUND: Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions. OBJECTIVE: To report the rationale for and methods of a study to develop evidence-informed care recommendations that guide health care providers in the assessment, prescription, monitoring and progression of exercise for patients hospitalized with AECOPD. METHODS: The present study was a multicomponent knowledge translation project incorporating evidence from systematic reviews of exercise involving populations with chronic obstructive pulmonary disease and/or common comorbidities. A Delphi process was then used to obtain expert opinion from clinicians, academics and patients to identify the parameters of safe and effective exercise for patients with AECOPD. RESULTS: Clinical decision-making tool(s) for patients and practitioners supported by a detailed knowledge dissemination, implementation and evaluation framework. CONCLUSION: The present study addressed an important knowledge gap: the lack of availability of parameters to guide safe and effective exercise prescription for hospitalized patients with AECOPD, with or without comorbid conditions. In the absence of such parameters, health care professionals may adopt an ‘activity as tolerated’ approach, which may not improve physical activity levels in their patients. The present study synthesizes the best available evidence and expert opinion, and will generate decision-making tools for use by patients and their health care providers.

Purpose: This study reports on the prevalence and impact of pain in individuals with different chronic respiratory diseases attending pulmonary rehabilitation (PR). Method: A retrospective review of medical records data was conducted for 488 participants who had attended a PR programme over a 2-year period. Data on pain and medication history taken from multidisciplinary medical records, together with participant demographics and PR outcomes, were extracted. We compared pain among participants with different types of chronic respiratory disease. Results: The overall prevalence of pain was 77%, with a significantly higher prevalence among individuals with obstructive lung diseases (80%) compared with restrictive lung diseases (69%; p = 0.04). Some participants (17%) who took pain medications did not discuss pain with their clinicians. The presence of pain and different reporting of pain did not have a negative impact on the PR programme completion rate ( p = 0.74), improvements in exercise capacity ( p = 0.51), or health-related quality of life (all four chronic respiratory disease questionnaire domains, p>0.05). Conclusions: The prevalence of pain is high among individuals with chronic respiratory disease attending PR. The presence or absence of pain was not negatively associated with the programme completion rate or PR outcomes; therefore, pain should not deter clinicians from referring patients to PR.

Background The presence of comorbid conditions could impact performance in pulmonary rehabilitation (PR) programmes. We aimed to compare the comorbidity prevalence among those with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) and evaluate the impact on PR response. Methods We performed a retrospective cohort study, recording comorbidities for all patients with COPD or ILD referred to PR. Participants were classified as responders to PR if they met the minimal important difference for exercise capacity and health-related quality of life (HRQoL). The prevalence of comorbidities and impact on PR outcomes were compared by lung disease and by sex using a univariate analysis and multivariate logistic regression. Results The mean number of comorbidities was similar among those with COPD (3.3±2.1, n=242) and ILD (3.2±1.9, n=66) (p>0.05). Females had a higher number of comorbidities than males in both COPD (p=0.001) and ILD (p=0.017) populations. Circulatory (64%) and endocrine/metabolic (45%) conditions were most common in COPD. In ILD, digestive (55%) and circulatory (53%) comorbidities were most prevalent. In people with ILD, those over 65 years, with musculoskeletal/connective tissue disease or circulatory disease were less likely to obtain meaningful improvements in exercise capacity. There was no impact of comorbidities on exercise capacity in COPD or on HRQoL in ILD. Conclusions The majority of patients with COPD or ILD enrolled in PR programmes have multiple comorbidities that may affect improvements in exercise capacity. PR programmes may be less effective for older adults with ILD and comorbid circulatory or musculoskeletal disease., Comorbidities are common in people with chronic lung disease and can affect their ability to exercise. People with COPD have a similar comorbidity profile to people with interstitial lung disease (ILD). People with ILD and musculoskeletal disease or circulatory conditions are less likely to improve their exercise capacity after pulmonary rehabilitation. http://bit.ly/2p8WSIn

A key factor for the adoption of an active lifestyle is self-determined motivation; however, it is often overlooked in COPD. Understanding the motives underlying patients’ decision to be (or not) physically active will provide insight into future interventions. This study assessed the motives for patients with COPD to engage in physical activity (PA) and their association with PA behaviour. A cross-sectional study was conducted in stable patients with COPD. Motivation was assessed with the Exercise Motivation Inventory-2 (EMI-2; score 0[Not at all true for me]–5[Very true for me]; 5 dimensions) and PA with accelerometry [ActiGraph-GT3X+, 7 days; moderate to vigorous PA (MVPA), steps/day]. Spearman’s correlations (ρ) were used to assess their relationship. 60 participants were enrolled (67.2±7.7 years; 76.7% men; FEV1 49.5±19.7pp). Patients’ motives to be physically active were mostly Health, Fitness and Psychological. Correlations with PA were weak and non-significant (p>0.05) (Table 1). Patients with COPD value Health, Fitness and Psychological motives to be physically active, although these are not related to their PA behaviour. Findings highlight the complex nature of PA and the need to further explore factors influencing PA and motivation in this population. info:eu-repo/semantics/publishedVersion

Fatigue is highly prevalent in COPD and may be associated with reduced physical activity (PA) and poor outcomes. This study explored the relationship between fatigue, objectively measured PA and health-related factors in people with COPD. Fatigue was assessed with the Checklist of Individual Strength (CIS20) and CIS20-Subjective Fatigue (CIS20-SF) and PA with Actigraph GT3X monitors (moderate-to-vigorous PA, MVPA; total PA; steps/day). Dyspnoea (modified Medical Research Council, mMRC), exercise tolerance (6-min walk distance, 6MWD), lung function (spirometry) and GOLD AD were collected. Spearman (ρ) and Pearson (r) correlations and multiple regressions were performed. Variables entered the model if correlation≥0.2. 54 patients participated (68±7 years; 82% men) and 69% reported fatigue (CIS20-SF≥27). Fatigue was significantly correlated with MVPA, steps/day, mMRC, 6MWD, GOLD AD and FEV pp (Table 1). In regression models for CIS20 (p=.001; r =.61) and CIS20-SF (p=.003; r =.56), dyspnoea was the only significant variable. Table 1. Descriptives and correlations between fatigue, PA and health-related factors. Descriptives CIS20 CIS20-SF 1 2 2 d THANK YOU FOR ACCEPTING COOKIES You can now hide this message or find out more about cookies. Hide More info

Context: Explanations provided by health professionals may underpin helpful or harmful symptom beliefs and expectations of people living with chronic breathlessness. Objectives: This study sought perspectives from health professionals with clinical/research expertise in chronic breathlessness on priority issues in chronic breathlessness explanations and research. Methods: Authors (n = 74) of publications specific to chronic breathlessness were invited to a three-round Delphi survey. Responses to open-ended questions (Round 1 "What is important to: include/avoid when explaining chronic breathlessness; prioritize in research?") were transformed to Likert scale (1-9) items for rating in subsequent rounds. A priori consensus was defined as ≥70% of respondents rating an item as important (Likert rating 7-9) and interquartile range ≤2. Results: Of the 31 Round 1 respondents (nine countries, five professional disciplines), 24 (77%) completed Rounds 2 and 3. Sixty-three items met consensus (include n = 28; avoid n = 9; research n = 26). Explanations of chronic breathlessness should use patient-centered communication; acknowledge the distress, variability, and importance of this sensation; emphasize current management principles; clarify maladaptive beliefs and expectations; and avoid moral culpability and inappropriate reassurance. Research priorities included the need 1) for a comprehensive understanding of breathlessness science; 2) to optimize, explore, and develop effective interventions, both pharmacological and nonpharmacological; and 3) determine effective models of care including strategies for education and training of health professionals and people caring for, or living with, chronic breathlessness. Conclusion: These consensus-based concepts for chronic breathlessness explanations and research provide a starting point for conversations between patients, carers, clinicians, and researchers within the chronic breathlessness community usc Refereed/Peer-reviewed

Doutoramento em Ciências e Tecnologias da Saúde Self-management has been acknowledged as a critical part of Chronic Obstructive Pulmonary Disease (COPD) management. However, evidence to support this type of intervention is still limited. This Thesis focuses on understanding whether self-management interventions can support patients with COPD to manage their disease and impact significantly on their health. Specifically, it aimed to: (i) gain more insight on the role of home telemonitoring to reduce the frequency of COPD exacerbations and healthcare utilisation and improve health-related outcomes; and (ii) investigate the impact of a physical activity (PA)-focused behaviour intervention combined with pulmonary rehabilitation (PR) on patients with COPD. Five studies were conducted. Two systematic reviews (Chapter 3) addressed the first aim of this Thesis by updating the body of evidence on home telemonitoring in COPD regarding its effectiveness, methodologies, patients’ adherence and satisfaction. Findings showed that there is still no clear indication that home telemonitoring improves health-related outcomes and reduces healthcare utilisation in COPD. A number of limitations, such as the small sample sizes and the telemonitoring technology, may have accounted for these results. Therefore, further work needs to be conducted before home telemonitoring can be incorporated into clinical practice. The second aim of this Thesis was addressed with three original studies. One study (Chapter 4) assessed the step-count accuracy of activity monitors (Yamax PW/EX-510 pedometer, GT3X+ accelerometer) which supported the feasibility study (Chapter 5) and the main study (Chapter 6). The main findings suggest that a PA-focused behavioural intervention combined with PR can be used to support patients with COPD in achieving a more active lifestyle. Nevertheless, it did not produce further improvements in health-related outcomes. More robust research is warranted to support these findings and assess the short- and long-term impact of this intervention in COPD. In conclusion, the role of patient self-management through home telemonitoring and a PA-focused behavioural intervention is not fully understood. This Thesis contributes for advancing the knowledge in this area and provides important recommendations for future research. A autogestão tem sido reconhecida como parte fundamental da gestão da Doença Pulmonar Obstrutiva Crónica (DPOC). No entanto, a evidência deste tipo de intervenções é ainda limitada. Esta Tese tem como objetivo compreender se as intervenções de autogestão podem ajudar os pacientes com DPOC a gerir melhor a sua doença e se têm um impacto significativo na sua saúde. Especificamente, esta Tese pretendeu: (i) aprofundar o papel da telemonitorização no domicílio para reduzir a frequência de exacerbações e a utilização de cuidados de saúde por parte dos pacientes com DPOC, bem como melhorar os resultados relacionados com a saúde; e (ii) investigar o impacto de uma intervenção comportamental para a promoção da atividade física (AF) em pacientes com DPOC (Walk2Bactive) durante e após um programa de reabilitação respiratória (RR). Foram realizados cinco estudos. Duas revisões sistemáticas (Capítulo 3) responderam ao primeiro objetivo desta Tese, sistematizando o conhecimento acerca da telemonitorização no domicílio no que diz respeito à sua eficácia, metodologias, adesão e satisfação de pacientes com DPOC. Os resultados revelaram que ainda não existe uma indicação clara de que a telemonitorização no domicílio produz melhorias nos resultados de saúde e na redução da utilização de cuidados de saúde em pacientes com DPOC. O número reduzido de participantes e a tecnologia utilizada em alguns estudos pode ter influenciado estes resultados. Assim, existe a necessidade de mais investigação nesta área antes de a telemonitorização poder ser incorporada na prática clínica. O segundo objetivo desta Tese foi alcançado através de três estudos originais. O primeiro estudo (Capítulo 4) avaliou a precisão dos monitores de AF (pedómetro Yamax PW/EX-510, acelerómetro GT3X+) utilizados no estudo piloto (Capítulo 5) e estudo principal (Capítulo 6). Os resultados principais sugerem que a intervenção comportamental para a promoção da AF pode ajudar os pacientes com DPOC a alcançar um estilo de vida mais ativo. No entanto, não produz melhorias nos resultados relacionados com a saúde. É necessário realizar investigação mais robusta nesta área para corroborar estes resultados e avaliar os efeitos da intervenção a curto e longo prazo. Em suma, o papel da autogestão na DPOC através da telemonitorização no domicílio e de uma intervenção comportamental para a promoção da AF ainda não é totalmente compreendido. Esta Tese contribuiu para avançar o conhecimento nesta área e apresenta recomendações importantes para pesquisas futuras.