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The Hospital Anxiety and Depression Scale (HADS) is used to assess anxiety and depression in individuals with chronic obstructive pulmonary disease (COPD); however, its measurement properties lack critical appraisal. We aimed to summarize and critically appraise the validity, reliability, and responsiveness of the HADS in COPD. Five electronic databases were searched. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines were used to assess the methodological and evidence quality in the selected studies. Twelve studies assessed the psychometric properties of the HADS-Total and its subscales HADS-Anxiety and HADS-Depression in COPD. High-quality evidence supported the structural and criterion validity of the HADS-A, the internal consistency of the HADS-T, HADS-A, and HADS-D with Cronbach's alpha values of 0.73–0.87, and before–after treatment responsiveness of HADS-T and its subscales (minimal clinically important difference = 1.4–2; effect size = 0.45–1.40). Moderate-quality evidence supported the test–retest reliability of the HADS-A and HADS-D with excellent coefficient values of 0.86–0.90. The HADS-A is recommended for use in individuals with stable COPD. The lack of high-quality evidence on the validity of the HADS-D and HADS-T prevented drawing robust conclusions about their clinical utility in COPD. Anxiety and depression are common in individuals with chronic obstructive pulmonary disease (COPD). Anxiety and depression can negatively impact the physical and mental health of individuals with COPD. The HADS can be used to assess anxiety and depression in COPD in rehabilitation settings. [ABSTRACT FROM AUTHOR]

Informal caregivers play an important role in chronic disease management but their experience is often neglected. The objective of this study was to explore the content validity of the Zarit Burden Interview (ZBI) in caregivers of individuals with COPD in Canada and Portugal. Cognitive debriefing interviews were conducted with informal caregivers of individuals with moderate to very severe COPD. Participants completed the ZBI and verbalised their thinking process to assess the adequacy of the questionnaire's content and instructions. Content validity was assessed using deductive content analysis of interviews and descriptive statistics of questionnaire responses. Nine caregivers from Canada (age = 67 ± 8 years) and 13 from Portugal (age = 69 ± 7 years) participated. For Canadian caregivers, 3/22 items were not understood, and 8/22 items were not relevant to at least 1/3 of them. For Portuguese caregivers, 1/22 items were not understood, and 20/22 items were not relevant to at least 1/3 of them. The distribution of response choices was approximately symmetrical for 17/22 items in the Canadian sample. The response option "no/never" was selected by at least 75% of Portuguese participants for 18/22 items. The instrument was well understood by caregivers of people with COPD, but its relevance is uncertain. Informal caregivers provide essential care for people living with disability and chronic disease, but their experience is often neglected. The Zarit Burden Interview assesses caregiver burden but has not been validated in caregivers of people with chronic obstructive pulmonary disease. In its current form, the Zarit Burden Interview does not adequately represent the experience of COPD caregivers. We recommend selecting tools that assess caregiver burden that have been validated in the caregiver population of interest. [ABSTRACT FROM AUTHOR]

Reducing sedentary behavior (SB) in individuals with chronic obstructive pulmonary disease (COPD) is being increasingly recognized as a novel health target. Understanding healthcare professionals (HCPs) behavior that influences a reduction in SB in this population could facilitate achieving this target. To explore the determinants of behavior related to HCPs targeting a reduction in SB in people with COPD. We used a qualitative semi-structured interview approach informed by the Theoretical Domains Framework (TDF). Sixteen HCPs were interviewed. Interview transcripts were mapped against the relevant TDF domain(s) and then higher order themes were generated. Directed content analysis resulted in mapping 949 quotes to the TDF domains with environmental context and resources being the most coded domain. Three higher order themes were identified: 1) HCPs need more knowledge on reducing SB; 2) Strategies suggested to include in pulmonary rehabilitation (PR) to reduce SB; and 3) Barriers to adding SB to PR. Domains of environmental context and resources, knowledge, social/professional role and identity, reinforcement, social influences, skills and beliefs about capabilities were relevant to the study population to reduce SB in people with COPD. Knowledge of SB varied across participants. This study provided information on potential behavioral targets for future interventions that involve HCPs and aim to reduce SB among people with COPD. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) imposes tremendous challenges for both patients and informal caregivers. Caregivers are key players in the management of COPD. Recently, COVID-19 further increased reliance on informal caregivers who urgently need specific support. This systematic literature review aimed to systematically describe the content and explore the effects of interventions to support informal caregivers of people with COPD. Methods: A mixed-methods systematic review was conducted. PubMed, Scopus, Web of Science, and EBSCO were searched. Studies implementing interventions supporting informal caregivers of people with COPD were included. Data were extracted and analysed in outcome domains and categories using framework analysis. Results: Twenty (14 quantitative, 4 mixed-methods, and 2 qualitative) studies were included. Informal caregivers were mainly female (86%). Caregiving context was poorly/never described. Interventions included patient-caregiver dyads and never caregivers only. Informal caregivers were invited to participate if available. Interventions were delivered across all COPD phases (acute/stable/advanced) and settings (inpatient/outpatient/home), with a wide range of total length, frequency, and duration of sessions. All included education about the disease and its management. Discharge/action plans (n = 12); adherence to therapy and healthy lifestyles (n = 9); and family concerns and psychosocial issues (n = 7) were also commonly addressed. Only 9 (45%) studies reported caregiver-related outcomes, and overall positive effects were observed in 7/9 outcome domains, using a high variety of qualitative and qualitative methods. Often categories were addressed but not assessed. Conclusion: Interventions have a narrow scope (i.e., education) and have not been specifically designed to support informal caregivers. Current evidence showed positive effects, but high methodological heterogeneity exists. Future studies need to explore caregiver-tailored, taking into consideration gender differences; multicomponent; and flexibly administered interventions to effectively support COPD caregivers. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The purpose of this study was to systematically review the association between handgrip strength (HGS) and mortality, morbidity, and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD). Methods The following databases were used: CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, SPORTDiscus, and PsycINFO. Studies published between 2000 and 2020 in English, Portuguese, or French that examined the association of HGS with mortality, morbidity, and HRQL in individuals with stable COPD were selected. Two authors independently extracted data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. The study effects were pooled using random effects meta-analysis models after assessing heterogeneity. The search generated 710 studies, and 18 were included in the review. Studies evaluated a total of 12,046 individuals with stable COPD (mean percent of the predicted forced expiratory volume in 1 second = 34%–80%) using over 10 diverse protocols for HGS measurement. Statistically significant, small, and negative relationships were found between HGS and mortality (r  = −0.03; 95% CI = −0.05 to −0.02). Independent of the outcome measure used to assess morbidity, the estimate of the overall relationship was small to moderate and negative: Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Index Updated (r  = −0.42; 95% CI = −0.61 to −0.03); exacerbations (r  = −0.02; 95% CI = −0.04 to −0.00); and hospitalizations (r  = −0.69; 95% CI = −1.70 to 0.32). Similarly, for HRQL, independent of the outcome measure, the estimate of the overall relationship was small to fair and negative: COPD Assessment Test (weighted r  = −0.22; 95% CI = −0.32 to −0.12), Chronic Respiratory Disease Questionnaire domains (−0.24 <  r  < −0.14), EuroQol Five-Dimension Questionnaire (utility score) (r  = −0.17; 95% CI = −0.26 to −0.07), EuroQol Five-Dimension Questionnaire domains (−0.32 <  r  < −0.06), and St George Respiratory Questionnaire total (r  = −0.26; 95% CI = −0.33 to −0.17). The quality of the evidence ranged from low to very low across outcomes. Conclusion Although heterogeneity was present among HGS measurement protocols, small to moderate associations were found, indicating that those with lower HGS have an increased likelihood of death, a higher risk of increased COPD morbidity (as assessed with Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity indexes), and poorer HRQL. [ABSTRACT FROM AUTHOR]

This systematic review aimed to synthesize the evidence of the psychometric properties of self-efficacy patient-reported outcome measures (PROMs) in patients with chronic obstructive pulmonary disease (COPD). We conducted a systematic search of MEDLINE and other common databases from inception until September 2020. Studies that reported psychometric properties of self-efficacy outcome measures in COPD patients were included. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 2018 guidelines for data extraction and evidence synthesis. Eighteen studies that assessed nine self-efficacy PROMs were eligible for inclusion. The assessment of structural validity indicated sufficient results rating for the Exercise Self-Regulatory Efficacy Scale and the Self-Care-Self-Efficacy Scale, and insufficient rating for the COPD Self-Efficacy Scale and the Pulmonary Rehabilitation Adaptation Index for Self-Efficacy (PRAISE). Construct validity measures displayed sufficient results rating with correlations ranging from −0.48 to − 0.71 between self-efficacy PROMs and other PROMs such as St. George's Respiratory Questionnaire, Hospital Anxiety and Depression Scale and Chronic Respiratory Questionnaire. Internal consistency measures indicated sufficient rating for all self-efficacy PROMs with a Cronbach's alpha range of 0.71 − 0.98. Responsiveness was assessed for the PRAISE with an overall sufficient rating (effect sizes of 0.21 − 0.37). The evidence regarding the psychometric properties of self-efficacy PROMs in COPD is variable. The PRAISE is responsive to changes in self-efficacy in COPD patients attending a pulmonary rehabilitation program. When using self-efficacy PROMs in clinical practice or research, clinicians and researchers should consider the psychometric properties and choose the appropriate outcome measure based on the purpose. [ABSTRACT FROM AUTHOR]

Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR. A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values. Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV1 49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT (p > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD. The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions. [ABSTRACT FROM AUTHOR]

Background: Participation in life roles is a critical patient-centered health outcome associated with morbidity and mortality in older adults, but it is not measured routinely in people with COPD. We aimed to validate a participation measure, the Late Life Disability Instrument (LLDI), in people with COPD.Research Question: To what extent does the LLDI demonstrate test-retest measurement error and reliability, internal consistency, construct and face validity, and floor or ceiling effects when applied to people with COPD?Study Design and Methods: In this cross-sectional study, LLDI scores were compared with scores on measures of theoretically related constructs and between groups based on symptom severity, prognosis, and frailty. A subsample (n = 36) completed the LLDI a second time over the phone within one week. Participants and health-care professionals were asked about the relevance, comprehensiveness, and comprehensibility of the LLDI. Floor and ceiling effects were explored, and the internal consistency (Cronbach's α) of the LLDI was calculated.Results: Ninety-six older adults with COPD participated. The frequency and limitation domains of the LLDI showed excellent test-retest reliability (two-way random effect intraclass correlation coefficient, 0.90 [standard error of measurement, 1.74 points] and 0.90 [standard error of measurement, 3.16 points], respectively). Both domains showed fair correlations with physical function, depression, and quality of life (r = 0.38-0.59). The relationship with anxiety was poor for the LLDI frequency domain (r = -0.21) and fair for LLDI limitation domain (r = -0.45). Both domains discriminated between people with different symptom severity, prognosis, and frailty (P ≤ .026). Neither domain showed floor or ceiling effects, and Cronbach's α was 0.69 and 0.91 for the LLDI frequency and limitation domains, respectively. All healthcare professionals and most participants agreed that the LLDI measures participation (79%) and that the items were relevant (81%).Interpretation: The LLDI shows test-retest reliability, internal consistency, and construct and face validity in people with COPD. The LLDI can be used to assess participation in this population. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) can lead to increased dependence on the informal caregiver and, consequently, to distress associated with caregiving burden. In the general population, higher levels of physical activity (PA) are related to lower distress levels; however, this relationship has been scarcely studied in COPD. This study aimed to explore the relationship between distress and PA in informal caregivers of patients with COPD, and the influence of caregivers' (age, sex) and patients' (age, sex, lung function) characteristics and caregiving duration on this relationship. A cross-sectional study was conducted with 50 caregivers (62.7 ± 9.8 years, 88% female; 78% caring for a spouse/partner; 38% caring >40 h/week; patients' FEV1=45.2 ± 21.3% predicted). Data collection comprised questions related to the caregiving context, distress related to caregiving burden assessed with the Informal Caregiver Burden Assessment Questionnaire (QASCI; total score, 7 subscales), and self-reported PA with the Habitual Physical Activity Questionnaire (HPAQ). Spearman's correlation coefficient and linear regressions were used. Significant, negative and moderate correlations were found between the QASCI (28.5 ± 19.8) and the HPAQ (5.2 ± 1.3) (ρ=-0.46; p = 0.01); and between the HPAQ and some QASCI subscales (emotional burden ρ=-0.47; implications for personal life ρ=-0.52; financial burden ρ=-0.44; perception of efficacy and control mechanisms ρ=-0.42; p < 0.01). Two linear regression models were tested to predict QASCI total score including as predictors: 1) HPAQ alone (p = 0.001; r2=0.23); 2) HPAQ and caregiving h/week (p < 0.001; r2=0.34). Higher self-reported PA levels are related to decreased levels of distress associated with caregiver burden in COPD caregivers. Duration of caregiving may negatively influence this relationship. [ABSTRACT FROM AUTHOR]

Background: Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease. Aim: The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations. Design: Systematic review with meta-analysis (PROSPERO: CRD42019139425). Data sources: MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool. Results: Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis (n = 3–7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37–15.55, p < 0.001) or home-based palliative care (8.79, 6.76–11.43, p < 0.001), opioids (4.76, 1.87–12.11, p = 0.001), sedatives (2.03, 1.78–2.32, p < 0.001) and dying at home (1.47, 1.14–1.89, p = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22–0.32, p < 0.001), non-invasive ventilation (0.63, 0.44–0.89, p = 0.009), cardiopulmonary resuscitation (0.29, 0.18–0.47, p < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16–0.64, p < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations. Conclusion: People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted r = 0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted r = 0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted r = 0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest. [ABSTRACT FROM AUTHOR]

Background: Individuals with chronic obstructive pulmonary disease (COPD) often experience high health‐care utilization following pulmonary rehabilitation, suggesting suboptimal transitions to home. Objective: To understand the experiences of persons with COPD and health‐care professionals regarding transitions from pulmonary rehabilitation to home, including factors impacting these transitions. Design: A descriptive qualitative study. Setting and participants: Health‐care professionals working at, and persons with COPD who attended, an inpatient or outpatient pulmonary rehabilitation programme at one large, urban health‐care centre. The centre is located in Ontario, Canada. Main variable studied: Experiences of participants with care transitions between pulmonary rehabilitation and home. Semi‐structured interviews were audio‐recorded, transcribed verbatim, and thematically analysed. Results: Ten patients and eight health‐care professionals participated. Four main themes were identified around the overall experiences with pulmonary rehabilitation and transitions to home: (a) pulmonary rehabilitation as a safe environment; (b) pulmonary rehabilitation as a highly structured environment; (c) contrasting perceptions of the role of pulmonary rehabilitation; and (d) dependency on pulmonary rehabilitation programmes. Persons with COPD and health‐care professionals identified three key factors that influenced this transition: (a) patients' social support, (b) application of self‐management strategies prior to discharge, and (c) patients' physical and mental health. Conclusion: Participants agreed that some patients with COPD experienced suboptimal transitions from pulmonary rehabilitation to home that were characterized by suboptimal self‐management. Further research is needed to develop and evaluate interventions to improve transitions. Such interventions should include strategies to elicit long‐term behaviour change to assist patients when they return into the community. [ABSTRACT FROM AUTHOR]

Chronic pain affects up to 88% of people with chronic obstructive pulmonary disease (COPD) and has been associated with comorbidities. However, with pain not evaluated during pulmonary rehabilitation (PR) assessments, it is unclear whether PR impacts pain intensity and coping ability. This study aimed to 1) determine the effect of PR on pain qualities, coping behavior and psychological symptoms in those with COPD and chronic pain; and 2) assess the impact of PR on exercise capacity and quality of life in individuals with COPD and chronic pain compared to those without pain. Patients with COPD and comorbidities enrolling in outpatient PR were assessed for chronic pain. Those with chronic pain completed the Brief Pain Inventory, Coping Strategies Questionnaire-24, Fear Avoidance Behavior Questionnaire and measures of anxiety and depression. Changes in HRQOL and 6-minute walk distance (6MWD) following PR were compared between participants with and without chronic pain. Thirty-four participants with chronic pain and 34 participants without pain were included (mean ± SD, FEV1 47 ± 19% predicted). In those with chronic pain, PR did not affect pain intensity (median[IQR] pre/post PR 3[2–5] vs. 4[2–6] points, p = 0.21), anxiety (7[2–9] vs. 5[3–8] points, p = 0.82) or depression (4[2–8] vs. 3[1–6] points, p = 0.38) and did not change pain coping strategies. Both groups improved in 6MWD (mean difference [95% CI] 17[−39 to 72] m), and those without pain had greater improvement in mastery (p = 0.013). PR was effective in patients with moderate to severe COPD whether or not they reported chronic pain at the time of their initial assessment. [ABSTRACT FROM AUTHOR]

In people with chronic obstructive pulmonary disease (COPD), there is increasing recognition that the prolonged accumulation of sedentary time (ST) is associated with adverse cardio-metabolic health outcomes. Nevertheless, changing this lifestyle, which has evolved over several decades, is likely to be challenging. This study reports the determinants, perceived by individuals with COPD, as being important for reducing ST. An in-depth understanding of this information is essential when planning an intervention to reduce ST. Fourteen individuals with COPD completed semi-structured one-on-one interviews, which were audio recorded and transcribed verbatim. Both the interview schedule and mapping of data items extracted from the interview transcripts were informed by the Theoretical Domains Framework (TDF). A total of 867 quotes were mapped to the 14 TDF domains. Seven of the fourteen domains were identified as being important determinants for reducing ST: knowledge, beliefs about consequences, beliefs about capabilities, environmental context and resources, social influences, social/professional role and identity, and behavioural regulation. There was a lack of knowledge regarding the meaning of sedentary behaviour. Participants' desire to be educated by knowledgeable health professionals in a formal programme was a dominant theme across multiple domains. The most frequently reported barriers to reducing ST related to the domains of social/professional role and identity and environmental context and resources, while the most frequently reported enablers were related to the domains pertaining to beliefs about consequences and social influences. Potential strategies to reduce ST among people with COPD include education and other determinants identified in this research. [ABSTRACT FROM AUTHOR]

Background/Aims: Thoracic kyphosis in people with chronic obstructive pulmonary disease can be measured from digital photogrammetry or three-dimensional motion capture. This study aimed to determine the reliability, validity and agreement for non-radiological measures of thoracic kyphosis in chronic obstructive pulmonary disease. Methods: A total of 19 participants with chronic obstructive pulmonary disease were included. Cobb angles from chest radiographs and spinous process landmarks using photogrammetry and three-dimensional motion capture were evaluated. Findings: The mean kyphosis (± standard deviation) was 48.8 ± 10.9 degrees by radiograph; 49.6 ± 12.9 degrees by three-dimensional motion capture and 52.2 ± 11.1 degrees by photogrammetry. Radiographic Cobb angle and photogrammetry measurements demonstrated excellent intra- and inter-rater reliability. Correlation between non-radiological kyphosis measurements and chest radiographs was strong (Pearson's r2 >0.75 for both). Limits of agreement between radiographs and 3D motion capture were –9 degrees to 7 degrees, and –12 to 8 degrees between radiographs and photogrammetry. Conclusions: Non-radiological measures of thoracic kyphosis are reliable and valid in chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Background: Pain is a common symptom in people with chronic obstructive pulmonary disease (COPD) which negatively influences quality of life and psychological well-being. However, our understanding of how those with COPD interpret the experience of pain is very limited. Objectives: To explore how individuals with moderate to severe COPD experience pain. Methods: Eight patients diagnosed with COPD who reported experiencing pain for greater than three months participated in in-depth interviews. Transcripts were subjected to interpretative phenomenological analysis. Results: Five themes were identified: 1) pain complicates the clinical profile of COPD; 2) uncertainly of the pain experience: frustrations related to health care professionals’ explanation for their pain and the need to legitimize; 3) language and behavior of pain: portraying pain as frustrating and unpredictable; 4) psychological reactions toward pain: depression and fear-avoidance behavior; and 5) altered identity perception: reduced self-worth, guilt in not meeting the expectations of others. Conclusions: Patients report difficulty in explaining the persistence of pain. This fosters a need to legitimize their pain, which influences feelings of frustration and self-worth. An understanding of these responses will assist health care professionals in managing on-going pain in those with COPD. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Background and objective Cardiorespiratory responses and symptoms in response to endurance exercise in patients with COPD vary with the number and position of involved limbs. Responses to such variations have never been quantified for strength exercises. We therefore assessed acute cardiorespiratory responses during brief bouts of weight lifting exercises. Methods We compared double- versus single-limb leg extensions and arm elevations, as well as arm elevation done above or below shoulder level in patients with moderate to severe COPD ( n = 10, 6 males, 66 (8.1 years), forced expiratory volume on 1 s ( FEV1 ) % predicted = 34% (14%)). Minute ventilation, oxygen uptake, oxygen saturation, heart rate ( HR), blood pressure ( BP), rate of perceived exertion ( RPE) and recovery time were collected during single sets of each exercise (10 repetitions at 80% of one repetition maximum). Results Ventilatory and gas exchange responses were not affected by the number of exercising limbs. Changes in HR, BP and RPE scores during arm elevation above shoulder level were greater after double- compared with single-arm elevation ( P ≤ 0.001) and greater when exercising above compared with below shoulder level ( P ≤ 0.01). Double-arm elevation above shoulder level required 1.5 min longer HR recovery time ( P ≤ 0.041) compared with other exercises. Conclusion Double-arm elevation above shoulder level appears to be more challenging than other strength exercise variations. Partitioning exercises and limb position may reduce perceived exertion during training. [ABSTRACT FROM AUTHOR]

Background: Balance deficits and an increased fall risk are well documented in individuals with COPD. Despite evidence that balance training programs can improve performance on clinical balance tests, their minimal clinically important difference (MCID) is unknown. The aim of this study was to determine the MCID of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), and Activities-Specific Balance Confidence (ABC) scale in patients with COPD undergoing pulmonary rehabilitation.Methods: We performed a secondary analysis of data from two studies of balance training in COPD (n = 55). The MCID for each balance measure was estimated using the following anchor and distribution-based approaches: (1) mean change scores on a patient-reported global change in balance scale, (2) optimal cut-point from receiver operating characteristic curves (ROCs), and (3) the minimal detectable change with 95% confidence (MDC95).Results: Data from 55 patients with COPD (mean age, 71.2 ± 7.1 y; mean FEV1, 39.2 ± 15.8% predicted) were used in the analysis. The smallest estimate of MCID was from the ROC method. Anchor-based estimates of the MCID ranged from 3.5 to 7.1 for the BBS, 10.2 to 17.4 for the BESTest, and 14.2 to 18.5 for the ABC scale; their MDC95 values were 5.0, 13.1, and 18.9, respectively.Conclusions: Among patients with COPD undergoing pulmonary rehabilitation, a change of 5 to 7 points for the BBS, 13 to 17 points for the BESTest, and 19 points for the ABC scale is required to be both perceptible to patients and beyond measurement error. [ABSTRACT FROM AUTHOR]

Rationale: In patients with chronic obstructive pulmonary disease (COPD), partitioned exercise training using one-legged cycling leads to greater improvements in peak oxygen uptake than conventional two-legged cycling.Objectives: We evaluated the feasibility of incorporating one-legged cycling as the principal aerobic training modality for pulmonary rehabilitation in COPD.Methods: Physiotherapists underwent four teaching sessions about the principles and practical implementation of one-legged cycling training. Patients enrolled in a pulmonary rehabilitation program underwent 6-8 weeks of training in which one-legged cycling three times per week was the principal aerobic exercise activity. Participants cycled for 15 minutes with each leg, in each session. An incremental cardiopulmonary exercise test was completed before and after pulmonary rehabilitation along with standard pulmonary rehabilitation outcome measures. Participants and physiotherapists completed a satisfaction survey at the end of the program.Measurements and Main Results: A total of 22 out of 32 participants (14 male; mean [SD] age, 66 [7] years; FEV1% predicted, 32 [17]%; median [interquartile range] Medical Research Council dyspnea scale, 3.5 [3.0-4.3]) completed pulmonary rehabilitation. Peak oxygen uptake increased 1.1 (0.4-1.7) ml·min(-1)·kg(-1) (8%) from baseline (P<0.01). The mean (95% confidence interval) 6-minute-walk test distance improved by 72 (45-98) m (P=0.001). The change in the Chronic Respiratory Questionnaire total score of 1.6 (1.1-2.1; P<0.001) was achieved by improvement in all four domains above the clinically important difference. All the physiotherapists considered one-legged cycling safe and would continue to prescribe it; 75% of participants would recommend it to other patients.Conclusions: One-legged cycling was successfully implemented into a "real-life" pulmonary rehabilitation program, demonstrating improvements in cardiorespiratory fitness with associated improvement in function for patients with moderate/severe COPD. One-legged cycling should be recommended in professional pulmonary rehabilitation guidelines as an option for exercise training and be available in other pulmonary rehabilitation programs. Clinical trial registered with www.clinicaltrials.gov (NCT01930526). [ABSTRACT FROM AUTHOR]

Background. Exercise is recommended for people with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet there is little information to guide safe and effective mobilization and exercise for these patients. Objectives. The purpose of this study was to develop a clinical decision-making tool to guide health care professionals in the assessment, prescription, monitoring, and progression of mobilization and therapeutic exercise for patients with AECOPD. Design and Methods. A 3-round interdisciplinary Delphi panel identified and selected items based on a preselected consensus of 80%. These items were summarized in a paper-based tool titled Mobilization in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD-Mob). Focus groups and questionnaires were subsequently used to conduct a sensibility evaluation of the tool. Results. Nine researchers, 13 clinicians, and 7 individuals with COPD identified and approved 110 parameters for safe and effective exercise in AECOPD. These parameters were grouped into 5 categories: (1) "What to Assess Prior to Mobilization," (2) "When to Consider Not Mobilizing or to Discontinue Mobilization," (3) "What to Monitor During Mobilization for Patient Safety," (4) "How to Progress Mobilization to Enhance Effectiveness," and (5) "What to Confirm Prior to Discharge." The tool was evaluated in 4 focus groups of 18 health care professionals, 90% of whom reported the tool was easy to use, was concise, and would guide a health care professional who is new to the acute care setting and working with patients with AECOPD. Limitations. The tool was developed based on published evidence and expert opinion, so the applicability of the items to patients in all settings cannot be guaranteed. The Delphi panel consisted of health care professionals from Canada, so items may not be generalizable to other jurisdictions. Conclusions. The AECOPD-Mob provides practical and concise information on safe and effective exercise for the AECOPD population for use by the new graduate or novice acute care practitioner. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the effect of distractive auditory stimulus (DAS) in the form of music on exercise capacity, symptoms and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). Topics discussed include the findings which suggest that DAS may reduce symptoms of dyspnea and fatigue when applied during exercise training, but would not for overall dyspnea management.

Background: We have recently demonstrated the efficacy of balance training in addition to Pulmonary Rehabilitation (PR) at improving measures of balance associated with an increased risk of falls in individuals with Chronic Obstructive Pulmonary Disease (COPD). Few knowledge translation (KT) projects have been conducted in rehabilitation settings. The goal of this study was to translate lessons learnt from efficacy studies of balance training into a sustainable clinical service. Methods: Health care professionals (HCPs) responsible for delivering PR were given an hour of instruction on the principles and practical application of balance training and the researchers offered advice regarding; prescription, progression and practical demonstrations during the first week. Balance training was incorporated three times a week into conventional PR programs. Following the program, HCPs participated in a focus group exploring their experiences of delivering balance training alongside PR. Service users completed satisfaction surveys as well as standardized measures of balance control. At six month follow-up, the sustainability of balance training was explored. Results: HCPs considered the training to be effective at improving balance and the support provided by the researchers was viewed as helpful. HCPs identified a number of strategies to facilitate balance training within PR, including; training twice a week, incorporating an interval training program for everyone enrolled in PR, providing visual aids to training and promoting independence by; providing a set program, considering the environment and initiating a home-based exercise program early. Nineteen service users completed the balance training [ten male mean (SD) age 73 (6) y]. Sixteen patients (84 %) enjoyed balance training and reported that it helped them with everyday activities and 18 (95 %) indicated their wish to continue with it. Scores on balance measures improved following PR that included balance training (all p < 0.05). At six month follow-up balance training is being routinely assessed and delivered as part of standardised PR. Conclusions: Implementing balance training into PR programs, with support and training for HCPs, is feasible, effective and sustainable. [ABSTRACT FROM AUTHOR]

The article discusses a study which aims to determine the prevalence of pain and pain characteristics in association with the clinical aspects of chronic obstructive pulmonary disease (COPD) and to investigate instruments used in assessing COPD-related pain. Topics discussed include pain characteristics with clinical associations such as common pain regions, prevalence, and intense pain due to level of breathlessness.

Background: Despite the strong evidence base, the perception remains that the provision of pulmonary rehabilitation (PR) services are extremely limited. Imbalances in PR delivery give rise to unnecessary health costs and underserviced populations. We conducted a systematic review to characterize the international provision of PR, comparing its structure and delivery across countries, and gaining insight into the availability of PR in relation to geographical prevalence. Methods: Electronic databases were searched from inception to September 2013 using the key words 'pulmonary rehabilitation' and 'survey.' Two authors independently reviewed studies and assessed study quality. Data was extracted and double-checked to ensure accuracy. Results: The majority of programs (55-99%) were offered in an outpatient setting with the exception of Ireland, where the majority of programs were offered in the community (65%). Exercise was the primary component across all programs (77-100%), followed by education (74-100%). Physical therapists were the most common member of the PR team (49-100%). Functional walk tests were the most frequently used outcome measure, although the specific test utilized varied across countries. The current availability of PR services ≤1.2% of individuals with COPD. Conclusion: Components provided in PR are similar, irrespective of country, while patient outcome measures demonstrated variation across countries. Recent surveys report the use of community resources for the delivery of PR programs, although the majority are outpatient based. The small number of potential individuals enrolled in PR suggests that an international increase in access and capacity would improve quality of life and reduce healthcare utilization in this population. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of people with a diagnosis of chronic obstructive pulmonary disease (COPD) among those completing non-pulmonary rehabilitation (NPR) programmes and to describe their characteristics. Methods: Electronic data of participants who completed an in-patient rehabilitation programme between July 1, 2010, and July 1, 2012 were retrospectively reviewed. Data extracted were month and year of birth, sex, height, weight, referral source, admission and discharge dates, programme admitted to, reason for admission, most responsible health condition, number of co-morbidities, referral agency on discharge, and Functional Independence Measure (FIM) scores on admission and discharge. Results: The prevalence of COPD among participants who completed the NPR programmes was 7.5%. The most common reasons for admission were cardiac conditions (n=69, 20%), followed by post-unilateral hip replacement (n=40, 11%) and post-unilateral hip fracture (n=38, 11%). Patients were discharged after an average stay of 20 (SD 13) days. The mean FIM score was 91 (SD 11) at admission and 108 (SD 9) at discharge. Conclusions: The prevalence of a COPD diagnosis among participants in NPR programmes was 7.5%. COPD is a common comorbidity for people in rehabilitation programmes who have had amputations, have a cardiac condition, have undergone organ transplantation, or require complex care. [ABSTRACT FROM AUTHOR]

The article discusses a study that determined incremental shuttle walk test (ISWT) measurement properties for assessing peak exercise capacity of patients with chronic diseases. ISWT studies on validity, reliability and responsivenes were conducted on patients with cardiac disease and chronic obstructive pulmonary disease (COPD) for peak consumption of oxygen. Results showed the responsiveness of ISWT to bronchodilator administration and pulmonary rehabilitation.

Highlights: [•] Telemonitoring interventions should be adjusted to their target population. [•] Assessment of patients’ acceptance of telemonitoring technology should be considered prior to its implementation. [•] Future research should consider the inclusion of easy-to-use technology and more training sessions. [•] Frequency of data collection/transmission should be flexible to improve adherence. [•] Changes in patients’ self-management behavior should be explored in future studies. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a respiratory disease associated with a systemic inflammatory response. Peripheral muscle dysfunction has been well characterized in individuals with COPD and results from a complex interaction between systemic and local factors. Objective: In this narrative review, we will describe muscle wasting in people with COPD, the associated structural changes, muscle regenerative capacity and possible mechanisms for muscle wasting. We will also discuss how structural changes relate to impaired muscle function and mobility in people with COPD. Key Observations: Approximately 30-40% of individuals with COPD experience muscle mass depletion. Furthermore, muscle atrophy is a predictor of physical function and mortality in this population. Associated structural changes include a decreased proportion and size of type-I fibers, reduced oxidative capacity and mitochondrial density mainly in the quadriceps. Observations related to impaired muscle regenerative capacity in individuals with COPD include a lower proportion of central nuclei in the presence or absence of muscle atrophy and decreased maximal telomere length, which has been correlated with reduced muscle cross-sectional area. Potential mechanisms for muscle wasting in COPD may include excessive production of reactive oxygen species (ROS), altered amino acid metabolism and lower expression of peroxisome proliferator-activated receptors-gamma-coactivator 1-alpha mRNA. Despite a moderate relationship between muscle atrophy and function, impairments in oxidative metabolism only seems weakly related to muscle function. Conclusion: This review article demonstrates the cellular modifications in the peripheral muscle of people with COPD and describes the evidence of its relationship to muscle function. Future research will focus on rehabilitation strategies to improve muscle wasting and maximize function. [ABSTRACT FROM AUTHOR]

An abstract of the article "Measurement of Activities of Daily Living in Patients With COPD: A Systematic Review" by Tania Janaudis is presented.

The article discusses the results of a study that investigated the balance-training program's effect on the balance and physical function in patients with chronic obstructive pulmonary disease (COPD) during a pulmonary rehabilitation (PR). The study showed an 82.5 percent mean compliance with the balance-training program. It concluded that balance training is feasible and effective as part of the PR for improving balance performance and muscle strength in patients with COPD.

Chronic obstructive pulmonary disease (COPD) often leads to an increased dependence on the informal carer, which can result in higher levels of distress, anxiety or depression associated with the burden of caregiving and, consequently, reduced quality of life [1]. Several instruments have been used to assess carer burden in COPD; however, their measurement properties have been poorly assessed in this population [2]. The Questionário de Avaliação de Sobrecarga do Cuidador Informal (QASCI) is a Portuguese questionnaire, originally created for carers of patients with stroke [3] and later validated in a sample with various chronic diseases, including respiratory diseases [4]. However, its reliability and validity in informal carers of patients with COPD have yet to be established. Therefore, this study aimed to assess the reliability and validity of the QASCI questionnaire for informal carers of patients with COPD. The Portuguese questionnaire QASCI evaluates the distress associated with burden of caregiving (scores range from 0 to 100, with higher scores indicating higher levels of burden). It has 32 items divided in 7 subscales (emotional burden; personal life implications; financial burden; reactions to demands; mechanism of efficacy and control; familiar support; and satisfaction with the role). Each item is scored with a 5-point Likert scale. Reliability included internal consistency assessment using the Cronbach's alpha. Construct validity was assessed using the following questionnaires: Zarit Burden Interview (ZBI) for concurrent validity; the Hospital Anxiety and Depression Scale (HADS) (anxiety and depression) and WHOQOL-Bref (quality of life) for convergent validity. Pearson's (r) or Spearman's (ρ) correlation coefficients were used according to the distribution of each variable. QASCI was expected to present a stronger (positive) correlation with ZBI than with HADS (r ≥ 0.5) and a negative correlation with WHOQOL-Bref (r≤–0.4) [3,4]. Forty-one carers (62.4 ± 10.1 years, 90.2% female; patients' FEV1=43.7 ± 19.7%pred) completed the questionnaires. Cronbach's alpha of the full QASCI scale was 0.767 and the subscales presented values between.633 and.929. QASCI and ZBI had a very strong positive correlation (r = 0.914; p=.01). QASCI had a strong positive correlation with HADS anxiety (r = 0.608; p=.01) and depression (ρ = 0.617; p=.01) subscales and moderate to strong negative correlations with all the WHOQOL-Bref subscales (–0.418 to 0.723, p=.01). QASCI presented good internal consistency and construct validity results. QASCI seems to be a promising measure to evaluate distress levels associated with burden of caregiving in informal carers of patients with COPD. [ABSTRACT FROM AUTHOR]

The article discusses a systematic review which determine the effect of supervised exercise programs after primary pulmonary rehabilitation (PR) on exercise capacity and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD). It concluded that supervised exercise programs after primary PR appear to be more effective than usual care for preserving exercise capacity in the medium term but not in the long term.

Good communication will impact clinical practice by assisting patients in understanding health information as well as medical recommendations. Health literacy is important for communication between healthcare professionals and patients with Chronic Obstructive Lung Disease (COPD). In this article we review the concepts, definitions and measurement tools used to evaluate health literacy and recommend ways in which this information may be integrated into clinical practice. Increased awareness of health literacy will assist clinicians to improve patients' knowledge of their disease and adherence to healthcare recommendations. [ABSTRACT FROM AUTHOR]

Purpose: To determine (1) the relationship among three common upper-limb tests for patients with chronic obstructive pulmonary disease (COPD): unsupported upper limb exercise test (UULEX), 6-minute pegboard and ring test (6PBRT), and a muscle-strength test using a hand-held dynamometer; and (2) the responsiveness of these three tests to changes after pulmonary rehabilitation that included a resistance arm-training programme. Methods: The study was a secondary analysis of a randomized controlled trial (RCT). The UULEX and the 6PBRT were used to measure peak arm exercise capacity and arm function, respectively. A handheld dynamometer was used to measure elbow and shoulder flexion force. We analyzed baseline data for all participants in the RCT, as well as baseline and post-PR data for those who completed 6-week follow-up testing. Results: 36 patients with COPD (mean forced expiratory volume in 1 second [FEV1]=35% [SD 15%] predicted; age 66 [9] y) participated, of whom 13 completed an arm-training programme. The correlations among the test results ranged from 0.41 to 0.81 (p<0.0001). Standardized response means were 1.0 for muscle force of elbow flexion, 1.2 for shoulder flexion, and 1.8 for the 6PBRT and UULEX. Conclusions: Although the three tests (UULEX, 6PBRT, and muscle-strength test using a hand-held dynamometer) are intended to measure different constructs, they were moderately to highly correlated with one another. The 6PBRT, UULEX, and muscle-strength test were demonstrated to be responsive to the resistance arm-training programme. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective: Field and laboratory-based tests are used to measure exercise capacity in people with COPD. A comparison of the cardiorespiratory responses to field tests, referenced to a laboratory test, is needed to appreciate the relative physiological demands. We sought to compare peak and submaximal cardiorespiratory responses to the 6-min walk test, incremental shuttle walk test and endurance shuttle walk test with a ramp cycle ergometer test (CET) in patients with COPD. Methods: Twenty-four participants (FEV1 50 ± 14%; 66.5 ± 7.7 years; 15 men) completed four sessions, separated by ≥24 h. During an individual session, participants completed either two 6-min walk tests, incremental shuttle walk tests, endurance shuttle walk tests using standardized protocols, or a single CET, wearing a portable gas analysis unit (Cosmed K4b2) which included measures of heart rate and arterial oxygen saturation (SpO2). Results: Between tests, no difference was observed in the peak rate of oxygen uptake ( F3,69 = 1.2; P = 0.31), end-test heart rate ( F2,50 = 0.6; P = 0.58) or tidal volume ( F3,69 = 1.5; P = 0.21). Compared with all walking tests, the CET elicited a higher peak rate of carbon dioxide output (1173 ± 350 mL/min; F3,62 = 4.8; P = 0.006), minute ventilation (48 ± 17 L/min; F3,69 = 10.2; P < 0.001) and a higher end-test SpO2 (95 ± 4%; F3,63 = 24.9; P < 0.001). Conclusions: In patients with moderate COPD, field walking tests elicited a similar peak rate of oxygen uptake and heart rate as a CET, demonstrating that both self- and externally paced walking tests progress to high intensities. [ABSTRACT FROM AUTHOR]

The article presents a study that determined the effect of pulmonary rehabilitation on the critical walk speed of patients with chronic obstructive pulmonary disease (COPD) undergoing rehabilitation. The study compared the critical speed with the speed chosen during self-paced walking. It assessed critical speed in patients with COPD before and after rehabilitation. It reveals increased critical walk speed in patients with COPD after pulmonary rehabilitation.

The article presents a study that determined which tests of exercise capacity relate to average daily energy expenditure. The study quantified aerobic reserve during daily life in people with chronic obstructive pulmonary disease. It focused on 26 people with COPD and collected and six-minute walk distance and incremental shuttle walk distance. It measured peak oxygen uptake during a symptom-limited ramp cycle ergometry test.

The article discusses a study which focused on the measurement of arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The types of arm exercise tests used in this study included arm ergometry, ring shifts, dowel lifts, proprioceptive neuromuscular facilitation and activities of daily living. The clinical characteristics of COPD include airway obstruction, systemic inflammation and skeletal muscle dysfunction.

Background: Patients with chronic respiratory diseases often have the simple goal of wanting to walk for longer. We evaluated the properties of a patient goal-oriented, symptom-limited, self-paced walk (SPW).Methods: Patients with symptomatic chronic respiratory disease, referred for a 6-week course of pulmonary rehabilitation (PR), were screened for eligibility. Baseline assessments included two SPWs with both time and speed measured, two 6-min walk tests (6MWTs), and the Medical Research Council dyspnea scale. On program completion, two SPWs and one 6MWT were performed. The repeatability, responsiveness, and validity of the SPW were assessed.Results: Two SPWs were completed by 50 and 37 patients before and after rehabilitation, respectively. The speed (r = -0.54, P < .001) but not the time (r = -0.23, P = .19) of the SPW correlated with Medical Research Council dyspnea grade. The mean SPW time increased on the second day of testing from 15.1 ± 8.4 min to 17.9 ± 7.7 min (P = .004), and the effect of test day was unaltered by PR (P = .80). The coefficient of repeatability for SPW time was 16.1 min. Both the mean SPW time (10.6 min; 95% CI, 6.6-14.5 min; P < .001) and the mean speed (3.5 m/min; 95% CI, 1.3-5.7 m/min; P < .01) increased after rehabilitation.Conclusions: The SPW time is an easily understandable, patient goal-oriented assessment with construct validity that is highly responsive to the effects of PR. The variability in SPW time makes it better suited to interpreting group rather than individual changes.Trial Registry: ClinicalTrials.gov; No.: NCT00781183; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background In patients with chronic obstructive pulmonary disease (COPD), interval exercise has gained recent attention as a possible means of achieving greater physiological training effects compared with continuous exercise. The primary aim of this systematic review was to compare the effects of interval versus continuous training on peak oxygen uptake, peak power, 6 minute walk test (6MWT) distance and health-related quality of life in individuals with COPD. Methods Randomised controlled trials comparing the effects of interval versus continuous training in patients with COPD were identified after searches of six databases and reference lists of appropriate studies in May 2009. Two reviewers independently assessed study quality. Weighted mean differences (WMD) with 95% CIs were calculated using a random effects model for measures of exercise capacity and health-related quality of life. Results: Eight randomised controlled trials, with a total of 388 patients with COPD, met the inclusion criteria. No significant differences were found for peak power (WMD 1 W, 95% CI 1 to 3) or peak oxygen uptake (WMD 0.04 l/min, 95% CI 0.13 to 0.05) between interval and continuous training. The WMD for the Chronic Respiratory Questionnaire dyspnoea score was 0.2 units (95% CI 0.5 to 0.0). There was no difference in 6MWT distance between groups (WMD 4 m, 95% CI 15 to 23). Conclusions Interval and continuous training modalities did not differ in their effect on measures of exercise capacity or health-related quality of life. Interval training may be considered as an alternative to continuous training in patients with varying degrees of COPD severity. [ABSTRACT FROM AUTHOR]

The article presents a study of acute exacerbations of COPD in patients following pulmonary rehabilitation. The study involved a six-month study of sixty subjects who completed pulmonary rehabilitation and were followed up until acute exacerbation of COPD occurred. The research results indicate that patients with lower functional exercise capacity are more likely to experience acute exacerbation of COPD following pulmonary rehabilitation.

The article presents a study that evaluates the influence of rollator use on health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). The randomized controlled trial was used to 31 postrehabilitation patients with COPD, who received a rollator or usual care for 8 weeks. The results of the study revealed that there was no rollator effect on quality of life when the patients were provided with rollator. Actual use of a rollator determines its effect.

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The article compares the nature and rehabilitation of individuals with chronic obstructive pulmonary disease (COPD) and HIV/AIDS. COPD is characterized by repeated acute exacerbations due to chronic bronchitis and it mostly affect men. HIV is a retrovirus that targets T cells which help the body in fighting off infection and disease and infections associated with this virus are increasing among women. Pulmonary rehabilitation is effective in improving the symptoms of COPD.

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this systematic review was to determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) compared to other rehabilitation interventions such as: exercise, education, other breathing techniques or exercise and/or pulmonary rehabilitation among adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature on IMT and COPD was conducted according to the Cochrane Collaboration protocol. Inclusion criteria for the review included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions such as general exercise, education, other breathing techniques or exercise/pulmonary rehabilitation among adults with COPD. 274 articles were retrieved, and 16 met the inclusion criteria. Seven meta-analyses were performed that compared targeted or threshold IMT to exercise (n = 3) or to education (n = 4). Results showed significant improvements in inspiratory muscle strength and endurance, and in the dyspnea scale on a quality of life measure, for participants in the IMT versus education group. In other instances where meta-analyses could not be performed, a qualitative review was performed. IMT results in improved inspiratory muscle strength and endurance compared to education. Further trials are required to investigate the effect of IMT (or combined IMT) compared to other rehabilitation inventions for outcomes such as dyspnea, exercise tolerance, and quality of life. [ABSTRACT FROM AUTHOR]

This study explored factors that influence self-care from the perspective of individuals with Chronic Obstructive Pulmonary Disease (COPD). Seven focus groups were held with individuals who had physician diagnosed COPD and experienced daily symptoms that limited activities. Forty-two subjects participated in the study. All sessions were audiotaped, transcribed and coded independently. The main theme identified was surviving COPD: the context for living and the two sub-themes identified were adjusting physically and emotionally to COPD. Participants discussed their self-care practices within the context of the purpose and meaning of life. Although participants experienced major physical limitations, the issues highlighted were those of individuals striving to survive with COPD and to hold on to some quality of life through adjusting physically and emotionally. Individuals with COPD have developed strategies to adapt to the disease, compensate for limitations, and integrate self-care activities for managing COPD into their daily routine. Health professionals should use approaches that support the whole needs of the individual to achieve the best quality of life for individuals with COPD and their families. [Copyright &y& Elsevier]