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Sample records for home-based pulmonary rehabilitation

  1. Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Ozalevli, Sevgi; Karaali, Hayriye Kul; Ilgin, Duygu; Ucan, Eyup Sabri

    2010-02-28

    The aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF). A prospective study. Seventeen patients diagnosed with IPF. A home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale), pulmonary function (pulmonary function test), exercise capacity (6-minute walking test, 6MWD), and general health related quality of life (Medical Outcomes Short Form-36) were evaluated. A significant decrease in perceived dyspnea (p = 0.003) and leg fatigue (p Home-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.

  2. Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

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    Ozalevli Sevgi

    2010-02-01

    Full Text Available Abstract Objective The aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF. Design A prospective study. Patients Seventeen patients diagnosed with IPF. Methods A home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale, pulmonary function (pulmonary function test, exercise capacity (6-minute walking test, 6MWD, and general health related quality of life (Medical Outcomes Short Form-36 were evaluated. Results A significant decrease in perceived dyspnea (p = 0.003 and leg fatigue (p Conclusion Home-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.

  3. A Canadian, Multicentre, Randomized Clinical Trial of Home-Based Pulmonary Rehabilitation in Copd: Rationale and Methods

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    François Maltais

    2005-01-01

    Full Text Available BACKGROUND: Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation.

  4. Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial

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    Mendes de Oliveira Júlio C

    2010-12-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed. Methods Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks. Results There was a significant difference in the distance covered on the six-minute walk test (p Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.

  5. Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial.

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    Mendes de Oliveira, Júlio C; Studart Leitão Filho, Fernando S; Malosa Sampaio, Luciana M; Negrinho de Oliveira, Ana C; Hirata, Raquel Pastrello; Costa, Dirceu; Donner, Claudio F; de Oliveira, Luís Vf

    2010-12-20

    Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed. Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks. There was a significant difference in the distance covered on the six-minute walk test (p home groups after participating in the rehabilitation program compared to baseline. A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.

  6. Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients

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    Nascimento ESP

    2015-03-01

    Full Text Available Eloisa Sanches Pereira do Nascimento,1 Luciana Maria Malosá Sampaio,1 Fabiana Sobral Peixoto-Souza,1 Fernanda Dultra Dias,1 Evelim Leal Freitas Dantas Gomes,1 Flavia Regina Greiffo,2 Ana Paula Ligeiro de Oliveira,2 Roberto Stirbulov,3 Rodolfo Paula Vieira,2 Dirceu Costa11Laboratory of Functional Respiratory Evaluation (LARESP, 2Laboratory of Pulmonary and Exercise Immunology (LABPEI, Nove de Julho University (UNINOVE, São Paulo, SP, Brazil; 3Department of Pneumology, Santa Casa University Hospital, São Paulo, SP, BrazilAbstract: Chronic obstructive pulmonary disease (COPD is a respiratory disease characterized by chronic airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is characterized by pulmonary and systemic inflammation. However, increases in the levels of inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study was to evaluate whether a home-based pulmonary rehabilitation (HBPR program improves exercise tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of health-related quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers (interleukin [IL]-6 and IL-8. At the end of the evaluations, patients received a booklet containing the physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25 patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant increase in the walked distance and the maximal

  7. [Benefits of a home-based pulmonary rehabilitation program for patients with severe chronic obstructive pulmonary disease].

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    Regiane Resqueti, Vanessa; Gorostiza, Amaia; Gáldiz, Juan B; López de Santa María, Elena; Casan Clarà, Pere; Güell Rous, Rosa

    2007-11-01

    The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease (COPD) are uncertain. We aimed to assess the short- and medium-term efficacy of such a program in this clinical setting. Patients with severe COPD (stages III-IV, classification of the Global Initiative for Chronic Obstructive Lung Disease) and incapacitating dyspnea (scores 3-5, Medical Research Council [MRC] scale) were randomized to a control or domiciliary rehabilitation group. The 9-week supervised pulmonary rehabilitation program included educational sessions, respiratory physiotherapy, and muscle training in weekly sessions in the patient's home. We assessed the following variables at baseline, 9 weeks, and 6 months: lung function, exercise tolerance (3-minute walk test), dyspnea (MRC score), and health-related quality of life with the Chronic Respiratory Questionnaire (CRQ). Thirty-eight patients with a mean (SD) age of 68 (6) years were enrolled. The mean MRC score was 4 (0.8) and mean forced expiratory volume in 1 second was 29% of reference. Twenty-nine patients completed the study (6 months). Distance covered on the walk test increased significantly in the rehabilitation group (P=.001) and the difference was maintained at 6 months. Dyspnea also improved significantly with rehabilitation (Pevident at 6 months. Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks: dyspnea (3.1 [0.8] vs 3.6 [0.7]; P=.02) and fatigue (3.7 [0.8] vs 4.2 [0.9]; P=.002). A clinically relevant but not statistically significant change in mastery over disease was detected (from 4.3 to 4.9). All improvements were maintained at 6 months. Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months.

  8. Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients

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    Ghanem Maha

    2010-01-01

    Full Text Available Background: A key component in the management of chronic obstructive pulmonary disease (COPD patients is pulmonary rehabilitation (PR, the corner stone of which is exercise training. Aim: This study aims to evaluate the effect of a two-months, home-based PR program with outpatient supervision every two weeks, on exercise tolerance and health-related quality of life (HRQL using Arabic-translated standardized generic and specific questionnaires in COPD patients recently recovered from acute exacerbation, Design: Randomized clinical trial. Setting and Subjects: A total of 39 COPD patients who recovered from acute exacerbation were randomly allocated either a two-month home-based PR program in addition to standard medical therapy or standard medical therapy alone in the period between July 2008 and March 2009. Methods: Pulmonary function tests (PFTs, six-minute walk distance (6-MWD test, Arabic-translated chronic respiratory disease questionnaire-self administered standardized format (CRQ-SAS and quality of life scale Short Form (SF-36 were compared between 25 patients with moderate to severe COPD who underwent a two-month PR program (group 1 and 14 COPD patients who did not (group 2. Results: Group 1 showed significant improvement in the 6-MWD, and HRQL scores at two months compared with the usual care patients in group 2 (P less than 0.05. Improvement in both CRQ-SAS and SF-36 scores were statistically significant and comparable in group 1. Conclusion: The supervised, post discharge, two-month home-based PR program is an effective non pharmacological intervention in the management of stable patients with COPD. The 6-MWD is a simple, inexpensive and safe test to assess physical and functional capabilities among COPD patients. HRQL can be measured in patients with COPD either by disease-specific tools that have been specifically designed for use in patients with respiratory system disorders or by generic HRQL tools that can be used across

  9. Real-life feasibility and effectiveness of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease requiring medical equipment

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    Coquart JB

    2017-12-01

    Full Text Available Jérémy B Coquart,1 Olivier Le Rouzic,2 Ghazi Racil,3 Benoit Wallaert,2 Jean-Marie Grosbois4 1CETAPS, EA 3832, UFR STAPS, University of Rouen, Normandie-Univ, Mont Saint Aignan, France; 2Department of Respiratory Diseases, University of Lille, CHRU Lille, Lille, France; 3Department of Biology, Faculty of Sciences, El Manar University, Tunis, Tunisia; 4FormAction Santé, Pérenchies, France Background: Pulmonary rehabilitation (PR is a key treatment of chronic obstructive pulmonary disease (COPD but studies are still needed to identify the most pertinent criteria to personalize this intervention and improve its efficacy.Objective: This real-life retrospective study compared the effects of home-based PR on exercise tolerance, anxiety, depression, and health-related quality of life (HRQoL in COPD patients, according to their medical equipment.Methods: Exercise tolerance, anxiety, depression, and HRQoL were evaluated in 109 patients equipped with long-term oxygen therapy (LTOT, 84 patients with noninvasive ventilation (NIV, 25 patients with continuous positive airway pressure (CPAP, and 80 patients with no equipment (NE, before, just after, and 6 and 12 months after PR.Results: At baseline, the body mass index in the CPAP and NIV groups was higher (p<0.05 than in the other two groups, and the forced expiratory volume in 1 second was lower in the LTOT and NIV groups (p<0.001. All parameters improved after PR in the four groups (p<0.05, but for exercise tolerance, only the 6-minute stepper test showed maintained improvement after 6 and 12 months, whereas the 10 times sit-to-stand and timed up-and-go tests were only improved just after PR. At every time point, exercise tolerance was lower in the LTOT group (p<0.05, with a similar trend in the NIV group.Conclusion: Despite differences in the medical equipment to treat COPD, home-based PR showed comparable feasibility, safety, and efficacy in all equipment-based groups. Medical equipment should

  10. [Comparison of home-based and outpatient, hospital-based, pulmonary rehabilitation in patients with chronic respiratory diseases].

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    Grosbois, J-M; Le Rouzic, O; Monge, E; Bart, F; Wallaert, B

    2013-02-01

    The comprehensive care and personalized pulmonary rehabilitation (PR) of patients with chronic respiratory disease is effective regardless of the place of performance. The objective of this prospective observational study was to compare two types of care in an outpatient rehabilitation center, versus a home-based PR. Two hundred and eighty-six patients were supported : 137 patients were included in outpatients (age : 61.2±10.8years, BMI: 28.7±7.1), 149 in home-based PR (age: 62.9±12years, BMI: 26.1±6.6). The choice between outpatient and home was a function of distance from the center and the patient's wishes. The outpatient care was done in groups of six, four times a week for 6weeks. At home she was single, once a week for 8weeks with continued physical activity independently of the other days a week depending on individual action plan. The therapeutic education programs and psycho-social support were identical in both structures. The assessment included assessment of exercise tolerance test in 6minutes stepper (TS6), anxiety and depression and quality of life. There were no incidents or accidents during the PR in the two structures. The exercise intolerance was significantly higher in patients TS6 home (332.9±154.8 versus 460.2±137.9 counts, Prespiratory unselected patients is as safe and effective at home or in outpatient center on exercise tolerance and quality of life. Home-based PR is an alternative to outpatient care as long as all activities, physical training, therapeutic education and psychosocial support, are achieved. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  11. Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease.

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    Kawagoshi, Atsuyoshi; Kiyokawa, Noritaka; Sugawara, Keiyu; Takahashi, Hitomi; Sakata, Shunichi; Satake, Masahiro; Shioya, Takanobu

    2015-03-01

    We evaluated the effects of low-intensity and home-based pulmonary rehabilitation (PR) on physical activity (PA) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease (COPD). We assessed PA using a newly developed triaxial accelerometer (A-MES™, Kumamoto, Japan), which measures the time spent walking, standing, sitting and lying down. Twenty-seven elderly patients with COPD (age 74 ± 8 yrs; %FEV1 56.6 ± 18.7%) participated. They were randomly selected to undergo PR (pulmonary rehabilitation only) or PR + P (PR plus the feedback from using a pedometer). Their PA and pulmonary function, exercise capacity (6-min walking distance; 6MWD), quadriceps femoris muscle force (QF) were evaluated before the PR began (baseline) and at 1 year later. We compared the patients' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups. The increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR. The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects. These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA, and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Acceptability and validity of a home exercise diary used in home-based pulmonary rehabilitation: A secondary analysis of a randomised controlled trial.

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    Lahham, Aroub; McDonald, Christine F; Mahal, Ajay; Lee, Annemarie L; Hill, Catherine J; Burge, Angela T; Cox, Narelle S; Moore, Rosemary; Nicolson, Caroline; O'halloran, Paul; Gillies, Rebecca; Holland, Anne E

    2018-02-02

    Evaluating adherence to home-based pulmonary rehabilitation (PR) could be challenging due to lack of direct supervision and the complex nature of the rehabilitation model. To measure adherence to home-based PR in the HomeBase trial, participants were encouraged to work towards a goal of at least 30 min of whole-body exercise on most days of the week and report their participation using a home exercise diary. This project aimed to evaluate the acceptability and validity of the home exercise diary. Diary return and completion rates assessed acceptability of the home exercise diary. Home participants underwent physical activity (PA) monitoring using the Sensewear armband during the final week of an 8-week PR. The correlation between self-documented and objective daily exercise minutes was calculated. Objective exercise minutes were defined as bouts of ≥10 min spent in ≥ moderate PA. Differences in self-documented weekly exercise minutes between sufficiently active (≥7000 daily steps) and inactive participants were computed. Diaries were returned by 92% of programme completers. Of those who returned diaries, 72% have completed exercise documentation. Fifteen programme completers underwent PA monitoring [mean age 69 (9) (SD) years, FEV 1 55 (19) %predicted]. A moderate correlation was observed between self-documented and objective mean daily exercise minutes (r = .59, P = .02). Active participants [n = 6, 10 253 (1521) daily steps] documented more exercise (111 min) during week eight compared with inactive participants [n = 9, 2705 (1772) daily steps, P = .002]. The self-documented home exercise diary is an acceptable and valid method to reflect exercise participation during home-based PR. © 2018 John Wiley & Sons Ltd.

  13. Home-based exercise training in chronic obstructive pulmonary disease

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    Milenković Branislava

    2007-01-01

    Full Text Available Introduction The role of rehabilitation programmes in chronic obstructive pulmonary disease (COPD patients is to lower dyspnoea, improve exercise tolerance and quality of life. Objective We have developed a short-course, home-based, rehabilitation programme of physical exercise for lower limb muscles, based on walking at patients’ fastest pace. The aim of the study was to investigate the effectiveness of such a programme regarding the exercise tolerance, pulmonary functions and quality of life. Method Twenty-nine individuals with stable COPD (22 males, 7 females, with a mean age of 59.6±8.9 years participated in the study. Subjects were assessed before and after the 8-week rehabilitation programme using the six-minute walking test (6MWT, Borg breathlessness score, oxygen saturation, St. George’s Hospital Respiratory Questionnaire (SGRQ, the Hospital Anxiety and Depression Scale (HADS and spirometry. Results The 6MWT distance improved significantly from 337 to 362 m, representing 8.3% (25 m improvement over baseline. SGRQ activity, impact and total scores improved significantly after the rehabilitation programme (p<0.01 and quality of life, too. Anxiety and depression scores were significantly lower than the baseline (p<0.01, as well as dyspnoea sensation (p<0.01. Pulmonary function improved after an eight-week exercise programme, too (p<0.01. Conclusion This short-term and simple home-based exercise programme improved health status in COPD. It also improved exercise tolerance, breathlessness sensation and quality of life in COPD patients.

  14. Home-based cardiac rehabilitation for people with heart failure

    DEFF Research Database (Denmark)

    Zwisler, Ann Dorthe Olsen; Norten, RJ; Dean, SG

    2016-01-01

    AIMS: To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs. METHODS: Randomised...

  15. Home-based rehabilitation: Physiotherapy student and client ...

    African Journals Online (AJOL)

    Background. Home-based rehabilitation (HBR) in under-resourced areas in a primary healthcare (PHC) context exposes students to the real-life situations of their clients. There is a scarcity of literature on student and client experiences of HBR in the physiotherapy context. Increased knowledge of HBR could result in an ...

  16. Home based rehabilitation for patients with COPD : an attractive alternative

    NARCIS (Netherlands)

    Wijkstra, Peter

    2007-01-01

    Pulmonary rehabilitation programs are well established to provide a multidisciplinary approach to control and alleviate symptoms and to optimise functional capacity in patients with chronic obstructive pulmonary disease (COPD). In the last decade a large number of studies have investigated the

  17. Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease

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    Oerkild, Bodil; Frederiksen, Marianne; Hansen, Jorgen Fischer

    2012-01-01

    To compare home-based cardiac rehabilitation (CR) with usual care (control group with no rehabilitation) in elderly patients who declined participation in centre-based CR.......To compare home-based cardiac rehabilitation (CR) with usual care (control group with no rehabilitation) in elderly patients who declined participation in centre-based CR....

  18. [Guided home-based vestibular rehabilitation assisted by audiovisual media].

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    Trinidad Ruiz, Gabriel; Domínguez Pedroso, Mónica; Cruz de la Piedad, Eduardo; Solís Vázquez, Raquel; Samaniego Regalado, Beatriz; Rejas Ugena, Eladio

    2010-01-01

    To describe the creation and validation process of a new audiovisual support model for the design of guided home-based vestibular rehabilitation programs (GHVR), we introduce a prospective experimental study. 89 patients who underwent vestibular rehabilitation (VR) were evaluated throughout 2009. For the model design, we built a video library with VR exercises that can be combined using DVD creation software to tailor VR protocols. Treatment incidents, adherence, need to convert to a posturography-based program and variations in the Dizziness Handicap Inventory (DHI) score and dynamic visual acuity (DVA) were assessed. A good response was found, not only with respect to adherence (5.6% abandonment), but also in the clinical parameters, with a mean DHI score variation of 33.14 points, and a decrease in lines lost in the DVA test from 4.24 to 1.52 lines at the end of the treatment. Our study results show the possibility of building an audiovisual aid for creating GHVR programs. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  19. Home-based rehabilitation interventions for adults living with HIV: a ...

    African Journals Online (AJOL)

    Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and ...

  20. Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors.

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    Housley, S N; Garlow, A R; Ducote, K; Howard, A; Thomas, T; Wu, D; Richards, K; Butler, A J

    2016-08-25

    An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation. Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy. Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy. Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care.

  1. SERIES "NOVELTIES IN PULMONARY REHABILITATION" New tools in pulmonary rehabilitation

    NARCIS (Netherlands)

    Wijkstra, P. J.; Wempe, J. B.

    2011-01-01

    In patients with more severe chronic obstructive pulmonary disease ( COPD), the benefits of rehabilitation might not be clear and, therefore, new treatment options have been developed to increase the benefits of rehabilitation. This review provides an overview of new approaches being developed as an

  2. A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

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    Cameron-Tucker HL

    2016-08-01

    Full Text Available Helen Laura Cameron-Tucker,1 Richard Wood-Baker,1 Lyn Joseph,1 Julia A Walters,1 Natalie Schüz,2 E Haydn Walters1 1Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, 2School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia Purpose: With the limited reach of pulmonary rehabilitation (PR and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD, a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab compared to usual waiting time (usual care followed by group PR. Patients and methods: People with COPD were randomized to tele-rehab (intervention or usual care (controls. Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1, before (TP2, and after (TP3 PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors. Results: Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4 education sessions. Seventeen attended supervised exercise (5±2 sessions. Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1 m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71 m, while others showed no change, 0 (33 m

  3. What To Expect During Pulmonary Rehabilitation

    Science.gov (United States)

    ... NHLBI on Twitter. What To Expect During Pulmonary Rehabilitation Pulmonary rehabilitation (PR) can have many parts, and not all ... your endurance and muscle strength, so you're better able to carry out daily activities. The plan ...

  4. Home-based vs supervised rehabilitation programs following knee surgery: a systematic review.

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    Papalia, Rocco; Vasta, Sebastiano; Tecame, Andrea; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    Following knee surgery, rehabilitation can dramatically affect the postoperative course and the final outcomes of the procedure. We systematically reviewed the current literature comparing clinical outcomes of home-based and outpatient supervised rehabilitation protocols following knee surgery. We searched Medline, CINAHL, Embase, Google Scholar, The Cochrane Library and SPORTDiscus. The reference lists of the previously selected articles were then examined by hand. Only studies comparing clinical outcomes of patients who had undergone knee surgery followed by different rehabilitation programs were selected. Then the methodological quality of each article was evaluated using the Coleman methodology score (CMS), a 10-criterion scoring list assessing the methodological quality of the selected studies. Eighteen studies were evaluated in the present review. Three were retrospective studies. The remaining 15 studies were prospective randomized clinical trials. The supervised and home-based protocols did not show an overall significant difference in the outcomes achieved within the studies reviewed. The mean CMS was 77.2. The heterogeneity of the rehabilitation protocols used in the studies reviewed makes it difficult to draw definite conclusion on the subject. Supervision and location does not seem to directly determine the final outcomes. Numerous variables, including comorbidities and motivation, could influence the results and deserve to be accounted for in future investigations. Better designed studies are needed to show a clear superiority of one rehabilitation approach over another and its applicability to the various surgical procedures involving the knee.

  5. Aerobic exercise in pulmonary rehabilitation

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    Thiago Brasileiro de Vasconcelos

    2013-01-01

    Full Text Available The aim of this study was to conduct a literature review on the usefulness of aerobic exercise in pulmonary rehabilitation. This is an exploratory study of literature through the electronic databases Medline, Lilacs, Scielo, Pubmed and Google Scholar, published between 1996 and 2012, conducted during the period February to May 2012 with the following keywords: COPD, pulmonary rehabilitation, aerobic exercises, physical training, quality of life. The change in pulmonary function and dysfunction of skeletal muscles that result in exercise intolerance and reduced fitness and may cause social isolation, depression, anxiety and addiction. The training exercise is the most important component of the program of pulmonary rehabilitation where the aerobic training provides consistent results in clinical improvement in levels of exercise tolerance and decreased dyspnea generating more benefits to the body, reducing the chance of cardiovascular disease and improves quality and expectation of life. We demonstrated that the use of aerobic exercise in pulmonary rehabilitation program, allows an improvement of motor skills, decreased muscle fatigue and deconditioning, reducing sedentary lifestyle; however, has little or no effect on the reduction of strength and atrophy muscle.

  6. AEROBIC EXERCISE IN PULMONARY REHABILITATION

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    Thiago Brasileiro de Vasconcelos

    2013-05-01

    Full Text Available The aim of this study was to conduct a literature review on the usefulness of aerobic exercise in pulmonary rehabilitation. This is an exploratory study of literature through the electronic databases Medline, Lilacs, Scielo, Pubmed and Google Scholar, published between 1996 and 2012, conducted during the period February to May 2012 with the following keywords: COPD, pulmonary rehabilitation, aerobic exercises, physical training, quality of life. The change in pulmonary function and dysfunction of skeletal muscles that result in exercise intolerance and reduced fitness and may cause social isolation, depression, anxiety and addiction. The training exercise is the most important component of the program of pulmonary rehabilitation where the aerobic training provides consistent results in clinical improvement in levels of exercise tolerance and decreased dyspnea generating more benefits to the body, reducing the chance of cardiovascular disease and improves quality and expectation of life. We demonstrated that the use of aerobic exercise in pulmonary rehabilitation program, allows an improvement of motor skills, decreased muscle fatigue and deconditioning, reducing sedentary lifestyle; however, has little or no effect on the reduction of strength and atrophy muscle.

  7. Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

    DEFF Research Database (Denmark)

    Maribo, Thomas; Nielsen, Claus Vinther

    treating stroke patients at home in three regions in Denmark. The three regions have a total population of three million. The survey was targeted at health care professionals that typically take part in municipal health service: nurses, physiotherapists, occupational therapists, speech......-language pathologists, nursing assistants and neuropsychologists. The questionnaire had one open-ended question: “Which instruments, outcome measures or tests are commonly used to describe functioning in persons with stroke?”. The questionnaire underlined that only instruments routinely used to assess functioning were......Relevance: Stroke is one of the major chronic diseases leading to long-term disability. Stroke treatment has improved and in-hospital stays have been reduced, leading to increasing emphasis on home-based rehabilitation. The transition from hospital to home-based rehabilitation is critical, as vital...

  8. The Role of Clinical and Geographic Factors in the Use of Hospital versus Home-Based Cardiac Rehabilitation

    Science.gov (United States)

    Brual, Janette; Gravely, Shannon; Suskin, Neville; Stewart, Donna E.; Grace, Sherry L.

    2012-01-01

    Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis…

  9. Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Remedios López-Liria

    2015-01-01

    Full Text Available Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC. Results. The groups did not significantly differ in the leg side (right/left or clinical characteristics (P>0.05. After the intervention, both groups showed significant improvements (P<0.001 from the baseline values in the level of pain (visual analogue scale, the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices, balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.

  10. Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

    Science.gov (United States)

    Henriksen, Eva; Burkow, Tatjana M; Johnsen, Elin; Vognild, Lars K

    2013-08-09

    Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient's TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO's standard for information security risk management. A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality

  11. Home-based upper extremity rehabilitation support using a contactless ultrasonic sensor.

    Science.gov (United States)

    Griffith, Henry; Biswas, Subir

    2017-07-01

    Home-based rehabilitation protocols have been shown to improve outcomes amongst individuals with limited upper-extremity (UE) functionality. While approaches employing both video conferencing technologies and gaming platforms have been successfully demonstrated for such applications, concerns regarding patient privacy and technological complexity may limit further adoption. As an alternative solution for assessing adherence to prescribed UE rehabilitation protocols, the Echolocation Activity Detector, a linear array of first-reflection ultrasonic distance sensors, is proposed herein. To demonstrate its utility for home-based rehabilitation, a controlled experiment exploring the ability of the system to distinguish between various parameters of UE motion, including motion plane, range, and speed, was conducted for five participants. Activity classification is accomplished using a quadratic support vector machine classifier using time-domain features which exploit the known geometric relationships between the patient and the device, along with the ideal kinematics of the activities of interest. Average classification accuracy for the five classes of UE motion considered herein exceeds 91%.

  12. Pulmonary rehabilitation: definition, concept, and history.

    Science.gov (United States)

    Nici, Linda; ZuWallack, Richard L

    2014-06-01

    Pulmonary rehabilitation is a complex intervention for which it is difficult to craft a succinct yet inclusive definition. Pulmonary rehabilitation should be considered for all patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic or have decreased functional status despite otherwise optimal medical management. The essential components of pulmonary rehabilitation are exercise training and self-management education, tailored to the needs of the individual patient and integrated into the course of the disease trajectory. Emerging data support a role for pulmonary rehabilitation in nontraditional contexts, such as during exacerbation in the non-COPD patient and in the home setting. Published by Elsevier Inc.

  13. Home-based rehabilitation in the postoperative treatment of flexor tendon repair.

    Science.gov (United States)

    Sanmartín-Fernández, M; Fernández-Bran, B; Couceiro-Otero, J

    To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation. Data, as range-of-motion and complications, were collected 6months after the surgery. Fifteen digits had full recovery of flexion. One patient suffered a rupture in the fifth postoperative week. Ten of the 21 digits developed a flexion contracture of the proximal interphalangeal joint; in 5 the contracture was less or equal to 10° without impairment of function or aesthetics. Over recent decades, specialized hand therapy has been of great importance in the postoperative treatment of hand diseases. Unfortunately, these professionals are not always available in our area in the first days after surgery. With this protocol, the patient is in charge of carrying out the postoperative exercises, which could lead to a worse final result and a higher rate of complications. The home-based rehabilitation program yielded complete recovery of joint mobility in most cases with a low complication rate. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Rehabilitation outcome in home-based versus supervised exercise programs for chronically dizzy patients.

    Science.gov (United States)

    Kao, Chung-Lan; Chen, Liang-Kung; Chern, Chang-Ming; Hsu, Li-Chi; Chen, Chih-Chun; Hwang, Shinn-Jang

    2010-01-01

    We aimed to evaluate the effectiveness of vestibular rehabilitation (VR) exercise between supervised and home-based programs in young and senior age groups of patients with chronic dizziness. Dizziness Handicap Inventory (DHI), Dynamic gait index (DGI), Tinetti fall risk performance scales and Timed "Up and Go" test (TUG) were administered to patients on their initial and follow-up visits for forty-one patients suffering from chronic dizziness. Twenty-eight patients received three 30-min vestibular training exercise sessions per week. Thirteen patients who could not visit our clinic on regular basis were instructed to do the same set of exercises at home, with the same duration and frequency. All scales were evaluated again on their follow-up visits 2 months later. Patients in both groups showed statistically significant improvement in DHI and Tinetti scales. A higher percentage of patients in the supervised-exercise-program (SP) group showed clinically significant outcome improvements. Age was not a predictive factor for rehabilitation outcome. We concluded that for all ages of chronically dizzy patients, 2 months of VR can reduce handicap, improve balance function and a consequent improvement of life quality. Health care professionals need to be educated about the importance of rehabilitation program for treatment of chronic dizziness. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  15. A low cost, adaptive mixed reality system for home-based stroke rehabilitation.

    Science.gov (United States)

    Chen, Yinpeng; Baran, Michael; Sundaram, Hari; Rikakis, Thanassis

    2011-01-01

    This paper presents a novel, low-cost, real-time adaptive multimedia environment for home-based upper extremity rehabilitation of stroke survivors. The primary goal of this system is to provide an interactive tool with which the stroke survivor can sustain gains achieved within the clinical phase of therapy and increase the opportunity for functional recovery. This home-based mediated system has low cost sensing, off the shelf components for the auditory and visual feedback, and remote monitoring capability. The system is designed to continue active learning by reducing dependency on real-time feedback and focusing on summary feedback after a single task and sequences of tasks. To increase system effectiveness through customization, we use data from the training strategy developed by the therapist at the clinic for each stroke survivor to drive automated system adaptation at the home. The adaptation includes changing training focus, selecting proper feedback coupling both in real-time and in summary, and constructing appropriate dialogues with the stroke survivor to promote more efficient use of the system. This system also allows the therapist to review participant's progress and adjust the training strategy weekly.

  16. Design of a home-based adaptive mixed reality rehabilitation system for stroke survivors.

    Science.gov (United States)

    Baran, Michael; Lehrer, Nicole; Siwiak, Diana; Chen, Yinpeng; Duff, Margaret; Ingalls, Todd; Rikakis, Thanassis

    2011-01-01

    This paper presents the design of a home-based adaptive mixed reality system (HAMRR) for upper extremity stroke rehabilitation. The goal of HAMRR is to help restore motor function to chronic stroke survivors by providing an engaging long-term reaching task therapy at home. The system uses an intelligent adaptation scheme to create a continuously challenging and unique multi-year therapy experience. The therapy is overseen by a physical therapist, but day-to-day use of the system can be independently set up and completed by a stroke survivor. The HAMMR system tracks movement of the wrist and torso and provides real-time, post-trial, and post-set feedback to encourage the stroke survivor to self-assess his or her movement and engage in active learning of new movement strategies. The HAMRR system consists of a custom table, chair, and media center, and is designed to easily integrate into any home.

  17. Home-based aerobic interval training improves peak oxygen uptake equal to residential cardiac rehabilitation: a randomized, controlled trial.

    Science.gov (United States)

    Moholdt, Trine; Bekken Vold, Mona; Grimsmo, Jostein; Slørdahl, Stig Arild; Wisløff, Ulrik

    2012-01-01

    Aerobic capacity, measured as the peak oxygen uptake, is a strong predictor of survival in cardiac patients. Aerobic interval training (AIT), walking/running four times four minutes at 85-95% of peak heart rate, has proven to be effective in increasing peak oxygen uptake in coronary heart disease patients. As some patients do not attend organized rehabilitation programs, home-based exercise should be an alternative. We investigated whether AIT could be performed effectively at home, and compared the effects on peak oxygen uptake with that observed after a standard care, four-week residential rehabilitation. Thirty patients undergoing coronary artery bypass surgery were randomized to residential rehabilitation or home-based AIT. At six months follow-up, peak oxygen uptake increased 4.6 (±2.7) and 3.9 (±3.6) mL·kg(-1) min(-1) (both peffect between patients randomized to home-based AIT compared to patients attending organized rehabilitation (95% confidence interval -1.8, 3.5). AIT patients reported good adherence to exercise training. Even though these first data indicate positive effects of home-based AIT in patients undergoing coronary artery bypass surgery, more studies are needed to provide supporting evidence for the application of this rehabilitation strategy. ClinicalTrials.gov NCT00363922.

  18. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study.

    Science.gov (United States)

    Kraal, Jos J; Van den Akker-Van Marle, M Elske; Abu-Hanna, Ameen; Stut, Wim; Peek, Niels; Kemps, Hareld Mc

    2017-08-01

    Aim Although cardiac rehabilitation improves physical fitness after a cardiac event, many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time. Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness. Methods and results We randomised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training. Although training adherence was similar between groups, satisfaction was higher in the home-based group ( p = 0.02). Physical fitness improved at discharge ( p home-based p = 0.31 and centre-based p = 0.87). Physical activity levels did not change during the one-year study period (centre-based p = 0.38, home-based p = 0.80). Healthcare costs were statistically non-significantly lower in the home-based group (€437 per patient, 95% confidence interval -562 to 1436, p = 0.39). From a societal perspective, a statistically non-significant difference of €3160 per patient in favour of the home-based group was found (95% confidence interval -460 to 6780, p = 0.09) and the probability that it was more cost-effective varied between 97% and 75% (willingness-to-pay of €0 and €100,000 per quality-adjusted life-years, respectively). Conclusion We found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness, physical activity level or health-related quality of life. However, home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training. We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation.

  19. Home-based aerobic interval training improves peak oxygen uptake equal to residential cardiac rehabilitation: a randomized, controlled trial.

    Directory of Open Access Journals (Sweden)

    Trine Moholdt

    Full Text Available Aerobic capacity, measured as the peak oxygen uptake, is a strong predictor of survival in cardiac patients. Aerobic interval training (AIT, walking/running four times four minutes at 85-95% of peak heart rate, has proven to be effective in increasing peak oxygen uptake in coronary heart disease patients. As some patients do not attend organized rehabilitation programs, home-based exercise should be an alternative. We investigated whether AIT could be performed effectively at home, and compared the effects on peak oxygen uptake with that observed after a standard care, four-week residential rehabilitation. Thirty patients undergoing coronary artery bypass surgery were randomized to residential rehabilitation or home-based AIT. At six months follow-up, peak oxygen uptake increased 4.6 (±2.7 and 3.9 (±3.6 mL·kg(-1 min(-1 (both p<0.005, non-significant between-group difference after residential rehabilitation and AIT, respectively. Quality of life increased significantly in both groups, with no statistical significant difference between groups. We found no evidence for a different treatment effect between patients randomized to home-based AIT compared to patients attending organized rehabilitation (95% confidence interval -1.8, 3.5. AIT patients reported good adherence to exercise training. Even though these first data indicate positive effects of home-based AIT in patients undergoing coronary artery bypass surgery, more studies are needed to provide supporting evidence for the application of this rehabilitation strategy.ClinicalTrials.gov NCT00363922.

  20. A Wireless Posture Monitoring System for Personalized Home-Based Rehabilitation

    Directory of Open Access Journals (Sweden)

    Pedro Macedo

    2015-06-01

    Full Text Available We live in an aging society, an issue that will be exacerbated in the coming decades, due to low birth rates and increasing life expectancy. With the decline in physical and cognitive functions with age, it is of the utmost importance to maintain regular physical activity, in order to preserve an individual’s mobility, motor capabilities and coordination. Within this context, this paper describes the development of a wireless sensor network and its application in a human motion capture system based on wearable inertial and magnetic sensors. The goal is to enable, through continuous real- time monitoring, the creation of a personalized home-based rehabilitation system for the elderly population and/or injured people. Within this system, the user can benefit from an assisted mode, in which their movements can be compared to a reference motion model of the same movements, resulting in visual feedback alerts given by the application. This motion model can be created previously, in a ‘learning phase’, under supervision of a caregiver.

  1. Evaluation of bluetooth low power for physiological monitoring in a home based cardiac rehabilitation program.

    Science.gov (United States)

    Martin, Timothy; Ding, Hang; D'Souza, Matthew; Karunanithi, Mohan

    2012-01-01

    Cardiovascular disease (CVD) is the leading cause of mortality in Australia, and places large burdens on the healthcare system. To assist patients with CVDs in recovering from cardiac events and mediating cardiac risk factors, a home based cardiac rehabilitation program, known as the Care Assessment Platform (CAP), was developed. In the CAP program, patients are required to manually enter health information into their mobile phones on a daily basis. The manual operation is often subject to human errors and is inconvenient for some elderly patients. To improve this, an automated wireless solution has been desired. The objectives of this paper are to investigate the feasibility of implementing the newly released Bluetooth 4.0 (BT4.0) for the CAP program, and practically evaluate BT4.0 communications between a developed mobile application and some emulated healthcare devices. The study demonstrated that BT4.0 addresses usability, interoperability and security for healthcare applications, reduces the power consumption in wireless communication, and improves the flexibility of interface for software development. This evaluation study provides an essential mobile BT4.0 framework to incorporate a large range of healthcare devices for clinical assessment and intervention in the CAP program, and hence it is useful for similar development and research work of other mobile healthcare solutions.

  2. Home-based respiratory rehabilitation in adult patients with moderate or severe persistent asthma.

    Science.gov (United States)

    Renolleau-Courtois, Delphine; Lamouroux-Delay, Aurore; Delpierre, Stéphane; Badier, Monique; Lagier-Tessonnier, Françoise; Palot, Alain; Gouitaa, Marion; Tummino, Céline; Charpin, Denis; Molinari, Nicolas; Chanez, Pascal

    2014-06-01

    We assessed retrospectively the feasibility of a home-based respiratory rehabilitation (RR) program for asthmatics under optimal pharmacological treatment, as this type of care can reduce costs and offer a more patient-friendly approach for subjects with persistent asthma. Fifty-two patients with persistent asthma were recruited to the RR program (20 males, 32 females, 54 ± 11 (SD) years, forced expiratory volume in one second 71 ± 33% of predicted mean value, BMI 29.9 ± 7.9 kg/m(2)). This two-month protocol comprised education sessions, respiratory physiotherapy and an exercise training program at home and in groups supervised by an adapted physical activity instructor. Thirty-nine patients completed the whole RR program, i.e. 25% dropout. The dropout rate was significantly higher with respect to younger patients in employment. The number of exacerbations decreased significantly during the year following the program, regardless of whether the patients had dropped out (p asthma. Both functional and physiologic indices improved during the follow-up period.

  3. Pulmonary Rehabilitation: MedlinePlus Health Topic

    Science.gov (United States)

    ... Handouts Postural drainage (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Pulmonary Rehabilitation updates ... this? GO MEDICAL ENCYCLOPEDIA Postural drainage Related Health Topics Lung Diseases National Institutes of Health The primary ...

  4. The Health Benefits of a 12-Week Home-Based Interval Training Cardiac Rehabilitation Program in Patients With Heart Failure.

    Science.gov (United States)

    Safiyari-Hafizi, Hedieh; Taunton, Jack; Ignaszewski, Andrew; Warburton, Darren E R

    2016-04-01

    Recently, high-intensity interval training has been advocated for the rehabilitation of persons living with heart failure (HF). Home-based training is more convenient for many patients and could augment compliance. However, the safety and efficacy of home-based interval training remains unclear. We evaluated the safety and efficacy of a supervised home-based exercise program involving a combination of interval and resistance training. Measures of aerobic power, endurance capacity, ventilatory threshold, and quality of life in 40 patients with HF, were taken at baseline and after 12 weeks. Patients were matched and randomized to either control (CTL; n = 20) or experimental (EXP; n = 20) conditions. The EXP group underwent a 12-week high-intensity interval and resistance training program while the CTL group maintained their usual activities of daily living. In the EXP group, we found a significant improvement in aerobic power, endurance capacity, ventilatory threshold, and quality of life. There were no significant changes in the CTL group. We have shown that a home-based cardiac rehabilitation program involving interval and resistance training is associated with improved aerobic capacity and quality of life in patients with HF. This research has important implications for the treatment of HF. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  5. A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial.

    Science.gov (United States)

    Standen, P J; Threapleton, K; Richardson, A; Connell, L; Brown, D J; Battersby, S; Platts, F; Burton, A

    2017-03-01

    To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke. Two group feasibility randomised controlled trial of intervention versus usual care. Patients' homes. Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation. Eight weeks' use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care. The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living. Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient. To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support.

  6. Outpatient pulmonary rehabilitation - rehabilitation models and shortcomings in outpatient aftercare.

    Science.gov (United States)

    Korczak, Dieter; Huber, Beate; Steinhauser, Gerlinde; Dietl, Markus

    2010-07-29

    The chronic obstructive pulmonary disease (COPD) and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C). The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based), by the length of intervention (from two weeks to 36 months), by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are attained in out-patient as well as in in

  7. Patient Reported Outcomes in a New Home-Based Rehabilitation Programme for Prostate Cancer Patients

    DEFF Research Database (Denmark)

    Villumsen, Brigitta R.; Grønbech Jørgensen, Martin; Frystyk, Jan

    2015-01-01

    The most optimal exercise plan for men with prostate cancer (PC) receiving androgen deprivation therapy needs to be identified. We plan to investigate a 12-week home-based health programme (exergaming) on physical function, fatigue and metabolic parameters in this group. In addition, our study...

  8. Self-Administered, Home-Based SMART (Sensorimotor Active Rehabilitation Training) Arm Training: A Single-Case Report.

    Science.gov (United States)

    Hayward, Kathryn S; Neibling, Bridee A; Barker, Ruth N

    2015-01-01

    This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant's and researchers' journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  9. Daily home-based spirometry during withdrawal of inhaled corticosteroid in severe to very severe chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Rodriguez-Roisin R

    2016-08-01

    Full Text Available Roberto Rodriguez-Roisin,1 Kay Tetzlaff,2,3 Henrik Watz,4 Emiel FM Wouters,5 Bernd Disse,2 Helen Finnigan,6 Helgo Magnussen,4 Peter MA Calverley7 1Respiratory Institute, Servei de Pneumologia, Hospital Clínic IDIBAPS-CIBERES, Universitat de Barcelona, Barcelona, Spain; 2Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany; 3Department of Sports Medicine, University of Tübingen, Tübingen, Germany; 4Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany; 5Department of Respiratory Medicine, University Hospital Maastricht, Maastricht University, Maastricht, the Netherlands; 6Department of Biostatistics and Data Sciences, Boehringer Ingelheim, Bracknell, UK; 7Institute of Ageing and Chronic Disease, Aintree University Hospital, Liverpool, UK Abstract: The WISDOM study (NCT00975195 reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration. We subsequently determined the validity of home-based spirometry for detecting changes in lung function by comparing in-clinic and home-based forced expiratory volume in 1 second in patients who underwent stepwise fluticasone propionate withdrawal over 12 weeks versus patients remaining on fluticasone propionate for 52 weeks. Bland–Altman analysis of these data confirmed good agreement between in-clinic and home-based measurements, both across all visits and at the individual visits at study weeks 6, 12, 18, and 52. There was a measurable difference between the forced expiratory volume

  10. Satisfaction and Experience with a Supervised Home-Based Real-Time Videoconferencing Telerehabilitation Exercise Program in People with Chronic Obstructive Pulmonary Disease (COPD

    Directory of Open Access Journals (Sweden)

    Ling Ling Y Tsai

    2016-12-01

    Full Text Available Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8 and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD age 73 (8 years, forced expiratory volume in 1 second (FEV1 60 (23 % predicted showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing.

  11. Acupuncture as an adjunct to pulmonary rehabilitation.

    LENUS (Irish Health Repository)

    Deering, Brenda M

    2012-02-01

    PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and by both systemic and airway inflammation. In COPD, acupuncture has been shown to improve quality-of-life scores and decrease breathlessness; similar findings have also been reported after pulmonary rehabilitation (PR). The hypothesis of this study was that acupuncture in conjunction with pulmonary rehabilitation would improve COPD outcome measures compared to pulmonary rehabilitation alone. METHODS: The design was a randomized prospective study; all subjects had COPD. There were 19 controls, 25 who underwent PR, and 16 who had both acupuncture and PR. The primary outcome measure was a change in measures of systemic inflammation at the end of PR and at 3 month followup. Lung function, including maximum inspiratory pressure (PiMax), quality-of-life scores, functional capacity including steps taken, dyspnea scores, and exercise capacity, were secondary endpoints. RESULTS: After PR, both groups had significantly improved quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and PiMax, but no change in measures of systemic inflammation compared with the controls. There were no differences in most of the outcome measures between the 2 treatment groups except that subjects who had both acupuncture and PR remained less breathless for a longer period. CONCLUSION: The addition of acupuncture to PR did not add significant benefit in most of the outcomes measured.

  12. Effects of a home-based rehabilitation program in obese type 2 diabetics.

    Science.gov (United States)

    Labrunée, M; Antoine, D; Vergès, B; Robin, I; Casillas, J-M; Gremeaux, V

    2012-09-01

    To assess, in obese type 2 diabetics (T2D), the impact of a home-based effort training program and the barriers to physical activity (PA) practice. Twenty-three obese T2D patients (52.7 ± 8.2 years, BMI = 38.5 ± 7.6 kg/m(2)) were randomized to either a control group (CG), or an intervention group (IG) performing home-based cyclergometer training during 3 months, 30 min/day, with a monthly-supervised session. The initial and final measurements included: maximal graded effort test on cyclergometer, 6-minute walk test (6MWT) and 200-meter fast walk test (200mFWT), quadriceps maximal isometric strength, blood tests and quality of life assessment (SF- 36). A long-term assessment of the amount of physical activity (PA) and the barriers to PA practice was conducted using a questionnaire by phone call. Patients in the CG significantly improved the maximal power developed at the peak of the cyclergometer effort test (P quality of life. At a mean distance of 17 ± 6.4 months, the PA score remained low in the two groups. The main barriers to PA practice identified in both groups were the perception of a low exercise capacity and a poor tolerance to effort, lack of motivation, and the existence of pain associated to PA. This home-based intervention had a positive impact on biometrics and physical ability in the short term in obese T2D patients, but limited effects in the long term. The questionnaires completed at a distance suggest considering educational strategies to increase the motivation and compliance of these patients. Copyright © 2012. Published by Elsevier Masson SAS.

  13. A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation.

    Science.gov (United States)

    Wang, Duojin; Wu, Jing; Lin, Qinglian

    2017-04-28

    The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships. A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs. The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.

  14. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD

    Directory of Open Access Journals (Sweden)

    Chun EM

    2015-01-01

    Full Text Available Eun Mi Chun,1 Soo Jeong Han,2 Hitesh N Modi3 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Republic of Korea; 2Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea; 3Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Republic of Korea Background: The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD, using a fluoroscopy-guided chest X-ray.Patients and methods: Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.Results: There were significant improvements (2,022.8±1,548.3 mm² to 3,010.7±1,495.6 mm² and 2,382.4±1,475.9 mm² to 3,315.9±1,883.5 mm²; right side P=0.001 and left side P=0.019, respectively in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.Conclusion: The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary

  15. Effects of home-based exercise rehabilitation on quality of life after coronary artery bypass graft and PCI early post-discharge

    Directory of Open Access Journals (Sweden)

    Shadi Moafi

    2011-11-01

    Full Text Available Background: The barriers to participation in cardiac rehabilitation programs are individual and economic problems and limited availability and access of rehabilitation services. Because of the important role of rehabilitation, home based exercise rehabilitation is a new approach to participate in such programs. The purpose of this study was to evaluate the effects of home-based rehabilitation on quality of life (QoL in patients with coronary artery disease after coronary artery bypass graft (CABG and PCI.Materials and Method: Participants included 18 CABG (3 women, 15 men and 40 PCI (12 women, 28 men low to moderate risk patients. Finally 17 patients in the exercise group and 16 patients in the control group remained. The SF-36 was used to evaluate changes in QoL before and after the program.Result: forty-three percent was dropped out from the program. Before and after program, the exercise group was better in all domains of QoL (p<0.05. After 8 weeks of cardiac rehabilitation, significant improvements were observed in quality of life in both groups (p<0.05 but the exercise group showed more improvements in three domains.Conclusion: Home-based exercise rehabilitation after CABG and PCI may improve QoL and provide an efficient low-cost approach to cardiac rehabilitation. It may be helpful due to limited availability and resources in Iran. Nevertheless, for increasing participation and decreasing drop out it needs more training

  16. Effectiveness and Limitations of Unsupervised Home-Based Balance Rehabilitation with Nintendo Wii in People with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Massimiliano Pau

    2015-01-01

    Full Text Available Balance training represents a critical part of the rehabilitation process of individuals living with multiple sclerosis (MS since impaired postural control is a distinctive symptom of the disease. In recent years, the use of the Nintendo Wii system has become widespread among rehabilitation specialists for this purpose, but few studies have verified the effectiveness of such an approach using quantitative measures of balance. In this study, we analyzed the postural sway features of a cohort of twenty-seven individuals with MS before and after 5 weeks of unsupervised home-based balance training with the Wii system. Center of pressure (COP time-series were recorded using a pressure platform and processed to calculate sway area, COP path length, displacements, and velocities in mediolateral (ML and anteroposterior (AP directions. Although the results show a significant reduction in sway area, COP displacements, and velocity, such improvements are essentially restricted to the ML direction, as the Wii platform appears to properly stimulate the postural control system in the frontal plane but not in the sagittal one. Available Wii games, although somewhat beneficial, appear not fully suitable for rehabilitation in MS owing to scarce flexibility and adaptability to MS needs and thus specific software should be developed.

  17. Rehabilitation of discharged patients with Chronic Obstructive Pulmonary Disease

    DEFF Research Database (Denmark)

    Morsø, Lars; Sall Jensen, Morten; von Plessen, Christian

    2017-01-01

    BACKGROUND: Rehabilitation after hospital stay implies several benefits for patients with chronic obstructive pulmonary disease (COPD); still few patients are referred and participate in rehabilitation programs. We conducted a case study to investigate the effects of interventions targeting...

  18. Developing concepts in the pulmonary rehabilitation of COPD

    NARCIS (Netherlands)

    Ambrosino, N.; Casaburi, R.; Ford, G.; Goldstein, R.; Morgan, M. D. L.; Rudolf, M.; Singh, S.; Wijkstra, P. J.

    Randomised trials have demonstrated that pulmonary rehabilitation (PR) can improve dyspnoea, exercise tolerance and health related quality of life. Rehabilitation has traditionally been provided in secondary care to patients with moderate to severe disease. Current concepts are however recommending

  19. Virtual rehabilitation: what are the practical barriers for home-based research?

    OpenAIRE

    Threapleton, Kate; Drummond, Avril E.R.; Standen, Penny

    2016-01-01

    Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations ...

  20. Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease

    DEFF Research Database (Denmark)

    Jakobsen, Anna Svarre; Laursen, Lars C; Rydahl-Hansen, Susan

    2015-01-01

    Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study...

  1. [Respiratory muscle training in pulmonary rehabilitation].

    Science.gov (United States)

    Croitoru, Alina; Bogdan, Miron Alexandru

    2013-01-01

    Respiratory muscles are essential in maintaining normal ventilation and adequate gas exchanges. Any imbalance in their function can lead to clinical symptoms: dyspnea, hypercapnia, exercise intolerance, ineffective cough. In the pulmonary rehabilitation a particular area is represented by the respiratory muscle training in various lung diseases. Inspiratory muscles training, particularly in COPD patients, has a beneficial effect, resulting in increased strength and endurance of respiratory muscles, decreased dyspnea level, improved quality of life and exercise tolerance. It is a therapy that can be used alone or in combination with generalized physical training, especially in patients with inspiratory muscle weakness.

  2. Home-Based Multidisciplinary Rehabilitation following Hip Fracture Surgery: What Is the Evidence?

    Directory of Open Access Journals (Sweden)

    Kathleen Donohue

    2013-01-01

    Full Text Available Objective. To determine the effects of multidisciplinary home rehabilitation (MHR on functional and quality of life (QOL outcomes following hip fracture surgery. Methods. Systematic review methodology suggested by Cochrane Collboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided. Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT. Over the long-term, the MHR group showed greater improvements in balance confidence, functional status, and lower extremity muscle strength compared to NT group, whereas the effect on QOL and mobility was inconsistent across the studies. Several methodological issues related to study design were noted across the studies. Conclusion. The MHR was found to be more effective compared to the NT in improving functional status and lower extremity strength in patients with hip fracture surgery. Results of this review do not make a strong case for MHR due to high risk of bias in the included studies. Further research is required to accurately characterize the types of disciplines involved in MHR and frequency and dosage of intervention.

  3. Does pulmonary rehabilitation reduce peripheral blood pressure in patients with chronic obstructive pulmonary disease?

    Science.gov (United States)

    Canavan, Jane L; Kaliaraju, Djeya; Nolan, Claire M; Clark, Amy L; Jones, Sarah E; Kon, Samantha S C; Polkey, Michael I; Man, William D-C

    2015-08-01

    Pulmonary rehabilitation (PR) can improve aerobic exercise capacity, health-related quality of life and dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Recent studies have suggested that exercise training may improve blood pressure and arterial stiffness, albeit in small highly selected cohorts. The aim of the study was to establish whether supervised outpatient or unsupervised home PR can reduce peripheral blood pressure. Resting blood pressure was measured in 418 patients with COPD before and after outpatient PR, supervised by a hospital-based team (HOSP). Seventy-four patients with COPD undergoing an unsupervised home-based programme acted as a comparator group (HOME). Despite significant improvements in mean (95% confidence interval) exercise capacity in the HOSP group (56 (50-60) m, p arterial blood pressure (MAP) did not change in either the HOSP (SBP: p = 0.47; DBP: p = 0.06; MAP: p = 0.38) or HOME group (SBP: p = 0.67; DBP: p = 0.38; MAP: p = 0.76). Planned subgroup analysis of HOSP patients with known hypertension and/or cardiovascular disease showed no impact of PR upon blood pressure. PR is unlikely to reduce blood pressure, and by implication, makes a mechanism of action in which arterial stiffness is reduced, less likely. © The Author(s) 2015.

  4. Why do patients decline participation in offered pulmonary rehabilitation?

    DEFF Research Database (Denmark)

    Mathar, Helle; Fastholm, Pernille; Lange, Peter

    2017-01-01

    OBJECTIVE: The purpose of this study is to produce insight in the explanations for declining pulmonary rehabilitation given by patients with chronic obstructive pulmonary disease. SETTING: The participants were recruited from a hospital in Denmark, among patients hospitalized due to an exacerbation...... of chronic obstructive pulmonary disease and among stable patients attending an outpatient clinic. PARTICIPANTS: Patients who decline participation in offered pulmonary rehabilitation, who speak Danish, who are able to give informed consent and to participate in a 1-hour interview. METHOD: The research...... pulmonary rehabilitation. Each category was named using a content characteristic word. RESULTS: This study shows that some patients do not remember or recall that they have been offered pulmonary rehabilitation during hospitalization. Especially the oldest patients perceive themselves to be too frail from...

  5. Home-based versus hospital-based high-intensity interval training in cardiac rehabilitation: a randomized study.

    Science.gov (United States)

    Aamot, Inger-Lise; Forbord, Siv Hege; Gustad, Kjersti; Løckra, Vibeke; Stensen, Andreas; Berg, Astrid Tarlebø; Dalen, Håvard; Karlsen, Trine; Støylen, Asbjørn

    2014-09-01

    High-intensity interval training (HIT) as exercise therapy is gradually implemented in cardiac rehabilitation as the cardiovascular benefits from exercise is intensity dependent. However, in previous studies, HIT has been performed with strict supervision. The aim of the study was to assess the feasibility and effectiveness of different modes of HIT in cardiac rehabilitation. a randomized clinical study. Ninety participants with coronary artery disease (80 men/10 women, mean age 57 ± 8 years) were randomly assigned to one of three exercise modes: group exercise (GE), treadmill exercise (TE), or home-based exercise (HE). HIT was performed twice a week for 12 weeks with an exercise intensity of 85-95% of peak heart rate. The primary outcome measure was change in peak oxygen uptake (peak VO2). Eighty-three participants (92%) completed the intervention without any severe adverse events. Peak VO2 increased from 34.7 ± 7.3 to 39.0 ± 8.0 ml/kg/min, 32.7 ± 6.5 to 36.0 ± 6.2 ml/kg/min, and 34.4 ± 4.8 to 37.2 ± 5.2 ml/kg/min in TE, GE, and HE, respectively. Mean group difference for TE vs. HE was 1.6 ml/kg/min (95% confidence interval, CI, 0.7 to 3.1, p = 0.02), TE vs. GE 1.1 ml/kg/min (95% CI-0.5 to 2.5, p = 0.27), and GE vs. HE 0.6 ml/kg/min (95% CI -1.0 to 2.1, p = 1). However, on-treatment analysis showed no significant difference between groups. HIT was efficiently performed in three settings of cardiac rehabilitation, with respect to target exercise intensity, exercise attendance, and increase in peak VO2. Exercise mode was not essential for exercise capacity. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  6. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM: a randomised controlled trial [ISRCTN72884263

    Directory of Open Access Journals (Sweden)

    Lane Deirdre

    2003-09-01

    Full Text Available Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the

  7. [Evidences related to pulmonary rehabilitation in the respiratory pathology].

    Science.gov (United States)

    Croitoru, Alina; Bogdan, Miron Alexandru

    2014-01-01

    Pulmonary rehabilitation represents a modern therapeutic approach of respiratory diseases, with a multidisciplinary character, including: physical training, therapeutic education, psychosocial counseling, and nutritional approach. Pulmonary rehabilitation addresses to any patient suffering from pulmonary pathology whose quality of life is affected by the respiratory symptoms, regardless of the degree of functional impairment. This article is an analysis of evidences from the medical literature on outcomes of rehabilitation programs conducted in various lung diseases. The main indication of pulmonary rehabilitation is the chronic obstructive pulmonary disease - COPD (stable state and exacerbation) in which most studies were carried out. Pulmonary rehabilitation in patients with other respiratory pathology has its reason in the pathophysiological changes that they undergo (impaired lung function and gas exchange, muscle atrophy and deconditioning etc.) leading to symptoms, lower exercise tolerance and decrease daily physical activity, all of which ultimately result in impaired quality of life. The role of rehabilitation is reviewed in the following diseases: post-surgical lung volume reduction for emphysema, asthma, bronchiectasis, interstitial lung disease, cystic fibrosis, lung cancer, neuromuscular disease, intensive care, obstructive sleep apnea, pulmonary hypertension, post-tuberculous sequelae, lung transplantation.

  8. Pulmonary Rehabilitation in COPD: A Reappraisal (2008–2012

    Directory of Open Access Journals (Sweden)

    Pierachille Santus

    2013-01-01

    Full Text Available Chronic Obstructive Pulmonary Disease (COPD is a complex pathological condition associated with an important reduction in physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life. Pulmonary rehabilitation is aimed to eliminate or at least attenuate these difficulties, mainly by promoting muscular reconditioning. The scope of this paper has been the analysis of the literature on pulmonary rehabilitation in COPD patients has appeared in the last five years, focusing on the principal outcomes obtained. The results demonstrate that pulmonary rehabilitation has a beneficial effect on dyspnoea relief, improving muscle strength and endurance. Moreover, pulmonary rehabilitation appears to be a highly effective and safe treatment for reducing hospital admissions mortality and improving health-related quality of life in COPD patients. It represents, therefore, a very important therapeutic option that, along with standard pharmachological therapy, can be used to obtain the best patient management. The favourable results obtained with pulmonary rehabilitation programs should stimulate researchers to improve our understanding of the mechanisms that form the basis of the beneficial effects of this therapeutic intervention. This would in turn increase the effectiveness of pulmonary rehabilitation in COPD patients.

  9. Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture A Randomized Clinical Trial

    Science.gov (United States)

    Latham, Nancy K.; Harris, Bette Ann; Bean, Jonathan F.; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M.; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M.

    2015-01-01

    .1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. CONCLUSIONS AND RELEVANCE Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. PMID:24549550

  10. Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.

    Science.gov (United States)

    Latham, Nancy K; Harris, Bette Ann; Bean, Jonathan F; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M

    2014-02-19

    ; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined. clinicaltrials.gov Identifier: NCT00592813.

  11. Characterization of Pulmonary Rehabilitation Programs in Canada in 2005

    Directory of Open Access Journals (Sweden)

    Dina Brooks

    2007-01-01

    Full Text Available BACKGROUND: Pulmonary rehabilitation (PR is recognized as the prevailing standard of care for patients with chronic respiratory conditions. National surveys of PR programs provide important information regarding the structure, content and organization of these programs.

  12. Pulmonary Rehabilitation and Palliative Care for the Lung Cancer Patient.

    Science.gov (United States)

    Tiep, Brian; Sun, Virginia; Koczywas, Marianna; Kim, Jae; Raz, Dan; Hurria, Arti; Hayter, Jennifer

    2015-10-01

    Pulmonary rehabilitation, as a quality of life intervention, has a role to play in palliative care for lung cancer patients. Combining the art and skills of clinical care, physiological, and behavioral tools, pulmonary rehabilitation can serve to rebuild the functional capacity of patients limited by breathlessness and deconditioning. Exercise programs are the primary tool used to restore and rebuild the patient's endurance by challenging the entire pathway of oxygen transport and improving gas exchange. Other tools of pulmonary rehabilitation include breathing retraining, self-management skills, airway clearance techniques, bronchodilitation, smoking cessation and oxygen therapy. Pulmonary rehabilitation is now becoming a part of supportive care for patients undergoing chemotherapy and radiation therapy. The ability to be more active without suffering the consequences of dyspnea on exertion boosts the patient's self-efficacy and allows for an improved quality of life, so that lung cancer patients can participate in their family lives during this therapeutic challenge.

  13. The Effect of Home-Based Cardiac Rehabilitation on Functional Capacity, Behavior, and Risk Factors in Patients with Acute Coronary Syndrome in China

    Directory of Open Access Journals (Sweden)

    Rongjing Ding

    2017-02-01

    Full Text Available Aim: To investigate the effect of home-based cardiac rehabilitation on functional capacity, health behavior, and risk factors in patients with acute coronary syndrome in China. Methods: Eighty patients with acute coronary syndrome were enrolled in this prospective randomized controlled study. Patients in the cardiac rehabilitation group (n=52 received home-based cardiac rehabilitation with a heart manual and a home exercise video for 3 months and patients in the control group (n=28 received only routine secondary prevention. The 6-min walk distance, laboratory test results, healthy behavior (questionnaire, quality of life (12-item Short Form Health Survey, anxiety (7-item Generalized Anxiety Disorder Questionnaire, and depression (9-item Patient Health Questionnaire were evaluated at the beginning and after treatment for 3 months. Results: Compared with baseline data, 52 patients who participated in cardiac rehabilitation had longer 6-min walk distance (515.26±113.74 m vs 0.445.30±97.92 m, P<0.0002, higher proportions of “always exercise” (78.26% vs. 28%, P<0.05, “always limit food with sugar” (65.22% vs 12%, P<0.05, “always eat fruits 200–400 g every day” (82.61% vs. 4%, P<0.05. and “always eat vegetables 300–500 g every day” (21.74% vs. 12%, P<0.06 after treatment for 3 months. The low-density lipoprotein cholesterol control rate (52.17% vs. 28%, P<0.05 and the systolic blood pressure control rate (100% vs. 68%, P<0.05 were also significantly increased after treatment for 3 months in the cardiac rehabilitation group. No significant increase was found in the control group after treatment for 3 months. No cardiac-event related to home exercise was reported in both groups. Conclusion: Home-based cardiac rehabilitation is a feasible and available cardiac rehabilitation mode in China.

  14. Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail.

    Science.gov (United States)

    Bongartz, Martin; Kiss, Rainer; Ullrich, Phoebe; Eckert, Tobias; Bauer, Jürgen; Hauer, Klaus

    2017-09-12

    Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment

  15. Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease--protocol.

    Science.gov (United States)

    Heron, Neil; Kee, Frank; Donnelly, Michael; Tully, Mark A; Cupples, Margaret E

    2015-11-17

    Cardiovascular diseases (CVDs), including myocardial infarction, heart failure, peripheral arterial disease and strokes, are highly prevalent conditions and are associated with high morbidity and mortality. Cardiac rehabilitation (CR) is an effective form of secondary prevention for CVD but there is a lack of information regarding which specific behaviour change techniques (BCTs) are included in programmes that are associated with improvements in cardiovascular risk factors. This systematic review will describe the BCTs which are utilised within home-based CR programmes that are effective at reducing a spectrum of CVD risk factors. The review will be reported in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of home-based CR initiated following a vascular event (myocardial infarction, heart failure, peripheral arterial disease and stroke patients) will be included. Articles will be identified through a comprehensive search of MEDLINE, Embase, PsycINFO, Web of Science and Cochrane Database guided by a medical librarian. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data, identifying which specific BCTs are included in programmes that are associated with improvements in particular modifiable vascular risk factors. This review will be of value to clinicians and healthcare professionals working with cardiovascular patients by identifying specific BCTs which are used within effective home-based CR. It will also inform the future design and evaluation of complex health service interventions aimed at secondary prevention in CVD. PROSPERO registration CRD42015027036 .

  16. Daily home-based spirometry during withdrawal of inhaled corticosteroid in severe to very severe chronic obstructive pulmonary disease.

    Science.gov (United States)

    Rodriguez-Roisin, Roberto; Tetzlaff, Kay; Watz, Henrik; Wouters, Emiel Fm; Disse, Bernd; Finnigan, Helen; Magnussen, Helgo; Calverley, Peter Ma

    2016-01-01

    The WISDOM study (NCT00975195) reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration. We subsequently determined the validity of home-based spirometry for detecting changes in lung function by comparing in-clinic and home-based forced expiratory volume in 1 second in patients who underwent stepwise fluticasone propionate withdrawal over 12 weeks versus patients remaining on fluticasone propionate for 52 weeks. Bland-Altman analysis of these data confirmed good agreement between in-clinic and home-based measurements, both across all visits and at the individual visits at study weeks 6, 12, 18, and 52. There was a measurable difference between the forced expiratory volume in 1 second values recorded at home and in the clinic (mean difference of -0.05 L), which may be due to suboptimal patient effort in performing unsupervised recordings. However, this difference remained consistent over time. Overall, these data demonstrate that home-based and in-clinic spirometric measurements were equally valid and reliable for assessing lung function in patients with COPD, and suggest that home-based spirometry may be a useful tool to facilitate analysis of changes in lung function on a day-to-day basis.

  17. Respiratory care year in review 2013: neonatal respiratory care, pulmonary function testing, and pulmonary rehabilitation.

    Science.gov (United States)

    Smallwood, Craig D; Haynes, Jeffrey M; Carlin, Brian W; Hess, Dean R

    2014-05-01

    Respiratory care practice includes neonatal respiratory care, pulmonary function testing, and pulmonary rehabilitation. The purpose of this paper is to review the recent literature related to these topics in a manner that is most likely to have interest to the readers of Respiratory Care.

  18. Vitamin d status in patients with chronic obstructive pulmonary disease who participate in pulmonary rehabilitation

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Martinez, Gerd; Durakovic, Amal

    2011-01-01

    PURPOSE: Vitamin D deficiency is common in patients with chronic obstructive pulmonary disease; however, no study has evaluated the influence of vitamin D status on effects of pulmonary rehabilitation (PR). METHODS: We studied 311 patients, who participated in a 7-week outpatient PR. Vitamin D...

  19. Nominal Group Technique consultation of a Pulmonary Rehabilitation Programme

    OpenAIRE

    Hayley A Hutchings; Rapport, Frances L; Sarah Wright; Marcus A. Doel; Clare Clement; Lewis, Keir E.

    2014-01-01

    Objective: The purpose of the study was to determine what patients, professionals and significant others regarded as the most important positive- and challenging aspects of Pulmonary Rehabilitation Programmes for patients with Chronic Obstructive Pulmonary Disease (COPD) and to gain insight into how such programmes could be developed and improved. Method: A modified Nominal Group Technique method was used in three consultation workshops (one with COPD patients who had recently undertaken a Pu...

  20. Structures, processes and outcomes of the Aussie Heart Guide Program: A nurse mentor supported, home based cardiac rehabilitation program for rural patients with acute coronary syndrome.

    Science.gov (United States)

    Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

    2018-03-01

    Cardiac rehabilitation has a number of benefits for patients, yet participation in it is sub-optimal, especially in regional Australia. Innovative models of cardiac rehabilitation are needed to improve participation. Providing nurse mentors to support patients transitioning from hospital to home represents a new model of service delivery in Australia. To explore the impact of a home-based cardiac rehabilitation program in assisting patients to recover from Acute Coronary Syndrome and meeting the expectations of nurse mentors delivering the program. This case study was underpinned by the structure, process and outcomes model and occurred in three Australian hospitals 2008-2011. Thirteen patients recovering from acute coronary syndrome were interviewed by telephone and seven nurse mentors completed a survey after completing the program. Mentor perceptions concerning the structures of the home-based CR program included the timely recruitment of patients, mentor training to operationalise the program, commitment to development of the mentor role, and the acquisition of knowledge and skills about cognitive behavioural therapy and patient centred care. Processes included the therapeutic relationship between mentors and patients, suitability of the program and the promotion of healthier lifestyle behaviours. Outcomes identified that patients were satisfied with the program's audiovisual resources, and the level of support and guidance provided by their nurse mentors. Mentors believed that the program was easy to use in terms of its delivery. Patients believed the program assisted their recovery and were satisfied with the information, guidance and support received from mentors. There were positive signs that the program influenced patients' decisions to change unhealthy lifestyle behaviours. Outcomes highlighted both rewards and barriers associated with mentoring patients in their homes by telephone. Experience gained from developing a therapeutic relationship with

  1. Pulmonary Rehabilitation Improves Outcomes in Chronic Obstructive Pulmonary Disease Independent of Disease Burden.

    Science.gov (United States)

    Schroff, Praful; Hitchcock, Jason; Schumann, Christopher; Wells, J Michael; Dransfield, Mark T; Bhatt, Surya P

    2017-01-01

    Current practice guidelines recommend pulmonary rehabilitation as an adjunct to standard pharmacologic therapy for individuals with moderate to severe chronic obstructive pulmonary disease (COPD). Whether pulmonary rehabilitation benefits all subjects with COPD independent of baseline disease burden is not known. To test whether pulmonary rehabilitation benefits patients with COPD independent of baseline exercise capacity, dyspnea, and lung function. Data from a prospectively maintained database of participants with COPD enrolled in pulmonary rehabilitation at the University of Alabama at Birmingham from 1996 to 2013 were retrospectively analyzed. Subjects were divided into four quartiles based on their baseline level of dyspnea as assessed by the San Diego Shortness of Breath Questionnaire at the initial visit. Similar quartiles were assessed for FEV1 percent predicted as well as the 6-minute-walk distance (6MWD). The primary outcome was the change in quality of life as measured by the 36-item Short Form Health Survey (SF-36). Secondary outcomes were change in dyspnea, 6MWD, and depression scores assessed using the Beck Depression Inventory-II. Differences between baseline and final scores were compared using paired t tests and across quartiles using analysis of variance. A total of 229 subjects were included. Their mean age was 66.5 (SD, 9) years. Ninety-one (40%) were female, and 42 (18%) were African American. The mean FEV1 percent predicted was 46.3% (20.0%). On completion of pulmonary rehabilitation, clinically significant improvements were seen in most components of SF-36: physical function, 11.5 (95% confidence interval [CI], 7.4-15.5; P mental health, 5.4 (95% CI, 2.6-8.3; P Pulmonary rehabilitation results in significant improvement in quality of life, dyspnea, and functional capacity independent of baseline disease burden.

  2. Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up.

    Science.gov (United States)

    Masiero, Stefano; Poli, Patrizia; Bonaldo, Lara; Pigatto, Maurizia; Ramonda, Roberta; Lubrano, Ennio; Punzi, Leonardo; Maffulli, Nicola

    2014-06-01

    To assess the 12-month's follow-up effects on pain, mobility, and physical function outcomes of a supervised training and home-based rehabilitation for ankylosing spondylitis patients stabilized with TNF-inhibitor therapy. Controlled clinical trial (sequentially determined allocation) with 12-months' follow-up. Patients' homes. A total of 69 subjects were allocated to either a rehabilitation programme (rehabilitation group, n = 22), an educational-behavioural programme (educational group, n = 24), and to neither programme (control group, n = 23). Rehabilitation programme included supervised training and home exercises (stretching, strengthening, aerobic, chest, and spine/hip joint flexibility exercises); educational-behavioural programme included information on ankylosing spondylitis, pain and stress mechanisms, and control. Spinal pain intensity, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, chest expansion, and cervical and lumbar spine active range of motion measured by a pocket goniometer. At baseline, the three groups exhibited comparable demographic characteristics and basal evaluations. Intra-group changes in the rehabilitation group from baseline to 12 months yielded statistically significant gains (p Ankylosing Spondylitis Disease Activity Index (p = 0.012 and p = 0.050), and in some goniometric measurements as cervical rotation (p = 0.007 and p = 0.014), toraco-lumbar rotation (p = 0.009 and p = 0.050), and total cervical movements (p = 0.009 and p = 0.001). In comparison with the educational-behavioural programme or no intervention, supervised training and home exercises improved long-term outcome in patients with ankylosing spondylitis. © The Author(s) 2013.

  3. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home study.

    Science.gov (United States)

    Kraal, Jos J; Peek, Niels; Van den Akker-Van Marle, M Elske; Kemps, Hareld Mc

    2014-11-01

    Home-based exercise training in cardiac rehabilitation (CR) has the potential to improve CR uptake, decrease costs and increase self-management skills. The FIT@Home study evaluates home-based CR with telemonitoring guidance using coaching interventions including strategies for behavioural changes with the aim to maintain adherence to a healthy lifestyle and to improve long-term effects. In this interim analysis we provide short-term results on exercise capacity, quality of life and training adherence of the first 50 patients included in the FIT@Home study. The study design was a randomised controlled trial. Low to moderate risk CR patients were randomised to a 12-week home-based training (HT) programme or a 12-week centre-based training (CT) programme. In both groups, training was performed at 70-85% of maximal heart rate (HRmax) for 45-60 min, 2-3 times per week. The HT group received three supervised training sessions, before commencing training with a heart rate monitor in their home environment. These patients received individual coaching by telephone weekly, based on training data uploaded on the Internet. The CT programme was performed under the direct supervision of a physical therapist. Exercise capacity and health-related quality of life were assessed at baseline and at 12 weeks. CT (n = 25) and HT (n = 25) both showed a significant improvement in peak oxygen uptake (peak VO2) (10% and 14% respectively) and quality of life after 12 weeks of training, without significant between-group differences. The average training intensity of the HT group was 73.3 ± 3.5% of HRmax. Training adherence was similar between groups. This analysis shows that HT with telemonitoring guidance has similar short-term effects on exercise capacity and quality of life as CT in CR patients. © Authors 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study.

    Science.gov (United States)

    Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

    2017-05-01

    Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  5. Does an 8-week home-based exercise program affect physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients with pulmonary embolism? Study protocol for a multicenter randomized clinical trial.

    Science.gov (United States)

    Rolving, Nanna; Brocki, Barbara C; Mikkelsen, Hanne R; Ravn, Pernille; Bloch-Nielsen, Jannie Rhod; Frost, Lars

    2017-05-30

    The existing evidence base in pulmonary embolism (PE) is primarily focused on diagnostic methods, medical treatment, and prognosis. Only a few studies have investigated how everyday life is affected by PE, although many patients are negatively affected both physically and emotionally after hospital discharge. Currently, no documented rehabilitation options are available for these patients. We aim to examine whether an 8-week home-based exercise intervention can influence physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients medically treated for PE. One hundred forty patients with incident first-time PE will be recruited in five hospitals. After inclusion, patients will be randomly allocated to either the control group, receiving usual care, or the intervention group, who will be exposed to an 8-week home-based exercise program in addition to usual care. The intervention includes an initial individual exercise planning session with a physiotherapist, leading to a recommended exercise program of a minimum of three weekly training sessions of 30-60 minutes' duration. The patients have regular telephone contact with the physiotherapist during the 8-week program. At the time of inclusion, after 2 months, and after 6 months, the patients' physical capacity is measured using the Incremental Shuttle Walk test. Furthermore the patients' quality of life, sick leave, and use of psychotropic drugs is measured using self-reported questionnaires. In both randomization arms, all follow-up measurements and visits will take place at the hospital from which the patient was discharged. Levels of eligibility, consent, adherence, and retention will be used as indicators of study feasibility. We expect that the home-based exercise program will improve the physical capacity and quality of life for the patients in the intervention group. The study will furthermore contribute significantly to the limited knowledge about the optimal rehabilitation of

  6. Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project

    NARCIS (Netherlands)

    Amirabdollahian, F; Ates, Sedar; Basteris, A.; Cesario, A.; Buurke, Jaap; Hermens, Hermanus J.; Hofs, D.; Johansson, E.; Mountain, G.; Nasr, N.; Nijenhuis, S.M.; Prange, Grada Berendina; Rahman, N.; Sale, P.; Schätzlein, F.; van Schooten, B.; Stienen, Arno

    2014-01-01

    Objective: this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for

  7. Effectiveness of outpatient pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Sundararajan, L; Balami, J; Packham, S

    2010-01-01

    Pulmonary rehabilitation (PR) has been shown to be an effective intervention in the management of patients with chronic obstructive pulmonary disease (COPD), but its role in elderly patients is not clearly defined. We investigated the effectiveness of rehabilitation in elderly patients with COPD. Patients underwent multidisciplinary PR in a hospital outpatient gym twice weekly for 6 weeks. Lung function, shuttle walk distance, breathlessness (using a 10-point Borg scale), and responses to the Chronic Respiratory Questionnaire (CRQ) were assessed before and after rehabilitation. Patients (N = 200; 131 male) were divided into 2 groups: group A, those 70 years or older (n = 102, mean age 76 years); and group B, those younger than 70 years (n = 98, mean age 61.4 years). Shuttle walk distance increased significantly (P Elderly patients with COPD gain similar improvements from PR as younger patients and should not be excluded from rehabilitation based on age alone.

  8. Outpatient pulmonary rehabilitationrehabilitation models and shortcomings in outpatient aftercare

    Directory of Open Access Journals (Sweden)

    Dietl, Markus

    2010-01-01

    Full Text Available Background: The chronic obstructive pulmonary disease (COPD and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. Objectives: The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Methods: Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI. In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Results: Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C. The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based, by the length of intervention (from two weeks to 36 months, by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Discussion: Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction

  9. Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial

    DEFF Research Database (Denmark)

    Oerkild, Bodil; Frederiksen, Marianne; Hansen, Jorgen Fischer

    2011-01-01

    investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up. METHODS: randomised clinical trial comparing home-based CR with comprehensive centre-based CR among patients = 65 years with coronary heart disease. RESULTS: seventy-five patients...... in the secondary outcomes of systolic blood pressure (-0.6 mmHg, 95% CI -11.3, 10.0), LDL cholesterol (0.3 mmol/l, 95% CI -0.04, 0.7), HDL cholesterol (0.2 mmol/l, 95% CI -0.01, 0.3), body composition, proportion of smokers and health-related quality of life. A group of patients who did not have an effect...

  10. Chronic Obstructive Pulmonary Disease-Evolving Concepts in Treatment: Advances in Pulmonary Rehabilitation.

    Science.gov (United States)

    Nici, Linda; ZuWallack, Richard

    2015-08-01

    Over the past three decades, pulmonary rehabilitation has risen to the stature as a gold standard for the treatment of chronic obstructive pulmonary disease (COPD). This rise is owing to both the development of science explaining mechanisms underlying its effectiveness and the demonstration of its substantial benefits across multiple outcome areas of importance to patients. Arguably, pulmonary rehabilitation provides the greatest improvements of any therapy in the areas of dyspnea-relief, exercise performance, and functional and health status. Emerging science also indicates that it reduces subsequent health care utilization and-when administered in the perihospital period-mortality risk. These beneficial effects are realized despite the fact that pulmonary rehabilitation has virtually no direct effect on lung function in COPD. Instead, this comprehensive, patient-centered intervention reduces the negative effects from systemic morbidity (such as muscle wasting) and comorbidity (such as depression and anxiety) that frequently accompany COPD. Two major components of pulmonary rehabilitation are exercise training and behavioral interventions. An example of the latter is a collaborative action plan for the early recognition and prompt treatment of the COPD exacerbation. Innovation in pulmonary rehabilitation includes (1) expanding its applicability, such as demonstrating effectiveness in the non-COPD respiratory patient, in milder COPD, in the periexacerbation period, and its provision in the home and community settings; (2) improving its process, such as refining the self-management and behavioral interventions, and the promotion of physical activity in the home and community settings; and (3) promoting its accessibility, such as exploring its potential usefulness in nontraditional settings (the home and community) and developing technology to assist in its implementation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. The feasibility of a home-based sedentary behaviour intervention for hospitalised chronic obstructive pulmonary disease (COPD patients: Sitting and ExacerbAtions Trial (COPD-SEAT

    Directory of Open Access Journals (Sweden)

    Mark Orme

    2015-10-01

    COPD-SEAT will be one of the first trials aimed at reducing sedentary behaviour at home in patients hospitalised for an acute exacerbation of COPD. This trial will provide valuable insight into the feasibility of implementing an at-home technology-based feedback intervention for reducing sedentary behaviour into patients existing care. Findings will inform a future large-scale trial acting as an adjuvant to pulmonary rehabilitation.

  12. Effect of comorbidities on response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Maged Hassan

    2016-01-01

    Conclusions: Pulmonary rehabilitation can be offered to COPD patients from different severity stages. Comorbidities occur very commonly in patients with COPD and their presence worsens the baseline functional status in these patients which makes them more liable to achieve larger benefits from PR.

  13. Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Pulmonary Disease: Review of Selected Guidelines: AN OFFICIAL STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION.

    Science.gov (United States)

    Garvey, Chris; Bayles, Madeline Paternostro; Hamm, Larry F; Hill, Kylie; Holland, Anne; Limberg, Trina M; Spruit, Martijn A

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is associated with disabling dyspnea, skeletal muscle dysfunction, and significant morbidity and mortality. Current guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Translating exercise science into safe and effective exercise training requires interpretation and use of multiple guidelines and recommendations. The purpose of this statement is to summarize for clinicians 3 current chronic obstructive pulmonary disease guidelines for exercise that may be used to develop exercise prescriptions in the PR setting. The 3 guidelines have been published by the American College of Sports Medicine, the American Thoracic Society/European Respiratory Society, and the American Association of Cardiovascular and Pulmonary Rehabilitation. In addition to summarizing these 3 guidelines, this statement describes clinical applications, explores areas of uncertainty, and suggests strategies for providing effective exercise training, given the diversity of guidelines and patient complexity.

  14. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests.

    Science.gov (United States)

    Nikoletou, Dimitra; Man, William D-C; Mustfa, Naveed; Moore, Julie; Rafferty, Gerrard; Grant, Robert L; Johnson, Lorna; Moxham, John

    2016-01-01

    To evaluate the effectiveness of a home-based inspiratory muscle training (IMT) programme using multiple inspiratory muscle tests. Sixty-eight patients (37 M) with moderate to severe chronic obstructive pulmonary disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.; FEV1/FVC 35.7 [11.2]%) were randomised into an experimental or control group and trained with a threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or muscle endurance (RME), chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS) and the SF-36. Between-group changes were assessed using one-way analysis of variance (ANOVA). PImax and perception of well-being improved significantly post-IMT [p = 0.04 and evaluation of changes in muscle function post-IMT. A seven-week, home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility, respiratory muscle endurance and exercise capacity. Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes. Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity.

  15. Measures of dyspnea in pulmonary rehabilitation

    Directory of Open Access Journals (Sweden)

    Crisafulli Ernesto

    2010-06-01

    Full Text Available Abstract Dyspnea is the main symptom perceived by patients affected by chronic respiratory diseases. It derives from a complex interaction of signals arising in the central nervous system, which is connected through afferent pathway receptors to the peripheral respiratory system (airways, lung, and thorax. Notwithstanding the mechanism that generates the stimulus is always the same, the sensation of dyspnea is often described with different verbal descriptors: these descriptors, or linguistic 'clusters', are clearly influenced by socio-individual factors related to the patient. These factors can play an important role in identifying the etiopathogenesis of the underlying cardiopulmonary disease causing dyspnea. The main goal of rehabilitation is to improve dyspnea; hence, quantifying dyspnea through specific tools (scales is essential in order to describe the level of chronic disability and to assess eventual changes after intervention. Improvements, even if modest, are likely to determine clinically relevant changes (minimal clinically important difference, MCID in patients. Currently there exist a large number of scales to classify and characterize dyspnea: the most frequently used in everyday clinical practice are the clinical scales (e.g. MRC or BDI/TDI, in which information is obtained directly from the patients through interview and psychophysical scales (such as the Borg scale or VAS, which assess symptom intensity in response to a specific stimulus, e.g. exercise. It is also possible to assess the individual's dyspnea in relation to specific situations, e.g. chronic dyspnea (with scales that classify patients according to different levels of respiratory disability; exertional dyspnea (with tools that can measure the level of dyspnea in response to a physical stimulus; and transitional (or 'follow up' dyspnea (with scales that measure the effect in time of a treatment intervention, such as rehabilitation.

  16. Evaluation of a newly designed shirt-based ECG and breathing sensor for home-based training as part of cardiac rehabilitation for coronary artery disease.

    Science.gov (United States)

    Skobel, Erik; Martinez-Romero, Alvaro; Scheibe, Britta; Schauerte, Patrick; Marx, Nikolaus; Luprano, Jean; Knackstedt, Christian

    2014-11-01

    Participation in phase-III cardiac rehabilitation (CR) remains low but adherence could potentially be improved with supervised home-based CR. New technological approaches are needed to provide sufficient supervision with respect to safety and performance of individual exercise programmes. The newly designed closed-loop tool, HeartCycle's guided exercise (GEX) system, will support professionals and patients during exercise-based CR. Patients wear a dedicated shirt with incorporated wireless sensors, and ECG, heart rate (HR), breathing frequency (BF), and activity are monitored during exercise. This information is streamed live to a mobile device (PDA) that processes these parameters. A phase-I study was performed to evaluate feasibility, function, and reliability of this GEX device and compare it to conventional cardiac exercise testing (CPX, spiroergometry) in 50 patients (seven women, mean ± SD age 69 ± 9 years, body mass index 26 ± 3 kg/m(2), ejection fraction 58 ± 10%). ECG, HR, and BF were monitored using standard equipment and the GEX device simultaneously. Furthermore, HR recorded on the PDA was compared with CPX measurements. The fit of the shirt and the sensor was good. No technical problems were encountered. All occurring arrhythmia were reliably detected. There was an acceptable comparability between HR on the GEX device vs. CPX, a good comparability between HR on the PDA vs. CPX, and a moderate comparability between BF on the GEX device vs. Comparability between CPX and the GEX device was acceptable for HR measurement and moderate for BF; arrhythmias were reliably detected. HR processing and display on the PDA was even better comparable. The whole system seems suitable for monitoring home-based CR. Further studies are now needed to implement training prescription to facilitate individual exercise. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Managing mood disorders in patients attending pulmonary rehabilitation clinics

    Directory of Open Access Journals (Sweden)

    Selvarajah S

    2013-01-01

    Full Text Available Colleen Doyle,1–3 David Dunt,2 David Ames,1 Suganya Selvarajah11National Ageing Research Institute, Royal Melbourne Hospital Royal Park Campus, Parkville, Victoria, Australia; 2Centre for Health Policy, Programs and Economics, University of Melbourne, Parkville, Victoria, Australia; 3Australian Catholic University, Fitzroy, Victoria, AustraliaBackground: There is good evidence for the positive benefits of pulmonary rehabilitation (PR in the prevention of hospital admissions, lower mortality, and improved health-related quality of life. There is also increasing evidence about the impact of PR on mental health and, in particular, mood disorders. We aimed to identify how depression in chronic obstructive pulmonary disease (COPD patients in Victoria, Australia, is being managed in PR, to identify the prevalence of depressive symptoms among COPD patients who attend PR, and to determine whether patients with depressive symptoms or anxiety symptoms dropped out of PR early.Method: Of 61 PR clinics, 44 were invited and 22 agreed to participate. Telephone interviews were conducted to see how depression and anxiety in COPD patients were being recognized and managed in these clinics. A total of 294 questionnaires were distributed to patients by clinic coordinators to determine the prevalence of anxiety/depression, as measured by the Hospital Anxiety and Depression Scale. Coordinators were contacted to provide information on whether respondents dropped out of rehabilitation early or continued with their treatment at 2–4 months post program.Results: Seven clinics were not aware of local guidelines on assessment/treatment/management of mood. Four clinics did not use any screening tools or other aids in the recognition and management of depression and/or anxiety. Overall, eight clinics participating in this study requested advice on suitable screening tools. The patient survey indicated that the mean depression score on the Hospital Anxiety and Depression

  18. Preoperative pulmonary rehabilitation for marginal-function lung cancer patients.

    Science.gov (United States)

    Hashmi, Asra; Baciewicz, Frank A; Soubani, Ayman O; Gadgeel, Shirish M

    2017-01-01

    Background This study aimed to evaluate the impact of preoperative pulmonary rehabilitation in lung cancer patients undergoing pulmonary resection surgery with marginal lung function. Methods Short-term outcomes of 42 patients with forced expiratory volume in 1 s lung resection between 01/2006 and 12/2010 were reviewed retrospectively. They were divided into group A (no preoperative pulmonary rehabilitation) and group B (receiving pulmonary rehabilitation). In group B, a second set of pulmonary function tests was obtained. Results There were no significant differences in terms of sex, age, race, pathologic stage, operative procedure, or smoking years. Mean forced expiratory volume in 1 s and diffusing capacity for carbon monoxide in group A was 1.40 ± 0.22 L and 10.28 ± 2.64 g∙dL-1 vs. 1.39 ± 0.13 L and 10.75 ± 2.08 g∙dL-1 in group B. Group B showed significant improvement in forced expiratory volume in 1 s from 1.39 ± 0.13 to 1.55 ± 0.06 L ( p = 0.02). Mean intensive care unit stay was 6 ± 5 days in group A vs. 9 ± 9 days in group B ( p = 0.22). Mean hospital stay was 10 ± 4 days in group A vs. 14 ± 9 days in group B ( p = 0.31). There was no significant difference in morbidity or mortality between groups. Conclusion Preoperative pulmonary rehabilitation can significantly improve forced expiratory volume in 1 s in some marginal patients undergoing lung cancer resection. However, it does not improve length of stay, morbidity, or mortality.

  19. Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial.

    Science.gov (United States)

    Román, Miguel; Larraz, Concepción; Gómez, Amalia; Ripoll, Joana; Mir, Isabel; Miranda, Eduardo Z; Macho, Ana; Thomas, Vicenç; Esteva, Magdalena

    2013-02-11

    Pulmonary Rehabilitation for moderate Chronic Obstructive Pulmonary Disease in primary care could improve patients' quality of life. This study aimed to assess the efficacy of a 3-month Pulmonary Rehabilitation (PR) program with a further 9 months of maintenance (RHBM group) compared with both PR for 3 months without further maintenance (RHB group) and usual care in improving the quality of life of patients with moderate COPD.We conducted a parallel-group, randomized clinical trial in Majorca primary health care in which 97 patients with moderate COPD were assigned to the 3 groups. Health outcomes were quality of life, exercise capacity, pulmonary function and exacerbations. We found statistically and clinically significant differences in the three groups at 3 months in the emotion dimension (0.53; 95%CI0.06-1.01) in the usual care group, (0.72; 95%CI0.26-1.18) the RHB group (0.87; 95%CI 0.44-1.30) and the RHBM group as well as in fatigue (0.47; 95%CI 0.17-0.78) in the RHBM group. After 1 year, these differences favored the long-term rehabilitation group in the domains of fatigue (0.56; 95%CI 0.22-0.91), mastery (0.79; 95%CI 0.03-1.55) and emotion (0.75; 95%CI 0.17-1.33). Between-group analysis only showed statistically and clinically significant differences between the RHB group and control group in the dyspnea dimension (0.79 95%CI 0.05-1.52). No differences were found for exacerbations, pulmonary function or exercise capacity. We found that patients with moderate COPD and low level of impairment did not show meaningful changes in QoL, exercise tolerance, pulmonary function or exacerbation after a one-year, community based rehabilitation program. However, long-term improvements in the emotional, fatigue and mastery dimensions (within intervention groups) were identified. ISRCTN94514482.

  20. Improved Health-Related Quality of Life After Lung Volume Reduction Surgery and Pulmonary Rehabilitation

    OpenAIRE

    Beling, Janna

    2009-01-01

    Purpose: It has been hypothesized that lung volume reduction surgery (LVRS) and pulmonary rehabilitation improve health-related quality of life (HRQOL). The purpose of this study was to test the hypothesis by examining the long-term functional consequences and general health status of patients with emphysema who have undergone LVRS and pulmonary rehabilitation. Methods: Forty-nine subjects with severe emphysema, aged 51 to 84 years old, post-LVRS and pulmonary rehabilitation participated in t...

  1. [Rehabilitation of hypoplastic pulmonary arteries and anatomic correction of pulmonary atresia with interventricular communication].

    Science.gov (United States)

    Chetaille, P; Fraisse, A; Ghez, O; Kreitmann, B; Voisin, M; Aubert, F; Metras, D

    2001-05-01

    Conventional treatment of pulmonary atresia with ventricular septal defect (VSD), hypoplastic pulmonary arteries (PA) and major aorto-pulmonary collaterals (MAPCAs) is controversial: from symptomatic and palliative treatment for some authors to surgery with unifocalisation of collaterals for others. These treatments never use native pulmonary arteries as only source of pulmonary flow, but create "neo-pulmonary arteries". Nine cases of pulmonary atresia with VSD, hypoplastic PA and MAPCAs were treated by rehabilitation of native PA through a staged approach: 1) surgical neonatal connection between right ventricule (RV) and hypoplastic PA, 2) evaluation and interventionnal catheterism with angioplasty of PA stenosis and closure of collaterals, 3) complete surgical correction with reconstruction of right outflow track and PA and closure of VSD. After first surgical stage of RV-PA connection at the mean age of 4.8 months (+/- 5.6 months), 8 patients were alive and underwent 22 cardiac catheterisms (mean of 2.7 per patient), with angioplasty of PA, and occlusion of MAPCAs in 6 and 2 patients respectively. Seven patients underwent complete anatomical correction at the mean age of 28.8 months (+/- 17.7 months) with one late death. The 6 remaining patients had encouraging hemodynamic status (RV pressure/LV pressure ratio at 0.6 +/- 0.26; mean left and right distal pulmonary pressure at 15.2 mmHg (+/- 9.1 mmHg)), and good functionnal status (3 in NYHA functionnal class 1, and 3 in class 2), for a mean follow-up of 79.5 months (+/- 41.4 months). One patient had reoperation on right outflow track stenosis, 6 years after correction. This small series enhances the feasibility of a staged approach with rehabilitation of small PA, allowing complete surgical correction with the native PA with good hemodynamic and functional results in pulmonary atresia, with VSD, hypoplastic PA and MAPCAs.

  2. Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting.

    Science.gov (United States)

    Sivan, Manoj; Gallagher, Justin; Makower, Sophie; Keeling, David; Bhakta, Bipin; O'Connor, Rory J; Levesley, Martin

    2014-12-12

    Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 - 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently

  3. Effects of inpatient pulmonary rehabilitation in patients with interstitial lung disease.

    Science.gov (United States)

    Huppmann, Patrick; Sczepanski, Bernd; Boensch, Martina; Winterkamp, Sandra; Schönheit-Kenn, Ursula; Neurohr, Claus; Behr, Juergen; Kenn, Klaus

    2013-08-01

    Pulmonary rehabilitation is recommended for patients with chronic lung diseases including idiopathic pulmonary fibrosis according to international guidelines. However, data for patients with interstitial lung disease (ILD) are limited. We examined the effect of an inpatient pulmonary rehabilitation on functional status and quality of life in ILD patients. We evaluated 402 consecutive ILD patients who were admitted to a specialised pulmonary rehabilitation centre (1999-2010). All patients performed a standardised pulmonary rehabilitation programme including pulmonary function tests, blood-gas analysis, 6-min walk test (6MWT), dyspnoea rating and health-related quality of life questionnaire (the 36-item short-form health survey; SF-36) on admission and discharge. Mean duration of pulmonary rehabilitation was 30±1 days. 6MWT distance improved by 46±3 m (308±6 m versus 354±6 m; pmental health summary scores (physical 6±1 points, pmental health 10±1 points, ppulmonary hypertension also benefited from pulmonary rehabilitation. In a large cohort of patients with ILD, pulmonary rehabilitation had a positive impact on functional status and quality of life. Considering the limited treatment options in this patient population pulmonary rehabilitation appears to be a valuable adjunct therapy.

  4. The effect of home-based inspiratory muscle training on exercise capacity, exertional dyspnea and pulmonary function in COPD patients.

    Science.gov (United States)

    Bavarsad, Maryam Bakhshandeh; Shariati, Abdolali; Eidani, Esmaeil; Latifi, Mahmud

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is currently the fourth cause of mortality worldwide. Patients with COPD experience periods of dyspnea, fatigue, and disability, which impact on their life. The objective of this study was to investigate the effect of short-term inspiratory muscle training on exercise capacity, exertional dyspnea, and pulmonary lung function. A randomized, controlled trial was performed. Thirty patients (27 males, 3 females) with mild to very severe COPD were randomly assigned to a training group (group T) or to a control group (group C). Patients in group T received training for 8 weeks (15 min/day for 6 days/week) with flow-volumetric inspiratory exerciser named (Respivol). Each patient was assessed before and after 8 weeks of training for the following clinical parameters: exercise capacity by 6-min walking test (6MWT), exertional dyspnea by Borg scale, and pulmonary lung function by spirometry. Patients used training together with medical treatment. The data were analyzed using paired t-test and independent t-test. Results showed statistically significant increase in 6MWT at the end of the training from 445.6 ± 22.99 to 491.06 ± 17.67 meters? (P training group but not in the control group. The values for exercise capacity and dyspnea improved after 8 weeks in group T in comparison with group C (P = 0.001 and P = 0.0001, respectively). No changes were observed in any measure of pulmonary function in both groups. Short-term inspiratory muscle training has beneficial effects on exercise capacity and exertional dyspnea in COPD patients.

  5. Potential of a suite of robot/computer-assisted motivating systems for personalized, home-based, stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Feng Xin

    2007-03-01

    Full Text Available Abstract Background There is a need to improve semi-autonomous stroke therapy in home environments often characterized by low supervision of clinical experts and low extrinsic motivation. Our distributed device approach to this problem consists of an integrated suite of low-cost robotic/computer-assistive technologies driven by a novel universal access software framework called UniTherapy. Our design strategy for personalizing the therapy, providing extrinsic motivation and outcome assessment is presented and evaluated. Methods Three studies were conducted to evaluate the potential of the suite. A conventional force-reflecting joystick, a modified joystick therapy platform (TheraJoy, and a steering wheel platform (TheraDrive were tested separately with the UniTherapy software. Stroke subjects with hemiparesis and able-bodied subjects completed tracking activities with the devices in different positions. We quantify motor performance across subject groups and across device platforms and muscle activation across devices at two positions in the arm workspace. Results Trends in the assessment metrics were consistent across devices with able-bodied and high functioning strokes subjects being significantly more accurate and quicker in their motor performance than low functioning subjects. Muscle activation patterns were different for shoulder and elbow across different devices and locations. Conclusion The Robot/CAMR suite has potential for stroke rehabilitation. By manipulating hardware and software variables, we can create personalized therapy environments that engage patients, address their therapy need, and track their progress. A larger longitudinal study is still needed to evaluate these systems in under-supervised environments such as the home.

  6. Potential of a suite of robot/computer-assisted motivating systems for personalized, home-based, stroke rehabilitation

    Science.gov (United States)

    Johnson, Michelle J; Feng, Xin; Johnson, Laura M; Winters, Jack M

    2007-01-01

    Background There is a need to improve semi-autonomous stroke therapy in home environments often characterized by low supervision of clinical experts and low extrinsic motivation. Our distributed device approach to this problem consists of an integrated suite of low-cost robotic/computer-assistive technologies driven by a novel universal access software framework called UniTherapy. Our design strategy for personalizing the therapy, providing extrinsic motivation and outcome assessment is presented and evaluated. Methods Three studies were conducted to evaluate the potential of the suite. A conventional force-reflecting joystick, a modified joystick therapy platform (TheraJoy), and a steering wheel platform (TheraDrive) were tested separately with the UniTherapy software. Stroke subjects with hemiparesis and able-bodied subjects completed tracking activities with the devices in different positions. We quantify motor performance across subject groups and across device platforms and muscle activation across devices at two positions in the arm workspace. Results Trends in the assessment metrics were consistent across devices with able-bodied and high functioning strokes subjects being significantly more accurate and quicker in their motor performance than low functioning subjects. Muscle activation patterns were different for shoulder and elbow across different devices and locations. Conclusion The Robot/CAMR suite has potential for stroke rehabilitation. By manipulating hardware and software variables, we can create personalized therapy environments that engage patients, address their therapy need, and track their progress. A larger longitudinal study is still needed to evaluate these systems in under-supervised environments such as the home. PMID:17331243

  7. Assessing home-based rehabilitation within the development of an integrated model of care for people living with HIV in a resource-poor community

    Directory of Open Access Journals (Sweden)

    Saul Cobbing

    2017-01-01

    Full Text Available Background: People living with HIV (PLHIV are living longer lives but are at a greater risk of developing disability. South Africa has the largest antiretroviral therapy (ART programme in the world, shifting HIV from a deadly to a chronic disease. The integration of rehabilitation into chronic care is therefore now crucial to ensure the highest quality of life of PLHIV.Aim: To describe how a home-based rehabilitation (HBR programme adhered to the fundamental principles of a theoretical model of integrated care developed for the study setting in KwaZulu-Natal, South Africa.Method: The process and results from the HBR programme were assessed in relation to the model of care to ascertain which principles of the model were addressed with the HBR programme and which elements require further investigation.Results: The HBR programme was able to apply a number of principles such as evidence-based practice, task shifting to lay personnel, enabling patient-centred care and maximising function and independence of PLHIV. Other elements such as the adoption of a multidisciplinary approach, training on the use of disability screening tools and the use of evidence to influence policy development were more difficult to implement.Conclusion: It is possible to implement elements of the integrated model of care. Further research is needed to understand how principles that require further training and collaboration with other stakeholders can be implemented. The results of this study provide additional evidence towards understanding the feasibility of the theoretical model and what is required to adjust and test the full model.

  8. Feasibility of web-based protocol in a 12 weeks home-based IMT program for individuals with COPD

    DEFF Research Database (Denmark)

    Sørensen, Dorthe; Svenningsen, Helle

    2016-01-01

    of a web-based protocol with feedback function using mechanical threshold loading (MTL) as a home-based IMT in individuals with COPD. Thirty-six individuals with inspiratory muscle weakness were randomly selected from a pulmonary rehabilitation program to perform 12 weeks of MTL with either a web...

  9. Veterans with chronic obstructive pulmonary disease achieve clinically relevant improvements in respiratory health after pulmonary rehabilitation.

    Science.gov (United States)

    Major, Stephen; Moreno, Marcella; Shelton, John; Panos, Ralph J

    2014-01-01

    To measure respiratory health and respiratory-related (RR) health care utilization in veterans with chronic obstructive pulmonary disease referred to pulmonary rehabilitation (PR) at the Cincinnati Veterans Administration (VA) Medical Center. We reviewed the records of 430 patients referred for PR from 2008 to 2010: 78 met inclusion criteria and completed PR (PR group); 92 qualified for PR but declined participation (referral group). All PR participants completed the St. George's Respiratory Questionnaire (SGRQ), BODE index, 6-minute walk test (6MWT), UCSD Shortness of Breath Questionnaire (UCSDSOBQ), Pulmonary Disease Knowledge Test, and self-reported use of short-acting bronchodilators before and after PR. All VA health care encounters during the 12 months before and after PR (PR group) or referral (referral group) were reviewed. Respiratory health improved after PR: SGRQ (60.6 ± 15.1, 51.1 ± 16.7), BODE (4.65 ± 1.93, 3.41 ± 1.84), 6MWT (497 ± 367 m, 572 ± 397 m), UCSDSOBQ (68.3 ± 21.1, 61.0 ± 20.9), Pulmonary Disease Knowledge Test (75.9 ± 12.4%, 85.9 ± 11.1%), short-acting bronchodilator (22.5 ± 25.3, 12.8 ± 15.6 inhalations per week) (before, after PR; P rehabilitation improves respiratory health in veterans with chronic obstructive pulmonary disease and decreases RR health care utilization.

  10. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease.

    Science.gov (United States)

    Rochester, Carolyn L; Fairburn, Carl; Crouch, Rebecca H

    2014-06-01

    Pulmonary rehabilitation (PR) is an important therapeutic intervention that should no longer be considered suitable only for patients with chronic obstructive pulmonary disease (COPD). A strong rationale exists for providing PR to persons with a broad range of respiratory disorders other than COPD. Evidence shows that PR for these patients is feasible, safe and effective. A disease-relevant approach should be undertaken, based on individual patients' needs. Further research is needed to better understand the optimal program content, duration and outcomes measures, to enable diverse patients to achieve maximal benefits of PR. Published by Elsevier Inc.

  11. Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial.

    Science.gov (United States)

    Bravo-Escobar, Raquel; González-Represas, Alicia; Gómez-González, Adela María; Montiel-Trujillo, Angel; Aguilar-Jimenez, Rafael; Carrasco-Ruíz, Rosa; Salinas-Sánchez, Pablo

    2017-02-20

    Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk. A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life. No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart

  12. Effectiveness of pulmonary rehabilitation in COPD with mild symptoms

    DEFF Research Database (Denmark)

    Rugbjerg, Mette; Iepsen, Ulrik Winning; Jørgensen, Karsten Juhl

    2015-01-01

    PURPOSE: Most guidelines recommend pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary disease (COPD) and modified Medical Research Council dyspnea scale (mMRC) levels ≥2, but the effectiveness of PR in patients with less advanced disease is not well established. Our aim...... was to investigate the effects of PR in patients with COPD and mMRC ≤1. METHODS: The methodology was developed as a part of evidence-based guideline development and is in accordance with the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. We identified...... randomized controlled trials (RCTs) through a systematic, multidatabase literature search and selected RCTs comparing the effects of PR with usual care in patients with COPD and mMRC ≤1. Predefined critical outcomes were health-related quality of life (HRQoL), adverse effects and mortality, while walking...

  13. An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

    NARCIS (Netherlands)

    M.A. Spruit (Martijn); S.J. Singh (Sally); C. Garvey (Chris); R. Zu Wallack (Richard); L. Nici (Linda); C. Rochester (Carolyn); K. Hill (Kylie); A.E. Holland (Anne); S.C. Lareau (Suzanne); W.D.-C. Man (William); F. Pitta (Fabio); L. Sewell (Louise); J. Raskin (Jonathan); J. Bourbeau (Jean); R. Crouch (Rebecca); F.M.E. Franssen (Frits); R. Casaburi (Richard); J.H. Vercoulen (Jan); I. Vogiatzis (Ioannis); R.A.A.M. Gosselink (Rik); E.M. Clini (Enrico); T.W. Effing (Tanja); F. Maltais (François); J. van der Palen (Job); T. Troosters; D.J.A. Janssen (Daisy); E. Collins (Eileen); J. Garcia-Aymerich (Judith); D. Brooks (Dina); B.F. Fahy (Bonnie); M.A. Puhan (Milo); M. Hoogendoorn (Martine); R. Garrod (Rachel); A.M.W.J. Schols (Annemie); B. Carlin (Brian); R. Benzo (Roberto); P. Meek (Paula); M. Morgan (Mike); M.P.M.H. Rutten-van Mölken (Maureen); A.L. Ries (Andrew); B. Make (Barry); R.S. Goldstein (Roger); C.A. Dowson (Claire); J.L. Brozek (Jan); C.F. Donner (Claudio); E.F.M. Wouters (Emiel)

    2013-01-01

    textabstractBackground: Pulmonary rehabilitation is recognized as a core component of themanagement of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable

  14. Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

    NARCIS (Netherlands)

    Arnold, R; Ranchor, AV; Koeter, GH; de Jongste, MJL; Wempe, JB; ten Hacken, NHT; Otten, [No Value; Sanderman, R

    Objective: Perceptions of mastery and self-efficacy may be related to better outcomes in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). This study examined (1) whether patients with COPD improved during a rehabilitation programme with respect to quality of

  15. Pulmonary rehabilitation programs in lung transplant: a literature review

    Directory of Open Access Journals (Sweden)

    Juliana Maria de Sousa Pinto

    2015-09-01

    Full Text Available Objective: To analyze, using a literature review, Pulmonary Rehabilitation (RP Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periódicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation” and Portuguese (“reabilitação” AND/OR “transplante pulmonar”. The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients.

  16. Prescribing exercise training in pulmonary rehabilitation: A clinical experience

    Directory of Open Access Journals (Sweden)

    S. Bernard

    2014-03-01

    Full Text Available Built around exercise training, pulmonary rehabilitation (PR is a multidisciplinary, evidence‐based, comprehensive approach to working with the patient as a whole and not just the pulmonary component of the disease. Integrated into the individualized treatment, this intervention aims to reduce symptoms, optimize functional status, increase participation in daily life, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease. Although there are many other components that should be considered to manage the impairment and symptom burden, supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation. This paper addresses our clinical experience at Institut universitaire de cardiologie et de pneumologie de Québec to assess and manage exercise training in line with the current recommendations and guidelines surrounding PR. Resumo: Construída com base no exercício físico, a reabilitação pulmonar (RP é uma abordagem multidisciplinar, fundamentada e abrangente para trabalhar com o doente como um todo, e não apenas com a componente pulmonar da doença. Integrado no tratamento individual, esta intervenção visa reduzir os sintomas, optimizar o estado funcional, aumentar a participação na vida diária e reduzir os custos do tratamento de saúde, através da estabilização ou inversão das manifestações sistémicas da doença. Embora existam muitos outros componentes que devem ser tidos em consideração para gerir o peso da incapacidade e dos sintomas, o exercício físico supervisionado é considerado o fundamento da reabilitação pulmonar eficiente. Este documento trata da nossa experiência clínica no Institut universitaire de cardiologie et de pneumologie de Québec para avaliar e gerir o exercício físico em linha com as recomendações e orientações actuais envolvendo a RP

  17. Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial

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    Román Miguel

    2013-02-01

    Full Text Available Abstract Background Pulmonary Rehabilitation for moderate Chronic Obstructive Pulmonary Disease in primary care could improve patients’ quality of life. Methods This study aimed to assess the efficacy of a 3-month Pulmonary Rehabilitation (PR program with a further 9 months of maintenance (RHBM group compared with both PR for 3 months without further maintenance (RHB group and usual care in improving the quality of life of patients with moderate COPD. We conducted a parallel-group, randomized clinical trial in Majorca primary health care in which 97 patients with moderate COPD were assigned to the 3 groups. Health outcomes were quality of life, exercise capacity, pulmonary function and exacerbations. Results We found statistically and clinically significant differences in the three groups at 3 months in the emotion dimension (0.53; 95%CI0.06-1.01 in the usual care group, (0.72; 95%CI0.26-1.18 the RHB group (0.87; 95%CI 0.44-1.30 and the RHBM group as well as in fatigue (0.47; 95%CI 0.17-0.78 in the RHBM group. After 1 year, these differences favored the long-term rehabilitation group in the domains of fatigue (0.56; 95%CI 0.22-0.91, mastery (0.79; 95%CI 0.03-1.55 and emotion (0.75; 95%CI 0.17-1.33. Between-group analysis only showed statistically and clinically significant differences between the RHB group and control group in the dyspnea dimension (0.79 95%CI 0.05-1.52. No differences were found for exacerbations, pulmonary function or exercise capacity. Conclusions We found that patients with moderate COPD and low level of impairment did not show meaningful changes in QoL, exercise tolerance, pulmonary function or exacerbation after a one-year, community based rehabilitation program. However, long-term improvements in the emotional, fatigue and mastery dimensions (within intervention groups were identified. Trial registration ISRCTN94514482

  18. Home-based exercise: promising rehabilitation for symptom relief, improved functional status and quality of life for post-surgical lung cancer patients.

    Science.gov (United States)

    Hoffman, Amy J; Brintnall, Ruth Ann; von Eye, Alexander; Jones, Lee W; Alderink, Gordon; Patzelt, Lawrence H; Brown, Jean K

    2014-06-01

    Post-thoracotomy non-small cell lung cancer (NSCLC) patients report cancer-related fatigue (CRF) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life (QOL). The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF, other symptoms, functional status, and QOL for post-surgical NSCLC patients starting within days after hospital discharge. Seven post-thoracotomy NSCLC patients completed the Brief Fatigue Inventory (BFI) measuring CRF severity, and the M.D. Anderson Symptom Inventory measuring symptom severity at pre- and post-surgery, and at the end of each week of the six-week intervention. Additionally, the Medical Outcomes Short-Form-36 measuring physical and mental functional status; and the Quality of Life Index (QLI) measuring QOL were completed pre- and post-surgery, after week 3, and at the end of the intervention (week 6). Participants had a mean age of 65 years, a mean of 6 co-morbid conditions, and initiated the intervention within 4 days after hospital discharge. Participants' CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference. Likewise, participants' post-intervention functional status and QOL improved to near or above pre-surgical levels. The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF, other symptom severity, functional status, and QOL. Further testing via a two-arm randomized controlled trial is being conducted.

  19. Pulmonary rehabilitation for moderate COPD (GOLD 2)--does it have an effect?

    DEFF Research Database (Denmark)

    Gottlieb, Vibeke; Lyngsø, Anne Marie; Jensen, Birgitte Nybo

    2011-01-01

    Although pulmonary rehabilitation is an integrated part of standard care in patients with severe COPD, it is uncertain whether those with less severe COPD benefit from such treatment. The aim of the present survey was to evaluate the effect of rehabilitation in patients with moderate COPD...... and to determine their willingness to participate in rehabilitation....

  20. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer.

    Science.gov (United States)

    Bobbio, Antonio; Chetta, Alfredo; Ampollini, Luca; Primomo, Gian Luca; Internullo, Eveline; Carbognani, Paolo; Rusca, Michele; Olivieri, Dario

    2008-01-01

    The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated. A prospective observational study was designed. Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test. In such conditions, maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated; when this resulted as being < or =15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered. Twelve patients fulfilled inclusion criteria, completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery. The postoperative record of these patients was collected. On completion of pulmonary rehabilitation, the resting pulmonary function test and diffuse lung capacity of patients was unchanged, whereas the exercise performance was found to have significantly improved; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min (p<0.01). Eleven patients underwent lobectomy; no postoperative mortality was noted and mean hospital stay was 17 days. Postoperative pulmonary complication was recorded in 8 patients. Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are candidates for lung resection for non-small cell lung cancer.

  1. Determinants of successful completion of pulmonary rehabilitation in COPD

    Directory of Open Access Journals (Sweden)

    Brown AT

    2016-02-01

    Full Text Available Angel T Brown,1 Jason Hitchcock,2 Christopher Schumann,2 J Michael Wells,1,3,4 Mark T Dransfield,1,3,4 Surya P Bhatt1,3 1Division of Pulmonary, Allergy, and Critical Care Medicine, 2Department of Cardiopulmonary Rehabilitation, 3UAB Lung Health Center, University of Alabama at Birmingham, 4Veterans Affairs Medical Center, Birmingham, AL, USA Background: Despite known benefits, a significant proportion of patients with COPD do not complete pulmonary rehabilitation (PR. Little is known regarding which factors promote successful completion of PR. Methods: We analyzed data from a prospectively maintained database of subjects with COPD who attended a PR program at the University of Alabama at Birmingham, from 1996 to 2013. Subjects were categorized as either completers or non-completers, based on successful completion of at least 8 weeks of PR. Demographics and comorbidities were recorded. Short Form 36 Health Survey, Beck Depression Inventory-II, and San Diego Shortness of Breath Questionnaire were administered to all participants at baseline and on completion of PR to assess participants’ perception of their health status, severity of depression, and dyspnea with performance of activities of daily living. Univariate and multivariable analyses were performed to identify predictors of successful completion of PR. Results: Four hundred and forty subjects were included, of whom 229 completed PR. Forty-one percent were female, and 17% were African American. Compared with non-completers, completers had greater Short Form 36 Health Survey pain score, lower forced expiratory volume in the first second, and lower Beck Depression Inventory score, and included a lower percentage of current smokers. On multivariate analysis, cigarette smoking at enrollment was associated with lower likelihood of completion of PR (adjusted odds ratio 0.38, 95% confidence interval 0.16–0.90; P=0.02.Conclusion: Cigarette smoking was the sole independent predictor of PR

  2. Protective roles of pulmonary rehabilitation mixture in experimental pulmonary fibrosis in vitro and in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, L.; Ji, Y.X.; Jiang, W.L.; Lv, C.J. [School of Pharmaceutical Sciences, Binzhou Medical University, Yantai (China)

    2015-05-08

    Abnormal high mobility group protein B1 (HMGB1) activation is involved in the pathogenesis of pulmonary fibrosis. Pulmonary rehabilitation mixture (PRM), which combines extracts from eight traditional Chinese medicines, has very good lung protection in clinical use. However, it is not known if PRM has anti-fibrotic activity. In this study, we investigated the effects of PRM on transforming growth factor-β1 (TGF-β1)-mediated and bleomycin (BLM)-induced pulmonary fibrosis in vitro and in vivo. The effects of PRM on TGF-β1-mediated epithelial-mesenchymal transition (EMT) in A549 cells, on the proliferation of human lung fibroblasts (HLF-1) in vitro, and on BLM-induced pulmonary fibrosis in vivo were investigated. PRM treatment resulted in a reduction of EMT in A549 cells that was associated with attenuating an increase of vimentin and a decrease of E-cadherin. PRM inhibited the proliferation of HLF-1 at an IC{sub 50} of 0.51 µg/mL. PRM ameliorated BLM-induced pulmonary fibrosis in rats, with reduction of histopathological scores and collagen deposition, and a decrease in α-smooth muscle actin (α-SMA) and HMGB1 expression. An increase in receptor for advanced glycation end-product (RAGE) expression was found in BLM-instilled lungs. PRM significantly decreased EMT and prevented pulmonary fibrosis through decreasing HMGB1 and regulating RAGE in vitro and in vivo. PRM inhibited TGF-β1-induced EMT via decreased HMGB1 and vimentin and increased RAGE and E-cadherin levels. In summary, PRM prevented experimental pulmonary fibrosis by modulating the HMGB1/RAGE pathway.

  3. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD.

    Science.gov (United States)

    Holland, Anne E; Wadell, Karin; Spruit, Martijn A

    2013-12-01

    Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD) and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

  4. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD

    Directory of Open Access Journals (Sweden)

    Anne E. Holland

    2013-12-01

    Full Text Available Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

  5. [A randomized controlled trial study of pulmonary rehabilitation with respiratory physiology as the guide on prognosis in patients with chronic obstructive pulmonary disease].

    Science.gov (United States)

    Zhang, Zai-qi; Chen, Rong-chang; Yang, Quan-kun; Li, Ping; Wang, Cheng-zhi; Zhang, Zhi-hui

    2008-10-01

    To observe the effect of pulmonary rehabilitation with respiratory physiology as guide in patients with chronic obstructive pulmonary disease (COPD). Sixty patients of severe and very severe COPD as categorized by global proposed diagnostic criteria for COPD (GOLD, 2006) were enrolled for study. They were randomly divided into three groups, and with 20 patients in each group. The patients in group A were given pulmonary rehabilitation guided by respiratory physiology thrice a day, 15 minutes each time for 8 weeks. The patients in group B were given pulmonary rehabilitation with pursed lip respiration thrice a day, 15 minutes per time for 8 weeks. The patients in group C were given no pulmonary rehabilitation. Six minute-walk-distance (6MWD), medical research council (MRC) dyspnea scale, activities of daily living (ADL), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and quality of life (QOL) were determined before and after respective pulmonary rehabilitation course. (1) There were 3, 5, 5 patients in group A, group B, group C dropped off in the course of rehabilitation respectively. (2) The patients' MRC grade after pulmonary rehabilitation in group A and group B decreased compared with that before pulmonary rehabilitation (both P0.05). (3) 6MWD, ADL, MEP, MIP of patients in group A and group B increased after pulmonary rehabilitation compared with that before pulmonary rehabilitation, and 6MWD, ADL, MEP, MIP of patients in group A were increased after pulmonary rehabilitation more than those in group B (Prehabilitation were improved more than those before pulmonary rehabilitation (Prehabilitation in two groups (all P>0.05). The difference in QOL was not marked between group A and group B after pulmonary rehabilitation (all P>0.05). (1) The pulmonary rehabilitation with pursed lip respiration and the pulmonary rehabilitation with the guide of respiratory physiology ameliorates dyspnea, improves ADL, QOL, exercise tolerance, function of

  6. Pulmonary rehabilitation program including respiratory conditioning for chronic obstructive pulmonary disease (COPD): Improved hyperinflation and expiratory flow during tidal breathing.

    Science.gov (United States)

    Yoshimi, Kaku; Ueki, Jun; Seyama, Kuniaki; Takizawa, Makiko; Yamaguchi, Seiko; Kitahara, Eriko; Fukazawa, Shinji; Takahama, Yukiko; Ichikawa, Masako; Takahashi, Kazuhisa; Fukuchi, Yoshinosuke

    2012-06-01

    Pulmonary rehabilitation has generally relieved symptoms, strengthened exercise endurance and improved health-related quality of life (QOL) in patients with COPD, but recovery of pulmonary function remains questionable. This analysis of our innovative rehabilitation program is directed at documenting changes in patients' expiratory airflow limitation, pulmonary symptoms and QOL. This program is designed to provide "respiratory conditioning", a physical therapist-assisted intensive flexibility training that focuses on stretching and rib cage mobilization. Thirty-one patients with COPD who attended rehabilitation sessions at Juntendo University Hospital from 1999 to 2006 were analyzed. Pulmonary function, expiratory flow limitation during tidal breathing, six minute walk distance (6MWD), respiratory muscle strength, and St. George Respiratory Questionnaire (SGRQ) were measured before and after pulmonary rehabilitation. In participants ages 68±7 years, the FEV(1)% predicted was 39.3±15.7%. 6MWD, SGRQ and respiratory muscle strength were significantly improved after pulmonary rehabilitation. Although neither FEV(1)% predicted nor FEV(1)/FVC was affected to a significant extent, indicating little effect on airflow limitation, expiratory flow limitation in supine as well as seated during tidal breathing improved significantly. Moreover, rehabilitation significantly diminished TLC% predicted, FRC% predicted, RV% predicted and RV/TLC values, thus indicating a reduction of hyperinflation of the lungs at rest. The present results suggest that our rehabilitation program with respiratory conditioning significantly lowered the hyperinflation of lungs at rest as well as the expiratory flow limitation during tidal breathing. In patients with COPD, overall pulmonary function improved, exercise endurance increased and health-related QOL was enhanced.

  7. Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD

    Directory of Open Access Journals (Sweden)

    Arwel W. Jones

    2017-01-01

    Full Text Available Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD, but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake, and the number of participants who received a discharge assessment (completion. Only one quasi-randomised study (n=115 (of 2468 records identified met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training compared with controls (pulmonary rehabilitation only. There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD.

  8. Short term and long term effects of pulmonary rehabilitation on physical activity in COPD.

    LENUS (Irish Health Repository)

    Egan, Claire

    2012-12-01

    The central purpose of pulmonary rehabilitation is to reduce morbidity by improving functional capacity through exercise. It is still unknown if improvements in functional capacity are maintained in the long-term and if this leads to increased physical activity levels as measured by a free-living activity monitor. The hypothesis of this study was that pulmonary rehabilitation would lead to a sustained increase in standard outcome measures and in daily physical activity.

  9. Smallest worthwhile effect of land-based and water-based pulmonary rehabilitation for COPD

    Directory of Open Access Journals (Sweden)

    Renae J. McNamara

    2015-06-01

    Full Text Available This study aimed to determine the smallest worthwhile effect of land-based and water-based pulmonary rehabilitation on 6-min walk distance among people with chronic obstructive pulmonary disease (COPD. Using a benefit–harm trade-off method, people with COPD who had completed two baseline 6-min walk tests at the commencement of outpatient pulmonary rehabilitation were presented with two scenarios: 8 weeks of land-based and 8 weeks of water-based pulmonary rehabilitation. Participants were guided through an iterative process allowing them to progressively refine their estimates of the smallest improvement due to each form of rehabilitation that would outweigh the associated costs, risks and inconvenience presented in the scenario. 100 people with COPD participated (mean±sd age 72±9 years, forced expiratory volume in 1 s 54±16% predicted and baseline 6-min walk distance 377±101 m. For land-based pulmonary rehabilitation, the median smallest worthwhile effect was 20 m (95% CI 15–37 m. For water-based pulmonary rehabilitation, the median smallest worthwhile effect was 26 m (95% CI 15–33 m. These estimates did not differ significantly (p=0.10. People with COPD typically perceive that pulmonary rehabilitation would be worthwhile if it increased the 6-min walk distance by about 6%. The smallest worthwhile effects of land- and water-based pulmonary rehabilitation were similar.

  10. Employing the International Classification of Functioning, Disability and Health framework to capture user feedback in the design and testing stage of development of home-based arm rehabilitation technology.

    Science.gov (United States)

    Sivan, Manoj; Gallagher, Justin; Holt, Ray; Weightman, Andrew; O'Connor, Rory; Levesley, Martin

    2016-01-01

    The purpose of this study was to evaluate the International Classification of Functioning, Disability and Health (ICF) as a framework to ensure that key aspects of user feedback are identified in the design and testing stages of development of a home-based upper limb rehabilitation system. Seventeen stroke survivors with residual upper limb weakness, and seven healthcare professionals with expertise in stroke rehabilitation, were enrolled in the user-centered design process. Through semi-structured interviews, they provided feedback on the hardware, software and impact of a home-based rehabilitation device to facilitate self-managed arm exercise. Members of the multidisciplinary clinical and engineering research team, based on previous experience and existing literature in user-centred design, developed the topic list for the interviews. Meaningful concepts were extracted from participants' interviews based on existing ICF linking rules and matched to categories within the ICF Comprehensive Core Set for stroke. Most of the interview concepts (except personal factors) matched the existing ICF Comprehensive Core Set categories. Personal factors that emerged from interviews e.g. gender, age, interest, compliance, motivation, choice and convenience that might determine device usability are yet to be categorised within the ICF framework and hence could not be matched to a specific Core Set category.

  11. Effectiveness of cognitive behavioural therapy in a community-based pulmonary rehabilitation programme: A controlled clinical trial.

    Science.gov (United States)

    Luk, Edwin K; Gorelik, Alexandra; Irving, Louis; Khan, Fary

    2017-03-06

    To investigate whether the use of cognitive behavioural therapy in pulmonary rehabilitation addresses the depression and anxiety burden and thereby improves rehabilitation outcomes. Prospective controlled clinical trial. A total of 70 patients with chronic obstructive pulmonary disease who were referred to a community centre for pulmonary rehabilitation. Patients were allocated to either the control group, consisting of pulmonary rehabilitation alone, or to the treatment group, receiving pulmonary rehabilitation and an additional 6 sessions of group-based cognitive behavioural therapy. Assessments consisting of questionnaires and walk tests were conducted pre- and post-pulmonary rehabilitation. A total of 28 patients were enrolled. The cognitive behavioural therapy group had significant improvements in exercise capacity following pulmonary rehabilitation (mean change 32.9 m, p = 0.043), which was maintained at 3 months post-pulmonary rehabilitation (mean change 23.4 m, p = 0.045). Patients in the cognitive behavioural therapy group showed significant short-term improvements in fatigue, stress and depression (mean change 2.4, p = 0.016, 3.9, p = 0.024 and 4.3, p = 0.047, respectively) and a 3-month post-pulmonary rehabilitation improvement in anxiety score (mean change 3.1, p = 0.01). No significant changes were seen in the control group. The addition of cognitive behavioural therapy improved patients' physical, psychological and quality of life results. Cognitive behavioural therapy should be considered for inclusion in a pulmonary rehabilitation programme to enhance outcomes.

  12. Pulmonary rehabilitation for chronic obstructive pulmonary disease: a scientific and political agenda.

    Science.gov (United States)

    Fahy, Bonnie F

    2004-01-01

    Pulmonary rehabilitation (PR) is the standard of care for patients suffering chronic obstructive pulmonary disease (COPD). This report describes and defines PR and reviews the evidence regarding the efficacy of PR. COPD management guidelines that include PR have been published by the European Respiratory Society, the American Thoracic Society, and the British Thoracic Society, and those guidelines were supported by evidence-based guidelines published jointly by the American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation. The Global Initiative for Chronic Obstructive Lung Disease, which is also evidence-based, included the recommendation for referral to PR. Despite those recommendations, the availability of comprehensive PR programs (defined as being compliant with national practice standards) is limited. In the United States the lack of a national policy for PR reimbursement has led to differences in compensation among insurance providers, based on differences in the Local Medical Review Policies established by the "fiscal intermediaries." Since 1998 the American Association for Respiratory Care, the American College of Chest Physicians, the American Thoracic Society, and the National Association for Medical Direction of Respiratory Care have jointly lobbied for clear, consistent guidelines from the United States Health Care Financing Administration (HCFA, which was recently renamed the Centers for Medicare and Medicaid Services [CMS]). In 2002 new Medicare/Medicaid billing codes ("G codes") became available for billing PR procedures, but unfortunately the instructions for the use of those codes differ among the Local Medical Review Policies. There has been little success in the effort to establish a national coverage policy for PR. The respiratory therapist holds a unique role in PR. In the respiratory therapist's training curriculum PR is specifically addressed, making the respiratory therapist an asset to

  13. A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients

    NARCIS (Netherlands)

    Altenburg, Wytske A.; de Greef, Mathieu H. G.; ten Hacken, Nick H. T.; Wempe, Johan B.

    Purpose: Pulmonary rehabilitation (PR) has positive effects on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD). However, not all COPD patients benefit from PR to the same extent. We investigated whether there is a patient profile, which is associated with the improvement in

  14. Pulmonary rehabilitation improves subjective sleep quality in COPD.

    Science.gov (United States)

    Lan, Chou-Chin; Huang, Hui-Chuan; Yang, Mei-Chen; Lee, Chih-Hsin; Huang, Chun-Yao; Wu, Yao-Kuang

    2014-10-01

    Poor sleep quality is often reported among patients with COPD. Pulmonary rehabilitation (PR) is beneficial in improving exercise capacity and health-related quality of life (HRQOL). However, its benefit in terms of sleep quality in patients with COPD remains unclear. This study aimed to investigate the effects of PR on sleep quality of patients with COPD. Thirty-four subjects with COPD were studied. All subjects participated in a 12-week (2 sessions/week) hospital-based out-patient PR study. Baseline and post-PR status were evaluated by spirometry, a sleep questionnaire (Pittsburgh Sleep Quality Index [PSQI]), a disease-specific questionnaire of HRQOL (St George Respiratory Questionnaire [SGRQ]), cardiopulmonary exercise testing, respiratory muscle strength, and the Borg dyspnea scale. Mean FEV1/FVC in the subjects was 0.49 ± 0.13, and the mean FEV1 was 1.06 ± 0.49 L/min (49.7 ± 18.0% of predicted). After PR, the PSQI score decreased from 9.41 ± 4.33 to 7.82 ± 3.90 (P 5 also decreased (85.3-64.7%, P = .006). There were significant improvements in HRQOL (SGRQ, P = .003), exercise capacity (peak oxygen uptake, P rate, P sleep quality, along with concurrent improvements in HRQOL and exercise capacity. PR is an effective nonpharmacologic treatment to improve sleep quality in patients with COPD and should be part of their clinical management. Copyright © 2014 by Daedalus Enterprises.

  15. Pulmonary rehabilitation and sleep quality: a before and after controlled study of patients with chronic obstructive pulmonary disease

    OpenAIRE

    McDonnell, Lucy M; Hogg, Lauren; McDonnell, Lynn; White, Patrick

    2014-01-01

    Background: Poor sleep quality is common in chronic obstructive pulmonary disease (COPD). It is associated with poor quality of life. Pulmonary rehabilitation (PR) improves quality of life, exercise capacity, and anxiety and depression. Its effect on sleep quality is uncertain. Aim: To determine whether PR improves sleep quality in COPD. Methods: A prospective controlled ‘before and after’ study of sleep quality in COPD patients attending a community PR programme was conducted. Sleep quality ...

  16. The importance of components of pulmonary rehabilitation, other than exercise training, in COPD

    Directory of Open Access Journals (Sweden)

    Kylie Hill

    2013-09-01

    Full Text Available Comprehensive pulmonary rehabilitation is an important component in the clinical management of people with chronic obstructive pulmonary disease (COPD. Although supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation, there are many other components that should be considered to manage the impairments and symptom burden, as well as the psychosocial and lifestyle changes imposed by COPD. These include approaches designed to: 1 facilitate smoking cessation; 2 optimise pharmacotherapy; 3 assist with early identification and treatment of acute exacerbations; 4 manage acute dyspnoea; 5 increase physical activity; 6 improve body composition; 7 promote mental health; 8 facilitate advance care planning; and 9 establish social support networks. This article will describe these approaches, which may be incorporated within pulmonary rehabilitation, to optimise effective chronic disease self-management.

  17. The importance of components of pulmonary rehabilitation, other than exercise training, in COPD.

    Science.gov (United States)

    Hill, Kylie; Vogiatzis, Ioannis; Burtin, Chris

    2013-09-01

    Comprehensive pulmonary rehabilitation is an important component in the clinical management of people with chronic obstructive pulmonary disease (COPD). Although supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation, there are many other components that should be considered to manage the impairments and symptom burden, as well as the psychosocial and lifestyle changes imposed by COPD. These include approaches designed to: 1) facilitate smoking cessation; 2) optimise pharmacotherapy; 3) assist with early identification and treatment of acute exacerbations; 4) manage acute dyspnoea; 5) increase physical activity; 6) improve body composition; 7) promote mental health; 8) facilitate advance care planning; and 9) establish social support networks. This article will describe these approaches, which may be incorporated within pulmonary rehabilitation, to optimise effective chronic disease self-management.

  18. Physical activity and quality of life improvements of patients with idiopathic pulmonary fibrosis completing a pulmonary rehabilitation program.

    Science.gov (United States)

    Gaunaurd, Ignacio A; Gómez-Marín, Orlando W; Ramos, Carol F; Sol, Constanza M; Cohen, Meryl I; Cahalin, Lawrence P; Cardenas, Diana D; Jackson, Robert M

    2014-12-01

    Pulmonary rehabilitation is effective for patients with COPD, but its benefit is less clearly established in idiopathic pulmonary fibrosis (IPF), especially in regard to levels of physical activity and health-related quality of life. The objectives were to determine whether pulmonary rehabilitation increased physical activity as assessed by the International Physical Activity Questionnaire (IPAQ), and improved quality of life and symptoms as assessed by the St George respiratory questionnaire for IPF (SGRQ-I) and the Borg dyspnea index (BDI). Subjects who met current criteria for IPF were randomized to a 3-month pulmonary rehabilitation program (n = 11) or to a control group (n = 10). The rehabilitation group participated in twice-weekly, 90-min exercise sessions (24 total sessions). The control group maintained its preceding, normal physical activity. All subjects underwent 6-min walk tests to assess the postexertion BDI. The SGRQ-I and a 5-point self-assessment of health were completed at baseline, after 3 months of intervention or observation, and after 3-month follow-up. All subjects completed the IPAQ weekly. Subjects in the rehabilitation group maintained significantly higher levels of physical activity throughout the 3-month rehabilitation program (rehabilitation: 51,364 ± 57,713 [mean ± SD] metabolic equivalent of task-minutes; control: 20,832 ± 37,155, P = .027 by 2-tailed Mann-Whitney test). SGRQ-I symptom domain scores improved considerably by -9 ± 22 in the rehabilitation group, whereas in the control group they worsened (16 ± 12 rehabilitation compared with control, P = .013 by 2-tailed Mann-Whitney test). During the 3-month follow-up, self-reported physical activity levels in the rehabilitation group were 14,428 ± 8,884 metabolic equivalent of task-minutes and in the control group 16,923 ± 32,620 (P = .17 by 2-tailed Mann-Whitney test), demonstrating substantial reversal of activity in the rehabilitation group. BDI scores after 6-min walk tests

  19. The effect of pulmonary rehabilitation program on quality of life of elderly patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Neda Mirbagher-Ajorpaz

    2011-03-01

    Full Text Available Background: Considering the prevalence of chronic obstructive pulmonary disease (COPD and its well-known complications; different studies indicate the success of rehabilitation techniques to improve quality of life for those patients. The present study was conducted to determine the effect of the implementation of pulmonary rehabilitation techniques on quality of life in patients with COPD.Materials and Method: This quasi-experimental research was performed in the selected teaching hospitals in Isfahan on 80 elderly patients with COPD with moderate intensity during their 85-86 years. The patients divided randomly into two groups (40 patients in case group and 40 patients in control group. The disease severity was evaluated based on spirometry results. Data were collected by using quality of life questionnaire (SF-12. First, the quality of life of patients in both groups was evaluated by SF-12 and then the 20 minutes pulmonary rehabilitation programs in the case group were performed every morning and evening for two months. At the end of two months, the qualities of life in both groups were measured again. The results were analyzed using SPSS-10 software. Results: The results showed that there is a significant direct relationship between some demographic characteristics and their quality of life score (p=0.03. Pulmonary rehabilitation program enhanced the quality of life in those patients (p=0.01. Conclusion: Regarding these findings, it should be consider that demographic characteristics of patients and their rehabilitation programs should be included the pulmonary rehabilitation program to improve quality of life

  20. Exercises commonly used in rehabilitation of patients with chronic obstructive pulmonary disease: cardiopulmonary responses and effect over time

    NARCIS (Netherlands)

    Helvoort, H.A.C. van; Boer, R.C. de; Broek, L. van den; Dekhuijzen, R.; Heijdra, Y.F.

    2011-01-01

    OBJECTIVES: To compare conventional exercise-based assessment of pulmonary rehabilitation (PR) with improvement in training exercises employed during a PR program, and to describe the cardiopulmonary response of different training exercises during PR of patients with chronic obstructive pulmonary

  1. Predicting Respiratory Infection One Year After Inpatient Rehabilitation with Pulmonary Function Measured at Discharge in Persons with Spinal Cord Injury

    NARCIS (Netherlands)

    Postma, K.; Bussmann, J.B.; Haisma, J.A.; van der Woude, L.H.V.; Bergen, M.P.; Stam, H.J.

    2009-01-01

    Objective: To determine whether pulmonary function at discharge from inpatient rehabilitation can predict respiratory infection in spinal cord injury in the first year after discharge, and to determine which pulmonary function parameter predicts best. Design: Multicentre prospective cohort study.

  2. Pulmonary rehabilitation improves exercise capacity in subjects with kyphoscoliosis and severe respiratory impairment.

    Science.gov (United States)

    Fuschillo, Salvatore; De Felice, Alberto; Martucci, Michele; Gaudiosi, Carlo; Pisano, Viviana; Vitale, Dino; Balzano, Giovanni

    2015-01-01

    Patients with kyphoscoliosis and severe respiratory impairment frequently experience reduction in exercise tolerance, limitation in daily life activities, and deterioration in health-related quality of life (HRQOL). Noninvasive ventilation (NIV) as an add-on treatment to long-term oxygen therapy (LTOT) was shown to improve symptoms and HRQOL in these patients. Pulmonary rehabilitation can increase exercise capacity and HRQOL in patients with COPD, but its role in patients with restrictive thoracic disease, such as kyphoscoliosis, is uncertain. The aim of this study was to analyze the effects of combining pulmonary rehabilitation with LTOT and NIV treatments on arterial blood gases and the 6-min walk test (6MWT) in a homogeneous group of subjects with kyphoscoliosis. Twenty-three subjects with kyphoscoliosis and respiratory failure who were being treated with both LTOT and NIV and who had been referred to a pulmonary rehabilitation program were retrospectively analyzed. Eighteen subjects were included, and there was no control group. Pulmonary rehabilitation involved educational and physical training sessions and was carried out daily for 4-6 weeks. Exercise intensity was personalized based on individual tolerance, physiologic parameters, or physiotherapist judgment. Upon completion of pulmonary rehabilitation, a significant improvement in 6-min walk distance was observed (P = .04). The dyspnea score at the end of the 6MWT improved as well, although the improvement did not reach statistical significance (P = .06). These changes were not confirmed at a 12-month follow-up visit. No significant effects of pulmonary rehabilitation on arterial blood gases were observed. A combined intervention including a tailored pulmonary rehabilitation program together with LTOT and NIV seems to be of short-term benefit in subjects with kyphoscoliosis and severe respiratory impairment. Copyright © 2015 by Daedalus Enterprises.

  3. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

    Science.gov (United States)

    Spruit, Martijn A; Singh, Sally J; Garvey, Chris; ZuWallack, Richard; Nici, Linda; Rochester, Carolyn; Hill, Kylie; Holland, Anne E; Lareau, Suzanne C; Man, William D-C; Pitta, Fabio; Sewell, Louise; Raskin, Jonathan; Bourbeau, Jean; Crouch, Rebecca; Franssen, Frits M E; Casaburi, Richard; Vercoulen, Jan H; Vogiatzis, Ioannis; Gosselink, Rik; Clini, Enrico M; Effing, Tanja W; Maltais, François; van der Palen, Job; Troosters, Thierry; Janssen, Daisy J A; Collins, Eileen; Garcia-Aymerich, Judith; Brooks, Dina; Fahy, Bonnie F; Puhan, Milo A; Hoogendoorn, Martine; Garrod, Rachel; Schols, Annemie M W J; Carlin, Brian; Benzo, Roberto; Meek, Paula; Morgan, Mike; Rutten-van Mölken, Maureen P M H; Ries, Andrew L; Make, Barry; Goldstein, Roger S; Dowson, Claire A; Brozek, Jan L; Donner, Claudio F; Wouters, Emiel F M

    2013-10-15

    Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

  4. Pulmonary Rehabilitation: The Reference Therapy for Undernourished Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Nikolaos Samaras

    2014-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.

  5. Influence of ambient music on perceived exertion during a pulmonary rehabilitation session: a randomized crossover study.

    Science.gov (United States)

    Reychler, Gregory; Mottart, Florian; Boland, Maelle; Wasterlain, Emmanuelle; Pieters, Thierry; Caty, Gilles; Liistro, Giuseppe

    2015-05-01

    Pulmonary rehabilitation is a key element in the treatment of COPD. Music has been shown to have a positive effect on parameters related to a decrease in exercise tolerance. The aim of this study was to evaluate the effect of listening to ambient music on perceived exertion during a pulmonary rehabilitation session for COPD subjects. COPD subjects randomly performed a session of pulmonary rehabilitation with or without ambient music. Perceived exertion (Borg scales), anxiety (Hospital Anxiety and Depression Scale-Anxiety Subscale), dyspnea (visual analog scale), and cardiorespiratory parameters were compared at the end of both sessions. Forty-one subjects were analyzed. The characteristics of the COPD subjects were as follows: age, 70.5 ± 8.4 y; body mass index, 22.7 ± 3.9 kg/m(2); and FEV1, 38.6 ± 12.5 % predicted. Perceived exertion was not modified by ambient music, but anxiety was improved (P = .02). Dyspnea, fatigue and cardiorespiratory parameters were not influenced by music during a typical session of the pulmonary rehabilitation program. This study demonstrates that perceived exertion during one pulmonary rehabilitation session was not influenced by ambient music. However, a positive effect on anxiety was observed. (ClinicalTrials.gov registration NCT01833260.). Copyright © 2015 by Daedalus Enterprises.

  6. Long-term efficacy of pulmonary rehabilitation in patients with occupational respiratory diseases.

    Science.gov (United States)

    Ochmann, Uta; Kotschy-Lang, Nicola; Raab, Wolfgang; Kellberger, Jessica; Nowak, Dennis; Jörres, Rudolf A

    2012-01-01

    Pulmonary rehabilitation is a well-recognized treatment option in chronic obstructive lung disease improving exercise performance, respiratory symptoms and quality of life. In occupational respiratory diseases, which can be rather cost-intensive due to the compensation needs, very little information is available. This study aims at the evaluation of the usefulness of pulmonary rehabilitation in patients with occupational respiratory diseases, partly involving complex alterations of lung function and of the sustainability of effects. We studied 263 patients with occupational respiratory diseases (asthma, silicosis, asbestosis, chronic obstructive pulmonary disease) using a 4-week inpatient rehabilitation program and follow-up examinations 3 and 12 months later. The outcomes evaluated were lung function, 6-min walking distance (6MWD), maximum exercise capacity (Wmax), skeletal muscle strength, respiratory symptoms, exacerbations and associated medical consultations, quality of life (SF-36, SGRQ), anxiety/depression (HADS) and Medical Research Council and Baseline and Transition Dyspnea Index scores. Compared to baseline, there were significant (p rehabilitation, and these were maintained over 12 months (p rehabilitation. No changes were seen in the questionnaire outcomes. Pulmonary rehabilitation is effective even in the complex settings of occupational respiratory diseases, providing sustained improvement of functional capacity and reducing health care utilization. Copyright © 2012 S. Karger AG, Basel.

  7. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study.

    Science.gov (United States)

    Chumillas, S; Ponce, J L; Delgado, F; Viciano, V; Mateu, M

    1998-01-01

    To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit. A randomized clinical trial. A public hospital. Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40). Breathing exercises in the rehabilitation group. Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays. The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high- and moderate-risk patients in the rehabilitation group had fewer PPC. Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences. Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients, but does not affect surgery-induced functional alterations.

  8. [Clinical effect of pulmonary rehabilitation therapy including respiratory exercise and vibration expectoration on patients with pulmonary infection after abdominal surgery].

    Science.gov (United States)

    Zhou, Zhou; Han, Xiaotong; Ning, Fengling; Wen, Hui; Fan, Maiying; Yuan, Xia; Luo, Jieying; Zhang, Yi

    2017-03-01

    To investigate the clinical effect of pulmonary rehabilitation therapy including respiratory exercise and vibration expectoration on patients with pulmonary infection after abdominal surgery. A retrospective case control study was conducted. Seventy-six patients with pulmonary infection after abdominal surgery admitted to the First Affiliated Hospital of Hunan Normal University from September 2015 to September 2016 were enrolled. According to whether accept the pulmonary rehabilitation therapy or not, the patients were divided into two groups. In the control group (n = 35), the conventional expectoration method was adopted. The patients in pulmonary rehabilitation group (n = 41) received both methods of the control group and pulmonary rehabilitation treatment, including respiratory exercise (effective cough, lip reduction breathing), respiratory exercise device (respiratory exerciser tri-ball), and vibrated expectoration. The 24-hour sputum volume, degree of comfort, inflammatory and pulmonary function parameters, and recovery situation were recorded in the two groups. (1) There were no significant differences in the parameters of inflammation and pulmonary function before treatment between the two groups. After treatment, the white blood cell (WBC) and C-reactive protein (CRP) in both groups were significantly decreased, and the forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) were significantly increased. The above changes in pulmonary rehabilitation group were more significant than those of the control group [WBC (×109/L): 11.12±2.88 vs. 13.42±2.62 at 3 days, 8.22±1.48 vs. 9.27±1.92 at 5 days; CRP (mg/L): 13.47±4.77 vs. 16.03±4.94 at 3 days, 9.69±1.56 vs. 11.77±1.41 at 5 days; FEV1 (L): 2.48±0.14 vs. 2.29±0.16 at 3 days, FEV1/FVC: 0.78±0.04 vs. 0.75±0.04 at 3 days; all P rehabilitation group were significantly higher than that of the control group (mL: 30.51±4.15 vs. 18.30±3.64 at 1 day, 31.08±3.22 vs. 20.37±3

  9. Influence of comorbidities on the efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Higashimoto, Yuji; Yamagata, Toshiyuki; Maeda, Kazushige; Honda, Noritsugu; Sano, Akiko; Nishiyama, Osamu; Sano, Hiroyuki; Iwanaga, Takashi; Chiba, Yasutaka; Fukuda, Kanji; Tohda, Yuji

    2016-08-01

    To evaluate the influence of comorbidities and aging on pulmonary rehabilitation (PR) efficacy in patients with chronic obstructive pulmonary disease (COPD). This was a retrospective cohort study of patients with COPD attending an outpatient PR program. Comorbidity information was collected with the Charlson Index, BODE index and COPD-specific comorbidity test, and also included other common conditions not included in these indexes. The efficacy of PR was defined as a 54-m increase in 6-min walk distance or a four-point decrease in St. George's Respiratory Questionnaire score. Patients were divided into two age groups according to the median age of 72 years. A total of 21 of 52 patients (40%) showed a clinically significant benefit by the 6-min walk distance, and 29 patients (55.8%) by the St. George's Respiratory Questionnaire score. PR efficacy was not different between the elderly group and the younger group by either parameter. A total of 98% of the patients had at least one chronic comorbidity. Hypertension was the most frequently reported comorbidity (28.5%). Higher body mass index, Hospital Anxiety and Depression Scale anxiety score and St. George's Respiratory Questionnaire total score were associated with a good response to PR by the 6-min walk distance. None of the individual comorbidities or indexes were correlated with the efficacy of PR. Multiple logistic regression analysis showed that body mass index was independently associated with the response to PR. PR is equally effective in elderly and younger patients with COPD, with efficacy influenced by body mass index and anxiety. Geriatr Gerontol Int 2016; 16: 934-941. © 2015 Japan Geriatrics Society.

  10. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation

    NARCIS (Netherlands)

    Spruit, M.A.; Singh, S.J.; Garvey, C.; ZuWallack, R.; Nici, L.; Rochester, C.; Hill, K.; Holland, A.E.; Lareau, S.C.; Man, W.D.; Pitta, F.; Sewell, L.; Raskin, J.; Bourbeau, J.; Crouch, R.; Franssen, F.M.; Casaburi, R.; Vercoulen, J.H.M.M.; Vogiatzis, I.; Gosselink, R.; Clini, E.M.; Effing, T.W.; Maltais, F.; Palen, J.A.M. van der; Troosters, T.; Janssen, D.J.; Collins, E.; Garcia-Aymerich, J.; Brooks, D.; Fahy, B.F.; Puhan, M.A.; Hoogendoorn, M.; Garrod, R.; Schols, A.M.W.J.; Carlin, B.; Benzo, R.; Meek, P.; Morgan, M.; Molken, M.P. Rutten-van; Ries, A.L.; Make, B.; Goldstein, R.S.; Dowson, C.A.; Brozek, J.L.; Donner, C.F.; Wouters, E.F.; Rehabilitation, A.E.T.F.o.P.

    2013-01-01

    BACKGROUND: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our

  11. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation

    NARCIS (Netherlands)

    Spruit, Martijn A.; Singh, Sally J.; Garvey, Chris; ZuWallack, Richard; Nici, Linda; Rochester, Carolyn; Hill, Kylie; Holland, Anne E.; Lareau, Suzanne C.; Man, W.D.C.; Pitta, Fabio; Sewell, Louise; Raskin, Jonathan; Bourbeau, Jean; Crouch, Rebecca; Franssen, Frits M.E.; Casaburi, Richard; Vercoulen, Jan H.; Vogiatzit, Ioannis; Gosselink, Rik; Clini, Enrico M.; Effing, T.W.; Maltais, Francois; van der Palen, Jacobus Adrianus Maria; Troosters, Thierry; Janssen, Daisy J.A.; Collins, Eileen; Garcia-Aymerich, Judith; Brooks, Dina; Fahy, Bonnie F.; Puhan, Milo A.; Hoogendoorn, Martine; Garrod, Rachel; Schols, Annemie M.W.J.; Carlin, Brian; Benzo, Roberto; Meek, Paula; Morgan, Mike; Rutten-van Mölken, Maureen P.M.H.; Ries, Andrew L.; Make, Barry; Goldstein, Roger S.; Dowson, Claire A.; Brozek, Jan L.; Donner, Claudio F.; Wouters, Emiel F.M.

    2013-01-01

    Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our

  12. Computerized Respiratory Sounds: Novel Outcomes for Pulmonary Rehabilitation in COPD.

    Science.gov (United States)

    Jácome, Cristina; Marques, Alda

    2017-02-01

    Computerized respiratory sounds are a simple and noninvasive measure to assess lung function. Nevertheless, their potential to detect changes after pulmonary rehabilitation (PR) is unknown and needs clarification if respiratory acoustics are to be used in clinical practice. Thus, this study investigated the short- and mid-term effects of PR on computerized respiratory sounds in subjects with COPD. Forty-one subjects with COPD completed a 12-week PR program and a 3-month follow-up. Secondary outcome measures included dyspnea, self-reported sputum, FEV1, exercise tolerance, self-reported physical activity, health-related quality of life, and peripheral muscle strength. Computerized respiratory sounds, the primary outcomes, were recorded at right/left posterior chest using 2 stethoscopes. Air flow was recorded with a pneumotachograph. Normal respiratory sounds, crackles, and wheezes were analyzed with validated algorithms. There was a significant effect over time in all secondary outcomes, with the exception of FEV1 and of the impact domain of the St George Respiratory Questionnaire. Inspiratory and expiratory median frequencies of normal respiratory sounds in the 100-300 Hz band were significantly lower immediately (-2.3 Hz [95% CI -4 to -0.7] and -1.9 Hz [95% CI -3.3 to -0.5]) and at 3 months (-2.1 Hz [95% CI -3.6 to -0.7] and -2 Hz [95% CI -3.6 to -0.5]) post-PR. The mean number of expiratory crackles (-0.8, 95% CI -1.3 to -0.3) and inspiratory wheeze occupation rate (median 5.9 vs 0) were significantly lower immediately post-PR. Computerized respiratory sounds were sensitive to short- and mid-term effects of PR in subjects with COPD. These findings are encouraging for the clinical use of respiratory acoustics. Future research is needed to strengthen these findings and explore the potential of computerized respiratory sounds to assess the effectiveness of other clinical interventions in COPD. Copyright © 2017 by Daedalus Enterprises.

  13. "Knowing I can be helpful makes me feel good inside, it makes me feel essential": community health care workers' experiences of conducting a home-based rehabilitation intervention for people living with HIV in KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Cobbing, Saul; Chetty, Verusia; Hanass-Hancock, Jill; Myezwa, Hellen

    2017-10-01

    People living with HIV (PLHIV) are living longer lives on antiretroviral therapy and are prone to a wide range of disabilities. Innovative strategies are required to meet the rehabilitation needs of PLHIV, particularly in resource-poor communities where HIV is endemic and access to institution-based rehabilitation is limited. Home-based rehabilitation (HBR) is one such approach, but there is a paucity of research related to HBR programmes for PLHIV or the experiences of community care workers (CCWs) involved in these programmes. Following a four month randomised controlled trial of a HBR intervention designed specifically for PLHIV in KwaZulu-Natal, South Africa; four CCWs were interviewed. This study employed a qualitative research design, using semi-structured interviews to explore these workers' experiences of being involved in carrying out this intervention. Participants reported how their personal development, improvement in their own health and increased feelings of self-worth enabled them to successfully implement the intervention. Participants also described a number of inhibitors, including stigma and environmental challenges related to the distances between patients' homes, the steep terrain and the hot climate. Despite this, the participants felt empowered by acquiring knowledge and skills that enabled them to shift roles beyond rehabilitation provision. The findings of this study should be considered when employing a task shifting approach in the development and implementation of HBR interventions for PLHIV. By employing a less specialised cadre of community workers to conduct basic HBR interventions, both the relative lack of qualified rehabilitation professionals and the high levels of disability in HIV-epidemic communities can be simultaneously addressed.

  14. Pulmonary rehabilitation improves exercise capacity and dyspnea in air pollution-related respiratory disease.

    Science.gov (United States)

    Miyamoto, Naomi; Senjyu, Hideaki; Tanaka, Takako; Asai, Masaharu; Yanagita, Yorihide; Yano, Yudai; Nishinakagawa, Tsuyoshi; Kotaki, Kenji; Kitagawa, Chika; Rikitomi, Naoto; Kozu, Ryo; Honda, Sumihisa

    2014-01-01

    Air pollution in Japan caused respiratory disease, such as chronic bronchitis and asthma, in many individuals in the 1960s. Although air pollution has decreased, many victims of air pollution-related respiratory disease are limited in their activities of daily living because of respiratory symptoms. The purpose of this study was to evaluate the efficacy of pulmonary rehabilitation in victims of air pollution-related chronic bronchitis or asthma. Subjects were enrolled in a 12-week (2-week inpatient followed by 10-week outpatient) pulmonary rehabilitation program. The program comprised conditioning, strength training, endurance training, and patient education. We assessed the Modified Medical Research Council (MMRC) dyspnea grade, pulmonary function, peripheral muscle force, incremental shuttle walk distance (ISWD), and physical activity at baseline and immediately after the program. Twenty-nine subjects (mean age 74.2 ± 10.1 years, 11 males) completed the program, including 11 subjects with COPD and 18 subjects with asthma. Following rehabilitation, the participants (n = 29) showed significant improvements in MMRC dyspnea grade, vital capacity % predicted, quadriceps force and ISWD (all P rehabilitation is an effective method of improving exercise capacity and dyspnea in officially acknowledged victims of air pollution-related asthma. In conclusion, we recommend that patients with chronic bronchitis or asthma, resulting from exposure to air pollution, are referred for pulmonary rehabilitation.

  15. The feasibility and validity of a remote pulse oximetry system for pulmonary rehabilitation: a pilot study.

    Science.gov (United States)

    Tang, Jonathan; Mandrusiak, Allison; Russell, Trevor

    2012-01-01

    Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease. However, access to these services is limited especially in rural and remote areas. Telerehabilitation has the potential to deliver pulmonary rehabilitation programs to these communities. The aim of this study was threefold: to establish the technical feasibility of transmitting real-time pulse oximetry data, determine the validity of remote measurements compared to conventional face-to-face measures, and evaluate the participants' perception of the usability of the technology. Thirty-seven healthy individuals participated in a single remote pulmonary rehabilitation exercise session, conducted using the eHAB telerehabilitation system. Validity was assessed by comparing the participant's oxygen saturation and heart rate with the data set received at the therapist's remote location. There was an 80% exact agreement between participant and therapist data sets. The mean absolute difference and Bland and Altman's limits of agreement fell within the minimum clinically important difference for both oxygen saturation and heart rate values. Participants found the system easy to use and felt confident that they would be able to use it at home. Remote measurement of pulse oximetry data for a pulmonary rehabilitation exercise session was feasible and valid when compared to conventional face-to-face methods.

  16. ACE and response to pulmonary rehabilitation in COPD: two observational studies.

    Science.gov (United States)

    Kon, Samantha S C; Jolley, Caroline J; Shrikrishna, Dinesh; Montgomery, Hugh E; Skipworth, James R A; Puthucheary, Zudin; Moxham, John; Polkey, Michael I; Man, William D-C; Hopkinson, Nicholas S

    2017-01-01

    Skeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin-angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation. Two studies are described; in the first, the response of 168 COPD patients (mean forced expiratory volume in one second 51.9% predicted) to pulmonary rehabilitation was compared between different ACE insertion/deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking ACE inhibitors or angiotensin receptor antagonists (ARB). In study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61 (76)m and 78 (78)m, respectively, (p>0.05). In study 2, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243), 17.8 (16.0, 19.8) kg m-2 vs 16.5 (14.9, 18.4) kg/m2 (pACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE (I/D) genotype influence response to pulmonary rehabilitation.

  17. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD - A follow-up of 18 months

    NARCIS (Netherlands)

    Strijbos, JH; Postma, DS; vanAltena, R; Gimeno, F; Koeter, GH

    Aim: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week homecare rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. Methods: After randomization and

  18. Exercise rehabilitation in pulmonary patients: a review | Shaw ...

    African Journals Online (AJOL)

    A review of current literature indicates the need to further investigate the role of upper body RT on pulmonary function. Key words: Lung function, pulmonary function, resistance training, respiratory muscles, upper body resistance training. (Af. J. Physical, Health Education, Recreation and Dance: 2003 Special Edition: ...

  19. Promoting long-term benefits of pulmonary rehabilitation: the role of reducing the impact of respiratory exacerbations.

    Science.gov (United States)

    Fahy, Bonnie F

    2014-06-01

    The importance of exercise for pulmonary patients is unquestioned. Decreased functional status has been attributed to increased hospitalizations, leading to further decreases in functionality, decreased quality of life and increased mortality. Despite known benefits of pulmonary rehabilitation, recruitment and retention of program participants can be a challenge. Alternatives to traditional pulmonary rehabilitation are reviewed with an emphasis on physical activity, exacerbation awareness and a reduction in hospital admissions. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. [Pulmonary rehabilitation methods in the prevention of acute respiratory infections in patients with chronic obstructive pulmonary disease, the association with psycho-emotional state].

    Science.gov (United States)

    Tovt-Korshyns'ka, M I; Blaha, O S; Pudakova, S O; Tovt, V A

    2014-01-01

    In patients with chronic obstructive pulmonary disease stage I GOLD we revealed a significant reduction of acute respiratory infections frequency after pulmonary rehabilitation using salt aerosol therapy; however, in patients with chronic obstructive pulmonary disease stage II GOLD such a reduction we have not seen. We didn't find marked reduction of acute respiratory infections frequency also in patients with chronic obstructive pulmonary disease stage I GOLD with higher depression level.

  1. Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

    Directory of Open Access Journals (Sweden)

    Sundh J

    2017-06-01

    Full Text Available Josefin Sundh,1 Helena Lindgren,2 Mikael Hasselgren,2 Scott Montgomery,3–5 Christer Janson,6 Björn Ställberg,7 Karin Lisspers7 1Department of Respiratory Medicine, School of Medical Sciences, 2Medical Programme, School of Medical Sciences, 3Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, 4Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 5Department of Epidemiology and Public Health, University College, London, UK; 6Department of Medical Sciences, Respiratory, Allergy and Sleep Research, 7Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden Introduction: Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Materials and methods: Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. Results: In primary care, nurse-based asthma/COPD clinics were common (87%, with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%. In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%, occupational therapists (3% vs 10%, nutritionists (5% vs 13%, and counselors (1% vs 4%. A higher COPD Assessment Test score

  2. Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD

    DEFF Research Database (Denmark)

    Ringbaek, Thomas J.; Lavesen, Marie; Lange, Peter

    2016-01-01

    BACKGROUND: A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). OBJECTIVE: To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. METHODS: A total of 115 patients pa...

  3. Pulmonary rehabilitation in chronic respiratory diseases--from goals to outcomes.

    Science.gov (United States)

    Pesut, Dragica; Ciobanu, Laura; Nagorni-Obradovic, Ljudmila

    2008-01-01

    This paper is a review of current approaches on pulmonary rehabilitation (PR) in chronic pulmonary diseases. Pulmonary rehabilitation is the most accepted method of non-pharmacological treatment in patients with chronic obstructive pulmonary disease (COPD), bronchial asthma, bronchiectasis, cystic fibrosis, interstitial lung disease, neuromuscular degenerative disease and post-tuberculosis lung sequelae. Throughout its components, especially oxygen therapy, it is the most important intervention in chronic respiratory failure in order to improve exercise tolerance, lung function and self-management. Enrolling patients in pulmonary rehabilitation programmes is a consistent help to a better control of their illness and a step forward to the international standards of treating COPD and non-COPD chronic respiratory diseases. It is evidence-based that PR is effective in reducing dyspnoea, improving health-related quality of life, reducing the number of hospital days and the utilisation of costly healthcare resources; there are also psychosocial benefits from comprehensive PR programmes in patients with COPD. PR is currently considered as effective in patients with COPD and in some patients with chronic respiratory diseases other than COPD.

  4. Improved health-related quality of life after lung volume reduction surgery and pulmonary rehabilitation.

    Science.gov (United States)

    Beling, Janna

    2009-09-01

    It has been hypothesized that lung volume reduction surgery (LVRS) and pulmonary rehabilitation improve health-related quality of life (HRQOL). The purpose of this study was to test the hypothesis by examining the long-term functional consequences and general health status of patients with emphysema who have undergone LVRS and pulmonary rehabilitation. Forty-nine subjects with severe emphysema, aged 51 to 84 years old, post-LVRS and pulmonary rehabilitation participated in this study. Subjects reported changes in physical and mental domains on the Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36) over 3 time periods: prior to surgery, 6 months postsurgery, and 18 months postsurgery. The population as a whole was studied and both gender and age were analyzed as subsets. Subjects participated in an intensive 2-week (10 daily sessions) pulmonary rehabilitation program following LVRS. Subjects showed significant improvements in both the physical and mental component summaries at Time 2 (3 months post-LVRS through 6 months post-LVRS) and Time 3 (12 months post-LVRS through 18 months post-LVRS) when compared to Time 1 (pre-LVRS). On the mental component summary scale, subjects younger than 65 years old had significant improvement compared to subjects 65 years and older at Time 3 (P pulmonary rehabilitation appears to improve HRQOL in people with emphysema up to at least 18 months postsurgery. What these data further suggest is that even after declines in health, women can improve HRQOL later in life, and that greater focus should be given to the emotional needs of our older patients.

  5. Time to adapt exercise training regimens in pulmonary rehabilitation – a review of the literature

    Directory of Open Access Journals (Sweden)

    Lee AL

    2014-11-01

    Full Text Available Annemarie L Lee,1–4 Anne E Holland1–3 1Physiotherapy, Alfred Health, Melbourne, VIC, Australia; 2Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia; 3Physiotherapy, La Trobe University, Melbourne, VIC, Australia; 4Westpark Healthcare Centre, ON, Canada Abstract: Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD. Patients with a primary diagnosis of COPD often report comorbidities and other secondary manifestations, which diversifies the clinical presentation. Pulmonary rehabilitation that includes whole body exercise training is a critical part of management, and core programs involve endurance and resistance training for the upper and lower limbs. Improvement in maximal and submaximal exercise capacity, dyspnea, fatigue, health-related quality of life, and psychological symptoms are outcomes associated with exercise training in pulmonary rehabilitation, irrespective of the clinical state in which it is commenced. There may be benefits for the health care system as well as the individual patient, with fewer exacerbations and subsequent hospitalization reported with exercise training. The varying clinical profile of COPD may direct the need for modification to traditional training strategies for some patients. Interval training, one-legged cycling (partitioning and non-linear periodized training appear to be equally or more effective than continuous training. Inspiratory muscle training may have a role as an adjunct to whole body training in selected patients. The benefits of balance training are also emerging. Strategies to ensure that health enhancing behaviors are adopted and maintained are essential. These may include training for an extended duration, alternative environments to undertake the initial program, maintenance programs following initial exercise training, program repetition

  6. Home-based Functional Electrical Stimulation for long-term denervated human muscle: History, basics, results and perspectives of the Vienna Rehabilitation Strategy

    Directory of Open Access Journals (Sweden)

    Helmut Kern

    2014-03-01

    Full Text Available We will here discuss the following points related to Home-based Functional Electrical Stimulation (h-b FES as treatment for patients with permanently denervated muscles in their legs: 1. Upper (UMN and lower motor neuron (LMN damage to the lower spinal cord; 2. Muscle atrophy/hypertrophy versus processes of degeneration, regeneration, and recovery; 3. Recovery of twitch- and tetanic-contractility by h-b FES; 4. Clinical effects of h-b FES using the protocol of the “Vienna School”; 5. Limitations and perspectives. Arguments in favor of using the Vienna protocol include: 1. Increased muscle size in both legs; 2. Improved tetanic force production after 3-5 months of percutaneous stimulation using long stimulus pulses (> 100 msec of high amplitude (> 80 mAmp, tolerated only in patients with no pain sensibility; 3. Histological and electron microscopic evidence that two years of h-b FES return muscle fibers to a state typical of two weeks denervated muscles with respect to atrophy, disrupted myofibrillar structure, and disorganized Excitation-Contraction Coupling (E-CC structures; 4. The excitability never recovers to that typical of normal or reinnervated muscles where pulses less than 1 msec in duration and 25 mAmp in intensity excite axons and thereby muscle fibres. It is important to motivate these patients for chronic stimulation throughout life, preferably standing up against the load of the body weight rather than sitting. Only younger and low weight patients can expect to be able to stand-up and do some steps more or less independently. Some patients like to maintain the h-b FES training for decades. Limitations of the procedure are obvious, in part related to the use of multiple, large surface electrodes and the amount of time patients are willing to use for such muscle training.

  7. Fatigue in patients with COPD participating in a pulmonary rehabilitation program

    Directory of Open Access Journals (Sweden)

    Cindy J Wong

    2010-09-01

    Full Text Available Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,31College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, CanadaBackground: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD. While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors.Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records.Results: Almost all (95.3% participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%, reduced motivation (83.3%, mental fatigue (69.9%, and general fatigue (54.5%. Close to half (42.9% of participants reported symptoms of anxiety, while almost one quarter (21.4% reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01 and reduced motivation (ρ = 0.31, P < 0.05. Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01. Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores.Conclusions: Fatigue (particularly the physical and

  8. Rehabilitation of Discharged Patients With Chronic Obstructive Pulmonary Disease—Are New Strategies Needed?

    Directory of Open Access Journals (Sweden)

    Lars Morsø

    2017-01-01

    Full Text Available Background: Rehabilitation after hospital stay implies several benefits for patients with chronic obstructive pulmonary disease (COPD; still few patients are referred and participate in rehabilitation programs. We conducted a case study to investigate the effects of interventions targeting the referral, uptake, and completion for a program of early rehabilitation in the primary health-care sector. Methods: We undertook targeted initiatives to make patients participate in an individualized rehabilitation program with gradual increased intensity. After discharge, primary care COPD nurses and physiotherapists guided patients through progressing exercises in small groups online. Patients proceeded to class-based exercises, patient education and/or leisure activities, or continued telerehabilitation. We evaluated the effects of the intervention by assessing referral rates, completion, and readmission. Results: Sixteen (23% of discharged patients patients were referred to rehabilitation. In comparison, only 1 (0.8% in 131 patients from Vejle hospital was referred to Vejle hospital. Twelve patients completed rehabilitation, all having severe COPD. All started the program within 2 weeks and proceeded to the online-guided exercises within 4 weeks. Study data showed that after 30 days, 1 (6.3% of the 16 patients in the rehabilitation program had been readmitted compared to 8 (14.8% of 55 patients who were not referred. After 90 days, 2 (12.5% and 11 (20.0% patients were readmitted, respectively. The readmission rate showed a nonsignificant decline in patients participating in rehabilitation. Conclusion: This case study showed that the referral rate of patients with COPD to early municipal rehabilitation is extremely low without a targeted effort and still insufficient in spite of a focused intervention. We showed that completion of a municipal rehabilitation program shortly after discharge is possible even for patients with severe COPD. The findings from

  9. Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial.

    Science.gov (United States)

    Vieira, Ágata; Melo, Cristina; Machado, Jorge; Gabriel, Joaquim

    2018-02-01

    To analyse the effect of a six-month home-based phase III cardiac rehabilitation (CR) specific exercise program, performed in a virtual reality (Kinect) or conventional (booklet) environment, on executive function, quality of life and depression, anxiety and stress of subjects with coronary artery disease. A randomized controlled trial was conducted with subjects, who had completed phase II, randomly assigned to intervention group 1 (IG1), whose program encompassed the use of Kinect (n = 11); or intervention group 2 (IG2), a paper booklet (n = 11); or a control group (CG), only subjected to the usual care (n = 11). The three groups received education on cardiovascular risk factors. The assessed parameters, at baseline (M0), 3 (M1) and 6 months (M2), were executive function, control and integration in the implementation of an adequate behaviour in relation to a certain objective, specifically the ability to switch information (Trail Making Test), working memory (Verbal Digit Span test), and selective attention and conflict resolution ability (Stroop test), quality of life (MacNew questionnaire) and depression, anxiety and stress (Depression, Anxiety and Stress Scale 21). Descriptive and inferential statistical measures were used, significance level was set at .05. The IG1 revealed significant improvements, in the selective attention and conflict resolution ability, in comparison with the CG in the variable difference M0 - M2 (p = .021) and in comparison with the IG2 in the variable difference M1 - M2 and M0 - M2 (p = .001 and p = .002, respectively). No significant differences were found in the quality of life, and depression, anxiety and stress. The virtual reality format had improved selective attention and conflict resolution ability, revealing the potential of CR, specifically with virtual reality exercise, on executive function. Implications for Rehabilitation In cardiac rehabilitation, especially in phase III, it is

  10. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial.

    Science.gov (United States)

    Bourne, Simon; DeVos, Ruth; North, Malcolm; Chauhan, Anoop; Green, Ben; Brown, Thomas; Cornelius, Victoria; Wilkinson, Tom

    2017-07-17

    To obtain evidence whether the online pulmonary rehabilitation(PR) programme 'my-PR' is non-inferior to a conventional face-to-face PR in improving physical performance and symptom scores in patients with COPD. A two-arm parallel single-blind, randomised controlled trial. The online arm carried out pulmonary rehabilitation in their own homes and the face to face arm in a local rehabilitation facility. 90 patients with a diagnosis of chronic obstructive pulmonary disease (COPD), modified Medical Research Council score of 2 or greater referred for pulmonary rehabilitation (PR), randomised in a 2:1 ratio to online (n=64) or face-to-face PR (n=26). Participants unable to use an internet-enabled device at home were excluded. Coprimary outcomes were 6 min walk distance test and the COPD assessment test (CAT) score at completion of the programme. A 6-week PR programme organised either as group sessions in a local rehabilitation facility, or online PR via log in and access to 'myPR'. The adjusted mean difference for the 6 min walk test (6MWT) between groups for the intention-to-treat (ITT) population was 23.8 m with the lower 95% CI well above the non-inferiority threshold of -40.5 m at -4.5 m with an upper 95% CI of +52.2 m. This result was consistent in the per-protocol (PP) population with a mean adjusted difference of 15 m (-13.7 to 43.8). The CAT score difference in the ITT was -1.0 in favour of the online intervention with the upper 95% CI well below the non-inferiority threshold of 1.8 at 0.86 and the lower 95% CI of -2.9. The PP analysis was consistent with the ITT. PR is an evidenced-based and guideline-mandated intervention for patients with COPD with functional limitation. A 6-week programme of online-supported PR was non-inferior to a conventional model delivered in face-to-face sessions in terms of effects on 6MWT distance, and symptom scores and was safe and well tolerated. © Article author(s) (or their employer(s) unless otherwise stated in the

  11. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Bove, Dorthe Gaby; Overgaard, Dorthe; Lomborg, Kirsten

    2015-01-01

    INTRODUCTION: In its final stages, chronic obstructive pulmonary disease is a severely disabling condition that is characterised by dyspnoea, which causes substantial anxiety. Anxiety is associated with an impaired quality of life and increased hospital admissions. Untreated comorbid anxiety can ...... Region of Denmark (number H-1-2013-092) was queried for ethical approval. Trial results will be disseminated in peer-reviewed publications and presented at scientific conferences. TRIAL REGISTRATION NUMBER: NCT02366390....

  12. Chronic obstructive pulmonary disease (COPD) rehabilitation at primary health‐care centres – the KOALA project

    DEFF Research Database (Denmark)

    Godtfredsen, Nina Skavlan; Grann, Ove; Larsen, Hanne Bormann

    2012-01-01

    Background:  Implementation of pulmonary rehabilitation in primary health care in Denmark is a new challenge in the management of patients with chronic obstructive pulmonary disease (COPD). Objectives:  To assess the feasibility of introducing a nationwide web-based tool for data recording...... health-care centres have been invited to participate. We present summary statistics and correlation analyses of the 1699 patients who have been enrolled so far. Results:  Thirty-three municipalities are currently engaged in the KOALA project. Descriptive analyses reveal that 33% of the patients do...

  13. Shuttle Walking Test as Predictor of Survival in Chronic Obstructive Pulmonary Disease Patients Enrolled in a Rehabilitation Program

    DEFF Research Database (Denmark)

    Ringbæk, Thomas; Martinez, Gerd; Brøndum, Eva

    2010-01-01

    BACKGROUND: The Incremental Shuttle Walking Test (ISWT) is used to assess exercise capacity in chronic obstructive pulmonary disease (COPD) and is employed as an outcome measure for pulmonary rehabilitation. We studied the value of this test in predicting survival in COPD patients enrolled......: This study shows that the ISWT is a strong and independent predictor of survival in patients with COPD enrolled in a rehabilitation program....

  14. [Can Pulmonary Rehabilitation during Preoperative Chemoradiotherapy for Non-small Cell Lung Cancer Improve the Respiratory Function?].

    Science.gov (United States)

    Tokunaga, Yoshimasa; Tarumi, Shintaro; Yokomise, Hiroyasu

    2016-01-01

    Chemoradiotherapy for non-small cell lung cancer (NSCLC) can impair pulmonary function, particularly when it is followed by surgery. This study aimed to document the changes in respiratory function as a result of a perioperative intensive pulmonary rehabilitation program in patients with NSCLC who underwent induction chemoradiotherapy. A total of 82 consecutive patients underwent pulmonary resection after undergoing induction chemoradiotherapy. A pulmonary rehabilitation program was started at the same time as the induction chemoradiotherapy. Standard respiratory function tests were performed before and after induction chemoradiotherapy. Treatment-related mortality and the incidence of postoperative respiratory complications were investigated. The Wilcoxon signed-rank test was used to analyze the differences in spirometric changes. All patients underwent a pulmonary rehabilitation program for an average of 10 weeks. Significant increases were observed in forced vital capacity (FVC) [+6.4%, p=.0096] and forced expiratory volume in 1 second( FEV(1))[ +10.4%, prespiratory impairment (FVC respiratory morbidity was 6.1%.

  15. EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Brøndum, Eva; Martinez, Gerd

    2008-01-01

    BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five......-dimension questionnaire (EQ-5D), endurance shuttle walk test (ESWT), and the St George's Respiratory Questionnaire (SGRQ) before and after the programme, and at the 3-month follow-up visit. RESULTS: Two hundred and two (88.4%) patients had FEV(1)... scale. At completion of the programme, statistical significant improvements were seen for ESWT 157.3s; prehabilitation on ESWT and SGRQ were maintained at 3-month follow-up (158.9s...

  16. Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

    Directory of Open Access Journals (Sweden)

    Marcela Muñoz-Torrico

    Full Text Available ABSTRACT The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination, arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT, and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements". The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation; and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns, and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae.

  17. Effects of a Pulmonary Rehabilitation Program for Several Asthme. Case Presentation

    Directory of Open Access Journals (Sweden)

    Gómez V

    2012-05-01

    Full Text Available Objective: to present the effectiveness of pulmonary rehabilitation programs in the treatment of a patient with asthma. Case: this is the case of a young Caucasian girl —17 years old— with severe asthma diagnosis, with symptoms since she was eight years old, 10th grade student. She was referred to the program of Pulmonary Rehabilitation after three hospitalizations during the last year due to asthmatic crises, dyspnoea in activities of daily living, and intolerance to physical exercise. In the initial evaluation, a patient with non-controlled asthma was found; she was receiving short-acting medication admitting that she was not complying with regular use and with a prescribed dose of the pharmacological treatment and that she ignored the importance of this commitment for optimal evolution. The patient expressed concern about the progressive deterioration at her respiratory and functional level during the last year and her fear and anxiety for not being able to breathe during activities befitting her age. One month after receiving bronchodilators and long-acting steroids permanently and complying with recommendations about regular use and adequate inhalatory technique, the patient was included in a three-timesa-week program of pulmonary rehabilitation during eight weeks for upper and lower extremity endurance and resistance training. This intervention showed significant changes in the patient at functional level and a greater social participation.

  18. Adherence to a Maintenance Exercise Program 1 Year After Pulmonary Rehabilitation WHAT ARE THE PREDICTORS OF DROPOUT?

    NARCIS (Netherlands)

    Heerema-Poelman, Ankie; Stuive, Ilse; Wempe, Johan B.

    2013-01-01

    PURPOSE: To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence. METHODS: Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation

  19. Shuttle Walking Test as Predictor of Survival in Chronic Obstructive Pulmonary Disease Patients Enrolled in a Rehabilitation Program

    DEFF Research Database (Denmark)

    Ringbæk, Thomas; Martinez, Gerd; Brøndum, Eva

    2010-01-01

    BACKGROUND: The Incremental Shuttle Walking Test (ISWT) is used to assess exercise capacity in chronic obstructive pulmonary disease (COPD) and is employed as an outcome measure for pulmonary rehabilitation. We studied the value of this test in predicting survival in COPD patients enrolled...

  20. [DGRW-update: relevance and evidence of pulmonary rehabilitation in chronic obstructive respiratory diseases (adults)].

    Science.gov (United States)

    Schultz, Konrad

    2014-06-01

    According to current guidelines, pulmonary rehabilitation is an essential part of the long-term management of the widespread diseases COPD and asthma, of which 11 million people in Germany are currently affected. The body of scientific evidence assuring the relevant positive effects of rehabilitation is of the highest level, especially in the case of COPD. These range from improvement in the major clinical symptoms of shortness of breath and diminished vitality, the reduction of the psychosocial consequences of the disease in terms of secondary anxiety and depression, the reduction of sick days and hospital stays to reduced patient mortality rates after hospitalization for COPD. Considering the enormous medical as well as socio-economic relevance of chronic obstructive pulmonary disease, the convincing body of evidence and the high levels of recommendation in evidence-based guidelines, there is a striking disparity with regard to those rehabilitation measures actually carried out, which, according to German national statutory pension insurance, account for less than 3% of all completed medical rehabilitation measures. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Contribution of Psychological Factors in Dropping out from Chronic Obstructive Pulmonary Disease Rehabilitation Programs

    Science.gov (United States)

    Tselebis, Athanasios; Kosmas, Epaminondas; Bratis, Dionisios; Pachi, Argiro; Ilias, Ioannis; Harikiopoulou, Maria; Theodorakopoulou, Elpida; Velentzas, Konstantinos; Dumitru, Silvia; Moussas, Georgios; Siafakas, Nikolaos; Tzanakis, Nikolaos

    2014-01-01

    Significant positive effects, particularly on psychological state in patients who completed the follow-up pulmonary rehabilitation programs, are indicated by a large number of studies. Yet, a remarkable proportion of selected patients drop out from these programs. In this study, we investigated existing differences on psychological variables among COPD patients who complete and those who drop out from pulmonary rehabilitation programs. The study included 144 patients, 43 (29.9%) of whom did not complete the program. SCL-90 was used for the assessment of psychological symptoms. On the SCL-90-R scale 55.6% of patients had abnormal findings. Patients who discontinued the program had higher rates of depression and somatization compared to those who completed it. Regarding the psychopathology scales of SCL-90R, we found that patients who discontinued the program showed higher levels of psychopathology on the scales of somatization, depression, paranoid ideation, and psychotism compared to those who completed the program. The final regression model showed that patients with low educational status and psychotism were more likely to leave the program. In conclusion, psychopathology contributes to patients dropping out from a COPD rehabilitation program; thus, psychological assessment prior to inclusion in rehabilitation programs may reduce dropouts. PMID:24689040

  2. Predicting respiratory infection one year after inpatient rehabilitation with pulmonary function measured at discharge in persons with spinal cord injury.

    Science.gov (United States)

    Postma, Karin; Bussmann, Johannes B; Haisma, Janneke A; van der Woude, Lucas H; Bergen, Michael P; Stam, Henk J

    2009-09-01

    To determine whether pulmonary function at discharge from inpatient rehabilitation can predict respiratory infection in spinal cord injury in the first year after discharge, and to determine which pulmonary function parameter predicts best. Multicentre prospective cohort study. A total of 140 persons with spinal cord injury. Pulmonary function was tested at discharge from inpatient rehabilitation. Pulmonary function parameters (expressed in absolute and percentage predicted values) were: forced vital capacity, forced expiratory volume in 1 sec, and peak expiratory flow. Respiratory infection was determined one year after discharge by a physician. Differences between the respiratory infection and non-respiratory infection groups were tested; and receiver operating characteristic curves were used to determine how accurately pulmonary function parameters could predict respiratory infection. Of the 140 participants, 14 (10%) experienced respiratory infection in the first year after discharge. All pulmonary function parameters were significantly lower in persons who experienced respiratory infection than in those who did not. All pulmonary function parameters were almost equally accurate in predicting respiratory infection; only percentage predicted forced vital capacity was less accurate. Pulmonary function at discharge from inpatient rehabilitation can be used as a predictor of respiratory infection in the first year after discharge in spinal cord injury. No single pulmonary function parameter was a clearly superior predictor of respiratory infection.

  3. Time to adapt exercise training regimens in pulmonary rehabilitation--a review of the literature.

    Science.gov (United States)

    Lee, Annemarie L; Holland, Anne E

    2014-01-01

    Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD). Patients with a primary diagnosis of COPD often report comorbidities and other secondary manifestations, which diversifies the clinical presentation. Pulmonary rehabilitation that includes whole body exercise training is a critical part of management, and core programs involve endurance and resistance training for the upper and lower limbs. Improvement in maximal and submaximal exercise capacity, dyspnea, fatigue, health-related quality of life, and psychological symptoms are outcomes associated with exercise training in pulmonary rehabilitation, irrespective of the clinical state in which it is commenced. There may be benefits for the health care system as well as the individual patient, with fewer exacerbations and subsequent hospitalization reported with exercise training. The varying clinical profile of COPD may direct the need for modification to traditional training strategies for some patients. Interval training, one-legged cycling (partitioning) and non-linear periodized training appear to be equally or more effective than continuous training. Inspiratory muscle training may have a role as an adjunct to whole body training in selected patients. The benefits of balance training are also emerging. Strategies to ensure that health enhancing behaviors are adopted and maintained are essential. These may include training for an extended duration, alternative environments to undertake the initial program, maintenance programs following initial exercise training, program repetition, and incorporation of approaches to address behavioral change. This may be complemented by methods designed to maximize uptake and completion of a pulmonary rehabilitation program.

  4. LONG-TERM BENEFITS OF REHABILITATION AT HOME ON QUALITY-OF-LIFE AND EXERCISE TOLERANCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

    NARCIS (Netherlands)

    WIJKSTRA, PJ; TENVERGERT, EM; VANALTENA, R; OTTEN, [No Value; KRAAN, J; POSTMA, DS; KOETER, GH

    Background - Pulmonary rehabilitation has been shown to have short term subjective and objective benefits for patients with chronic obstructive pulmonary disease (COPD). However, appropriately controlled studies have not previously been performed, nor have the benefits of different types of

  5. Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD?

    Directory of Open Access Journals (Sweden)

    Alison Jennifer A

    2007-05-01

    Full Text Available Abstract Background Pulmonary rehabilitation programs have been shown to increase functional exercise capacity and quality of life in COPD patients. However, following the completion of pulmonary rehabilitation the benefits begin to decline unless the program is of longer duration or ongoing maintenance exercise is followed. Therefore, the aim of this study is to determine if supervised, weekly, hospital-based exercise compared to home exercise will maintain the benefits gained from an eight-week pulmonary rehabilitation program in COPD subjects to twelve months. Methods Following completion of an eight-week pulmonary rehabilitation program, COPD subjects will be recruited and randomised (using concealed allocation in numbered envelopes into either the maintenance exercise group (supervised, weekly, hospital-based exercise or the control group (unsupervised home exercise and followed for twelve months. Measurements will be taken at baseline (post an eight-week pulmonary rehabilitation program, three, six and twelve months. The exercise measurements will include two six-minute walk tests, two incremental shuttle walk tests, and two endurance shuttle walk tests. Oxygen saturation, heart rate and dyspnoea will be monitored during all these tests. Quality of life will be measured using the St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale. Participants will be excluded if they require supplemental oxygen or have neurological or musculoskeletal co-morbidities that will prevent them from exercising independently. Discussion Pulmonary rehabilitation plays an important part in the management of COPD and the results from this study will help determine if supervised, weekly, hospital-based exercise can successfully maintain functional exercise capacity and quality of life following an eight-week pulmonary rehabilitation program in COPD subjects in Australia.

  6. COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

    Directory of Open Access Journals (Sweden)

    Pierobon A

    2017-07-01

    Full Text Available Antonia Pierobon,1 Elisa Sini Bottelli,1 Laura Ranzini,1 Claudio Bruschi,2 Roberto Maestri,3 Giorgio Bertolotti,4 Marinella Sommaruga,5 Valeria Torlaschi,1 Simona Callegari,1 Anna Giardini1 1Psychology Unit, 2Department of Pulmonary Rehabilitation, 3Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, 4Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tratate, 5Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Camaldoli, Italy Abstract: In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD criteria (mainly in Stage III–IV. The assessment included Mini Mental State Examination (MMSE, Montreal Cognitive Assessment (MoCA, anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%, anxiety (40.5%, good pharmacological adherence (80.3% and difficulties in following prescribed diet (24.1% and exercise (51.8%; they struggled with disease acceptance (30.9% and disease limitations acceptance (28.6%. Most of them received good family (89% or social (53% support. Nonpharmacological adherence

  7. Australian perspective regarding recommendations for physical activity and exercise rehabilitation in pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Gabbay E

    2011-12-01

    Full Text Available Robin Fowler1–3, Sue Jenkins2,3,5, Andrew Maiorana2,4, Kevin Gain2,3,6,7, Gerry O'Driscoll7–9, Eli Gabbay1–3,7–91Advanced Lung Disease Program, Royal Perth Hospital, 2School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, 3Lung Institute of Western Australia (LIWA, Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, 4Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, 5Physiotherapy Department, Sir Charles Gairdner Hospital, 6Respiratory Medicine Department, Royal Perth Hospital, 7School of Medicine, University of Western Australia, 8School of Medicine, University of Notre Dame, 9Heart and Lung Transplant Foundation of Western Australia, Perth, Western Australia, AustraliaAim: To determine the opinion of health care professionals within Australia, regarding acceptable levels of exertion and symptoms, and referral for exercise rehabilitation in patients with pulmonary arterial hypertension (PAH.Method: In 2010, 76 health care professionals at a specialist pulmonary hypertension meeting in Australia were surveyed using a self-administered questionnaire. The questionnaire included case studies of patients with PAH in World Health Organization (WHO functional classes II–IV. For each case study, respondents were asked to report their opinion regarding the acceptable level of exertion and symptoms during daily activities, and whether they would refer the patient for exercise rehabilitation. Three additional questions asked about advice in relation to four specific physical activities.Results: The response rate was 70% (n = 53. Overall, 58% of respondents recommended patients undertake daily activities 'as tolerated'. There was no consensus regarding acceptable levels of breathlessness or fatigue, but the majority of respondents considered patients should have no chest pain (73% and no more than mild light-headedness (92% during daily activities

  8. Does Increased Body Mass Index Effect the Gains of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Patients?

    Directory of Open Access Journals (Sweden)

    Hülya Doğan Şahin

    2017-12-01

    Full Text Available Objective: We aimed to compare the gain of pulmonary rehabilitation (PR in obese, pre-obese, and normal-weight patients with chronic obstructive pulmonary disease (COPD who underwent a PR program. Methods: COPD patients (n=137 underwent pulmonary and cardiac system examination and pulmonary function tests (PFTs before PR. Chest X-rays, arterial blood gases, body mass index, quality of life (QOL questionnaires, anxiety and depression scores, and Modified Medical Research Council dyspnea scale (MMRC scores were evaluated in all patients. A 6-min walk test was performed to determine the exercise capacity of the patients. All patients underwent an 8-week outpatient PR program. The patients were reevaluated at the end of 8th week in terms of all parameters. Results: The study group consisted of 44 normal-weight, 52 pre-obese, and 41 obese COPD patients. Before PR, there was no significant difference in terms of 6-min walk distance (6MWD, PFT, MMRC, or QOL scores between the groups (p>0.05 for all. After PR, partial arterial oxygen pressure and arterial saturation, MMRC, and QOL scores improved significantly in all three groups (p<0.05 for all. 6MWD and walkwork significantly increased after PR in all three groups (p<0.001 for all, but the gain in 6MWD was significantly lower in obese patients compared to pre-obese and normal-weight patients (p=0.049. Conclusion: Pre-obese and obese patients benefit from PR similarly to the normal-weight patients in terms of gas exchange, dyspnea perception, and QOL. But it seems to be that exercise capacity improves less in obese COPD patients compared to pre-obese and normal- weight patients.

  9. Effectiveness of a respiratory rehabilitation programme in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Prunera-Pardell, María Jesús; Padín-López, Susana; Domenech-Del Rio, Adolfo; Godoy-Ramírez, Ana

    To evaluate the effectiveness of the multidisciplinary respiratory rehabilitation (RR) programme in patients with severe or very severe chronic obstructive pulmonary disease pre the RR programme, at the end of the programme and one year after the RR, measuring changes in ability to exercise (walking test), effort tolerance(forced expiratory volume (FEV1)) and health-related quality of life. Quasi-experimental single group design. We included patients diagnosed with severe or very severe chronic obstructive pulmonary disease (stages III and IV of the GOLD classification) who entered the rehabilitation programme for the years 2011 and 2012. Demographic data, questionnaires on general health-related quality of life (SF-36) and specific to respiratory patients (St George's Respiratory Questionnaire), FEV1% and exercise capacity test (running test 6minutes) were collected. Data were collected before the RR programme, at the end of the RR programme and a year after completing the program. No significant differences in FEV1% values were observed. Regarding exercise capacity, an increase in distance walked in the walking test was noted, which changed significantly after training, 377±59.7 to 415±79 m after one year (Pprogramme for 8 weeks improved the exercise capacity, dyspnoea and quality of life of patients with severe and very severe chronic obstructive pulmonary disease. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  10. Participant experiences of a community-based maintenance program post-pulmonary rehabilitation.

    Science.gov (United States)

    Desveaux, Laura; Rolfe, Debbie; Beauchamp, Marla; Goldstein, Roger; Brooks, Dina

    2014-02-01

    The aim of the present study was to describe the perspectives of individuals with chronic obstructive pulmonary disease (COPD) who participated in a minimally supervised maintenance exercise intervention and identify the barriers and facilitators associated with participation. The intervention was delivered in a community center and was designed to maintain exercise capacity and quality of life following discharge from pulmonary rehabilitation. This study utilized qualitative focus groups (FGs) involving individuals with COPD (n = 12) who had been attending the maintenance community program for at least 6 months. All individuals who met the inclusion criteria for the FGs consented to participate. Four themes were identified: (1) issues around attendance; (2) perceived benefits of the program; (3) perceived burdens of the program; and (4) recommendations for program improvement. Participants expressed more benefits than barriers, stating that their experience of improved function and quality of life facilitated their attendance. Barriers included exacerbations, fatigue, access to transportation, and weather. Participants endorsed the benefits of a community-based maintenance exercise program after pulmonary rehabilitation. Minimally supervised community-based programs with access to a case manager may provide a useful approach to enhancing adherence to exercise.

  11. Association of change in depression and anxiety symptoms with functional outcomes in pulmonary rehabilitation patients.

    Science.gov (United States)

    Pirraglia, Paul A; Casserly, Brian; Velasco, Robert; Borgia, Matthew L; Nici, Linda

    2011-07-01

    Pulmonary rehabilitation (PR) has emerged over the last decade as an essential component of an integrated approach to managing patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). We sought to examine how depression and anxiety symptom changes relate to disease-specific quality of life outcomes following PR. We performed a cohort study of 81 patients with COPD who completed PR at a Veterans Administration Medical Center. Pulmonary rehabilitation consisted of supervised exercise training and education twice weekly for 8 weeks. Beck Depression and Anxiety Inventories (BDI and BAI) assessed symptom burden at baseline and completion of PR. We measured change in disease-specific quality of life using the dyspnea, mastery, emotion and fatigue domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR) from baseline to completion of PR. Participants were 69.8±9.1 years old and all male. Forced expiratory volume in 1 s (FEV1) was 1.23±0.39 L. The CRQ-SR scores improved significantly: dyspnea (Pchange was not significantly associated with change in disease-specific quality of life domains. Addressing anxiety symptoms in PR patients may be indicated because disease-specific quality of life improvement appears to be associated with mood. Published by Elsevier Inc.

  12. Patients' and providers' perceptions of the impact of health literacy on communication in pulmonary rehabilitation.

    Science.gov (United States)

    Sadeghi, Shiva; Brooks, Dina; Goldstein, Roger S

    2013-05-01

    Chronic obstructive pulmonary disease (COPD) is the most prevalent form of chronic respiratory diseases worldwide. Pulmonary rehabilitation, including self-management education, highlights the importance of good patient-provider communication in establishing optimal care. There is a growing awareness of the potential impact of health literacy (HL) on the patients' access to and understanding of medical information. This study was designed to explore the patients' and health care professionals' (HCPs) perceptions of the role of HL in health communication. Semi-structured interviews and focus groups were conducted with 12 patients and 20 HCPs at a Pulmonary Rehabilitation Center in Metropolitan Toronto. Although the term health literacy was not familiar to many patients, the contribution of knowledge to patient well-being was consistently identified by patients and HCPs. Barriers to communication included provider time constraints and the use of medical jargon. For providers they also included patient characteristics, language, culture and awareness of health resources. Approaches that might improve communication incorporated family support, peer support, better print and visual teaching material and a trusting empathic patient-provider relationship. The findings provide an increased understanding of patients' and providers' perceptions of HL as a barrier to effective communication of medical information to patients with COPD as well as approaches that might improve this communication.

  13. The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution

    Directory of Open Access Journals (Sweden)

    Dominika Szalewska

    2015-08-01

    Full Text Available Objectives: Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation – hybrid cardiac rehabilitation (HCR seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD as a form of pension prevention paid by the Social Insurance Institution (SII. The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR. Material and Methods: One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males, aged 57.31±5.61 years, were divided into 2 subgroups: W white-collar employees (N = 22 and B blue-collar employees (N = 130. To evaluate functional capacity, an exercise test on a treadmill was used. Results: The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation – B: 1.09±3.10 days, W: 1.95±3.64 days. There were significant improvements (p < 0.05 in measured variables after HCR in both (W and B groups (max workload: 8.21±2.88 METs (measured in metabolic equivalents vs. 9.6±2.49 METs, 7.76±2.51 METs vs. 8.73±2.7 METs, resting heart rate (RHR: 77±16.22 bpm vs. 69.94±12.93 bpm, 79.59±14 bpm vs. 75.24±11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest 10 815.22±2968.24 vs. 9242.94±1923.08, 10 927.62±2508.47 vs. 9929.7±2304.94. In group B, a decrease in systolic blood pressure (BP syst. – 137.03±17.14 mm Hg vs. 131.82±21.13 mm Hg, heart rate recovery in the 1st minute after the end of peak exercise (HRR1 (99.38±19.25 vs. 93.9±19.48 and New York Heart Association (NYHA class (1.22±0.53 vs. 1.11±0.36 was observed. In group W, a decrease in diastolic

  14. Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy.

    Science.gov (United States)

    Yamana, Ippei; Takeno, Shinsuke; Hashimoto, Tatsuya; Maki, Kenji; Shibata, Ryosuke; Shiwaku, Hironari; Shimaoka, Hideki; Shiota, Etsuji; Yamashita, Yuichi

    2015-01-01

    Patients with postoperative pulmonary complications after esophagectomy often have increased mortality. The purpose of the study was to examine the efficacy of preventing postoperative pulmonary complications by an intensive preoperative respiratory rehabilitation (PR) program for esophageal cancer patients. This study was a prospective randomized controlled study. Thirty patients in the PR group and 30 patients in the no preoperative respiratory rehabilitation (NPR) group were included. The PR group received preoperative rehabilitation for more than 7 days, while the NPR group did not receive any preoperative rehabilitation. All patients underwent postoperative rehabilitation from the first postoperative day. The postoperative pulmonary complications were evaluated using the Clavien-Dindo classification (CDC) and the Utrecht Pneumonia Scoring System (UPSS). The CDC grade in the PR group was significantly lower than that in the NPR group (p = 0.014). The UPSS score in the PR group was significantly lower than that in the NPR group at postoperative day 1 (p = 0.031). In the multivariate analysis, NPR was an independent risk factor for postoperative pulmonary complications greater than CDC grade II (OR: 3.99, 95% CI: 1.28-12.4, p = 0.017). This study showed that the intensive PR program was capable of reducing the postoperative pulmonary complications in esophageal cancer patients. © 2015 S. Karger AG, Basel.

  15. Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation.

    Science.gov (United States)

    Florian, Juliessa; Rubin, Adalberto; Mattiello, Rita; Fontoura, Fabrício Farias da; Camargo, José de Jesus Peixoto; Teixeira, Paulo Jose Zimermann

    2013-01-01

    To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47%) had pulmonary fibrosis, 13 (22%) had pulmonary emphysema, and 18 (31%) had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001), the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001), role-physical, up 10 (p = 0.045); vitality, up 10 (p mental health, up 8 (p = 0.001). Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.

  16. [Use of pulmonary rehabilitation in the treatment of decreased respiratory muscle strength].

    Science.gov (United States)

    Neumannová, Kateřina

    2015-01-01

    Decreased respiratory muscle strength could lead to other health problems, which can decrease the quality of life of those patients. Ineffective expectoration and dyspnoea during physical activities and during activity of daily living are the most frequent disorders associated with decreased respiratory muscle strength. Multidisciplinary treatment including pulmonary rehabilitation programme is very important for those patients. Ventilatory muscle training (strength and endurance type of training), airway clearance techniques - active (e.g. autogenic drainage, instrumental techniques) and passive (e.g. manual thoracic compression, mechanical insufflator/exsufflator machine) and exercise training are the most frequent used techniques in these patients. Assessment of all respiratory muscles function - especially their respiratory and postural function - is important at the beginning of rehabilitation treatment.

  17. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease.

    Science.gov (United States)

    Casaburi, R; Porszasz, J; Burns, M R; Carithers, E R; Chang, R S; Cooper, C B

    1997-05-01

    We determined the effect on exercise tolerance and physiological exercise responses of rigorous rehabilitative exercise training in chronic obstructive pulmonary disease (COPD). Fifteen men and 10 women (mean age, 68 +/- 6 yr; FEV1, 0.93 +/- 0.27 L) participated in a rehabilitation program with an exercise component of three per week 45-min sessions of cycle ergometer training for 6 wk with exercise intensity kept near maximal targets. Before and after rehabilitation, patients performed an incremental test and a constant work rate (CWR) test at 80% of the peak work rate in the preprogram incremental test. Ventilation (V(E)) and gas exchange were measured breath by breath; arterialized venous blood was analyzed for blood gas determinations and lactate. Rehabilitation yielded an average increase in peak work rate in the incremental test of 36% (p effect. Further, for identical CWR tasks, V(E) was 10% lower (p exercise training for patients with severe COPD yields more efficient exercise breathing pattern and lower V(E); this is associated with improved exercise tolerance.

  18. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rajashree Ranjita

    2016-07-01

    Conclusions: Findings indicate that IAYT benefits coal miners with COPD, reducing dyspnea; fatigue and PR, and improving functional performance and peripheral capillary SpO2%. Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation programs for COPD patients.

  19. People attending pulmonary rehabilitation demonstrate a substantial engagement with technology and willingness to use telerehabilitation: a survey

    Directory of Open Access Journals (Sweden)

    Zachariah Seidman

    2017-07-01

    Conclusion: People attending metropolitan pulmonary rehabilitation, maintenance exercise classes and support groups had substantial technology engagement, with high device access and use, and good self-rated technology competence. The majority of participants were willing to use telerehabilitation, especially if they were regular users of technology devices. [Seidman Z, McNamara R, Wootton S, Leung R, Spencer L, Dale M, Dennis S, McKeough Z (2017 People attending pulmonary rehabilitation demonstrate a substantial engagement with technology and willingness to use telerehabilitation: a survey. Journal of Physiotherapy 63: 175–181

  20. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer.

    Science.gov (United States)

    Inoue, J; Ono, R; Makiura, D; Kashiwa-Motoyama, M; Miura, Y; Usami, M; Nakamura, T; Imanishi, T; Kuroda, D

    2013-01-01

    Postoperative pulmonary complications (PPCs) after esophagectomy have been reported to occur in 15.9-30% of patients and lead to increased postoperative morbidity and mortality, prolonged duration of hospital stay, and additional medical costs. The purpose of this retrospective cohort study was to investigate the possible prevention of PPCs by intensive preoperative respiratory rehabilitation in esophageal cancer patients who underwent esophagectomy. The subjects included 100 patients (87 males and 13 females with mean age 66.5 ± 8.6 years) who underwent esophagectomy. They were divided into two groups: 63 patients (53 males and 10 females with mean age 67.4 ± 9.0 years) in the preoperative rehabilitation (PR) group and 37 patients (34 males and 3 females with mean age 65.0 ± 7.8 years) in the non-PR (NPR) group. The PR group received sufficient preoperative respiratory rehabilitation for >7 days, and the NPR group insufficiently received preoperative respiratory rehabilitation or none at all. The results of the logistic regression analysis and multivariate analysis to correct for all considerable confounding factors revealed the rates of PPCs of 6.4% and 24.3% in the PR group and NPR group, respectively. The PR group demonstrated a significantly less incidence rate of PPCs than the NPR group (odds ratio: 0.14, 95% confidential interval: 0.02~0.64). [Correction added after online publication 25 June 2012: confidence interval has been changed from -1.86~ -0.22] This study showed that the intensive preoperative respiratory rehabilitation reduced PPCs in esophageal cancer patients who underwent esophagectomy. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  1. COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation.

    Science.gov (United States)

    Sahin, H; Naz, I; Varol, Y; Aksel, N; Tuksavul, F; Ozsoz, A

    The aim of this study was to compare the effects of pulmonary rehabilitation (PR) on six-minute walk test (6mWT) between chronic obstructive pulmonary disease (COPD) patients with moderate or severe carbon monoxide diffusion defects. We also evaluated dyspnea sensation, pulmonary functions, blood gases analysis, quality of life parameters and psychological symptoms in both groups before and after pulmonary rehabilitation. Patients with COPD underwent a comprehensive 8-week out-patient PR program participated in this study. Patients grouped according to diffusion capacity as moderate or severe. Outcome measures were exercise capacity (6mWT), dyspnea sensation, pulmonary function tests, blood gases analysis, quality of life (QoL) and psychological symptoms. A total of 68 patients enrolled in the study. Thirty-two (47%) of them had moderate diffusion defect [TlCO; 52 (47-61)mmol/kPa] and 36 (53%) of them had severe diffusion defect [TlCO; 29 (22-34)mmol/kPa]. At the end of the program, PaO2 (p=0.001), Modified Medical Research Council dyspnea scale (p=0.001), 6mWT (prehabilitation improves oxygenation, severity of dyspnea, exercise capacity and quality of life independent of level of carbon monoxide diffusion capacity in patents with COPD. Furthermore pulmonary rehabilitation may improve DlCO values in COPD patients with severe diffusion defect. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  2. Achievements and Limitations of a Strategy of Rehabilitation of Native Pulmonary Vessels in Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries.

    Science.gov (United States)

    Soquet, Jerome; Liava'a, Matthew; Eastaugh, Lucas; Konstantinov, Igor E; Brink, Johann; Brizard, Christian P; d'Udekem, Yves

    2017-05-01

    A strategy of rehabilitation for pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) comprises repetitive shunting and patching procedures of the central pulmonary arteries. We wanted to determine the feasibility and limitations of a strategy of rehabilitation. The outcomes of 37 consecutive patients operated from June 2003 to December 2014 for PA/VSD/MAPCAs were reviewed. The patients were directed to a rehabilitation strategy, except when they presented in heart failure with very large collaterals. Four patients with very large MAPCAs underwent a one-stage repair with unifocalization of collateral vessels at a median age of 8.6 months. There was no mortality in this group after a median follow-up of 4.6 years. Following a strategy of staged rehabilitation, 33 patients had 2.01 ± 0.9 procedures before repair. Median age at primary shunting was 3.3 weeks (0.4 to 31.9 weeks). Repair rate was 73% (22 patients), at a median age of 1.7 years. Three patients (10%) were left palliated and 3 patients (10%) died. Median follow-up in this group was 4.5 years. Complementary procedures to the rehabilitation strategy consisted in pulmonary artery reconstruction in 25 patients (76%) and MAPCAs ligation in 7 patients (21%). Pulmonary balloon angioplasty was required in 12 patients (36%) and MAPCAs coil occlusion in 8 patients (24%). A strategy of rehabilitation can be implemented in almost 90% of the cases, with a low mortality rate. Following this strategy, 73% of the patients can be successfully repaired. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. [Improvement of lasting effects in outpatient pulmonary rehabilitation with special regard to exercise therapy and sports].

    Science.gov (United States)

    Dalichau, S; Demedts, A; im Sande, A; Möller, T

    2010-02-01

    The aim of this study was to evaluate the effects of outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the Hamburg model, the OMR focuses on keeping up lasting effects. In the frame of a pre-experimental study, 113 male asbestosis patients aged 66.1+/-5.8 years participated 6 hrs. a day five times a week over a period of three weeks in phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied for 3 hrs. once a week over a period of twelve weeks (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near their places of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test) as well as health-related quality of life (SF-36), dyspnea (BDI/TDI) and oxygen partial pressure (pO2) were significantly improved in T2. These positive effects could be confirmed in T3. 89 patients (79%) were doing health-related sports regularly 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 24 patients breaking off any sporting activities wore off again down to and even below the starting condition at T1. In spite of a restrictive pulmonary disease, specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training once a week. Thus, the results emphasize the necessity to include strategies of aftercare in the concept of rehabilitation. Georg

  4. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy

    Directory of Open Access Journals (Sweden)

    Corhay JL

    2013-12-01

    Full Text Available Jean-Louis Corhay, Delphine Nguyen Dang, Hélène Van Cauwenberge, Renaud Louis Department of Pneumology, Centre Hospitalier Universitaire du Sart-Tilman Liège, Liège, Belgium Abstract: Chronic obstructive pulmonary disease (COPD is an obstructive and progressive airway disease associated with an important reduction in daily physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life (HRQoL. Nowadays, pulmonary rehabilitation (PR plays an essential role in the management of symptomatic patients with COPD, by breaking the vicious circle of dyspnea–decreased activity–deconditioning–isolation. Indeed the main benefits of comprehensive PR programs for patients with COPD include a decrease in symptoms (dyspnea and fatigue, improvements in exercise tolerance and HRQoL, reduction of health care utilization (particularly bed-days, as well as an increase in physical activity. Several randomized studies and meta-analyses greatly established the benefits of PR, which additionally, is recommended in a number of influential guidelines. This review aimed to highlight the impact of PR on COPD patients, focusing on the clinical usefulness of PR, which provides patients a good support for change. Keywords: chronic obstructive pulmonary disease, exercise training, physical activity, quality of life

  5. Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease and Metabolic Syndrome

    Directory of Open Access Journals (Sweden)

    Andrey V. Budnevsky

    2017-09-01

    Full Text Available Background: Chronic obstructive pulmonary disease (COPD is widespread and often combined with other diseases, including metabolic syndrome (MS, which are closely related. The purpose of this study was to assess the clinical efficacy of a PR program for patients with COPD and MS, in addition to standard therapy. Materials and Methods: We examined 70 patients with COPD and MS. The patients were divided into 2 groups. Group I included 35 patients who received standard pharmacologic therapy in combination with PR. Group II included 35 patients who received only standard pharmacologic therapy. Results: Group I patients demonstrated a decrease in exacerbation events from 3.96±0.43 to 2.24±0.10 (p=0.0002, in emergency service calls from 3.80±0.37 to 1.59±0.25 (p=0.0000, and in hospital admissions from 2.93±0.11 to 1.41±0.24 (p=0.0004 per year, as well as a significant decrease in the severity of COLD symptoms, improvements in exercise tolerance, MS components and QL, compared to Group II. Conclusion: The main benefits of a comprehensive PR program for patients with COPD and MS include a decrease in symptoms (dyspnea and fatigue, improvements in exercise tolerance, and reduction in health care utilization (particularly bed-days, as well as an increase in physical activity and an improvement in MS components.

  6. Home-based Healthcare Technology

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...... for the home setting and people’s everyday activities....

  7. Rehabilitation

    Science.gov (United States)

    ... doing things you did before. This process is rehabilitation. Rehabilitation often focuses on Physical therapy to help your ... who has had a stroke may simply want rehabilitation to be able to dress or bathe without ...

  8. Using a virtual game system to innovate pulmonary rehabilitation: safety, adherence and enjoyment in severe chronic obstructive pulmonary disease.

    Science.gov (United States)

    Wardini, Rima; Dajczman, Esther; Yang, Nathan; Baltzan, Marcel; Préfontaine, David; Stathatos, Maria; Marciano, Haguit; Watson, Shawn; Wolkove, Norman

    2013-01-01

    The present pilot study tested the use of a virtual game system (VGS) for exercise training in patients with moderate to very severe chronic obstructive pulmonary disease undergoing pulmonary rehabilitation (PR). Safety, feasibility, enjoyment and adherence were assessed. VGS (Wii [2006], Nintendo, USA) games were prescreened and categorized into lower- and upper-body workouts. Patients admitted for a three- to four-week inpatient PR program exercised daily. They were provided an opportunity to individually engage in VGS sessions three times weekly, varying with length of stay. Dyspnea, oxygen saturation and heart rate were measured before, during and after game sessions. Patients were considered to be adherent if they attended at least 50% of VGS sessions. Adverse events and enjoyment were evaluated. Thirty-two patients with a mean (± SD) age of 66±9 years and a mean forced expiratory volume in 1 s of 0.72±0.40 L participated. Among the 25 patients completing the program, adherence was 76%, with a mean attendance rate of 64±35%. Mean dyspnea score was 1.5±1.1 before and 3.2±1.2 after exercise. Mean oxygen saturation changed from 94±3% to 91±5% (P<0.001), while heart rate increased from 88±15 beats⁄min to 102±18 beats⁄min (P<0.001). One patient reported chest pain requiring nitroglycerin spray and five experienced transient desaturation below 85% with play. Patients enjoyed the program (visual analogue score 8±2.6⁄10) and most would highly recommend it to others. Moderate exercise using a VGS was safe, feasible and enjoyed as an adjunct to inpatient PR. This modality may encourage patients to maintain physical activity after PR.

  9. Pulmonary Rehabilitation Outcomes after Single or Double Lung Transplantation in Patients with Chronic Obstructive Pulmonary Disease or Interstitial Lung Disease.

    Science.gov (United States)

    Schneeberger, Tessa; Gloeckl, Rainer; Welte, Tobias; Kenn, Klaus

    2017-01-01

    Pulmonary rehabilitation (PR) following lung transplantation (LTx) has been shown to be effective with regard to exercise capacity and health-related quality of life (HRQL). However, outcome data is limited with respect to LTx as a population. Differences concerning the effects of PR in patients with single LTx (SLTx) or double LTx (DLTx) have not been studied yet. The aim was to compare possible differences concerning PR outcomes between SLTx and DLTx. In a retrospective analysis (period: 1997-2016), data from 722 patients with either chronic obstructive pulmonary disease (COPD; SLTx: n = 129, FEV1 51 ± 17% pred.; DLTx: n = 204, FEV1 74 ± 20% pred.) or interstitial lung disease (ILD; SLTx: n = 135, FVC 58 ± 18% pred.; DLTx: n = 254, FVC 63 ± 18% pred.) after LTx were included. All patients underwent a specialized inpatient PR program. The data of the 6-minute walk distance (6MWD) and HRQL (physical [PCS] and mental [MCS] component summary of the SF- 36 questionnaire) were analyzed. Independently from the procedure and pretransplant diagnosis, patients significantly (p < 0.05) improved the 6MWD without any differences between SLTx and DLTx (COPD: SLTx: +109 ± 68 m, DLTx: +117 ± 82 m; ILD: SLTx: +115 ± 80 m, DLTx: +132 ± 77 m). The PCS (COPD: SLTx: +9 ± 9 points, DLTx: +7 ± 9 points; ILD: SLTx: +6 ± 9 points, DLTx: +9 ± 9 points) and MCS (COPD: SLTx: +8 ± 15 points, DLTx: +7 ± 15 points; ILD: SLTx: +10 ± 13 points, DLTx: +8 ± 12 points) also improved significantly without any group differences. LTx patients with a pretransplant diagnosis of COPD or ILD all benefitted significantly and with clinical relevance with regard to exercise capacity and HRQL from an inpatient PR performed within 1 year postoperatively. PR outcomes were similar regardless of SLTx or DLTx. © 2017 S. Karger AG, Basel.

  10. Blood gas analysis, blood saturation and chosen parameters of spirometric examination in NSCLC patients undergoing chemotherapy and pulmonary rehabilitation.

    Science.gov (United States)

    Tokarski, Sławomir; Tokarska, Kamila; Schwarz, Ewa; Obrebska, Agnieszka; Mejer, Anna; Kowalski, Jan

    2014-04-01

    In industrialized countries lung cancer is associated with highest mortality among carcinoma. Progression of the disease is associated with diminished tolerance for physical activities, aggravated dyspnea and lowering of life quality. The aim of study was the evaluation of blood gas, blood saturation and chosen parameters of spirometric examination in NSCLC patients undergoing chemotherapy and pulmonary rehabilitation. Analysis of capillary blood was done using RapidPoint 405 Siemens device. Spirometric examination was done using PNEUMO abcMED device. Forty-nine patients with inoperable NSCLC were subjected to the examination. This included 38 men and 11 women aged between 46-75 years (mean age 63 +/- 7.5 years) who were separated into two groups: group I--25 patients undergoing standard chemotherapy (group C); group II--24 patients undergoing standard chemotherapy and pulmonary rehabilitation (group CK). All patients were subjected to blood gas analysis, blood saturation analysis and spirometric examination twice, before and after first-line chemotherapy Increase of pO2 and SaO2 in blood, and FEV1 and FVC in spirometric examination was significantly higher in patients undergoing pulmonary rehabilitation and chemotherapy (group II) (p blood gas, blood saturation analysis and chosen parameters of spirometric analysis. Pulmonary rehabilitation in patients with lung cancer seems to be an important form of supplementary treatment.

  11. Improvements in quadriceps force and work efficiency are related to improvements in endurance capacity following pulmonary rehabilitation in COPD patients.

    Science.gov (United States)

    Arizono, Shinichi; Taniguchi, Hiroyuki; Nishiyama, Osamu; Kondoh, Yasuhiro; Kimura, Tomoki; Kataoka, Kensuke; Ogawa, Tomoya; Watanabe, Fumiko; Nishimura, Koichi; Senjyu, Hideaki; Tabira, Kazuyuki

    2011-01-01

    The endurance time has been reported to be the most sensitive measure of improved exercise capacity in response to a variety of interventions for COPD. The aim of the present study was to determine whether the improvements in quadriceps force and measures obtained from a symptom-limited maximal test contributed to the improvements in endurance time following pulmonary rehabilitation. Fifty-seven consecutive COPD subjects completed a 10-week pulmonary rehabilitation program. The subjects completed a symptom-limited incremental cycle ergometry test and a constant work rate test before and after pulmonary rehabilitation. Peripheral and respiratory muscle strength was also measured. The relationships between the change in endurance time and the changes obtained from the incremental test and muscle strength test were investigated. The endurance time showed the greatest improvement among the exercise capacity indices. The changes in endurance time were significantly correlated to changes in quadriceps force, peak work rate, anaerobic threshold and work efficiency on the incremental load test. In the multiple stepwise regression analysis, changes in quadriceps force and work efficiency measured on the maximal exercise test were selected. These findings suggest that the improvements in endurance time after pulmonary rehabilitation may be explained by increased quadriceps force and improvements in peak work rate and work efficiency.

  12. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

    NARCIS (Netherlands)

    Retèl, Valesca P.; van den Boer, Cindy; Steuten, Lotte M. G.; Okła, Sławomir; Hilgers, Frans J.; van den Brekel, Michiel W.

    2015-01-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore,

  13. QUALITY-OF-LIFE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE IMPROVES AFTER REHABILITATION AT HOME

    NARCIS (Netherlands)

    WIJKSTRA, PJ; VANALTENA, R; KRAAN, J; OTTEN, [No Value; POSTMA, DS; KOETER, GH

    We have developed a rehabilitation programme at home and have investigated its effects on quality of life (QOL), lung function, and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). We studied 43 patients with severe airflow obstruction: forced expiratory volume in

  14. Interactive web-based pulmonary rehabilitation programme: a randomised controlled feasibility trial.

    Science.gov (United States)

    Chaplin, Emma; Hewitt, Stacey; Apps, Lindsay; Bankart, John; Pulikottil-Jacob, Ruth; Boyce, Sally; Morgan, Mike; Williams, Johanna; Singh, Sally

    2017-03-31

    The aim of this study was to determine if an interactive web-based pulmonary rehabilitation (PR) programme is a feasible alternative to conventional PR. Randomised controlled feasibility trial. Participants with a diagnosis of chronic obstructive pulmonary disease were recruited from PR assessments, primary care and community rehabilitation programmes. Patients randomised to conventional rehabilitation started the programme according to the standard care at their referred site on the next available date. 103 patients were recruited to the study and randomised: 52 to conventional rehabilitation (mean (±SD) age 66 (±8) years, Medical Research Council (MRC) 3 (IQR2-4)); 51 to the web arm (mean (±SD) age 66 (±10) years, MRC 3 (IQR2-4)). Participants had to be willing to participate in either arm of the trial, have internet access and be web literate. Patients randomised to the web-based programme worked through the website, exercising and recording their progress as well as reading educational material. Conventional PR consisted of twice weekly, 2 hourly sessions (an hour for exercise training and an hour for education). Recruitment rates, eligibility, patient preference and dropout and completion rates for both programmes were collected. Standard outcomes for a PR assessment including measures of exercise capacity and quality of life questionnaires were also evaluated. A statistically significant improvement (p≤0.01) was observed within each group in the endurance shuttle walk test (WEB: mean change 189±211.1; PR classes: mean change 184.5±247.4 s) and Chronic Respiratory disease Questionnaire-Dyspnoea (CRQ-D; WEB: mean change 0.7±1.2; PR classes: mean change 0.8±1.0). However, there were no significant differences between the groups in any outcome. Dropout rates were higher in the web-based programme (57% vs 23%). An interactive web-based PR programme is feasible and acceptable when compared with conventional PR. Future trials maybe around choice-based PR

  15. Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation

    Directory of Open Access Journals (Sweden)

    Juliessa Florian

    2013-06-01

    Full Text Available OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36. The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47% had pulmonary fibrosis, 13 (22% had pulmonary emphysema, and 18 (31% had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001, the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001, role-physical, up 10 (p = 0.045; vitality, up 10 (p < 0.001; social functioning, up 15 (p = 0.001; and mental health, up 8 (p = 0.001. CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.

  16. Does creatine supplementation enhance the effects of physical training during pulmonary rehabilitation in COPD?

    Directory of Open Access Journals (Sweden)

    Sarah. J. Deacon

    2006-12-01

    Full Text Available We conducted a randomised, placebo-controlled trial to examine whether creatine supplementation augments the benefits of pulmonary rehabilitation (PR, containing aerobic exercise and resistance training (RT. 80 subjects with COPD (GOLD stages I–IV [mean (SD age 68 (7.8 yrs, FEV1 44.1 (20.3 % predicted] completed 21 sessions of PR, with enhanced RT, following baseline measurements and randomisation to take creatine (Cr or placebo (Pl supplement. A subgroup had muscle biopsies. Groups were well matched at baseline except for gender (M:F Cr 19:19, Pl 31:11, Chi2 p = 0.03. Mean change in functional performance & muscle strength after PR are shown. Health status (CRQ-SR improved significantly after PR but did not differ between groups. Muscle biopsies showed evidence of creatine uptake. This adequately powered study showed significant improvements in all outcomes following PR. Creatine supplementation did not enhance these benefits.

  17. Pulmonary rehabilitation and noninvasive ventilation in patients with hypercapnic interstitial lung disease.

    Science.gov (United States)

    Dreher, Michael; Ekkernkamp, Emelie; Schmoor, Claudia; Schoenheit-Kenn, Ursula; Winterkamp, Sandra; Kenn, Klaus

    2015-01-01

    Pulmonary rehabilitation (PR) has a positive impact on functional status and quality of life in patients with interstitial lung disease (ILD). This study investigated the effects of PR in hypercapnic ILD patients receiving nighttime noninvasive positive pressure ventilation (NPPV). Consecutive ILD patients referred to a specialized inpatient PR center were included. All participated in a PR program. Those with hypercapnia received NPPV (NPPV group; n = 29); the remaining patients served as comparison group (n = 319). PR improved the 6-min walk distance by 64.4 ± 67.1 m versus baseline (p mental component score versus baseline in both groups. An individually tailored PR plus nighttime NPPV appears feasible in hypercapnic ILD patients and significantly improves exercise capacity and quality of life.

  18. Is the Cardiovascular Response Equivalent Between a Supervised Center-Based Setting and a Self-care Home-Based Setting When Rating of Perceived Exertion Is Used to Guide Aerobic Exercise Intensity During a Cardiac Rehabilitation Program?

    DEFF Research Database (Denmark)

    Tang, Lars H.; Zwisler, Ann-Dorthe; Berg, Selina K.

    2017-01-01

    OBJECTIVES: The aim of this study was to investigate if exercise intensity guided by rating of perceived exertion (RPE) results in an equivalent cardiovascular response when applied in either a center-based or a home-based setting. DESIGN: Data from patients with heart disease (post-valve surgery...

  19. A new pulmonary rehabilitation maintenance strategy through home-visiting and phone contact in COPD

    Directory of Open Access Journals (Sweden)

    Li Y

    2018-01-01

    Full Text Available Yi Li,1,2 Jing Feng,3,4 Yuechuan Li,2 Wei Jia,2 Hongyu Qian2 1Graduate School, Tianjin Medical University, 2Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, 3Respiratory Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 4Neuropharmacology Section, Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA Background: The benefit of pulmonary rehabilitation (PR for patients with COPD diminishes over time. We investigated a new strategy involving home-visit and phone contact and compared this to usual care in maintenance of PR benefits.Methods: A total of 172 stable COPD patients receiving 8-week PR program were recruited for this prospective study. Patients were allocated into usual care group (UC and PR maintenance group (PRMG randomly. Patients in PRMG participated in maintenance strategy at home under supervision through home-visit and phone contact. The 6-minute walking test (6MWT, COPD assessment test (CAT, and modified Medical Research Council scale (mMRC scores were evaluated every 3 months.Results: Of the total, 151 patients completed 8-week PR program with satisfactory PR results (p<0.001, and 104 patients finished the follow-up. The clinical improvements in 6MWT, CAT, and mMRC scores were maintained (p<0.001 in PRMG. In comparison, the benefit of PR diminished gradually in UC. The differences in 6MWT, CAT, and mMRC scores between groups were observed 6, 9, and 6 months after PR, respectively (p<0.05. Total frequency of exacerbations in PRMG was lower than UC (p=0.021.Conclusion: Maintenance strategy involving home-visit and phone contact is superior to usual care to preserve PR benefits, and reduces the acute COPD exacerbation rate. Keywords: COPD, pulmonary rehabilitation, 6-minute walking test, COPD assessment test, maintenance 

  20. Patient Profile of Drop-Outs From a Pulmonary Rehabilitation Program.

    Science.gov (United States)

    Almadana Pacheco, Virginia; Pavón Masa, María; Gómez-Bastero Fernández, Ana Paulina; Muñiz Rodríguez, Ana Mirian; Tallón Moreno, Rodrigo; Montemayor Rubio, Teodoro

    2017-05-01

    While the benefits of pulmonary rehabilitation programs (PR) in COPD have been demonstrated, poor adherence, related with worse clinical outcomes, is common. The purpose of this study was to examine causes for drop-out during a 12-week multidisciplinary pulmonary rehabilitation program and to investigate the characteristics of patients with poor adherence, with special emphasis on functional and clinical characteristics. A prospective study was performed between February and November 2015in 83 COPD patients enrolled in an outpatient program of 36 strength +resistance training sessions. Ambulances were provided to facilitate access to the clinic. Patients were divided into: adherent (A) (attended at least 70% of the program) or non-adherent (NA) (at least one session). A total of 83 patients were evaluated and 26 excluded; 15.7% refused to participate. The drop-out rate was 38.5%. The main causes were low motivation and transport problems. Lower forced vital capacity (NA, 58.9% vs A, 67.8%; P=.03), worse results on submaximal exercise test (NA, 6.2minutes vs A, 9.2minutes; P=.02), in total distance walked (NA, 42.6 vs A, 56.5; P=.03) and VO2 in ml/min/kg (NA, 11.4 vs A, 13.6; P=.03) and in ml/min (NA, 839 vs A, 1020; P=.04) were found in the non-adherent group. This group also showed higher use of oral steroids (NA, 23.8% vs A, 2.9%; P=.01). More than 1/3 of patients leave programs. The main causes are related to motivation and transport. The patients who dropout are those with worse functional tests, more exacerbations, steroids and smoking habit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Responsiveness and MCID Estimates for CAT, CCQ, and HADS in Patients With COPD Undergoing Pulmonary Rehabilitation: A Prospective Analysis.

    Science.gov (United States)

    Smid, Dionne E; Franssen, Frits M E; Houben-Wilke, Sarah; Vanfleteren, Lowie E G W; Janssen, Daisy J A; Wouters, Emiel F M; Spruit, Martijn A

    2017-01-01

    Pulmonary rehabilitation enhances health status and mood status in patients with chronic obstructive pulmonary disease (COPD). The aim was to determine the responsiveness of St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), COPD Clinical Questionnaire (CCQ), and Hospital Anxiety and Depression Scale (HADS) to pulmonary rehabilitation in patients with COPD, and estimate minimum clinically important differences (MCIDs) for CAT, CCQ, and HADS. A prospective analysis. MCIDs were estimated with anchor-based (anchor: SGRQ) and distribution-based methods. Newly estimated MCIDs were compared to known MCID estimates from a systematic literature search. Newly estimated MCIDs were calculated in patients treated in pulmonary rehabilitation. A subsample of 419 individuals with COPD (55.4% male, mean age 64.3 ± 8.8 years) were included from the Chance study. Health status was measured with SGRQ, CAT, and CCQ, before and after pulmonary rehabilitation. Mood status was assessed using HADS. 419 patients with COPD (forced expiratory volume in the first second 37.3% ± 12.1% predicted) completed pulmonary rehabilitation. SGRQ (-9.1 ± 14.0 points), CAT (-3.0 ± 6.8 points), CCQ (-0.6 ± 0.9 points), HADS-Anxiety (-1.7 ± 3.7 points), and HADS-Depression (-2.1 ± 3.7 points) improved significantly. New MCIDs were estimated for CAT (range: -3.8 to -1.0 points), CCQ (range: -0.8 to -0.2 points), HADS-Anxiety (range: -2.0 to -1.1 points), and HADS-Depression (range: -1.8 to -1.4 points). The SGRQ, CAT, CCQ, and HADS are responsive to pulmonary rehabilitation in patients with COPD. We propose MCID estimates ranging between -3.0 and -2.0 points for CAT; -0.5 and -0.3 points for CCQ, -1.8 and -1.3 points for HADS-Anxiety, and -1.7 and -1.5 points for HADS-Depression. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  2. Response of the COPD Assessment Test to pulmonary rehabilitation in unselected chronic respiratory disease.

    Science.gov (United States)

    Kon, Samantha S C; Clark, Amy L; Dilaver, Deniz; Canavan, Jane L; Patel, Mehul S; Polkey, Michael I; Man, William D-C

    2013-08-01

    The COPD Assessment Test (CAT) is a recently introduced, simple-to-use health status instrument that takes less time to complete than better-established health status instruments. In chronic obstructive pulmonary disease (COPD) patients, the CAT improves with pulmonary rehabilitation (PR), and changes correlate with improvements in longer-established health status instruments such as the Chronic Respiratory Questionnaire (CRQ). Increasing numbers of non-COPD patients are referred for PR, but it is not known whether the CAT is responsive to PR in these populations. The CAT score was prospectively measured in 365 consecutive patients (255 COPD, 110 non-COPD) before and after an 8-week PR programme. Pre to post change in CAT was calculated for COPD and non-COPD patients, and correlated with change in the CRQ. For both non-COPD and COPD patients, there was a similar and significant improvement in the mean (95% confidence interval) CAT score following PR (non-COPD: -2.1 (-1.0, -3.2) vs COPD: -3.0 (-2.2, -3.8); P = 0.19). Change in CAT was significantly correlated with all domains of the CRQ in non-COPD patients (all P respiratory disease patients undergoing PR, the CAT is a practical alternative to longer-established health status questionnaires. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  3. Stair-Climbing Capacity as a Marker of Improvement Following Pulmonary Rehabilitation.

    Science.gov (United States)

    Dubé, Bruno-Pierre; Houle-Péloquin, Marilyn; Sauvageau, Benoit; Lalande-Gauthier, Mélina; Poirier, Claude

    2017-05-01

    The aim of this study was to explore the potential and safety of a stair-climbing test as a tool to monitor improvement following pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Stair-climbing capacity was assessed in 139 patients with COPD before and after a comprehensive 8-week PR program, which included stair-climbing training. Stair-climbing capacity was assessed as the total number of flights of stairs climbed without stopping. A constant work rate endurance test (CET) was also performed before and after PR. Change in stair-climbing after PR (Δstairs) was compared and correlated to the change in endurance time (ΔCET) and, for 40 patients, to the change in COPD assessment test (ΔCAT) score. Most patients had moderate to severe COPD (mean forced expiratory volume in 1 second = 54% ± 20% predicted). Stair-climbing capacity, endurance time, and CAT score improved after PR (2.8 ± 1.4 vs 8.3 ± 3.3 flights, 408 ± 272 vs 717 ± 415 seconds, and 20.0 ± 6.4 vs 17.6 ± 6.6 units, respectively; P value for all climbing. Stair-climbing is responsive to training in patients with COPD and is correlated to the change in CAT score following PR. Although the test requires further standardization, it could eventually be used as a simple and safe way to assess improvement following interventions in COPD.

  4. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation.

    Science.gov (United States)

    Mador, M Jeffery; Deniz, Omer; Deniz, Omar; Aggarwal, Ajay; Shaffer, Mary; Kufel, Thomas J; Spengler, Christina M

    2005-09-01

    Respiratory muscle endurance training (hyperpnea training) has been shown to have beneficial effects in patients with COPD. The purpose of this study was to determine whether hyperpnea training, when added to an endurance exercise training program, would lead to additional benefits compared with endurance training alone in patients with COPD. Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program. Fifteen patients (mean [+/- SE] FEV1, 45 +/- 6% predicted) were randomized to combined therapy, and 14 patients (mean FEV1, 44 +/- 4% predicted) were randomized to endurance training. Peak exercise capacity, exercise endurance time during constant workload cycle exercise, 6-min walk distance, quality of life as measured by the chronic respiratory questionnaire, respiratory muscle strength and endurance, and quadriceps fatigability were measured before and after endurance or combined training. After rehabilitation, peak exercise capacity, exercise endurance time, 6-min walk distance, and quality of life all increased in both groups, but there was no significant difference in the extent of improvement between groups. Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group (17.5 +/- 2.7 vs 8.5 +/- 2.5 min, respectively; p = 0.02). Respiratory muscle strength was significantly increased, and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group, but the difference between groups did not reach statistical significance. The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD. However, this improvement did not translate into additional improvement in quality of life or exercise performance.

  5. Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference

    Science.gov (United States)

    Alma, Harma; de Jong, Corina; Jelusic, Danijel; Wittmann, Michael; Schuler, Michael; Blok, Bertine Flokstra-de; Kocks, Janwillem; Schultz, Konrad; Molen, Thys van der

    2016-01-01

    The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28–0.61 (CCQ), 1.46–3.08 (CAT) and 6.86–9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD. PMID:27597571

  6. Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Cameron-Tucker HL

    2014-05-01

    Full Text Available Helen L Cameron-Tucker,1 Richard Wood-Baker,1 Christine Owen,2 Lyn Joseph,3 E Haydn Walters11Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, University of Tasmania, Hobart, TAS, Australia; 2Faculty of Education, University of Tasmania, Hobart, TAS, Australia; 3Department of Respiratory Medicine, Royal Hobart Hospital, Hobart, TAS, AustraliaPurpose: Both exercise and self-management are advocated in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD. The widely used 6-week, group-based Chronic Disease Self-Management Program (CDSMP increases self-reported exercise, despite supervised exercise not being a program component. This has been little explored in COPD. Whether adding supervised exercise to the CDSMP would add benefit is unknown. We investigated the CDSMP in COPD, with and without a formal supervised exercise component, to address this question.Patients and methods: Adult outpatients with COPD were randomized to the CDSMP with or without one hour of weekly supervised exercise over 6 weeks. The primary outcome measure was 6-minute walk test distance (6MWD. Secondary outcomes included self-reported exercise, exercise stage of change, exercise self-efficacy, breathlessness, quality of life, and self-management behaviors. Within- and between-group differences were analyzed on an intention-to-treat basis.Results: Of 84 subjects recruited, 15 withdrew. 6MWD increased similarly in both groups: CDSMP-plus-exercise (intervention group by 18.6±46.2 m; CDSMP-alone (control group by 20.0±46.2 m. There was no significant difference for any secondary outcome.Conclusion: The CDSMP produced à small statistically significant increase in 6MWD. The addition of a single supervised exercise session did not further increase exercise capacity. Our findings confirm the efficacy of a behaviorally based intervention in COPD, but this would seem to be less than expected from

  7. Building consensus for provision of breathlessness rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure.

    Science.gov (United States)

    Man, William D-C; Chowdhury, Faiza; Taylor, Rod S; Evans, Rachael A; Doherty, Patrick; Singh, Sally J; Booth, Sara; Thomason, Davey; Andrews, Debbie; Lee, Cassie; Hanna, Jackie; Morgan, Michael D; Bell, Derek; Cowie, Martin R

    2016-08-01

    The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the 'most important' component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers. © The Author(s) 2016.

  8. Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation

    Directory of Open Access Journals (Sweden)

    André Luis Pereira de Albuquerque

    2016-04-01

    Full Text Available Objective: Pulmonary rehabilitation (PR improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. Methods: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV1 = 37.1 ± 11.8% of predicted who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography and determined maximal workloads. Results: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001 and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02. At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO2, and minute ventilation. The inspiratory (operating rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO2 during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. Conclusions: In severe COPD, PR appears to improve oxygen consumption and reduce VCO2, with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program.

  9. Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: a systematic review with meta-analyses

    Directory of Open Access Journals (Sweden)

    Rugbjerg M

    2015-04-01

    Full Text Available Mette Rugbjerg,1 Ulrik Winning Iepsen,1 Karsten Juhl Jørgensen,2 Peter Lange1,3,4 1The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark; 3Department of Respiratory Medicine, University Hospital Hvidovre, Copenhagen, Denmark; 4Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark Purpose: Most guidelines recommend pulmonary rehabilitation (PR for patients with chronic obstructive pulmonary disease (COPD and modified Medical Research Council dyspnea scale (mMRC levels ≥2, but the effectiveness of PR in patients with less advanced disease is not well established. Our aim was to investigate the effects of PR in patients with COPD and mMRC ≤1.Methods: The methodology was developed as a part of evidence-based guideline development and is in accordance with the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE Working Group. We identified randomized controlled trials (RCTs through a systematic, multidatabase literature search and selected RCTs comparing the effects of PR with usual care in patients with COPD and mMRC ≤1. Predefined critical outcomes were health-related quality of life (HRQoL, adverse effects and mortality, while walking distance, maximal exercise capacity, muscle strength, and dropouts were important outcomes. Two authors independently extracted data, assessed trial eligibility and risk of bias, and graded the evidence. Meta-analyses were performed when deemed feasible.Results: Four RCTs (489 participants were included. On the basis of moderate-quality evidence, we found a clinically and statistically significant improvement in short-term HRQoL of 4.2 units (95% confidence interval [CI]: [-4.51 to -3.89] on St George’s Respiratory

  10. Experiences of patients undergoing pulmonary rehabilitation during an exacerbation of chronic respiratory disease.

    Science.gov (United States)

    Vincent, Emma E; Chaplin, Emma J; Williams, Johanna Ea; Harvey-Dunstan, Theresa; Greening, Neil J; Steiner, Michael C; Morgan, Mike D; Singh, Sally J

    2017-08-01

    Chronic obstructive pulmonary disease (COPD) is characterized in the later stages by acute exacerbations that often require hospitalization. Pulmonary rehabilitation is recommended for patients with COPD to aid symptom control, improve quality of life and increase physical activity. We have previously reported a large intervention trial commenced during a hospital admission. The aim of this sub-study was to evaluate the patients' experiences of discharge following the hospitalization for an acute exacerbation of COPD. During a programme of early rehabilitation (ER) patient perceptions, experiences and healthcare use were collated during the month that followed their discharge. ER (started during their admission) was comprised of exercise training techniques that were modified to suit the environment of acute illness, together with an education and self-management programme. Each patient was then supported on the programme by telephone contact, following their discharge home, at 48 hours, 2 weeks and 4 weeks. We collected information in relation to the walking and exercise progression; we monitored patient recall of healthcare use, compliance/understanding of medical therapy, as well as their wider perceptions that may have influenced the recovery process. Healthcare use was captured using GP records and data analysis. Of the 100 patients, 47 males, (mean (standard deviation)) 71 (9.3) years, FEV1 1.14 L (0.6), BMI 26.6 (6.9), pack smoked years 45.8 (29.6), ethnicity White British 97%, were discharged home following an acute exacerbation of their respiratory symptoms, to an ER programme. At 48 hours following discharge, a minority (20%) of patients stated their symptoms were 'feeling better'; 15% highlighted that they found the prescribed 'exercise difficult'; 44% of patients felt at the end of the month that prescribed exercise programme had a 'positive effect' on their recovery from their exacerbation; 38% of patients felt their family had a positive effect on

  11. Health status of COPD patients undergoing pulmonary rehabilitation: A comparative responsiveness of the CAT and SGRQ.

    Science.gov (United States)

    Sciriha, Anabel; Lungaro-Mifsud, Stephen; Scerri, Josianne; Magro, Rosalie; Camilleri, Liberato; Montefort, Stephen

    2017-11-01

    The St. George's Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1-2) and severe to very severe (mMRC 3-4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3-4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3-4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3-4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.

  12. The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD.

    Science.gov (United States)

    Cleutjens, Fiona A H M; Spruit, Martijn A; Ponds, Rudolf W H M; Vanfleteren, Lowie E G W; Franssen, Frits M E; Dijkstra, Jeanette B; Gijsen, Candy; Wouters, Emiel F M; Janssen, Daisy J A

    2017-05-01

    To compare changes in pulmonary rehabilitation (PR) dropout and outcomes between chronic obstructive pulmonary disease (COPD) patients with and without cognitive impairment. A cross-sectional observational study. Patients with COPD were recruited from a PR centre in the Netherlands. The study population consisted of 157 patients with clinically stable COPD who were referred for and completed PR. A comprehensive neuropsychological examination before start of PR was administered. Changes from baseline to PR completion in functional exercise capacity [6-minute walk test (6MWT)], disease-specific health status [COPD Assessment Test (CAT) and St George's Respiratory Questionnaire-COPD specific (SGRQ-C)], psychological well-being [Hospital Anxiety and Depression Scale (HADS)], COPD-related knowledge, and their need for information [Lung Information Needs Questionnaire (LINQ)] were compared between patients with and without cognitive impairment using independent samples t tests or Mann-Whitney U tests. Out of 157 patients with COPD [mean age 62.9 (9.4) years, forced expiratory volume in the first second 54.6% (22.9%) predicted], 24 patients (15.3%) did not complete PR. The dropout rate was worse in patients with cognitive impairment compared to those without cognitive impairment (23.3% and 10.3%, P = .03). Mean changes in PR outcomes after PR did not differ between completers with and without cognitive impairment. The proportion of patients with a clinically relevant improvement in 6MWT, CAT, SGRQ-C, HADS, and LINQ scores was comparable for patients with and without cognitive impairment. PR is an effective treatment for patients with COPD and cognitive impairment. Yet patients with cognitive impairment are at increased risk for not completing the PR program. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Predictors of success for pulmonary rehabilitation in patients awaiting lung transplantation.

    Science.gov (United States)

    Kenn, Klaus; Gloeckl, Rainer; Soennichsen, Andreas; Sczepanski, Bernd; Winterkamp, Sandra; Boensch, M; Welte, Tobias

    2015-05-01

    Numerous studies have shown the effectiveness of comprehensive pulmonary rehabilitation (PR) programs in chronic obstructive pulmonary disease (COPD). At present, it is uncertain whether PR is also effective in the management of patients with various diseases awaiting lung transplantation (LTx). In a retrospective clinical preanalysis and postanalysis, we investigated the effects of a 5-week inpatient PR in LTx candidates. We compared data of patients with COPD, α-1-antitrypsin deficiency, interstitial lung disease, or cystic fibrosis before and after PR with regard to exercise capacity (6-min walking distance [6MWD]) and health-related quality of life (HRQL; SF36). Multivariate stepwise regression analysis was performed to detect predictors of PR outcome. Eight hundred eleven data sets from consecutive patients referred to our PR center before LTx could be analysed (COPD, 360; α-1-antitrypsin deficiency, 127; interstitial lung disease, 195; cystic fibrosis, 69; other, 60). After PR 6MWD increased by 56 ± 58 m (P mental summary component of SF36 by 8.7 ± 13.5 points (P < 0.001). Stepwise regression analysis yielded no relevant predictors of success or nonsuccess of PR with regard to age, sex, disease, body mass index, 6MWD, and HRQL on admission. Short-term comprehensive PR can significantly improve exercise capacity and HRQL in LTx candidates to a clinically relevant extent independent of the underlying lung disease. No relevant predictor influencing PR outcome could be detected. Further research is needed to evaluate the relevance of PR before LTx and its impact on clinical outcome after transplantation.

  14. The effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Hill Catherine J

    2010-02-01

    Full Text Available Abstract Background Non-cystic fibrosis bronchiectasis is characterised by sputum production, exercise limitation and recurrent infections. Although pulmonary rehabilitation is advocated for this patient group, its effects are unclear. The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity, cough, quality of life and the incidence of acute pulmonary exacerbations. Methods/Design This randomised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions. Participants will be randomly allocated to the intervention group (supervised, twice weekly exercise training with regular review of airway clearance therapy or a control group (twice weekly telephone support. Measurements will be taken at baseline, immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor. Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test. Quality of life and health status will be measured using the Chronic Respiratory Questionnaire, Leicester Cough Questionnaire, Assessment of Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale. The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary. Discussion Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population. Trial registration This study protocol is registered with ClinicalTrials.gov (NCT00885521.

  15. Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD

    Directory of Open Access Journals (Sweden)

    Coquart JB

    2016-06-01

    Full Text Available Jérémy B Coquart,1 Jean-Marie Grosbois,2,3 Cecile Olivier,4 Frederic Bart,2 Ingrid Castres,1 Benoit Wallaert4 1Faculté des Sciences du Sport, Université de Rouen, CETAPS, EA 3832, Mont Saint Aignan, 2Service de Pneumologie, Centre Hospitalier de Béthune, Beuvry, 3Formaction Santé, Perenchies, 4Service de Pneumologie et Immunoallergologie, Centre Hospitalier Universitaire de Lille, Hôpital Calmette, Université de Lille 2, France Background: This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR, including transcutaneous neuromuscular electrical stimulation (NMES or usual endurance physical exercise (UEPE, on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL in patients with COPD.Methods: Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES], while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]. NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home.Results: The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE, exercise capacity (+20.8% in GNMES and +21

  16. A randomised study of the effects of supplemental exercise sessions after a 7-week chronic obstructive pulmonary disease rehabilitation program

    DEFF Research Database (Denmark)

    Linneberg, Allan René; Rasmussen, Mathilde; Buch, Tove Fedder

    2012-01-01

    Background: Several studies have suggested that the effects of chronic obstructive pulmonary disease (COPD) rehabilitation programs tend to attenuate with time. We aimed to investigate the effects of supplemental exercise sessions following an initial 7-week COPD rehabilitation program with regard...... to exercise capacity and disease-specific quality of life (QoL). Methods: We performed a 7-week COPD rehabilitation program in 140 COPD patients. Patients (n = 118) who completed the initial program were randomised for additional six supervised supplemental exercise sessions or three follow-up examinations...... without exercise. Both groups were followed for 12 months. Primary end-points were QoL as measured by the St. George's Respiratory Questionnaire total score and exercise capacity as measured by the endurance shuttle walking time (ESWT). Results: A marked increase in ESWT (from 193 to 921 s) and a moderate...

  17. Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden

    Directory of Open Access Journals (Sweden)

    Mats Arne

    2016-11-01

    Full Text Available Background: Pulmonary rehabilitation (PR is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD. In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results: A total of 381 (55.9% of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients – neither in primary care nor at hospitals. Conclusion: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

  18. Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

    Science.gov (United States)

    Muñoz-Torrico, Marcela; Rendon, Adrian; Centis, Rosella; D'Ambrosio, Lia; Fuentes, Zhenia; Torres-Duque, Carlos; Mello, Fernanda; Dalcolmo, Margareth; Pérez-Padilla, Rogelio; Spanevello, Antonio; Migliori, Giovanni Battista

    2016-01-01

    The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements"). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae. RESUMO O papel da tuberculose como uma prioridade de saúde pública e a disponibilidade de ferramentas diagnósticas para avaliar o estado

  19. A Qualitative Exploration of Exercise Among Pulmonary Rehabilitation Participants: Insight From Multiple Sources of Social Influence.

    Science.gov (United States)

    Witcher, Chad S G; McGannon, Kerry R; Hernandez, Paul; Dechman, Gail; Ferrier, Suzanne; Spence, John C; Rhodes, Ryan E; Blanchard, Chris M

    2015-11-01

    Exercise training within the pulmonary rehabilitation (PR) context is considered the most effective strategy to reduce COPD symptoms. However, participation in PR and continued exercise training following program completion are low. Previous research examined factors related to attendance and adherence, but the knowledge base to date has been limited to quantitative findings that focus solely on participants diagnosed with COPD. In addition to quantitative research, exploring multiple perspectives (eg, PR participants, significant others, staff, and stakeholders) using qualitative research methods opens a window of additional understanding. The goal of this study was to obtain multiple perspectives on PR to gain insight into factors that affect exercise participation among individuals diagnosed with COPD. A total of 26 participants were interviewed via telephone, including 8 individuals diagnosed with COPD (4 men and 4 women, mean age of 67 [range of 58-77] y), 4 family members, 11 PR staff, and 3 community stakeholders. Analysis revealed 3 themes: task self-efficacy for exercise, provision of support and encouragement, and perceptions of gender differences. Despite initial concerns, individuals diagnosed with COPD reported becoming more confident during PR and emphasized the importance of being supported by staff. PR staff perceived that men tended to approach exercise in a more eager and aggressive manner compared with women, who were more cautious and hesitant. In addition to enhancing task self-efficacy, findings suggest that exercise participation and adherence within the PR environment may be improved by adopting a gender-tailored approach. Copyright © 2015 by Daedalus Enterprises.

  20. The Responsiveness of the Anxiety Inventory for Respiratory Disease Scale Following Pulmonary Rehabilitation.

    Science.gov (United States)

    Yohannes, Abebaw M; Dryden, Sheila; Hanania, Nicola A

    2016-07-01

    To date, there are no studies that have examined the responsiveness of the Anxiety Inventory for Respiratory disease (AIR) scale to any intervention in patients with COPD. We examined the responsiveness of the AIR scale in an 8-week pulmonary rehabilitation (PR) program. A total of 192 patients with COPD who were clinically stable and had a percent predicted FEV1 scale. Anxiety was measured using the self-administered AIR scale. The mean (SD) age was 71 (8.4) years and 51% were women. The AIR scale was responsive to PR with (AIR ≥ 8, high anxiety load) a mean change pre- vs post scores (12.25 vs 6.70, t = 7.56, P Anxiety is a predictor of noncompletion of PR. The AIR scale is sensitive to change following PR in patients with COPD and can be used in future studies evaluating interventions that reduce anxiety in this disease. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. Impact of a pulmonary rehabilitation programme on respiratory parameters and health care utilization in patients with chronic lung diseases other than COPD.

    Science.gov (United States)

    Al Moamary, M S

    2012-02-01

    Pulmonary rehabilitation is a tool that is receiving more acceptance in chronic lung diseases. A retrospective study was made in Riyadh, Saudi Arabia, on the impact of pulmonary rehabilitation on respiratory parameters and health care utilization in a group of outpatients with chronic lung diseases other than chronic obstructive pulmonary disease. A group of 51 patients diagnosed with interstitial lung diseases, bronchiectasis, asthma and scoliosis were studied. Initial number of emergency department visits and hospital admissions and use of prednisone and antibiotics were significantly associated with adherence to the pulmonary rehabilitation programme. There was a significant improvement in functional exercise capacity as manifested on the 6-minute walking distance and distance on treadmill, bicycle and arm ergometer and significantly better utilization of health care resources (fewer emergency department and outpatient department visits) over the 12 months after completion of the programme.

  2. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation.

    Science.gov (United States)

    Rochester, Carolyn L; Vogiatzis, Ioannis; Holland, Anne E; Lareau, Suzanne C; Marciniuk, Darcy D; Puhan, Milo A; Spruit, Martijn A; Masefield, Sarah; Casaburi, Richard; Clini, Enrico M; Crouch, Rebecca; Garcia-Aymerich, Judith; Garvey, Chris; Goldstein, Roger S; Hill, Kylie; Morgan, Michael; Nici, Linda; Pitta, Fabio; Ries, Andrew L; Singh, Sally J; Troosters, Thierry; Wijkstra, Peter J; Yawn, Barbara P; ZuWallack, Richard L

    2015-12-01

    Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients. The objectives of this document are to enhance implementation, use, and delivery of pulmonary rehabilitation to suitable individuals worldwide. Members of the American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly and the European Respiratory Society (ERS) Rehabilitation and Chronic Care Group established a Task Force and writing committee to develop a policy statement on PR. The document was modified based on feedback from expert peer reviewers. After cycles of review and revisions, the statement was reviewed and formally approved by the Board of Directors of the ATS and the Science Council and Executive Committee of the ERS. This document articulates policy recommendations for advancing healthcare professional, payer, and patient awareness and knowledge of PR, increasing patient access to PR, and ensuring quality of PR programs. It also recommends areas of future research to establish evidence to support the development of an updated funding and reimbursement policy regarding PR. The ATS and ERS commit to undertake actions that will improve access to and delivery of PR services for suitable patients. They call on their members and other health professional societies, payers, patients, and patient advocacy groups to join in this commitment.

  3. Pulmonary rehabilitation for COPD improves exercise time rather than exercise tolerance: effects and mechanisms

    Directory of Open Access Journals (Sweden)

    Miki K

    2017-04-01

    Full Text Available Keisuke Miki,1 Ryoji Maekura,1 Seigo Kitada,1 Mari Miki,1 Kenji Yoshimura,1 Hiroshi Yamamoto,2 Toshiko Kawabe,2 Hiroyuki Kagawa,1 Yohei Oshitani,1 Akitoshi Satomi,1 Kohei Nishida,1 Nobuhiko Sawa,1 Kimiko Inoue2 1Department of Respiratory Medicine, 2Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan Background: COPD patients undergoing pulmonary rehabilitation (PR show various responses. The purpose of this study was to investigate the possible mechanisms and predictors of the response to PR in COPD patients.Methods: Thirty-six stable COPD patients underwent PR including a 4-week high-intensity exercise training program, and they were evaluated by cardiopulmonary exercise testing. All patients (mean age 69 years, severe and very severe COPD 94% were classified into four groups by whether the exercise time (Tex or the peak oxygen uptake (VO2 increased after PR: two factors increased (both the Tex and the peak VO2 increased; two factors decreased; time only increased (the Tex increased, but the peak VO2 economized; and VO2 only increased (the Tex decreased, but the peak VO2 increased. Within all patients, the relationships between baseline variables and the post-to-pre-change ratio of the time–slope, Tex/(peak minus resting VO2, were investigated.Results: Compared with the two factors increased group (n=11, in the time only increased group (n=18, the mean differences from pre-PR at peak exercise in 1 minute ventilation (VE (P=0.004, VO2 (P<0.0001, and carbon dioxide output (VCO2 (P<0.0001 were lower, 2 VE/VO2 (P=0.034 and VE/VCO2 (P=0.006 were higher, and 3 the dead space/tidal volume ratio (VD/VT and the dyspnea level were similar. After PR, there was no significant difference in the ratio of the observed peak heart rate (HR to the predicted peak HR (220 – age [years] between the two groups. A significant negative correlation with the baseline time–slope (r=-0.496, P=0.002 and a

  4. Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects

    Directory of Open Access Journals (Sweden)

    Imen Ben Cheikh Rejbi

    2010-07-01

    Full Text Available Imen Ben Cheikh Rejbi1, Yassine Trabelsi1, Afef Chouchene1, Wafa Ben Turkia1, Helmi Ben Saad1, Abdelkarim Zbidi1, Abdelhamid Kerken2, Zouhair Tabka11Department of Physiology and Lung Testing, Faculty of Medicine of Sousse, Tunisia; 2Department of Biophysics, Faculty of Medicine of Monastir, TunisiaBackground: The six-minute walking distance (6MWD test has demonstrated validity and reliability to assess changes in functional capacity following pulmonary rehabilitation in patients with chronic obstructive lung disease. However, no attempt has been made to establish an iterative measurement of 6MWD during the overall period of pulmonary rehabilitation. Therefore, the aim of this study was to evaluate the impact of a twelve-week rehabilitation program on the iterative weekly measurement of 6MWD in chronic obstructive pulmonary disease (COPD patients and healthy subjects.Methods: Twenty-six patients with COPD and nine age-matched healthy subjects were studied. Measurements were taken at baseline and after twelve weeks except for the 6MWD. The exercise measurements included a six-minute walking test (6MWT and an incremental exercise test. Oxygen saturation, heart rate, and dyspnea will be monitored during all these tests. Results: At baseline there were significant differences between groups, except in age, body mass index, and oxygen saturation. After 12 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. The 6MWD, peak oxygen uptake VO2peak and anaerobic threshold increased significantly after training in both groups (P < 0.01. The averaged trace of the 6MWD of patients with COPD and healthy subjects was followed-up respectively by a logarithmic and linear fitting. 6MWD showed a plateau after eight weeks in patients with COPD, however, it increased continually overall in healthy subjects.Conclusion: Both patients with COPD and healthy subjects demonstrated functional responses to training but with

  5. Peer educator vs. respiratory therapist support: which form of support better maintains health and functional outcomes following pulmonary rehabilitation?

    Science.gov (United States)

    Wong, Eric Y; Jennings, Cally A; Rodgers, Wendy M; Selzler, Anne-Marie; Simmonds, Lindsay G; Hamir, Rashida; Stickland, Michael K

    2014-04-01

    This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes. Phase one (n=79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n=168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. George's Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR. Six-month follow-up data for phase one was collected for 66 COPD patients (n=35 peer support, n=31 UC) and 142 for phase two (n=42 peer support, n=52 RT support, n=48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT. Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes. There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Pulmonary rehabilitation improves only some domains of health-related quality of life measured by the Short Form-36 questionnaire

    Directory of Open Access Journals (Sweden)

    Chok Limsuwat

    2014-01-01

    Full Text Available Background: Pulmonary rehabilitation (PR has inconsistent effects on health-related quality of life (HRQL in patients with chronic lung diseases. We evaluated the effect of PR on HRQL outcomes using the 36-item short form of the medical outcomes (SF-36. Methods : We retrospectively reviewed the files of all patients who completed PR in 2010, 2011, and first half of 2012. We collected information on demographics, symptoms, pulmonary function tests, 6-minute walk tests (6-MWT, and responses on the SF-36 survey, including the physical component score (PCS and mental component score (MCS. Results: The study included 19 women and 22 men. The mean age was 69.8 ± 8.5 years. The diagnoses included chronic obstructive pulmonary disease (COPD; n = 31, asthma (n = 3, interstitial lung disease (n = 5, and obstructive sleep apnea (OSA; n = 2. The mean forced expiratory volume-one second (FEV1 was 1.16 ± 0.52 L (against 60.5 ± 15.9% of predicted value. There was a significant improvement in 6-MWT (P < 0.0001. The PCS improved post-PR from 33.8 to 34.5 (P = 0.02; the MCS did not change. Conclusion: These patients had low SF-36 scores compared to the general population; changes in scores after PR were low. These patients may need frequent HRQL assessment during rehabilitation, and PR programs should consider program modification in patients with small changes in mental health.

  7. Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD – a review

    Directory of Open Access Journals (Sweden)

    André Nyberg

    2016-11-01

    Full Text Available Even though chronic obstructive pulmonary disease (COPD is primarily a disease of the respiratory system, limb muscle dysfunction characterized by muscle weakness, reduced muscle endurance and higher muscle fatigability, is a common secondary consequence and a major systemic manifestation of the disease. Muscle dysfunction is especially relevant in COPD because it is related to important clinical outcomes such as mortality, quality of life and exercise intolerance, independently of lung function impairment. Thus, improving muscle function is considered an important therapeutic goal in COPD management. Pulmonary rehabilitation (PR is a multidisciplinary, evidence-based and comprehensive approach used to promote better self-management of the disease, minimize symptom burden, optimize functional status, and increase participation in activities of daily life. Exercise training, including cardiovascular and muscle exercises, is the cornerstone of PR and is considered the best available strategy to improve exercise tolerance and muscle function among patients with COPD. This paper addresses the various components of exercise training within PR used to improve limb muscle function in COPD, providing clinicians and health-care professionals with an overview and description of these various exercise modalities and of their effects on limb muscle function. Guidance and recommendations to help design optimal limb muscle training regimens for these patients are also presented. Keywords: COPD, Exercise, Muscle function, Limb muscle dysfunction, Pulmonary rehabilitation, Resistance training, Aerobic exercises

  8. Whakawhanaungatanga: the importance of culturally meaningful connections to improve uptake of pulmonary rehabilitation by Māori with COPD – a qualitative study

    Science.gov (United States)

    Levack, William MM; Jones, Bernadette; Grainger, Rebecca; Boland, Pauline; Brown, Melanie; Ingham, Tristram R

    2016-01-01

    Background Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD). However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Māori with COPD in New Zealand. Method Grounded theory nested within kaupapa Māori methodology. Transcripts were analyzed from interviews and focus groups with 15 Māori and ten New Zealand non-Māori invited to attend pulmonary rehabilitation for COPD. Māori participants had either attended a mainstream hospital-based program, a community-based program designed “by Māori, for Māori”, or had experienced both. Results Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1) participants’ past experiences (eg, of exercise; of health care systems), 2) attitudes and expectations, 3) access issues (eg, time, transport, and conflicting responsibilities), and 4) initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Māori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Māori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Māori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services offered a program in which they felt culturally safe and to which they were willing to return for ongoing rehabilitation. Conclusion Lack of attention to cultural factors in the delivery of

  9. Oxygen supplementation facilitating successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease following trans-tibial amputation: a case report

    Directory of Open Access Journals (Sweden)

    Sharma Sat

    2010-12-01

    Full Text Available Abstract Introduction Dysvascular amputations are increasingly performed in patients with underlying cardiac and pulmonary disorders. A limb prosthesis is rarely offered to patients with severe chronic obstructive pulmonary disease because of their inability to achieve the high energy expenditure required for prosthetic ambulation. We describe a case of successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease with the aid of oxygen supplementation. Case presentation A 67-year-old aboriginal woman with severe chronic obstructive pulmonary disease and hypercapnic respiratory failure underwent right trans-tibial (below the knee amputation for severe foot gangrene. An aggressive rehabilitation program of conditioning exercises and gait training utilizing oxygen therapy was initiated. She was custom-fitted with a right trans-tibial prosthesis. A rehabilitation program improved her strength, endurance and stump contracture, and she was able to walk for short distances with the prosthesis. The motion analysis studies showed a cadence of 73.5 steps per minute, a velocity of 0.29 meters per second and no difference in right and left step time and step length. Conclusion This case report illustrates that patients with significant severe chronic obstructive pulmonary disease can be successfully fitted with limb prostheses and undergo rehabilitation using supplemental oxygen along with optimization of their underlying comorbidities. Despite the paucity of published information in this area, prosthesis fitting and rehabilitation should be considered in patients who have undergone amputation and have severe chronic obstructive disease.

  10. A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study.

    Science.gov (United States)

    Zakrisson, Ann-Britt; Hiyoshi, Ayako; Theander, Kersti

    2016-04-01

    To investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over three years among patients with Chronic Obstructive Pulmonary Disease. Although Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established. A quasi-experimental design. Primary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after one year and three years. Exacerbation frequency was calculated from one year before to three years after the programme. No significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after one year and three years. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p = 0·091) but increased again in both groups after three years. There was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after one year. There is a need for support and coaching at regular follow-ups in primary health care. There is a need to support and

  11. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: A number needed to treat study

    Directory of Open Access Journals (Sweden)

    Gian Galeazzo Riario-Sforza

    2009-08-01

    Full Text Available Gian Galeazzo Riario-Sforza1, Cristoforo Incorvaia1, Fulvia Paterniti1, Laura Pessina1, Roberta Caligiuri1, Chiara Pravettoni1, Fabiano Di Marco2, Stefano Centanni21Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 2Unit of Respiratory Medicine, University of Milan, San Paolo Hospital, Milan, ItalyBackground: Pulmonary rehabilitation (PR is recognized as an evidence-based treatment in improving dyspnea and quality of life in patients with COPD. We evaluated the number needed to treat (NNT to achieve an increase in physical capacity, as defined by a significant improvement in the six-minute walk test (6MWT in patients with COPD undergoing PR.Methods: The study enrolled 284 patients aged 41 to 86 years (mean age 69.4 years divided into two groups: a study group (222 patients undergoing a PR program, and a control group (62 patients treated only with drugs. The study group included patients with COPD divided in four subgroups according to GOLD stages.Results: In the study group, 142 out of 222 patients (64% had an increase of at least 54 m in the 6MWT following PR versus 8 out of 62 patients (13% in the control group after the same time interval. The NNT in the overall study group was 2; the same NNT was obtained in GOLD stages 2, 3, and 4, but was 8 in stage 1.Conclusions: PR is highly effective in improving the exercise capacity of patients with COPD, as demonstrated by a valuable NNT, with better results in patients with a more severe disease.Keywords: chronic obstructive lung disease, exercise capacity, number needed to treat, pulmonary rehabilitation, six-minute walk test

  12. Danish evidence-based clinical guideline for use of nutritional support in pulmonary rehabilitation of undernourished patients with stable COPD

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Iepsen, Ulrik Winning; Topperup, Randi

    2015-01-01

    Background and aims Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL......) or quality of life. Therefore the topic was included in The Danish Health and Medicines Authority's development of an evidence-based clinical guideline for rehabilitation of patients with stable COPD. Methods The methods were specified by The Danish Health and Medicines Authority as part of a standardized...... approach to evidence-based national clinical practice guidelines. They included formulation of a PICO with pre-defined criteria for the Population, Intervention, Control and Outcomes. Existing guidelines or systematic reviews were used after assessment using the AGREE II tool or AMSTAR, if possible. We...

  13. Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial.

    Science.gov (United States)

    Engel, Roger Mark; Gonski, Peter; Beath, Ken; Vemulpad, Subramanyam

    2016-05-01

    Randomized clinical trial. To investigate the effect of including manual therapy (MT) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). The primary source of exercise limitation in people with COPD is dyspnea. The dyspnea is partly caused by changes in chest wall mechanics, with an increase in chest wall rigidity (CWR) contributing to a decrease in lung function. As MT is known to increase joint mobility, administering MT to people with COPD carries with it the potential to influence CWR and lung function. Thirty-three participants with COPD, aged between 55 and 70 years (mean = 65·5±4 years), were randomly assigned to three groups: pulmonary rehabilitation (PR) only, soft tissue therapy (ST) and PR, and ST, spinal manipulative therapy (SM), and PR. Outcome measures including forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), 6-minute walking test (6MWT), St. George's respiratory questionnaire (SGRQ), and the hospital anxiety and depression (HAD) scale were recorded at 0, 8, 16, and 24 weeks. There was a significant difference in FVC between the three groups at 24 weeks (P = 0·04). For the ST+SM+PR group versus PR only the increase was 0·40 l (CI: 0·02, 0·79; P = 0·03). No major or moderate adverse events (AE) were reported following the administration of 131 ST and 272 SM interventions. The increase in FVC is a unique finding. Although the underlying mechanisms responsible for this outcome are not yet understood, the most likely explanation is the synergistic effect resulting from the combination of interventions. These results support the call for a larger clinical trial in the use of MT for COPD.

  14. Effectiveness of a brief self-care support intervention for pulmonary rehabilitation among the elderly patients with chronic obstructive pulmonary disease in Korea.

    Science.gov (United States)

    Song, Hee-Young; Yong, Suk Joong; Hur, Hea Kung

    2014-01-01

    This study assessed effects of a brief self-care support intervention (SCSI) to promote health-related quality of life (HRQoL) and self-care adherence among elderly patients with COPD in Korea. A single-blinded, randomized pre-/posttest design A total of 40 participants were consecutively recruited from eligible patients admitted with an exacerbation of COPD to a department of pulmonology at a university hospital. Twenty participants were randomly divided into two groups: an experimental group and a control group. The experimental group received an SCSI utilizing a motivational interview. All participants were assessed with peak expiratory flow rate and 6-minute walking distance test, and answered Saint George's Respiratory Questionnaire (SGRQ) and a questionnaire on self-care adherence at pre-intervention and 2 months postintervention. After the intervention, SGRQ scores for symptom, activity, impact, and total were significantly lower and self-care adherence scores of medication and exercise were significantly higher in the experimental group. This study confirmed the short-tem effectiveness of a nurse-led self-management intervention for pulmonary rehabilitation on quality of life and self-care adherence among elderly patients with COPD. Further studies are warranted to verify effective strategies to improve exercise capacity for this population. Our findings suggest a brief intervention for rehabilitation nursing with more retainable, feasible, and cost-effective strategies to enhance self-management among the elderly patients with COPD. © 2013 Association of Rehabilitation Nurses.

  15. Rehabilitering

    DEFF Research Database (Denmark)

    Hørdam, Britta

    2008-01-01

    En interviewundersøgelse af patienter, der får gennemført hofteoperation, en opgørelse af deres selvvurdere helbredsstatus med henblik på at tilrettelægge rehabilitering baseret på patienternes egne præmisser.......En interviewundersøgelse af patienter, der får gennemført hofteoperation, en opgørelse af deres selvvurdere helbredsstatus med henblik på at tilrettelægge rehabilitering baseret på patienternes egne præmisser....

  16. The efficacy of early initiated, supervised, progressive resistance training compared to unsupervised, home-based exercise after unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Peter Bo; Bogh, Søren B; Kierkegaard, Signe

    2017-01-01

    OBJECTIVE: To examine if supervised progressive resistance training was superior to home-based exercise in rehabilitation after unicompartmental knee arthroplasty. DESIGN: Single blinded, randomized clinical trial. SETTING: Surgery, progressive resistance training and testing was carried out...

  17. A Randomized Controlled Trial of Postthoracotomy Pulmonary Rehabilitation in Patients with Resectable Lung Cancer

    NARCIS (Netherlands)

    Stigt, Jos A.; Uil, Steven M.; van Riesen, Susanne J. H.; Simons, Frans J. N. A.; Denekamp, Monique; Shahin, Ghada M.; Groen, Harry J. M.

    Introduction: Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy. The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life (QOL) and secondary objectives were to determine its

  18. Action plans and coping strategies in elderly COPD patients influence the result of pulmonary rehabilitation: an observational study.

    Science.gov (United States)

    Russo, Patrizia; Prinzi, Giulia; Kisialiou, Aliaksei; Cardaci, Vittorio; Stirpe, Emanuele; Conti, Vittoria; Fini, Massimo; Bonassi, Stefano

    2017-04-14

    COPD management needs a comprehensive assessment of clinical features (symptoms severity, co-morbidities) together with life-style, behavioural, socio-economic and multi-omics parameters. Among the other issues, psycho-cognitive assessment plays a critical role. Coping strategies are used to manage psychological stress. To evaluate the association between coping strategies and outcome of Pulmonary Rehabilitation (PR). Observational study. Inpatients comprehensive 3 weeks PR programme. Seventy-six patients, 70 years or older affected by COPD GOLD 3-4. Disease-specific status was examined using the Medical Research Council Dyspnea Scale, St. George's Respiratory Questionnaire, Maugeri Respiratory Failure, Borg And Barthel Scales. Cognitive And Psychological Clinical Alterations/Disorders Using: Mini-Mental State Examination; Montreal Cognitive Assessment; Center for Epidemiologic Studies Depression Scale; Zung Self-Rating Anxiety Scale. Quality of Life Using Activities of Daily Living; Instrumental Activities of Daily Living; 36-Item Short Form Health Survey General and Mental Health. Functional exercise capacity was measured at baseline and after PR using the Six-Minute Walking Test (6MWT). Coping strategies were measured with the Brief COPE. Internal consistency was determined examining Cronbach's α values. Concurrent validity was determined by examining Spearman r correlations between the single-item and multi-items. Brief-COPE scores after PR between patients who had a different response to respiratory outcomes was evaluated using Student's t and Mann-Whitney U tests. The change in distance (Delta6MWD) between final and baseline value in meters was positively associated with Self-distraction, Active Coping, and Planning strategies. Respiratory disease-specific health status outcomes, as well as the presence of use of long-term oxygen therapy, were not associated with coping strategies. Self-distraction and Planning strategies are associated to the success of

  19. Rehabilitering

    DEFF Research Database (Denmark)

    Caswell, Dorte; Høybye-Mortensen, Matilde; Dall, Tanja

    2013-01-01

    Rehabilitering som både begreb og indsats har været genstand for stigende fokus i de seneste år, på både politisk, organisatorisk og praksis-niveau. Fra januar 2013 træder en større reform af førtidspension og fleksjob i kraft, og med reformen etableres ’rehabilitering’ som både mål og middel i...

  20. Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework.

    Science.gov (United States)

    Cox, Narelle S; Oliveira, Cristino C; Lahham, Aroub; Holland, Anne E

    2017-04-01

    What are the barriers and enablers of referral, uptake, attendance and completion of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD)? Systematic review of qualitative or quantitative studies reporting data relating to referral, uptake, attendance and/or completion in pulmonary rehabilitation. People aged >18years with a diagnosis of COPD and/or their healthcare professionals. Data were extracted regarding the nature of barriers and enablers of pulmonary rehabilitation referral and participation. Extracted data items were mapped to the Theoretical Domains Framework (TDF). A total of 6969 references were screened, with 48 studies included and 369 relevant items mapped to the TDF. The most frequently represented domain was 'Environment' (33/48 included studies, 37% of mapped items), which included items such as waiting time, burden of illness, travel, transport and health system resources. Other frequently represented domains were 'Knowledge' (18/48 studies, including items such as clinician knowledge of referral processes, patient understanding of rehabilitation content) and 'Beliefs about consequences' (15/48 studies, including items such as beliefs regarding role and safety of exercise, expectations of rehabilitation outcomes). Barriers to referral, uptake, attendance or completion represented 71% (n=183) of items mapped to the TDF. All domains of the TDF were represented; however, items were least frequently coded to the domains of 'Optimism' and 'Memory'. The methodological quality of included studies was fair (mean quality score 9/12, SD 2). Many factors - particularly those related to environment, knowledge, attitudes and behaviours - interact to influence referral, uptake, attendance and completion of pulmonary rehabilitation. Overcoming the challenges associated with the personal and/or healthcare system environment will be imperative to improving access and uptake of pulmonary rehabilitation. PROSPERO CRD42015015976

  1. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial.

    Science.gov (United States)

    Ranjita, Rajashree; Hankey, Alex; Nagendra, H R; Mohanty, Soubhagylaxmi

    Coal mine dust exposure causes chronic airflow limitation in coal miners resulting in dyspnea, fatigue, and eventually chronic obstructive pulmonary disease (COPD). Yoga can alleviate dyspnea in COPD by improving ventilatory mechanics, reducing central neural drive, and partially restoring neuromechanical coupling of the respiratory system. To evaluate the effectiveness of Integrated Approach of Yoga Therapy (IAYT) in the management of dyspnea and fatigue in coal miners with COPD. Randomized, waitlist controlled, single-blind clinical trial. Eighty-one coal miners (36-60 years) with stable Stages II and III COPD were recruited. The yoga group received an IAYT module for COPD that included asanas, loosening exercises, breathing practices, pranayama, cyclic meditation, yogic counseling and lectures 90 min/day, 6 days/week for 12 weeks. Measurements of dyspnea and fatigue on the Borg scale, exercise capacity by the 6 min walk test, peripheral capillary oxygen saturation (SpO 2 %), and pulse rate (PR) using pulse oximetry were made before and after the intervention. Statistically significant within group reductions in dyspnea (P yoga group; all except the last were significant compared to controls (P Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation programs for COPD patients. Copyright © 2016 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

  2. Exercise therapy in the complex of physical rehabilitation of patients with pulmonary tuberculosis.

    OpenAIRE

    Nogas A.O.

    2012-01-01

    The programs of physical rehabilitation, which are directed on proceeding in the broken function of the external breathing, are appraised. In research 68 patients took part with a diagnosis the first diagnosed white plague (40 - men and 28 - women, middle ages - 29 years). The complex program of physical rehabilitation included: morning hygienical gymnastics, medical gymnastics, massotherapy, physical therapy procedures, hydropathy, manipulation interferences and educational programs. A tende...

  3. [Barriers to referral to pulmonary rehabilitation in COPD patients from the perspective of general practitioners].

    Science.gov (United States)

    Galera, O; Grimal, G; Bajon, D; Darolles, Y

    2017-06-01

    In spite of recommendations of the highest level of proof (rank A), the respiratory rehabilitation remains very widely sub-prescribed by general practitioners, who are nevertheless in the front line in the care and the follow-up of the patients affected by BPCO. Semi-qualitative study with the general practitioners installed in the city of Montauban (Tarn-et-Garonne). The rate of answer was 57%. Eighty-six percent of the patients BPCO followed in general medicine have never participated in a respiratory rehabilitation program. Eighty percent of the questioned general practitioners declared not to know the last recommendations of the HAS. A total of 66.7% of the questioned general practitioners considered that prescription of respiratory rehabilitation comes within their remit. Eighty seven percent of the general practitioners declare not to know the existing respiratory programs of rehabilitation in their region. The main barrier for prescription of respiratory rehabilitation for patients BPCO in general medicine could be the misunderstanding of the local existing programs. The distribution of existing tools such as the map of the programs of respiratory rehabilitation established by the group Alvéole of the Society of Pneumology of French language (SPLF) could so be a facilitating factor. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program.

    Science.gov (United States)

    Güngen, Belma Doğan; Tunç, Abdulkadir; Aras, Yeşim Güzey; Gündoğdu, Aslı Aksoy; Güngen, Adil Can; Bal, Serdar

    2017-07-11

    The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (pICU admission had a statistically significant relationship with parenteral nutrition (pICU admission (pICU admission. The relationship between pulmonary physiotherapy (PPT) and ICU admission- pneumonia onset at the end of three months was statistically significant (p=0.04 and p=0.043, respectively). This study showed that PPT improved the prognosis of ischemic stroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. NCT03195907 . Trial registration date: 21.06.2017 'Retrospectively registered'.

  5. Substantial need for early diagnosis, rehabilitation and treatment of chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lange, Peter; Marott, Jacob Louis; Dahl, Morten

    2012-01-01

    Our goal was to estimate the number of individuals with chronic obstructive pulmonary disease (COPD) in the Capital Region of Denmark and the need of resources required to implement the regional management programme for COPD....

  6. The benefit of pulmonary rehabilitation against quality of life alteration and functional capacity of chronic obstructive pulmonary disease patient assessed using St George’s respiratory questionnaire and 6 minutes walking distance test

    Directory of Open Access Journals (Sweden)

    Wiwien H. Wiyono

    2006-09-01

    Full Text Available Patients with chronic obstructive pulmonary disease (COPD have been shown to be benefit from pulmonary rehabilitation programs. We assessed an entirely outpatient-based program of pulmonary rehabilitation in patients with COPD, using the St George’s Respiratory Questionnaire (SGRQ and six minutes walking distance test (6MWD (which measures health-related quality of life and functional exercise tolerance as the primary outcome measure. We undertook a randomized, opened, prospective, parallel-group controlled study of outpatient rehabilitation program in 56 patients with COPD (52 men and 4 women. The active group (n=27 took part in a 6-weeks program of education and exercise. The control group (n=29 were reviewed routinely as medical outpatients. The SGRQ and 6MWD were administered at study entry and after 6 weeks. Outcome with SGRQ and 6MWD before and after therapy was performed. Decrease score SGRQ and increase 6MWD in both groups of study, it was analyzed by statistic study and in active group the decrease of SGRQ and the increase of 6MWD was statistically significant. In conclusion 6-weeks outpatient-based program significantly improved quality of life and functional capacity in mild-to-moderate COPD patient. (Med J Indones 2006; 15:165-72 Keywords: COPD, pulmonary rehabilitation, SGRQ, 6MWD

  7. Home-based COPD psychoeducation

    DEFF Research Database (Denmark)

    Bove, D G; Midtgaard, J; Kaldan, G

    2017-01-01

    in reducing symptoms of anxiety and increasing mastery of dyspnoea in patients with advanced chronic obstructive pulmonary disease (COPD). However, we do not know if the intervention is perceived as meaningful and applicable in the everyday life of patients with advanced COPD. METHODS: We conducted a nested...... post-trial qualitative study. The study methodology was Interpretive Description as described by Thorne. The study was based on semi-structured interviews with twenty patients from the RCT intervention group i.g. home-living people with a diagnosis of advanced COPD and symptoms of anxiety. RESULTS...

  8. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?

    Science.gov (United States)

    Heerema-Poelman, Ankie; Stuive, Ilse; Wempe, Johan B

    2013-01-01

    To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence. Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation (PR) in the rehabilitation center. Adherence (yes/no) to the maintenance program was assessed by a self-reported questionnaire, where adherence was defined as attending the maintenance program 1 year after PR. Early dropouts received a self-reported questionnaire after 6 months and the remaining patients after 12 months. Lung function, exercise capacity, exercise self-efficacy, illness perceptions, health-related quality of life, levels of anxiety and depression, duration of PR, and the number of exacerbations were studied as possible predictors of adherence. Ten patients died or were lost to followup. Of the remaining 60 patients, 73.3% and 63.3% were adherent to the maintenance exercise program after 6 and 12 months, respectively. Forced expiratory volume in 1 second (FEV1) (P = .021), Hospital Anxiety and Depression Scale depression score (P = .025), and duration of PR (P = .018) were significant predictors of adherence to the maintenance program. Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program. Adherence to the maintenance program needs to be improved for patients with lower FEV1, with signs of depression, or with a shorter initial PR course.

  9. [The rehabilitative treatment of the patients presenting with chronic obstructive pulmonary disease including the application of the manual handling methods].

    Science.gov (United States)

    Ayrapetova, N S; Eremushkin, M A; Antonovich, I V; Kuznetsov, O F; Samorukov, A E; Budylin, S P; Tarasova, L Yu; Derevnina, N A

    2017-01-01

    The objective of the present study was to identify the peculiar features and advantages of different methods for the mechanical impact on the thoracic tissues of the patients presenting with chronic obstructive pulmonary disease (COPD) and to develop specific indications for their clinical applications. This randomized prospective comparative study included 137 patients with COPD. In accordance with the currently accepted classification (GOLD, 2013), all the patients had COPD of medium severity. The smoldering inflammatory process was diagnosed in 75 (54.7%) patients, grade I and II respiratory insufficiency in 80 (58.4%) and 57 (41.6%) patients, respectively. The external respiration function was evaluated by means of pneumotachometry techniques during the forced expiratory maneuver and by spirometry. The pulmonary hemodynamics and myocardial contractility of the right ventricle were studied with the use of rheopulmonography and central hemodynamics by tetrapolar thoracic rheography. The routine inflammatory and immune tests were employed. Investigations of the systemic circulation have demonstrated the prevalence of its hyperkinetic type (54,0%) over the hypokinetic and eukinetic ones (23,3% and 22,7% respectively). All the patients were divided into three group identical in terms of clinical and functional characteristics. The patients comprising group 1 (n=46) were prescribed the rehabilitative treatment in the form of classical chest massage, those of group 2 (n=47) were treated by means of intense massage of asymmetric chest zones, and the patients included in group 3 (n=44) underwent manual therapy. It was shown that intense massage produced the most pronounced beneficial effect. Classical massage also resulted in the reduction of the inflammatory manifestations but its effectiveness was significantly lower than that of the intense treatment (рManual therapy failed to cause any appreciable changes in the character and severity of the inflammatory process (

  10. Effectiveness of pulmonary rehabilitation in patients with interstitial lung disease of different etiology: a multicenter prospective study.

    Science.gov (United States)

    Tonelli, Roberto; Cocconcelli, Elisabetta; Lanini, Barbara; Romagnoli, Isabella; Florini, Fabio; Castaniere, Ivana; Andrisani, Dario; Cerri, Stefania; Luppi, Fabrizio; Fantini, Riccardo; Marchioni, Alessandro; Beghè, Bianca; Gigliotti, Francesco; Clini, Enrico M

    2017-10-10

    Recent evidences show that Pulmonary Rehabilitation (PR) is effective in patients with Interstitial Lung Disease (ILD). It is still unclear whether disease severity and/or etiology might impact on the reported benefits. We designed this prospective study 1) to confirm the efficacy of rehabilitation in a population of patients with ILDs and 2) to investigate whether baseline exercise capacity, disease severity or ILD etiology might affect outcomes. Forty-one patients (IPF 63%, age 66.9 ± 11 ys) were enrolled in a standard PR course in two centers. Lung function, incremental and endurance cyclo-ergometry, Six Minutes Walking Distance (6MWD), chronic dyspnea (Medical Research Council scale-MRC) and quality of life (St. George Respiratory Questionnaire-SGRQ) were recorded before and at the end of PR to measure any pre-to-post change. Correlation coefficients between the baseline level of Diffuse Lung Capacity for Carbon monoxide (DLCO), Forced Vital Capacity (FVC), 6MWD, power developed during incremental endurance test, GAP index (in IPF patients only) and etiology (IPF or non-IPF) with the functional improvement at the 6MWDT (meters), at the incremental and endurance cyclo-ergometry (endurance time) and the HRQoL were assessed. Out of the 41 patients, 97% (n = 40) completed the PR course. Exercise performance (both at peak load and submaximal effort), symptoms (iso-time dyspnea and leg fatigue), SGRQ and MRC significantly improved after PR (p < .001). Patients with lower baseline 6MWD showed greater improvement in 6MWD (Spearman r score = - .359, p = .034) and symptoms relief at SGRQ (r = -.315, p = .025) regardless of underlying disease. Present study confirms that comprehensive rehabilitation is feasible and effective in patients with ILD of different severity and etiology. The baseline submaximal exercise capacity inversely correlates with both functional and symptom gains in this heterogeneous population.

  11. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

    Science.gov (United States)

    Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

    2015-09-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

  12. Differences in change in coping styles between good responders, moderate responders and non-responders to pulmonary rehabilitation.

    Science.gov (United States)

    Stoilkova-Hartmann, Ana; Janssen, Daisy J A; Franssen, Frits M E; Wouters, Emiel F M

    2015-12-01

    Pulmonary rehabilitation (PR) improves exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). Data on the effects of PR on coping styles are limited. Aim of the present study was to compare changes in coping styles between patients who had a good, moderate and no improvement in either exercise tolerance or health status after PR. Coping styles of 439 COPD patients undergoing PR were assessed by the Utrecht Coping List (UCL) at baseline and after PR. Patients' pulmonary function, six-minute walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS-A and HADS-D) were recorded. Good, moderate and non-responders were defined on the basis of minimally clinically important difference (MCID) for SGRQ total score and/or 6MWD. Overall, 54.0% of the patients fulfilled the criteria for good responders, while 22.1% were moderate responders. Change in passive reaction pattern coping style differed significantly between good responders and non-responders following PR (p coping styles after PR occurred among the good responders, whereas the majority of moderate responders' and non-responders' coping styles were not significantly influenced by PR. Good responders decreased their passive reaction pattern coping style in contrast to non-responders after PR. In general, PR did not change the coping among moderate and non-responders. Further research is warranted to determine whether including interventions targeting coping styles may modify coping behaviour of COPD patients, as well as improvement in exercise tolerance or health status after PR. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Exercise therapy in the complex of physical rehabilitation of patients with pulmonary tuberculosis.

    Directory of Open Access Journals (Sweden)

    Nogas A.O.

    2012-01-01

    Full Text Available The programs of physical rehabilitation, which are directed on proceeding in the broken function of the external breathing, are appraised. In research 68 patients took part with a diagnosis the first diagnosed white plague (40 - men and 28 - women, middle ages - 29 years. The complex program of physical rehabilitation included: morning hygienical gymnastics, medical gymnastics, massotherapy, physical therapy procedures, hydropathy, manipulation interferences and educational programs. A tendency is set to more hasty growth of indexes which characterize the level of violation of bronchial ability to travel the cross-country; frequencies of breathing, respiratory volume, minute volume of breathing. It is well-proven that over application of medical physical culture brings to rapid renewal of the broken function of the external breathing, improvement of the functional state of the respiratory and cardiovascular systems, strengthening of respiratory musculature, increase of efficiency of medicinal therapy, general physical health and diminishing of development of complications level.

  14. Time to adapt exercise training regimens in pulmonary rehabilitation – a review of the literature

    OpenAIRE

    Lee, Annemarie; Holland, Anne

    2014-01-01

    Annemarie L Lee,1–4 Anne E Holland1–3 1Physiotherapy, Alfred Health, Melbourne, VIC, Australia; 2Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia; 3Physiotherapy, La Trobe University, Melbourne, VIC, Australia; 4Westpark Healthcare Centre, ON, Canada Abstract: Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD). Patie...

  15. Time to adapt exercise training regimens in pulmonary rehabilitation – a review of the literature

    OpenAIRE

    Lee AL; Holl; AE

    2014-01-01

    Annemarie L Lee,1–4 Anne E Holland1–3 1Physiotherapy, Alfred Health, Melbourne, VIC, Australia; 2Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia; 3Physiotherapy, La Trobe University, Melbourne, VIC, Australia; 4Westpark Healthcare Centre, ON, Canada Abstract: Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD). Patients with...

  16. EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Brøndum, Eva; Martinez, Gerd

    2008-01-01

    scale. At completion of the programme, statistical significant improvements were seen for ESWT 157.3s; pVAS -2.1; p=0.056, SGRQ total score -2.8units; p... and -2.9units), while the effect on EQ-5 utility decreased (0.013; p=0.18). At baseline, there was a maximum score ("ceiling effect") for EQ-5D utility and EQ VAS in 29 (12.7%) and five (2.2%) of the patients, respectively. After rehabilitation these number increased to 41 (17.9%) and seven (3...

  17. “Music sets Things in Motion”. Music Therapy as Part of a Holistic Rehabilitation for People suffering from Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Kayser, Sunniva Ulstein

    2011-01-01

    The number of people diagnosed with Chronic Obstructive Pulmonary Disease (COPD) has the later years increased rapidly, and an under-developed treatment seems to contribute to increased mortality. Recent literature and research has uncovered the complexity of COPD and thus underlined the necessity for developing a more holistic rehabilitation. Through empirical experiences with a person suffering from COPD, I saw the necessity for exploring how Music Therapy could be part...

  18. Effect of 4 weeks of rehabilitation measured by 6 Minute Walking Test for males and females with moderate and serious Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Skotte, Esben

    2005-01-01

    This study is a part of a larger study that is being carried out among Chronic Obstructive Pulmonary Disease (COPD) patients at Glittreklinikken. Glittreklinikken is a rehabilitaion clinic that offers patients with COPD 4 weeks of rehabilitation. Initially 200 patients of both sexes with moderate and serious COPD were asked to participate in the study, and in the end 60 men and 42 women completed the testing. Various data was recorded and the results compared between the two sexes, with f...

  19. Outcomes after early and delayed rehabilitation for exacerbation of chronic obstructive pulmonary disease: a nationwide retrospective cohort study in Japan.

    Science.gov (United States)

    Matsui, Hiroki; Jo, Taisuke; Fushimi, Kiyohide; Yasunaga, Hideo

    2017-04-21

    The effectiveness of early pulmonary rehabilitation (PR) for exacerbation of chronic obstructive pulmonary disease (COPD) remains controversial. The present study aimed to compare the outcomes between early and delayed PR for exacerbation of COPD, using a national inpatient database. Using the Japanese Diagnosis Procedure Combination database, we examined patients who were transported to hospital for exacerbation of COPD, received PR during hospitalisation, and were discharged to their home. The patients were divided into those who received early PR (defined as PR starting within 48 h of admission) and those who received delayed PR. The outcomes included 90-day readmission, length of stay (LOS), and activities of daily living (Barthel index ≥15) at discharge. Multiple imputation was used for missing data. To assess the associations between early PR and the outcomes, we used risk-adjusted treatment effects and instrumental variable methods. We identified 12,572 eligible patients, including 8459 patients with delayed PR and 4113 with early PR. In the risk-adjusted treatment effect models, the early PR group had lower proportion of 90-day readmission (risk difference, -3.4%; 95% CI, -5.7% to -1.5%) and shorter LOS (-9.8 days; 95% CI, -10.8 days to -8.7 days) than the delayed PR group. There was no significant difference in activities of daily living at discharge between the two groups. The instrumental variable analyses showed similar results. In this national database study, early PR was associated with reduced 90-day readmission and shortened LOS in patients with exacerbation of COPD.

  20. Using Exploratory Focus Groups to Inform the Development of a Peer-Supported Pulmonary Rehabilitation Program: DIRECTIONS FOR FURTHER RESEARCH.

    Science.gov (United States)

    Poureslami, Iraj; Camp, Pat; Shum, Jessica; Afshar, Rowshanak; Tang, Tricia; FitzGerald, John Mark

    2017-01-01

    There has been limited research on the role of peer support in self-management for patients with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation (PR) programs. This research explored patient acceptability of "peer supporters" in promoting sustained self-management practices after PR and to assess their perceived self-efficacy to manage their disease. This qualitative study used focus groups and individual interviews to identify perspectives of peer supporters and benefits of participation in a PR program. The analysis included systematically reading and reviewing transcripts of the sessions, establishing themes, and sorting responses into thematic categories. A total of 28 patients with COPD (15 males) participated in either a focus group or interview. The majority of participants considered peer supporters to be good facilitators for motivating ongoing exercise after completing PR. Exercise sessions were viewed as extremely beneficial for disease management, and many were satisfied with the care they had received. Most subjects wanted to receive followup sessions with either a professional or peer after the intensive phase of PR. Overall, the concept of having a peer supporter involved in ongoing maintenance of self-management efforts after PR was generally viewed as positive. Integrating a peer support model into PR programs may improve better long-term health outcomes for COPD management as many participants endorsed the need for continued support after the program. It also improved our understanding of the role of "peer supports" in exercise and self-care maintenance after PR. The selection of peers and the specific model used warrants further investigation in a randomized controlled trial.

  1. Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Cruz, Joana; Brooks, Dina; Marques, Alda

    2016-02-01

    The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after pulmonary rehabilitation (PR) on PA levels (primary aim), health-related outcomes and self-efficacy (secondary aims) of patients with COPD. Thirty-two patients were randomly assigned to an experimental group (EG) or control group (CG). The EG received a PA-focused behavioural intervention during PR (3 months) and follow-up support (3 months). The CG received PR (3 months). Daily PA was collected: number of steps; time spent in moderate-to-vigorous PA (MVPA), total PA and sedentary activities (SA). Secondary outcomes comprised exercise capacity, muscle strength, health-related quality of life (HRQOL) and self-efficacy. Measures were collected at baseline, 3 and 6 months. Compared with the CG, the EG improved the number of steps (p = 0.006) and time spent in MVPA (p = 0.007), total PA (p = 0.014) and SA (p = 0.018) at 3 months. Differences were maintained after follow-up support (0.025 ≤ p ≤ 0.040), except for SA (p = 0.781). Exercise capacity, muscle strength and HRQOL were increased at 3 and 6 months (p ≤ 0.002) with no between-group differences (0.148 ≤ p ≤ 0.987). No changes were observed in self-efficacy (p = 0.899). A PA-focused behavioural intervention during and after PR may improve patients' PA levels. Further research is warranted to assess the sustainability of the findings. © The Author(s) 2015.

  2. Changes in pulmonary function during the early years after inpatient rehabilitation in persons with spinal cord injury: a prospective cohort study.

    Science.gov (United States)

    Postma, Karin; Haisma, Janneke A; de Groot, Sonja; Hopman, Maria T; Bergen, Michael P; Stam, Henk J; Bussmann, Johannes B

    2013-08-01

    To describe changes in pulmonary function (PF) during the 5 years after inpatient rehabilitation in persons with spinal cord injury (SCI) and to study potential determinants of change. Prospective cohort study. Eight rehabilitation centers with specialized SCI units. Persons with SCI (N=180). Not applicable. PF was determined by forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) as a percentage of the predicted value, at the start of rehabilitation, at discharge, and 1 and 5 years after discharge from inpatient rehabilitation. The population was divided into 3 subgroups on the basis of whether their PF declined, stabilized, or improved. FVC improved on average 5.1% over the whole period between discharge of inpatient rehabilitation and 5 years thereafter, but changes differed largely between persons. FVC declined in 14.9% of the population during the first year after discharge. During this year, body mass index, inspiratory muscle strength, change in peak power output, and change in peak oxygen uptake differed significantly between subgroups. FVC declined in 28.3% of the population during the following 4 years, but no differences were found between the subgroups for this period. Subgroups based on changes in FEV1 differed only with respect to change in peak oxygen uptake the first year after discharge. In our study, many persons with SCI showed a decline in PF, larger than the normal age-related decline, during the 5 years after inpatient rehabilitation. Results suggest that a decline in PF during the first year after inpatient rehabilitation is associated with higher body mass index, lower inspiratory muscle strength, and declined physical fitness. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. [Efficacy of integrative respiratory rehabilitation training in exercise ability and quality of life of patients with chronic obstructive pulmonary disease in stable phase: a randomized controlled trial].

    Science.gov (United States)

    Xu, Yuan-hong; Wang, Jun-hua; Li, Hai-feng; Zhu, Xiao-hu; Wang, Gang

    2010-05-01

    Chronic obstructive pulmonary disease (COPD) is an important clinical disease, and its global prevalence and mortality rates are high. It is meaningful to investigate the efficacy of integrative respiratory rehabilitation training in quality of life and respiratory physiology of COPD patients in stable phase. To observe the efficacy of integrative respiratory rehabilitation training in exercise ability and quality of life of COPD patients in stable phase. Eighty outpatients and inpatients with COPD from Department of Respiratory Medicine, Taihe Hospital, Yunyang Medical College were randomly divided into 4 groups, with 20 patients in each group. The patients in group A only received drug therapy, the patients in group B received traditional qigong training, the patients in group C received modern rehabilitation training, and the patients in group D received integrative respiratory rehabilitation training. Chronic respiratory questionnaire (CRQ), 6-minute walking distance and Borg score in each group were examined before and after one-, three-, and six-month and one-year treatment. The 6-minute walking distance, Borg score and CRQ score in group A had no significant changes after treatment (P>0.05). After one-month treatment, there were no significant differences in 6-minute walking distance and Borg score in groups B, C and D as compared with those before treatment (Prehabilitation training, traditional qigong training and integrative respiratory rehabilitation training programs all can improve the quality of life and exercise ability of COPD patients, and integrative respiratory rehabilitation training program is better than modern rehabilitation training and traditional qigong training programs. The efficacy of respiratory rehabilitation training is time-dependent, and need long-time adherence to the therapy.

  4. Teaching Home-Based Primary Care.

    Science.gov (United States)

    Reckrey, Jennifer M; Ornstein, Katherine A; Wajnberg, Ania; Kopke, M Victoria; DeCherrie, Linda V

    Despite the growing homebound population and the development of innovative models of care that work to bring care to people in their homes, home visits are not a routine part of education for many healthcare providers. This manuscript describes the experience of Mount Sinai Visiting Doctors teaching home-based primary care to learners of various disciplines and reports the results of a survey performed to assess trainee experience. Mount Sinai Visiting Doctors is the largest academic home-based primary care program in the country and trainees of various disciplines have nearly 1,700 contact days annually of directly supervised clinical teaching. In order to improve trainee education and meet our practice needs, trainees: 1) independently conduct urgent visits, 2) carry longitudinal panels of homebound patients, and 3) perform subspecialist consultations. Mount Sinai Visiting Doctors has exposed thousands of trainees to home-based primary care in the past 20 years and trainees report positive reviews of their experiences. As the need to train future providers in home-based primary care grows, we will be challenged to provide trainees with adequate exposure to multidisciplinary teams and to teach about the importance of continuity of care.

  5. [Pulmonary rehabilitation after total laryngectomy using a heat and moisture exchanger (HME)].

    Science.gov (United States)

    Lorenz, K J; Maier, H

    2009-08-01

    A complete removal of the larynx has profound consequences for a patient. Since laryngectomy involves the separation of the upper airway from the lower airway, it not only implies a loss of the voice organ but also leads to chronic lung problems such as increased coughing, mucus production and expectoration. In addition, laryngectomees complain of fatigue, sleeping problems, a reduced sense of smell and taste, and a loss of social contact. A heat and moisture exchanger (HME) cassette can replace a function of the upper airway which consists in conditioning inspired air. It can improve pulmonary symptoms in three ways. 1. An HME cassette heats and moisturises inhaled air and thus creates nearly physiological conditions in the region of the deep airway. 2. The use of an HME cassette leads to an increase in breathing resistance, thereby reducing dynamic airway compression and improving lung ventilation. 3. An HME cassette acts as a filter and removes larger particles from incoming air. This review examines the current understanding of lung physiology after laryngectomy and assesses the effects of HME cassettes on the conditioning of respiratory air, lung function and psychosocial problems. Georg Thieme Verlag KG Stuttgart, New York.

  6. Magnitude of exercise capacity and quality of life improvement following repeat pulmonary rehabilitation in patients with COPD

    Directory of Open Access Journals (Sweden)

    Sandoz JS

    2017-04-01

    Full Text Available Jacqueline S Sandoz,1,2 Mary M Roberts,1,3,4 Jin-Gun Cho,1,3–5 John R Wheatley1,3–5 1Respiratory Ambulatory Care Service, Western Sydney Local Health District, NSW, Australia; 2Canadian Alternatives in Non-invasive Ventilation (CANVent Program, Ottawa Hospital Rehabilitation Centre, Division of Respiratory Medicine, Ottawa Hospital, Ontario, Canada; 3Department of Respiratory and Sleep Medicine, Westmead Hospital, 4Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, 5Sydney Medical School, University of Sydney, Westmead, NSW, Australia Background: Maintenance and repeated pulmonary rehabilitation programs (PRPs for patients with COPD have attempted to prolong PRP benefits beyond 12–24 months. However, there is limited evidence as to the magnitude of benefit or the ideal interval between repeating the program under “real-world” conditions in which patients are referred based on clinical necessity. Therefore, we reviewed the effects of repeating PRP in a physician-referred cohort of patients with COPD. Methods: A total of 141 individuals with COPD completed PRP twice and 35 completed PRP three times over a 12-year period. We used linear mixed-effects models to quantify the magnitude and change in 6-minute walk distance (6MWD, St George’s Respiratory Questionnaire (SGRQ, and Hospital Anxiety and Depression Scale (HADS for each PRP. One-way analysis of variance with Tukey’s post hoc analysis compared the effects of different time intervals on 6MWD, SGRQ, and HADS between PRPs. Results: Despite 39 mL/year average decrease in forced expiratory volume in 1 second, overall 6MWD improved following each PRP (PRP1=58 m, P<0.0001; PRP2=42 m, P<0.0001; PRP3=32 m, P<0.003. Mean SGRQ decreased after PRP1 (-7.0 units; P<0.001 and PRP2 (-4.9 units;P<0.0001 but not after PRP3 (-3.2 units; P=0.10. HADS decreased after PRP1 (-1.9 units; P<0.0001 and PRP2 (-1.7 units; P=0.0001 but not after PRP3 (-0.4 units

  7. Supervised and home-based exercise training for patients with intermittent claudication

    Science.gov (United States)

    Wang, Jianxiong; Zhou, Shi; Bronks, Roger; Graham, John; Myers, Stephen

    2008-01-01

    Home-based exercise training, applied as the primary treatment in patients with intermittent claudication, has produced inconsistent effects on walking capacity in previous published studies. The aim of the present study was to evaluate whether a home-based exercise training program could maintain improved walking capacity and other functional variables achieved through a supervised exercise training program. The present design was a 48-week self-controlled study. The first 12-week period was a control stage in which no prescribed exercise program was provided, the second 12-week period was a supervised treadmill-walking training program and the following 24-week period was a home-based exercise program. Twenty-two subjects with intermittent claudication were recruited initially; 15 of them (14 men and one woman) completed the whole program. Walking capacity, peak oxygen uptake, walking economy and ankle-brachial index were measured at baseline and at 12, 24 and 48 weeks. There was no significant change in the measured variables after the control stage. The 12-week supervised treadmill-walking training program significantly increased pain-free walking time, maximal walking time and peak oxygen uptake. Walking economy was also significantly improved. These improvements were successfully maintained after 24 weeks of home-based training. The results indicated that 12 weeks of supervised treadmill-walking training followed by a home-based training program is an effective model of exercise rehabilitation for patients with intermittent claudication. PMID:22477417

  8. Respiratory care year in review 2011: long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury, education, and management.

    Science.gov (United States)

    Dunne, Patrick J; Macintyre, Neil R; Schmidt, Ulrich H; Haas, Carl F; Jones-Boggs Rye, Kathy; Kauffman, Garry W; Hess, Dean R

    2012-04-01

    For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury and acute respiratory distress syndrome, respiratory care education, and respiratory care management. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.

  9. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation.

    Science.gov (United States)

    Mezzani, Alessandro; Hamm, Larry F; Jones, Andrew M; McBride, Patrick E; Moholdt, Trine; Stone, James A; Urhausen, Axel; Williams, Mark A

    2012-01-01

    Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

  10. Reabilitação pulmonar na unidade de terapia intensiva: revisão de literatura Pulmonary rehabilitation in intensive care unit: a literature review

    Directory of Open Access Journals (Sweden)

    Danielle Corrêa França

    2010-03-01

    Full Text Available O longo período de imobilidade na internação em unidade de terapia intensiva (UTI desencadeia prejuízos aos sistemas musculoesquelético, cardiovascular, respiratório e neurológico. A reabilitação pulmonar na UTI, em especial o treinamento físico, visa restaurar a funcionalidade anterior ao episódio que determinou a necessidade da ventilação mecânica, reduzindo a dependência, prevenindo novas internações e, conseqüentemente, melhorando a qualidade de vida. Entretanto, é observada resistência na aplicação dessa modalidade de tratamento, devido ao receio das equipes. O objetivo do presente estudo foi efetuar uma revisão da literatura sobre as implicações dos programas de reabilitação pulmonar nas UTI. O levantamento bibliográfico foi feito nas bases de dados PubMed, Cochrane, PEDro e SciELO por meio dos descritores"reabilitação pulmonar""no cuidado intensivo" e"na unidade de terapia intensiva", além de estudos sugeridos por especialistas. Sete artigos (ensaios clínicos randomizados, estudos de coorte e retrospectivos foram avaliados. Todos sugeriram que a reabilitação na UTI é benéfica e não causa efeitos colaterais. Os principais benefícios identificados foram a melhora da deambulação, aumento de força da musculatura respiratória e esquelética, além de melhora funcional ligada às atividades de vida diária. De acordo com os estudos analisados, a reabilitação pulmonar em UTI mostrou-se uma modalidade segura, bem tolerada e que determina efeitos positivos aos pacientes.The long period of immobility in intensive care units (ICU may be harmful to patients' musculoskeletal, cardiovascular, respiratory and neurological systems. Pulmonary rehabilitation in ICU, particularly the physical training, aims to restore previous functionality prior to the event that determined the need for mechanical ventilation, thus reducing dependence, preventing new admissions, and improving patients' quality of life. However

  11. Factors facilitating and hindering the intention to promote pulmonary rehabilitation for patients with COPD among respiratory therapists

    Directory of Open Access Journals (Sweden)

    Chen YJ

    2017-09-01

    Full Text Available Yun-Ju Chen,1 Jun-Yu Fan,2 Su-Er Guo,2–4 Su-Lun Hwang,2,3 Tsung-Ming Yang4 1Division of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China; 2Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China; 3Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China; 4Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China Purpose: Pulmonary rehabilitation (PR is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients’ knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB to investigate both the behavioral intentions and the influential factors surrounding PR in RTs.Patients and methods: This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs.Results: The response rate after excluding respondents with incomplete data was 88.1% (n=379. A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the

  12. Factors facilitating and hindering the intention to promote pulmonary rehabilitation for patients with COPD among respiratory therapists.

    Science.gov (United States)

    Chen, Yun-Ju; Fan, Jun-Yu; Guo, Su-Er; Hwang, Su-Lun; Yang, Tsung-Ming

    2017-01-01

    Pulmonary rehabilitation (PR) is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs) are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients' knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB) to investigate both the behavioral intentions and the influential factors surrounding PR in RTs. This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs. The response rate after excluding respondents with incomplete data was 88.1% (n=379). A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the knowledge, attitudes, subjective norms, self-efficacy, and behavioral intentions components of total PR scores were 63.12%, 71.33%, 68.96%, 66.46%, and 80.29%. The factors significantly affecting RTs' intentions to suggest PR participation to COPD patients or encourage it were attitudes, subjective norms, and self-efficacy. The total model explained 22.5% of the variance in behavioral intentions. The results of the study suggest that RTs strongly intend to promote PR, but are hindered by insufficient knowledge, attitudes, and self-efficacy with regard to it. Applying TPB provided insight into which factors can be addressed, and by whom. For example, enhancing RTs' self-efficacy can be achieved

  13. Pulmonary rehabilitation. Sociedad Española de Neumología y Cirugía Torácica (SEPAR).

    Science.gov (United States)

    Güell Rous, María Rosa; Díaz Lobato, Salvador; Rodríguez Trigo, Gema; Morante Vélez, Fátima; San Miguel, Marta; Cejudo, Pilar; Ortega Ruiz, Francisco; Muñoz, Alejandro; Galdiz Iturri, Juan Bautista; García, Almudena; Servera, Emilio

    2014-08-01

    Pulmonary rehabilitation (PR) has been shown to improve dyspnea, exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). PR has also shown benefits in diseases other than COPD but the level of evidence is lower. The fundamental components of PR programs are muscle training, education and chest physiotherapy. Occupational therapy, psychosocial support and nutritional intervention should also be considered. Home programs have been shown to be as effective as hospital therapy. The duration of rehabilitation programs should not be less than 8 weeks or 20 sessions. Early initiation of PR, even during exacerbations, has proven safe and effective. The use of oxygen or noninvasive ventilation during training is controversial and dependent on the patient's situation. At present, the best strategy for maintaining the benefits of PR in the long term is unknown. Longer PR programs or telemedicine could play a key role in extending the results obtained. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  14. Who Needs Pulmonary Rehabilitation?

    Science.gov (United States)

    ... recommend a healthy eating plan to help you gain weight. They also may give you calorie and protein supplements to help you avoid weight loss and loss of muscle mass. Education Part of PR involves learning about your ...

  15. Application of neuromuscular electrical stimulation of the lower limb skeletal muscles in the rehabilitation of patients with chronic heart failure and chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ewa Barbara Kucio

    2017-03-01

    Full Text Available Increasing physical activity is a widely-known method of rehabilitation of patients with chronic heart failure (CHF and chronic obstructive pulmonary disease (COPD. However, what kind of procedure is to be applied if a patient suffers from advanced heart or respiratory failure, cannot undertake physical exercise due to locomotor system disorders or is currently undergoing respiratorotherapy? Recent research shows that neuromuscular electrical stimulation of the lower limb skeletal muscles (NMES may comprise an alternative to physical training in patients with CHF and COPD. The aim of this study is to summarize the current state of knowledge on the use of NMES in cardiac rehabilitation of patients with CHF and pulmonary rehabilitation of patients with COPD. As demonstrated in recent research on the topic, NMES – due to forcing the muscles to activate – increases exercise tolerance, muscle mass and endurance in patients with CHF and COPD. The beneficial effect of NMES on blood circulation in the muscles, aerobic enzymes activity, functioning of the vascular endothelium, reduction of pro-inflammatory cytokines concentration and increased quality of life has also been presented. It is to be accentuated that NMES treatment, due to lesser physical exertion and, in turn, a decreased feeling of dyspnea are more comfortable for the patient than traditional physical training. Moreover, NMES treatment, after foregoing training, can be applied at home. Potential side effects include transient muscle pain and minor skin damage due to improper positioning of the electrodes. To summarize, NMES treatment is well received by CHF and COPD patients and brings about increased exercise tolerance, as well as better quality of life. Devices used for NMES therapy, due to progressive miniaturization, are easily accessible and relatively inexpensive.

  16. Impact of cardiovascular comorbidities on COPD Assessment Test (CAT) and its responsiveness to pulmonary rehabilitation in patients with moderate to very severe COPD: protocol of the Chance study.

    Science.gov (United States)

    Smid, Dionne E; Wilke, Sarah; Jones, Paul W; Muris, Jean W M; Wouters, Emiel F M; Franssen, Frits M E; Spruit, Martijn A

    2015-07-21

    Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Patients with COPD are characterised by a reduced health status, which can be easily assessed by the COPD Assessment Test (CAT). Previous studies show that health status can be worsened by the presence of comorbidities. However, the impact of cardiovascular comorbidities on health status as assessed with CAT is not sufficiently investigated. Therefore, the current study has the following objectives: (1) to study the clinical, (patho)physiological and psychosocial determinants of the CAT, and impact of previously established and/or newly diagnosed cardiovascular comorbidities on health status in tertiary care patients with COPD; (2) to assess the effects of pulmonary rehabilitation on CAT scores in patients with COPD; (3) to develop reference values for the CAT in Dutch elderly patients without COPD; and (4) to validate the CAT in a broad sample of Dutch patients with COPD. The COPD, Health status and Comorbidities (Chance) study is a monocentre study consisting of an observational cross-sectional part and a longitudinal part. Demographic and clinical characteristics will be assessed in primary care, secondary care and tertiary care patients with COPD, and in patients without COPD. To assess health status, the CAT, Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ) will be used. The longitudinal part consists of a comprehensive pulmonary rehabilitation programme in 500 tertiary care patients. For the cross-sectional part of the study, 150 patients without COPD, 100 primary care patients and 100 secondary care patients will be assessed during a single home visit. The Medical Ethical Committee of the Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands (METC 11-3-070), has approved this study. The study has been registered at the Dutch Trial Register (NTR 3416). Published by the BMJ Publishing Group Limited. For permission to

  17. Impact and Effect of Preoperative Short-term Pulmonary Rehabilitation Training on 
Lung Cancer Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease: 
A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Yutian LAI

    2016-11-01

    Full Text Available Background and objective Pulmonary rehabilitation (PR is proposed as an effective strategy to decrease surgical morbidity. However, appropriate rehabilitation plan, initiation time, and optimal duration of PR remain unclear. Lung cancer patients with chronic obstructive pulmonary disease (COPD are considered high-risk population for postoperative pulmonary complications (PPCs because of poor lung fitness and cardiopulmonary endurance. This study aims to assess the impact of a one-week, systematic and highly-intensive rehabilitation on surgical lung cancer patients with mild to moderate COPD. Methods A randomized controlled trial with 48 subjects was conducted (24 patients each for the intervention and groups. The intervention group received seven days of systematic, integrated and highly-intensive PR before surgical treatment, including: pharmacotherapy with atomizing terbutaline, pulmicort and infusion of ambroxol; and physical rehabilitation with respiratory training and endurance training. The control group underwent standard preoperative care. Results For the intervention group, the postoperative length of stay was shorter [(6.17±2.91 d vs (8.08±2.21 d; P=0.013]; likewise for the duration of antibiotics use [(3.61±2.53 d vs (5.36±3.12 d; P=0.032]. No significant difference was found between the groups in total in-hospital cost [(46,455.6±5,080.9 ¥ vs (45,536.0±4,195.8 ¥, P=0.498], medicine cost [(7,760.3±2,366.0 vs (6,993.0±2,022.5, P=0.223], and material cost [(21,155.5±10,512.1 ¥ vs (21,488.8±3,470.6 ¥, P=0.883]. In the intervention group, peak expiratory flow [(268.40±123.94 L/min vs (343.71±123.92 L/min; P<0.001], 6-min walk distance (6-MWD [(595.42±106.74 m vs (620.90±99.27 m; P=0.004], and energy consumption [(59.93±10.61 kcal vs (61.03±10.47 kcal; P=0.004] were statistically different after the seven-day exercise, compared with those on the first day. Finally, for the intervention group the incidence of PPCs (8

  18. Effect of early progressive resistance training compared with home-based exercise after total hip replacement

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Søballe, Kjeld

    /week). The IG trained with loads of 10 repetition maximum from week 1 to 10 after THR. Before surgery and after the intervention, performance was evaluated by leg extension power (primary outcome), isometric strength (hip abduction + flexion), sit-to-stand test (STS), stair test and 20 meter walking speed......Introduction Muscle strength and physical function deficits persist after total hip replacement (THR). Training effect evidence after THR is lacking. This study investigates the effect of supervised progressive resistance training in early post-THR rehabilitation on muscle strength and functional...... performance. Material and Method 73 THR patients with preoperative self-assessed disability (HOOS ADL score≤67) were randomly assigned to a control group (CG, home-based exercise 7 days/week) or an intervention group (IG, home-based exercise 5 days/week and resistance training of hip and thigh muscles 2 days...

  19. Effects of a pulmonary rehabilitation program on physical capacity, peripheral muscle function and inflammatory markers in asthmatic children and adolescents: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Reimberg, Mariana Mazzuca; Castro, Rejane Agnelo Silva; Selman, Jessyca Pachi Rodrigues; Meneses, Aline Santos; Politti, Fabiano; Mallozi, Márcia Carvalho; Wandalsen, Gustavo Falbo; Solé, Dirceu; De Angelis, Kátia; Dal Corso, Simone; Lanza, Fernanda Cordoba

    2015-08-13

    Individuals with chronic lung disease are more susceptible to present reduction in exercise tolerance and muscles strength not only due to pulmonary limitations but also due systemic repercussions of the pulmonary disease. The aim of this study is to assess the physical capacity, peripheral muscle function, physical activity in daily life, and the inflammatory markers in children and adolescents with asthma after pulmonary rehabilitation program. This is a study protocol of randomized controlled trial in asthmatic patients between 6 to 18 years old. The assessments will be conducted in three different days and will be performed at the beginning and at the end of the protocol. First visit: quality of life questionnaire, asthma control questionnaire, pre- and post-bronchodilator spirometry (400 μcg salbutamol), inflammatory assessment (blood collection), and cardiopulmonary exercise test on a cycle ergometer to determine aerobic capacity. Second visit: assessment of strength and endurance of the quadriceps femoris and biceps brachii muscles with concomitant electromyography to assess peripheral muscle strength. Third visit: incremental shuttle walk test (ISWT) and accelerometer to evaluate functional capacity and physical activity in daily life during 7 days. Then, the volunteers will be randomized to receive pulmonary rehabilitation program (intervention group) or chest physiotherapy + stretching exercises (control group). Both groups will have a supervised session, twice a week, each session will have 60 minutes duration, with minimum interval of 24 hours, for a period of 8 weeks. Intervention group: aerobic training (35 minutes) intensity between 60 to 80 % of the maximum workload of cardiopulmonary exercise testing or of ISWT; strength muscle training will be applied to the quadriceps femoris, biceps brachii and deltoid muscles (intensity: 40 to 70 % of maximal repetition, 3 x 8 repetition); finally the oral high-frequency oscillation device (Flutter®) will be

  20. Active home-based cancer treatment

    Directory of Open Access Journals (Sweden)

    Bordonaro S

    2012-06-01

    Full Text Available Sebastiano Bordonaro Fabio Raiti, Annamaria Di Mari, Calogera Lopiano, Fabrizio Romano, Vitalinda Pumo, Sebastiano Rametta Giuliano, Margherita Iacono, Eleonora Lanteri, Elena Puzzo, Sebastiano Spada, Paolo TralongoUOC Medical Oncology, RAO, ASP 8 Siracusa, ItalyBackground: Active home-based treatment represents a new model of health care. Chronic treatment requires continuous access to facilities that provide cancer care, with considerable effort, particularly economic, on the part of patients and caregivers. Oral chemotherapy could be limited as a consequence of poor compliance and adherence, especially by elderly patients.Methods: We selected 30 cancer patients referred to our department and treated with oral therapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate. This pilot study of oral therapy in the patient’s home was undertaken by a doctor and two nurses with experience in clinical oncology. The instruments used were clinical diaries recording home visits, hospital visits, need for caregiver support, and a questionnaire specially developed by the European Organization for Research and Treatment of Cancer (EORTC, known as the QLQ-C30 version 2.0, concerning the acceptability of oral treatment from the patient’s perspective.Results: This program decreased the need to access cancer facilities by 98.1%, promoted better quality of life for patients, as reflected in increased EORTC QLQ-C30 scores over time, allowing for greater adherence to oral treatment as a result of control of drug administration outside the hospital. This model has allowed treatment of patients with difficult access to care (elderly, disabled or otherwise needed caregivers that in the project represent the majority (78% of these.Conclusions: This model of active home care improves quality of life and adherence with oral therapy, reduces the need to visit the hospital, and consequently decreases the number of lost hours of work on

  1. Eficácia da reabilitação pulmonar uma vez na semana em portadores de doença pulmonar obstrutiva Effectiveness of pulmonary rehabilitation once a week for patients with obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    LS Roceto

    2007-12-01

    Full Text Available CONTEXTUALIZAÇÃO: As doenças pulmonares obstrutivas podem interferir negativamente na qualidade de vida (QV dos pacientes, sendo que questionários específicos, como o Chronic Respiratory Questionnaire (CRQ, são aplicados para quantificar o impacto da doença e para mensurar os efeitos de diferentes protocolos de reabilitação. OBJETIVOS: Avaliar a eficácia da reabilitação pulmonar uma vez por semana associada a exercícios domiciliares em pacientes com doença pulmonar obstrutiva por meio das comparações do CRQ, das pressões respiratórias máximas (PImáx e PEmáx e da distância percorrida no teste de caminhada de seis minutos (TC6 pré e pós-tratamento. MÉTODO: O estudo foi desenvolvido no Ambulatório de Fisioterapia do hospital. Foram avaliados 34 portadores de doença pulmonar obstrutiva de ambos os sexos, sendo incluídos, no estudo, 19 pacientes, com idade média de 60,8 ± 14,2 anos. Todos realizaram avaliação e reavaliação fisioterapêutica contendo medidas de PImáx, PEmáx, TC6, e questionário CRQ. A fisioterapia era composta de exercícios respiratórios, aeróbios e resistidos, com freqüência de uma vez por semana, durante 12 semanas, associados a exercícios domiciliares duas vezes na semana. RESULTADOS: Foram utilizados os testes de Wilcoxon e de correlação de Spearman. Verificou-se diferença estatisticamente significativa nos períodos pré e pós-reabilitação para todos os domínios do CRQ (pBACKGROUND: Obstructive pulmonary diseases may interfere negatively with patients' quality of life (QOL. Specific QOL questionnaires such as the Chronic Respiratory Questionnaire (CRQ have been used to quantify the impact of the disease and measure the effects of different rehabilitation protocols. OBJECTIVE: To evaluate the effectiveness of pulmonary rehabilitation performed once a week in association with exercises at home among patients with obstructive pulmonary disease, by means of CRQ comparisons, maximum

  2. The Calibration Home Base for Imaging Spectrometers

    Directory of Open Access Journals (Sweden)

    Johannes Felix Simon Brachmann

    2016-08-01

    Full Text Available The Calibration Home Base (CHB is an optical laboratory designed for the calibration of imaging spectrometers for the VNIR/SWIR wavelength range. Radiometric, spectral and geometric calibration as well as the characterization of sensor signal dependency on polarization are realized in a precise and highly automated fashion. This allows to carry out a wide range of time consuming measurements in an ecient way. The implementation of ISO 9001 standards in all procedures ensures a traceable quality of results. Spectral measurements in the wavelength range 380–1000 nm are performed to a wavelength uncertainty of +- 0.1 nm, while an uncertainty of +-0.2 nm is reached in the wavelength range 1000 – 2500 nm. Geometric measurements are performed at increments of 1.7 µrad across track and 7.6 µrad along track. Radiometric measurements reach an absolute uncertainty of +-3% (k=1. Sensor artifacts, such as caused by stray light will be characterizable and correctable in the near future. For now, the CHB is suitable for the characterization of pushbroom sensors, spectrometers and cameras. However, it is planned to extend the CHBs capabilities in the near future such that snapshot hyperspectral imagers can be characterized as well. The calibration services of the CHB are open to third party customers from research institutes as well as industry.

  3. Patient influence in home-based reablement for older persons: qualitative research

    Directory of Open Access Journals (Sweden)

    Aud Moe

    2017-11-01

    Full Text Available Abstract Background Reablement services are rehabilitation for older people living at home, being person-centered in information, mapping and the goal-setting conversation. The purpose of this study was to gain knowledge about conversation processes and patient influence in formulating the patients’ goals. There are two research questions: How do conversation theme, structure and processes appear in interactions aiming to decide goals of home-based reablement rehabilitation for the elderly? How professionals’ communication skills do influence on patients' participation in conversation about everyday life and goals of home-based reablement? Methods A qualitative field study explored eight cases of naturally occurring conversations between patients and healthcare professionals in a rehabilitation team. Patients were aged 67–90 years old. The reablement team consisted of an occupational therapist, physiotherapist, nurse and care workers. Data was collected by audio recording the conversations. Transcribed text was analyzed for conversational theme and communication patterns as they emerged within main themes. Results Patient participation differed with various professional leadership and communication in the information, mapping and goalsetting process. In the data material in its entirety, conversations consisted mainly of three parts where each part dealt with one of the three main topics. The first part was “Introduction to the program.” The main part of the talk was about mapping (“Varying patient participation when discussing everyday life”, while the last part was about goal setting (“Goals of rehabilitation”. Conclusions Home-based reablement requires communication skills to encourage user participation, and mapping of resources and needs, leading to the formulation of objectives. Professional health workers must master integrating two intentions: goal-oriented and person-centered communication that requires communication

  4. A regional comparison of cardiac rehabilitation personnel. Adherence to the 1995 American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines by Staff Position.

    Science.gov (United States)

    Bennett, S B; Pescatello, L S

    1997-01-01

    The American Association of Cardiopulmonary Rehabilitation (AACVPR) established guidelines for cardiac rehabilitation (CR) personnel regarding educational degree attainment, licensure, and certification. New England hospital-based CR personnel were surveyed by staff position to determine their adherence to these guidelines. The New England Hospital-Based CR Program Questionnaire was designed to obtain information regarding program characteristics and personnel credentialing. Initially, 117 program directors agreed to participate, and 108 returned completed questionnaires for a response rate of 92.3%. Of the CR programs surveyed, 41% were within hospitals containing 101 to 250 beds, whereas most of those providing inpatient (66.6%) and outpatient (82.4%) CR enrolled less than 200 patients annually. Overall, 40.7% of personnel (n = 450) by staff position reported that they met the minimum recommendations, whereas 7.0% (n = 470) met the preferred AACVPR recommendations. Registered nurses (n = 67) and physical therapists (n = 58) were most compliant with the minimum guidelines: 89.6% and 84.5%, respectively. In contrast, 10.9% of the program directors/coordinators (PD/C; n = 128) met the minimum qualifications, and 5.5% met the preferred AACVPR qualifications. Most PD/C had Advanced Cardiac Life Support Certification (84.4%), but few (18%) attained American College of Sports Medicine (ACSM) certification. Overall, compliance of New England hospital-based CR personnel with the AACVPR minimum/preferred guidelines for educational degree and certification was lacking, as was acquisition of ACSM certification. The effect of these findings on the future status of recommended and required CR personnel qualifications for hire merits attention.

  5. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation

    NARCIS (Netherlands)

    Vorrink, Sigrid N W; Kort, Helianthe S M; Troosters, Thierry; Zanen, Pieter|info:eu-repo/dai/nl/173876412; Lammers, Jan-Willem J|info:eu-repo/dai/nl/071697624

    2016-01-01

    Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in

  6. Home-based HIV counselling and testing in Western Kenya ...

    African Journals Online (AJOL)

    Background. Objective: To describe our experience with the feasibility and acceptance of home-based HIV counselling and testing (HBCT) in two large, rural, administrative divisions of western Kenya. Design: Setting: Results: Conclusion. : Home-based HIV counselling and testing was feasible among this rural population ...

  7. Assessment of Community Mobilization and Home-based HIV ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Home-based HIV counselling and testing (HBHCT) and community mobilization have been proven to be effective in increasing the number of people linked to HIV care and treatment. An assessment was conducted in 18 health facilities in Uganda to evaluate the availability and extent of home based testing services and ...

  8. Challenges for sustainability of home based economic activities in ...

    African Journals Online (AJOL)

    Factors accountable for successful and sustainable home based economic activities were determined. Impacts of home based economic activities were found to be significant in the education of the children, income security and social welfare of families. The study emphasized home economic entrepreneurial education, ...

  9. Balance training in individuals with Parkinson's disease: Therapist-supervised vs. home-based exercise programme.

    Science.gov (United States)

    Atterbury, Elizabeth Maria; Welman, Karen Estelle

    2017-06-01

    Poor locomotion and balance in Parkinson's disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD. An experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I-III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI). Both groups improved in stride length (pexercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD. Copyright © 2017. Published by Elsevier B.V.

  10. Exercise adherence during home-based functional electrical stimulation cycling by individuals with spinal cord injury.

    Science.gov (United States)

    Dolbow, David R; Gorgey, Ashraf S; Ketchum, Jessica M; Moore, Jewel R; Hackett, Laurel A; Gater, David R

    2012-11-01

    The typically sedentary spinal cord injured population has limited physical activity options because of muscle paralysis, difficulties in transportation, and barriers to access rehabilitation/wellness facilities. It is important to investigate physical activity alternatives to increase physical activity levels and decrease the risk of inactivity-derived diseases. The goal of this study was to determine the effects of a home-based functional electrical stimulation cycling program on exercise adherence of those with spinal cord injury. Seventeen Veterans with posttraumatic C4-T11 American Spinal Injury Association Impairment Scale A-C spinal cord injury participated in two 8-wk exercise periods of home-based functional electrical stimulation lower extremity cycling. Exercise adherence and the effects of six factors thought to influence exercise adherence were studied during both exercise periods. Exercise adherence rates for exercise periods 1 and 2 were 71.7% and 62.9%, respectively. Age, history of exercise, and pain not associated with the exercise activity were determined to have significant impact on exercise adherence rates. Exercise adherence rates were well above the reported 35% in the able-bodied population, which provides evidence for the feasibility of a home-based functional electrical stimulation lower extremity cycling program. Younger adults with a history of being physically active have the highest potential for exercise adherence.

  11. [Sociability networks: approaches based on home-based therapeutic care services].

    Science.gov (United States)

    Argiles, Carmen Terezinha Leal; Kantorski, Luciane Prado; Willrich, Janaína Quinzen; Antonacci, Milena Hohmann; Coimbra, Valéria Cristina Christello

    2013-07-01

    Home-based therapeutic services emerge in the context of psychiatric reform in Brazil, as a step forward in the policy of de-institutionalization, as well as being essential services to overcome custody practices, typical of the asylum model. These services provide spaces for care, welcome and decent housing for people whose family and social ties have been affected by internment in psychiatric hospitals. The article seeks to evaluate the sociability network of users of home-based therapeutic services in Alegrete in the State of Rio Grande do Sul, based on a case report. This study is part of the research on 'Networks that Rehabilitate'--evaluating innovative experiments in the composition of psychosocial care networks. Data from semi-structured interviews with the six workers of the service were used. It was observed that the service provides unique and innovative experience to find solutions that bring people with long periods of psychiatric hospitalization back together with their family, the community and city life, thereby eliminating the segregation to which they were subjected. Coaching residents and workers in the creation of home-based therapeutic care services reveals the potential to reintegrate mentally handicapped patients into society.

  12. Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls.

    Science.gov (United States)

    Cull, Brooke J; Rosenkranz, Sara K; Dzewaltowski, David A; Teeman, Colby S; Knutson, Cassandra K; Rosenkranz, Richard R

    2016-01-01

    Childhood obesity is a major public health problem, with one third of America's children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants. Forty girls who are overweight or obese (aged 8-13 years) will be recruited from a Midwestern college town. Participants will be recruited through posted flyers, newspaper advertisements, email, and social media. The volunteer convenience sample of girls will be randomized to one of two home-based wellness coaching interventions: a general health education condition or a healthy eating physical activity skills condition. Trained female wellness coaches will conduct weekly hour-long home visits for 12 consecutive weeks. Assessments will occur at baseline, post-intervention (3 months after baseline), and follow-up (6 months after baseline) and will include height, weight, waist circumference, body composition, pulmonary function, blood pressure, systemic inflammation, physical activity (Actical accelerometer), and self-reported survey measures (relevant to fruit and vegetable consumption, physical activity, and quality of life). This study will evaluate the feasibility of home-based wellness coaching interventions for overweight and obese girls and secondarily assess the preliminary impact on health-related psychosocial, behavioral, and biomedical outcomes. Results will provide

  13. Psychometric properties of the Korean version of the Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE for individuals with COPD

    Directory of Open Access Journals (Sweden)

    Song HY

    2017-08-01

    Full Text Available Hee-Young Song,1 Kyoung A Nam2 1Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, South Korea; 2Division of Nursing, Hallym University, Chuncheon, South Korea Purpose: Self-efficacy is related to the emotional functioning and coping skills of an individual and is thought to be a predictor of health behaviors, which are particularly important for pulmonary rehabilitation (PR. To our knowledge, no measure of self-efficacy has been validated to explore behavior changes in the context of PR for patients with COPD in Korea. This study aimed to evaluate the psychometric properties of the Korean version of the Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE.Patients and methods: The original scale, developed and validated by Vincent et al was translated into Korean through a process involving forward and back translation of the original scale, and transcultural adaptation was performed following the structured procedure. Content validity was assessed by a panel of 6 expert judges. In a convenience sample of 118 patients with COPD, exploratory factor analysis using principal axis factoring, followed by oblique rotation was conducted to identify construct validity, and the concurrent validity was evaluated by testing correlations between the PRAISE and 6-minute walking distance test and the PRAISE and Saint George Respiratory Questionnaire results. Internal consistency was examined by calculating Cronbach’s alpha coefficients.Results: Exploratory factor analysis confirmed the 2-dimensional structure of the scale constructed from the original 15-item scale. The final scale was composed of 14 items that cumulatively explained 60.3% of the total variance. The 2 factors in the scale were named “general self-efficacy” and “exercise self-efficacy.” Significant correlations between the PRAISE, and 6-minute walking distance test and Saint George Respiratory Questionnaire showed the concurrent validity of the

  14. [Effectiveness of an educational program for respiratory rehabilitation of Chronic Obstructive Pulmonary Disease patients in Primary Care in improving the quality of life, symptoms, and clinical risk].

    Science.gov (United States)

    Blánquez Moreno, Cristina; Colungo Francia, Cristina; Alvira Balada, M Carme; Kostov, Belchin; González-de Paz, Luis; Sisó-Almirall, Antoni

    2017-10-04

    To determine the impact of an educational program to improve the management of chronic obstructive pulmonary disease (COPD) that contributes to an increase of the quality of life, exercise capacity, level of dyspnoea, and clinical risk. Intervention study without controls. Primary Healthcare Centre. 193 patients with COPD were invited, 73 accepted and 55 participated in the educational program. Respiratory rehabilitation educational program with basic concepts of pulmonary and respiratory pathophysiology, respiratory physiotherapy exercises, practical workshop on the use of the most frequent inhalation devices, understanding of chronic disease and self-care measures in case of exacerbation. The quality of life (the COPD assessment test), exercise tolerance (the Six-Minute Walk Test), rating of perceived exertion (Borg Dyspnoea Score) and clinical risk (BODE index) were assessed by means of validated questionnaires in Spanish. A total of 43 (78.2%) participants completed the program. An improvement in the quality of life by a mean of 3.3 points was observed (95%CI; 1.76-4.84). Just over half (53.5%) of the participants obtained a clinically relevant improvement. Participants also improved their physical exercise capacity at post-intervention by increasing the distance that they walked in 6min by a mean of 20.76m (95%CI; 2.57-38.95). Improvements in the level of dyspnoea and clinical risk were also observed. The educational program shows a statistically significant and clinically relevant improvement in the quality of life, fatigue, symptomatology, exercise capacity, level of dyspnoea, and clinical risk. The program is adaptable to the health care routine of healthcare centres. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  15. Home-Based Versus Laboratory-Based Robotic Ankle Training for Children With Cerebral Palsy: A Pilot Randomized Comparative Trial.

    Science.gov (United States)

    Chen, Kai; Wu, Yi-Ning; Ren, Yupeng; Liu, Lin; Gaebler-Spira, Deborah; Tankard, Kelly; Lee, Julia; Song, Weiqun; Wang, Maobin; Zhang, Li-Qun

    2016-08-01

    To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. Home versus laboratory within a research hospital. Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups. Children in home-based and laboratory-based groups were 8.7±2.8 (n=23) and 10.7±6.0 (n=18) years old, respectively. Six-week combined passive stretching and active movement intervention of impaired ankle in a laboratory or home environment using a portable rehabilitation robot. Active dorsiflexion range of motion (as the primary outcome), mobility (6-minute walk test and timed Up and Go test), balance (Pediatric Balance Scale), Selective Motor Control Assessment of the Lower Extremity, Modified Ashworth Scale (MAS) for spasticity, passive range of motion (PROM), strength, and joint stiffness. Significant improvements were found for the home-based group in all biomechanical outcome measures except for PROM and all clinical outcome measures except the MAS. The laboratory-based group also showed significant improvements in all the biomechanical outcome measures and all clinical outcome measures except the MAS. There were no significant differences in the outcome measures between the 2 groups. These findings suggest that the translation of repetitive, goal-directed, biofeedback training through motivating games from the laboratory to the home environment is feasible. The benefits of home-based robot-guided therapy were similar to those of laboratory-based robot-guided therapy. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. A Home-Based Palliative Care Consult Service for Veterans.

    Science.gov (United States)

    Golden, Adam G; Antoni, Charles; Gammonley, Denise

    2016-11-01

    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

  17. Interactive Healthcare Systems in the Home: Vestibular Rehabilitation

    DEFF Research Database (Denmark)

    Aarhus, Rikke; Grönvall, Erik; Larsen, Simon Bo

    2010-01-01

    Vestibular dysfunction is a balance disorder, causing dizziness that provokes discomfort and fall situations. This paper discusses early results from a project that aims to develop assistive technologies to support home-based rehabilitation for elderly affected by Vestibular dysfunction.......Vestibular dysfunction is a balance disorder, causing dizziness that provokes discomfort and fall situations. This paper discusses early results from a project that aims to develop assistive technologies to support home-based rehabilitation for elderly affected by Vestibular dysfunction....

  18. Pulmonary rehabilitation after total laryngectomy: a randomized cross-over clinical trial comparing two different heat and moisture exchangers (HMEs).

    Science.gov (United States)

    Herranz, Jesús; Espiño, María Alvarez; Morado, Carolina Ogen

    2013-09-01

    Post-laryngectomy heat and moisture exchanger (HME) use is known to have a beneficial effect on tracheal climate, pulmonary symptoms and related aspects. This study aims to investigate differences in clinical effects between the first and second generation Provox HMEs. The second generation (Provox XtraHME) has better humidification properties than the first generation (Provox HME), and has been shown to further improve tracheal climate. Forty-five laryngectomized patients, who were already using an HME, participated in a prospective, randomized cross-over clinical study in which each HME was used for 6 weeks. Results showed that for most parameters studied, the second generation HME performed equally well or better than the first generation HME. The improvement in tracheal climate translated into patients reporting significantly less tracheal dryness with the second generation than with the first generation (p = 0.039). Using an HME with better humidification properties is related to a reduction in tracheal dryness in our study population.

  19. Outcomes of home-based employment service programs for people with disabilities and their related factors--a preliminary study in Taiwan.

    Science.gov (United States)

    Lin, Yi-Jiun; Huang, I-Chun; Wang, Yun-Tung

    2014-01-01

    The aim of this exploratory study is to gain an understanding of the outcomes of home-based employment service programs for people with disabilities and their related factors in Taiwan. This study used survey method to collect 132 questionnaires. Descriptive and two-variable statistics including chi-square (χ(2)), independent sample t-test and analysis of variance were employed. The results found that 36.5% of the subjects improved their employment status and 75.8% of them improved in employability. Educational level and and vocational categories including "web page production", "e-commerce", "internet marketing", "on-line store" and "website set-up and management" were significantly "positively" associated with either of the two outcome indicators - change of employment status and employability. This study is the first evidence-based study about the outcomes of home-based employment service programs and their related factors for people with disabilities in Taiwan. The outcomes of the home-based employment service programs for people with disabilities were presented. Implications for Rehabilitation Home-based rehabilitation for people with disabilities can be effective. A programme of this kind supports participants in improving or gaining employment status as well as developing employability skills. Further consideration should be given to developing cost-effective home-based programmes and evaluating their effectiveness.

  20. Pulmonary rehabilitation at home guided by telemonitoring and access to healthcare facilities for respiratory complications in patients with neuromuscular disease.

    Science.gov (United States)

    Garuti, G; Bagatti, S; Verucchi, E; Massobrio, M; Spagnolatti, L; Vezzani, G; Lusuardi, M

    2013-02-01

    Pulmonary complications are the main cause of morbidity and mortality in neuromuscular patients. Aim of this study was to evaluate the feasibility of a home follow-up program combining telemonitoring and chest physiotherapy (CPT) in preventing acute respiratory episodes. Prospective observational study in a period of 24 months, and comparison with preintervention data of the same patients. Outpatients and community. Neuromuscular patients. Enrolment criteria were: reduced efficacy of cough, high family support, long home-to-hospital distance. Caregivers and patients had to register daily respiratory signs and symptoms. Each patient was equipped with a pulse oximeter with a modem for transmitting data to a remote control center, in charge of alerting the pulmonologist in case of sign and symptom deterioration. CPT interventions at home were planned after indication by the pulmonologist. The number of emergency room admissions or hospitalization following respiratory exacerbations were registered. Thirteen patients were enrolled. In the first year of monitoring, 18 alerts were transmitted to the pulmonologist, average 1.38±1.38 alert/patient. In the second year, the number of alerts were 5, average 0.38±0.65 alert/patient (Prespiratory therapists' interventions were conducted on 11 patients. In the first 12 months there were four episodes of hospitalisation, none in the following 12 months. In the year prior to the project, there were seven cases of hospitalisation and one case of emergency room admission. The combination of telemonitoring and CPT at home is feasible in the long-term for patients with neuromuscular disease. An apparent reduction of hospitalisation and emergency room admissions for respiratory complications can justify a randomized control trial to confirm efficacy and effectiveness.

  1. Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review.

    Science.gov (United States)

    Mohammed, Jibril; Da Silva, Hellen; Van Oosterwijck, Jessica; Calders, Patrick

    2017-08-01

    Patients with chronic obstructive pulmonary disease (COPD) show several extrapulmonary abnormalities such as impairment in the autonomic function (AF). Similarly, the use of respiratory training techniques such as controlled breathing techniques, noninvasive mechanical ventilation (NIMV), and oxygen supplementation for AF modulation in patients with COPD is popular in existing literature. However, the evidence to support their use is nonexistent. A systematic search of studies reporting on the effect of controlled breathing techniques, NIMV, and/or oxygen supplementation techniques on AF outcome parameters was conducted in three online databases: PubMed, Embase, and Web of Science. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, relevant studies were retained and qualitatively analyzed for evidence synthesis. The methodological quality in these studies was evaluated using the evidence based guideline development (EBRO) checklists per designs provided by the Dutch Cochrane Centre. Eighteen studies met the inclusion criteria of the review and were included and discussed. The evidence synthesis revealed that a strong and moderate level evidence supported oxygen supplementation and slow breathing techniques, respectively, in significantly enhancing the baroreceptor sensitivity (BRS) values in patients with COPD. The effect of the examined techniques on the heart rate variability and muscle sympathetic nerve activity was of a limited or inconsistent evidence. The findings from this review suggest that oxygen supplementation and controlled breathing techniques have profound positive influence on the BRS in patients with COPD. However, it is not fully clear whether these influence translates to any therapeutic benefit on the general AF of patients with COPD in the long term.

  2. Study protocol: home-based telehealth stroke care: a randomized trial for veterans.

    Science.gov (United States)

    Chumbler, Neale R; Rose, Dorian K; Griffiths, Patricia; Quigley, Patricia; McGee-Hernandez, Nancy; Carlson, Katherine A; Vandenberg, Phyllis; Morey, Miriam C; Sanford, Jon; Hoenig, Helen

    2010-06-30

    Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when

  3. Study protocol: home-based telehealth stroke care: a randomized trial for veterans

    Directory of Open Access Journals (Sweden)

    McGee-Hernandez Nancy

    2010-06-01

    Full Text Available Abstract Background Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. Methods We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a TR; or (b Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. Discussion For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and

  4. Challenges in participation: Users and their roles in the development of home-based Pervasive Healthcare applications

    DEFF Research Database (Denmark)

    Aarhus, Rikke; Grönvall, Erik; Kyng, Morten

    2010-01-01

    or laypeople as the primary user groups and to design healthcare applications to be used primarily in the home. This paper discusses challenges and possibilities related to the design of home-based healthcare applications and especially the users' possibilities for participation in creative PD activities....... Based upon ongoing design-work, related to home-based rehabilitation of elderly suffering from vestibular dysfunction (dizziness), this paper presents lessons learned and initial outcomes related to patient/citizen-focused development of healthcare solutions for private homes. We present initial ideas...... on how PD can be used to develop pervasive healthcare applications with less resourceful user-groups such as elderly people suffering from illness....

  5. Who is in charge? The impact of home-based computerized cognitive training on the Cognitive Training Alliance

    DEFF Research Database (Denmark)

    Wilms, Inge Linda

    2017-01-01

    Purpose: This case study observes and analyses how home-based computerized cognitive rehabilitation training impacts the relationship between the patient and home training assistants being either the spouse or paid care takers. The use of computerized cognitive training at home is fairly new...... and there is little knowledge of how delegation of responsibilities affects the alliance between the therapist, the patient and the home training assistants when training is conducted at home. The study investigates positive and negative effects on the marital relationship and identifies some of the skills...... to the emotional challenges of being a training assistant. A Cognitive Training Alliance model for a cognitive training alliance is proposed which takes into consideration the challenges of delegating training responsibility to computers and home-based assistants. Conclusion: It is important to understand how...

  6. A multicenter, prospective, clinical trial evaluating a novel adhesive baseplate (Provox StabiliBase) for peristomal attachment of postlaryngectomy pulmonary and voice rehabilitation devices.

    Science.gov (United States)

    Hilgers, Frans J M; Dirven, Richard; Wouters, Yannick; Jacobi, Irene; Marres, Henri A M; van den Brekel, Michiel W M

    2012-11-01

    Assessment of a novel adhesive baseplate (Provox StabiliBase) for heat and moisture exchanger (HME) and/or automatic speaking valve (ASV) application. Prospective, clinical, multicenter trial. This was a trial in laryngectomized patients comparing their usual adhesive with the trial adhesive. Primary outcome measure was overall patient preference; additional outcome parameters possibly explaining patients' preferences were 1) patient tolerance and preference with respect to daily handling of the adhesive; 2) adhesive lifespan, and 3) voice and speech with the adhesives. Study specific questionnaires, visual analog scales, patients' diaries, and stoma assessments were used for data collection. In total, 58 of the 65 laryngectomized individuals entered in the study completed the trial. Patients' overall preference for the new device was high (76%; P < .001). Significantly better performance was found for the trial adhesive with respect to ease of application (P = .034), fit (P < .001), and air leakage through the adhesive (P < .001). Comfort and stoma depth correlated weakly (r = 0.297; P = .024; deeper stoma-more comfort with StabiliBase). The adhesive lifespan with HME is significantly increased (1.7 times and 15.7 hours-plus airtight use; P < .001). This longer lifespan coincided with somewhat increased dirtying of the adhesive (P = .02). There were no serious adverse events. The StabiliBase adhesive for peristomal attachment of HMEs and/or ASVs was preferred by 76% of study participants and showed a promising prolonged lifespan. This new device further increases the options for stoma attachment in laryngectomized individuals, and subsequently the availability of optimal voice and pulmonary rehabilitation for a larger proportion of patients. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  7. Chronic Obstructive Pulmonary Disease in Women

    Directory of Open Access Journals (Sweden)

    Louis Laviolette

    2007-01-01

    Full Text Available BACKGROUND: Little is known about the comparative impact of chronic obstructive pulmonary disease (COPD between women and men and about women’s response to pulmonary rehabilitation.

  8. Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial

    National Research Council Canada - National Science Library

    Blanco, Isabel; Santos, Salud; Gea, Joaqím; Güell, Rosa; Torres, Ferran; Gimeno-Santos, Elena; Rodriguez, Diego A; Vilaró, Jordi; Gómez, Begona; Roca, Josep; Barberà, Joan Albert

    2013-01-01

    ... rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP). In this double-blind, randomised controlled trial patients received 20 mg sildenafil or placebo three times daily and underwent pulmonary rehabilitation for 3 months...

  9. Effects of Apple Supplement and Unsupervised Home-based Brisk ...

    African Journals Online (AJOL)

    Members in Group I (n = 7) were given apple fruit (Pyrus Malus) twice a day free of charge and were advised unsupervised home-based walking activity for three weeks. Members in Group II (n = 7) were given apple fruit alone. During the period of the study all participants were advised dietary fat restriction and their fasting ...

  10. Quality in home-based childcare : Impact and improvement

    NARCIS (Netherlands)

    Groeneveld, Marilene Gerarda

    2010-01-01

    The thesis ‘Quality in home-based childcare: Impact and improvement’ consists of two studies. The general aim of the first study is to examine children’s stress levels and wellbeing, and the role of caregiver stress and childcare quality. This first study is described in chapters 2, 3, and 4.

  11. A HOME-BASED MASSED PRACTICE SYSTEM FOR PEDIATRIC NEUROREHABILITATION

    Directory of Open Access Journals (Sweden)

    Yi-Ning Wu

    2013-11-01

    Full Text Available The objective of this paper is to introduce a novel low-cost human-computer interface (HCI system for home-based massed practice for children with upper limb impairment due to brain injury. Successful massed practice, a type of neurorehabilitation, may be of value for children with brain injury because it facilitates impaired limb use. Use of automated, home-based systems could provide a practical means for massed practice. However, the optimal strategy to deliver and monitor home-based massed practice is still unclear. We integrated motion sensor, video game, and HCI software technologies to create a useful home-based massed practice at targeted joints. The system records joint angle and number of movements using a low-cost custom hand-held sensor. The sensor acts as an input device to play video games. We demonstrated the system’s functionality and provided preliminary observations on usage by children with brain injury, including joint motion and muscle activation.

  12. HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS ...

    African Journals Online (AJOL)

    The relationship of poor practice of Home Based. Care and hospital re-admission of PLWHA ... Therefore HBC Training is important for family members who are taking care of their relatives ..... Relationships of believed attitude of HBC among family care givers and Hospital re- admission of PLWHA. Hospital re-admission.

  13. Cost effectiveness of facility and home based HIV voluntary ...

    African Journals Online (AJOL)

    Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage. Objective: To evaluate the cost effectiveness of facility- and ...

  14. Who are good home-based care volunteers? | Marincowitz | South ...

    African Journals Online (AJOL)

    Aim: The aim of the study was to describe the characteristics of volunteers who remained active in the home-based care project located in Tzaneen (Limpopo Province) and thereby assist the project leaders to improve the recruitment and quality of the service in the future. Methodology: Structured questionnaires were ...

  15. Understanding the agency of home-based care volunteers ...

    African Journals Online (AJOL)

    Volunteer motivations vary from altruism, to volunteering as a means to be recognised and increasing the chances of self-improvement. We propose that home-based-care volunteering may be viewed as a form of agency in response to a lack of recognition, support and acknowledgement for AIDS caregivers and their ...

  16. Home-based practices of complementary foods improvement are ...

    African Journals Online (AJOL)

    Items related to the early and current breastfeeding patterns and the mode of complementary feeding were recorded by interview of the mothers. Fortified cereals were defined as home-based improved flours by mixing “soumbala,” fishmeal, toasted groundnut, or several of these local foods with cereal. Soumbala is a ...

  17. The home as informal business location: Home-based business ...

    African Journals Online (AJOL)

    Home-based businesses (HBBs) are often considered the most 'formal' of the informal business sector types, where a formal structure such as a house or shack provides some form of security for these businesses. Notwithstanding this structural 'security', HBBs are merely a reflection of broader urban economic and spatial ...

  18. Who are good home-based care volunteers?

    African Journals Online (AJOL)

    a joint venture between a local NGO and public sector health workers. During the latter half of 1999, volun- teers were identified through a par- ticipatory process with communities in the area. Ninety-six (96) volun- teers were trained. They all attended one of the five-day introductory courses in home-based care. After.

  19. Effects of home-based long-term care services on caregiver health according to age.

    Science.gov (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

    2017-10-23

    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The

  20. Out-Patient Pulmonary Rehabilitation Improves Medial-Lateral Balance in Subjects With Chronic Respiratory Disease: Proof-of-Concept Study.

    Science.gov (United States)

    Smith, Michelle D; Harvey, Elizabeth H; van den Hoorn, Wolbert; Shay, Barbara L; Pereira, Gisèle M; Hodges, Paul W

    2016-04-01

    Recent studies show balance impairment in subjects with chronic respiratory disease. The aim of this proof-of-concept study was to investigate clinical and quantitative measures of balance in people with chronic respiratory disease following participation in an out-patient pulmonary rehabilitation (PR) program to better understand features of balance improvement. A secondary aim was to probe possible mechanisms for balance improvement to provide the foundation for optimal design of future studies. Eleven individuals with chronic respiratory disease enrolled in an 8-week out-patient PR program participated. Standing balance, measured with a force plate, in the medial-lateral and anterior-posterior directions with eyes open and closed was assessed with linear (SD and sway path length) and non-linear (diffusion analysis) center-of-pressure measures. Balance was evaluated clinically with the Timed Up and Go and Four Square Step Test. Fear of falling and balance confidence were assessed with questionnaires. After participation in PR, medial-lateral sway path length decreased (P = .031), and center-of-pressure diffusion in the medial-lateral direction was slower (P = .02) and traveled over less distance (P = .03) with eyes closed. This suggests greater control of medial-lateral sway. There was no change in anterior-posterior balance (P > .067). Performance improved on the Timed Up and Go (median [interquartile range] pre-PR = 9.4 [7.9-12.8] vs. post-PR = 8.1 [7.3-12.2] s, P = .003) and Four Square Step Test (median [interquartile range] pre-PR = 9.3 [7.2-14.2] vs. post-PR = 8.7 [7.4-10.2] s, P = .050). There were no changes in balance confidence (P = .72) or fear of falling (P = .57). Participation in an 8-week out-patient PR program improved balance, as assessed by clinical and laboratory measures. Detailed analysis of force plate measures demonstrated improvements primarily with respect to medial-lateral balance control. These data provide a basis for the development

  1. Paralysis: Rehabilitation

    Science.gov (United States)

    ... Forum About Us Donate Living with Paralysis > Rehabilitation Rehabilitation Rehabilitation and exercise are key to enhancing your health and quality of life. Find a rehabilitation center near you and become familiar with different ...

  2. Preliminary Study of the Effect of Low-Intensity Home-Based Physical Therapy in Chronic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Jau-Hong Lin

    2004-01-01

    Full Text Available This study was a preliminary examination of the effect of low-intensity home-based physical therapy on the performance of activities of daily living (ADL and motor function in patients more than 1 year after stroke. Twenty patients were recruited from a community stroke register in Nan-Tou County, Taiwan, to a randomized, crossover trial comparing intervention by a physical therapist immediately after entry into the trial (Group I or after a delay of 10 weeks (Group II. The intervention consisted of home-based physical therapy once a week for 10 weeks. The Barthel Index (BI and Stroke Rehabilitation Assessment of Movement (STREAM were used as standard measures for ADL and motor function. At the first follow-up assessment at 11 weeks, Group I showed greater improvement in lower limb motor function than Group II. At the second follow-up assessment at 22 weeks, Group II showed improvement while Group I had declined. At 22 weeks, the motor function of upper limbs, mobility, and ADL performance in Group II had improved slightly more than in Group I, but the between-group differences were not significant. It appears that low-intensity home-based physical therapy can improve lower limb motor function in chronic stroke survivors. Further studies will be needed to confirm these findings.

  3. On participatory design of home-based healthcare

    DEFF Research Database (Denmark)

    Grönvall, Erik; Kyng, Morten

    2013-01-01

    to reflect upon differences between a home-based PD process with non-workers, such as ours, and work-place projects, such as Utopia. Through this reflection, the paper contributes to a more general discussion on PD in non-work settings with weak users. Indeed, differences do exist between traditional PD...... projects in work settings, such as Utopia, and home-based PD with weak users especially in relation to knowledge about settings and how to reconcile differences in interests. The home as a place for (technology-assisted) treatment and PD must be carefully analyzed. Diverse interests and roles as well......Participatory design (PD) activities in private homes challenge how we relate to the PD process, compared to PD in professional settings. Grounded in a project related to chronic dizziness among older people, we identified four challenges when performing PD with ill, weak users in their private...

  4. Cloud Computing for Achieving Interoperability in Home-based Healthcare

    OpenAIRE

    Hu, Yan

    2017-01-01

    The care of chronic disease has become the main challenge for healthcare institutions around the world. As the incidence and prevalence of chronic diseases continue to increase, it is a big challenge for traditional hospital-based healthcare to meet requirements of patients. To meet the growing needs of patients, moving the front desk of healthcare from hospital to home is essential. Home-based healthcare for chronic disease involves many different organizations and healthcare providers. Ther...

  5. Home-based, early intervention with mechatronic toys for preterm infants at risk of neurodevelopmental disorders (CARETOY)

    DEFF Research Database (Denmark)

    Sgandurra, Giuseppina; Bartalena, Laura; Cioni, Giovanni

    2014-01-01

    , individualized, home-based and family-centred early intervention, managed remotely by rehabilitation staff. A randomised controlled trial (RCT) has been designed to evaluate the efficacy of CareToy training in a first sample of low-risk preterm infants. METHODS/DESIGN: The trial, randomised, multi...... parents will sign a written informed consent for participation, will be randomized in CareToy training and control groups at baseline (T0). CareToy group will perform four weeks of personalized activities with the CareToy system, customized by the rehabilitation staff. The control group will continue...... standard care. Infant Motor Profile Scale is the primary outcome measure and a total sample size of 40 infants has been established. Bayley-Cognitive subscale, Alberta Infants Motor Scale and Teller Acuity Cards are secondary outcome measures. All measurements will be performed at T0 and at the end...

  6. [The substantiation of the use of high-frequency intrapulmonary ventilation in the patients presenting with chronic obstructive pulmonary disease at the spa and health resort stage of rehabilitation].

    Science.gov (United States)

    Zaripova, T N; Zhilyakova, L V; Bulanova, Z P

    The importance of the development of the new methods for the rehabilitation of the patients presenting with chronic obstructive pulmonary disease under conditions of the spa and health resort-based treatment arises from the high prevalence and the progressive character of this disease, poor quality of the patients' life, great economic losses due to the reduction of the working capacity of the patients, and the high cost of COPD treatment. The objective of the present study was to substantiate the advisability of inclusion of high-frequency intrapulmonary ventilation in the program of the therapeutic and rehabilitative treatment of the patients with COPD based at a spa and health resort facility. The analysis of the results of examination and rehabilitative treatment included 49 patients treated at the «Belokurikha» health resort (14 women and 35 men presenting with stage 1 and 2 COPD). The patients were divided into two groups. The main one included 23 patients while the group of comparison consisted of 26 patients. Those of the main group were given the treatment that included the mineral water baths, inhalations, exercise therapy for the training of skeletal muscles, manual massage, high-frequency intrapulmonary ventilation, intake of extract maral root (Rhaponticum carthamoides) and the «Yantar antiox» (amber antiox) preparation. The patients of the comparison group received the same rehabilitative treatment but without high-frequency intrapulmonary ventilation. The effectiveness of the rehabilitative measures was comprehensively estimated from the dynamics of the clinical data, indices of the inflammatory activity, the results of spirography and 6 minute walking test. It has been shown that the introduction of high-frequency intrapulmonary ventilation into the spa and health resort-based rehabilitative program facilitates the elimination of clinical manifestation of the disease, promotes recovery of the external respiration function due to sputum

  7. Humanoid assessing rehabilitative exercises.

    Science.gov (United States)

    Simonov, M; Delconte, G

    2015-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation". The article presents the approach in which the rehabilitative exercise prepared by healthcare professional is encoded as formal knowledge and used by humanoid robot to assist patients without involving other care actors. The main objective is the use of humanoids in rehabilitative care. An example is pulmonary rehabilitation in COPD patients. Another goal is the automated judgment functionality to determine how the rehabilitation exercise matches the pre-programmed correct sequence. We use the Aldebaran Robotics' NAO humanoid to set up artificial cognitive application. Pre-programmed NAO induces elderly patient to undertake humanoid-driven rehabilitation exercise, but needs to evaluate the human actions against the correct template. Patient is observed using NAO's eyes. We use the Microsoft Kinect SDK to extract motion path from the humanoid's recorded video. We compare human- and humanoid-operated process sequences by using the Dynamic Time Warping (DTW) and test the prototype. This artificial cognitive software showcases the use of DTW algorithm to enable humanoids to judge in near real-time about the correctness of rehabilitative exercises performed by patients following the robot's indications. One could enable better sustainable rehabilitative care services in remote residential settings by combining intelligent applications piloting humanoids with the DTW pattern matching algorithm applied at run time to compare humanoid- and human-operated process sequences. In turn, it will lower the need of human care.

  8. Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis.

    Science.gov (United States)

    Prosperini, Luca; Fortuna, Deborah; Giannì, Costanza; Leonardi, Laura; Marchetti, Maria Rita; Pozzilli, Carlo

    2013-01-01

    To evaluate the effectiveness of a home-based rehabilitation of balance using the Nintendo Wii Balance Board System (WBBS) in patients affected by multiple sclerosis (MS). In this 24-week, randomized, 2-period crossover pilot study, 36 patients having an objective balance disorder were randomly assigned in a 1:1 ratio to 2 counterbalanced arms. Group A started a 12-week period of home-based WBBS training followed by a 12-week period without any intervention; group B received the treatment in reverse order. As endpoints, we considered the mean difference (compared with baseline) in force platform measures (i.e., the displacement of body center of pressure in 30 seconds), 4-step square test (FSST), 25-foot timed walking test (25-FWT), and 29-item MS Impact Scale (MSIS-29), as evaluated after 12 weeks and at the end of the 24-week study period. The 2 groups did not differ in baseline characteristics. Repeated-measures analyses of variance showed significant time × treatment effects, indicating that WBBS was effective in ameliorating force platform measures (F = 4.608, P = .016), FSST (F = 3.745, P = .034), 25-FWT (F = 3.339, P = .048), and MSIS-29 (F = 4.282, P = .023). Five adverse events attributable to the WBSS training (knee or low back pain) were recorded, but only 1 patient had to retire from the study. A home-based WBBS training might potentially provide an effective, engaging, balance rehabilitation solution for people with MS. However, the risk of WBBS training-related injuries should be carefully balanced with benefits. Further studies, including cost-effectiveness analyses, are warranted to establish whether WBBS may be useful in the home setting.

  9. Hospital at home: home-based end of life care

    Science.gov (United States)

    Shepperd, Sasha; Wee, Bee; Straus, Sharon E

    2014-01-01

    Background The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and patients with a terminal illness would prefer to receive end of life care at home. Objectives To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) to October 2009, Ovid MED-LINE(R) 1950 to March 2011, EMBASE 1980 to October 2009, CINAHL 1982 to October 2009 and EconLit to October 2009. We checked the reference lists of articles identified for potentially relevant articles. Selection criteria Randomised controlled trials, interrupted time series or controlled before and after studies evaluating the effectiveness of home-based end of life care with inpatient hospital or hospice care for people aged 18 years and older. Data collection and analysis Two authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible we presented the data in narrative summary tables. Main results We included four trials in this review. Those receiving home-based end of life care were statistically significantly more likely to die at home compared with those receiving usual care (RR 1.33, 95% CI 1.14 to 1.55, P = 0.0002; Chi 2 = 1.72, df = 2, P = 0.42, I2 = 0% (three trials; N=652)). We detected no statistically significant differences for functional status (measured by the Barthel Index), psychological well-being or cognitive status, between patients receiving home-based end of life care compared with those receiving standard care (which

  10. O efeito da assistência psicológica em um programa de reabilitação pulmonar para pacientes com doença pulmonar obstrutiva crônica The effect of psychotherapy provided as part of a pulmonary rehabilitation program for the treatment of patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Dagoberto Vanoni de Godoy

    2005-12-01

    Full Text Available OBJETIVO: Avaliar o efeito da psicoterapia sobre os níveis de ansiedade, depressão, qualidade de vida e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica, submetidos a um programa de reabilitação pulmonar. MÉTODOS: Ensaio clínico prospectivo, controlado e cego realizado com 49 portadores de doença pulmonar obstrutiva crônica randomizados em três grupos: programa de reabilitação pulmonar completo (grupo 1, sem exercícios físicos (grupo 2 e sem psicoterapia (grupo 3. Foram utilizados para avaliação: inventários de ansiedade e de depressão de Beck, questionário respiratório de Saint George e o produto da distância caminhada pelo peso. RESULTADOS: Os grupos 1 e 2 demonstraram melhora absoluta estatisticamente significativa na capacidade de realizar exercícios (p = 0,007, p = 0,008 e p = 0,06, respectivamente. Os grupos 1 e 2 demonstraram redução significativa dos níveis de ansiedade e depressão, e melhora no índice de qualidade de vida: grupo 1 - p = 0,0000, p OBJECTIVE: To assess the effect of psychotherapy on levels of anxiety and depression, as well as on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program. METHODS: A randomized, controlled, blind clinical trial was conducted involving 49 chronic obstructive pulmonary disease patients. Patients were randomized into three groups: those submitted to the complete pulmonary rehabilitation program, which included psychotherapy and an exercise regimen (group 1; those submitted to the program minus physical exercise (group 2; and those submitted to the program minus psychotherapy (group 3. The three groups underwent a 12-week treatment program. All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program through four instruments: The Beck Anxiety Inventory, Beck Depression Inventory and St. George's Respiratory Questionnaire

  11. Usability evaluation of low-cost virtual reality hand and arm rehabilitation games

    OpenAIRE

    Na Jin Seo, PhD; Jayashree Arun Kumar, MS; Pilwon Hur, PhD; Vincent Crocher, PhD; Binal Motawar, PT, MS; Kishor Lakshminarayanan, MS

    2016-01-01

    The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quali...

  12. Home based Tactile Discrimination Training (TDT) reduces phantom limb pain.

    Science.gov (United States)

    Wakolbinger, Robert; Diers, Martin; Hruby, Laura A; Sturma, Agnes; Aszmann, Oskar C

    2017-11-06

    Phantom limb pain (PLP) affects a high percentage of amputees. Since treatment options are limited, low quality of life and addiction to pain medication is frequent. New attempts, such as mirror therapy or electrical sensory discrimination training, make use of the brain's plasticity to alleviate this centrally derived pain. This pilot study assessed the question, whether home-based tactile discrimination training (TDT) leads to a stronger decrease in phantom limb pain levels, compared to a standard massage treatment. Controlled study. Outpatient. Amputees (upper/lower extremity) with PLP of VAS 4/10 or higher. Eight patients participated in the study. The treatment phase comprised two weeks (15min daily). Subjects were examined at baseline, after treatment, two weeks after and four weeks after completing the treatment. Pain was assessed with the West Haven Multidimensional Pain Inventory. There was a significantly stronger reduction in phantom limb pain in the treatment group receiving TDT. Phantom limb pain intensity ratings were significantly reduced at the end of therapy, two weeks after as well as four weeks after compared to pre-treatment. TDT seems to be an easy, cheap, time-effective and safe method to achieve sustained alleviation in PLP and also brings about a positive change in body image. Home-based TDT could achieve sustained reduction in PLP and should be considered as possible alternative to established treatment methods. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Stem cell homing-based tissue engineering using bioactive materials

    Science.gov (United States)

    Yu, Yinxian; Sun, Binbin; Yi, Chengqing; Mo, Xiumei

    2017-06-01

    Tissue engineering focuses on repairing tissue and restoring tissue functions by employing three elements: scaffolds, cells and biochemical signals. In tissue engineering, bioactive material scaffolds have been used to cure tissue and organ defects with stem cell-based therapies being one of the best documented approaches. In the review, different biomaterials which are used in several methods to fabricate tissue engineering scaffolds were explained and show good properties (biocompatibility, biodegradability, and mechanical properties etc.) for cell migration and infiltration. Stem cell homing is a recruitment process for inducing the migration of the systemically transplanted cells, or host cells, to defect sites. The mechanisms and modes of stem cell homing-based tissue engineering can be divided into two types depending on the source of the stem cells: endogenous and exogenous. Exogenous stem cell-based bioactive scaffolds have the challenge of long-term culturing in vitro and for endogenous stem cells the biochemical signal homing recruitment mechanism is not clear yet. Although the stem cell homing-based bioactive scaffolds are attractive candidates for tissue defect therapies, based on in vitro studies and animal tests, there is still a long way before clinical application.

  14. Home-Based Psychoeducational Intervention for Breast Cancer Survivors.

    Science.gov (United States)

    Şengün İnan, Figen; Üstün, Besti

    2017-03-15

    It is important to manage psychological distress and improve the quality of life (QOL) in patients after breast cancer treatment. The aim of this study was to evaluate the effects of a home-based, psychoeducational program on distress, anxiety, depression, and QOL in breast cancer survivors. The study was a single-group pretest and posttest quasi-experimental design. The data were collected using the Distress Thermometer, the Hospital Anxiety and Depression Scale, and the Turkish version of the World Health Organization Quality of Life Instrument, short form. The home-based, individual, face-to-face psychoeducational program was structured according to breast cancer survivors' needs and the Neuman Systems Model. A total of 32 Turkish breast cancer survivors participated in this study. There were statistically significant differences in the mean scores for distress, anxiety, and depression in the breast cancer survivors over 4 measurements. The mean scores for all subscales of the QOL at 6 months postintervention were significantly higher than the mean scores at baseline. The results indicated that the psychoeducational program may be effective in reducing distress, anxiety, and depression and in improving the QOL in breast cancer survivors. Psychoeducational programs may be effective and should be considered as part of the survivorship care for breast cancer survivors.

  15. Avaliação do aprendizado de pacientes com doença pulmonar obstrutiva crônica em um programa de reabilitação pulmonar Evaluation of learning in patients with chronic obstructive pulmonary disease during a pulmonary rehabilitation program

    Directory of Open Access Journals (Sweden)

    DS Galvez

    2007-08-01

    Full Text Available INTRODUÇÃO: Os pacientes que realizam um programa de reabilitação pulmonar participam, também, de um programa educativo com aulas expositivas abordando assuntos referentes à sua doença e ao tratamento. Esse programa visa levar o conhecimento necessário para que o paciente possa lidar com a doença e suas repercussões. OBJETIVO: Avaliar se o programa educativo aplicado aos pacientes submetidos a reabilitação pulmonar tem resultados efetivos no aprendizado dos mesmos. CASUÍSTICA E MÉTODO: Estudo prospectivo, envolvendo 22 pacientes que se submeteram a um programa de reabilitação pulmonar, com idade 63 (DP ± 11,8. Inicialmente foi aplicado um questionário desenvolvido e validado pelo Centro de Reabilitação Pulmonar da UNIFESP/LESF para avaliar o conhecimento da doença pré e pós-intervenção do programa educacional. Os pacientes foram divididos em dois grupos: um grupo com programa educativo e um grupo controle (sem programa educativo. O grupo educativo respondeu ao questionário duas vezes, pré e pós-programa, já o grupo controle respondeu ao questionário apenas uma vez. RESULTADOS: Os pacientes que foram submetidos ao programa educativo apresentaram aumento no percentual de respostas corretas quando comparados o pré e o pós-intervenção, 69% e 84% respectivamente, e uma diminuição na porcentagem de erros quando comparados o pré e o pós-intervenção, 20% e 14% respectivamente. CONCLUSÃO: O programa educativo aplicado aos pacientes do programa de reabilitação pulmonar mostrou-se efetivo, pois aumentou o conhecimento dos pacientes no que se refere à doença, suas conseqüências e seu tratamento.BACKGROUND: Patients who undergo pulmonary rehabilitation programs also participate in an educational program with classes covering matters related to their disease and treatment. Such programs aim to provide patients with the knowledge needed for them to be able to deal with their disease and its repercussions

  16. Effects on centre-based training and home-based training on physical function, quality of life and fall incidence in community dwelling older adults.

    Science.gov (United States)

    Kwok, Thomas M K; Tong, C Y

    2014-05-01

    This was a quasi-experimental study to compare the effects of center-based training with home-based training on physical function, quality of life and fall incidence in older adults. Fifty older adults were recruited to receive exercise training for 6 months. Participants in the center-based group received training under supervision of a physiotherapist at the day training center. Those in the home-based group received training assisted by a care worker at home. The outcome measures were the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS), Numeric Pain Rating Scale (NPRS), Short-form 12 (SF-12) and fall incidence. Assessments were performed on all participants before and after the 6-month intervention period. Center-based training supervised by a physiotherapist was found to have beneficial effects on physical function, quality of life and fall incidence while home-based training assisted by a care worker had no effect on physical condition and self-rated health status in community dwelling older adults. Service agents should provide center-based or home-based training to the ageing population in a user-friendly way with consideration of factors such as rehabilitation potential and accessibility of transportation.

  17. Effect of 3-Months Home-Based Exercise Program on Changes of Cognitive Functioning in Older Adults Living in Old People’s Home

    Directory of Open Access Journals (Sweden)

    Nemček Dagmar

    2016-05-01

    Full Text Available The aim of the study was to determine the effect of regular participation in home-based exercise programme on cognitive functioning changes in institutionalised older adults. Two groups of participants were recruited for the study: experimental (n = 17 in mean age 76 ± 5.6 years, who participated in home-based exercise program and control (n = 14 in mean age 80 ± 4.2 years. The standardised Stroop Color-Word Test-Victoria version (VST was used to measure the level of cognitive functions. Group differences were analyzed with Mann-Whitney U-test for independent samples and for differences between pre-measurements and post-measurements on experimental and control group we used non-parametric Wilcoxon Signed - Rank Test. The level of significance was α < 0.05. Application of 3-months home-based exercise program significantly improved the cognitive functions only in one (Word condition; p<0.01 from three VST conditions in institutionalised older adults. That’s why we recommend longer participation in home-based exercise program, at least 6- months, with combination of various types of cognitive interventions, like concepts of cognitive training, cognitive rehabilitation, and cognitive stimulation to improve cognitive functioning in older adults living in old peoples’ homes.

  18. Rehabilitation Options

    Science.gov (United States)

    ... for e-updates Please leave this field empty Rehabilitation Options SHARE Home > Treatment and Care > Continuum of Care > Rehabilitation Options Listen Beginning the Healing Process After undergoing ...

  19. Feasibility of home-based cardiac telerehabilitation: Results of TeleInterMed study.

    Science.gov (United States)

    Piotrowicz, Ewa; Korzeniowska-Kubacka, Iwona; Chrapowicka, Agnieszka; Wolszakiewicz, Jadwiga; Dobraszkiewicz-Wasilewska, Barbara; Batogowski, Marek; Piotrowski, Walerian; Piotrowicz, Ryszard

    2014-01-01

    Cardiac rehabilitation (CR) is recommended as an important component of a comprehensive approach to cardiovascular disease (CVD) patients. Data have shown that a small percentage of eligible patients participate in CR despite their well established benefits. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR. The purpose of the study was to evaluate a wide implementation and feasibility of home-based cardiac telerehabilitation (HTCR) in patients suffering from CVD and to assessits safety, patients' acceptance of and adherence to HTCR. The study included 365 patients (left ventricular ejection fraction 56 ± 8%; aged 58 ± 10 years). They participated in 4-week HTCR based on walking, nordic walking or cycloergometer training. HTCR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with CR. The influence on physical capacity was assessed by comparing changes - in time of exercise test, functional capacity, 6-min walking test distance from the beginning and the end of HTCR. At the end of the study, patients filled in a questionnaire in order to assess their acceptance of HTCR. HTCR resulted in a significant improvement in all parameters. There were neither deaths nor adverse events during HTCR. Patients accepted HTCR, including the need for interactive everyday collaboration with the monitoring center. There were only 0.8% non-adherent patients. HTCR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high and promising.

  20. Efficacy of home-based kinesthesia, balance & agility exercise training among persons with symptomatic knee osteoarthritis.

    Science.gov (United States)

    Rogers, Matthew W; Tamulevicius, Nauris; Semple, Stuart J; Krkeljas, Zarko

    2012-01-01

    The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ≥ 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach for persons with knee OA.

  1. EFFICACY OF HOME-BASED KINESTHESIA, BALANCE & AGILITY EXERCISE TRAINING AMONG PERSONS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Matthew W. Rogers

    2012-12-01

    Full Text Available The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA exercise program to improve symptoms among persons age > 50 years with knee osteoarthritis (OA. Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT, KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF, community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG. Thirty-three participants [70.7 (SD 8.5 years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05 improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid- point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise

  2. Chronic Obstructive Pulmonary Disease (COPD): A Review of the ...

    African Journals Online (AJOL)

    DATONYE ALASIA

    COPD often has extrapulmonary manifestations. Principal among these systemic manifestations is skeletal-. 32 muscle dysfunction .Pulmonary rehabilitation ..... Improvement in household stoves and risk of chronic obstructive pulmonary disease in. Xuanwei, China: retrospective cohort study. BMJ 2005;331:1050. 30.

  3. The precarious balance between ‘supply’ and ‘demand’ for health care: The increasing global demand for rehabilitation service for individuals living with chronic obstructive pulmonary disease

    Science.gov (United States)

    Landry, Michel D; Hamdan, Elham; Mazeedi, Sabriya Al; Brooks, Dina

    2008-01-01

    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. PMID:18990966

  4. Inpatient paediatric rehabilitation in chronic respiratory disorders.

    Science.gov (United States)

    Jung, Andreas; Heinrichs, Irmela; Geidel, Christian; Lauener, Roger

    2012-06-01

    Inpatient pulmonary rehabilitation programs have evolved from tuberculosis sanatoriums to modern medical centres providing standardized comprehensive care in a multidiciplinatory environment. Goals of rehabilitation programs for children and adolescents include restoration of professional activity, improvement of health condition, compliance and disease management as well as restoration of quality of life. Eligibility for an intervention is assessed by defined social and medical criteria. Comprehensive pulmonary rehabilitation programs provide a wide range of health care recourses, including diagnostic procedures, specific medical care, educational interventions and a multiprofessional team. Paediatric rehabilitation programs for chronic respiratory diseases, such as asthma or cystic fibrosis, have been shown to reduce symptoms, increase aerobic fitness and physical strength, improve pulmonary function and inflammation and enhance compliance, self-management, quality of life and psychological symptoms. Regional climatic effects have demonstrated an additional positive effect on the rehabilitation outcome. In addition, first evidence suggests an overall reduction of health care costs. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Midlife women's adherence to home-based walking during maintenance.

    Science.gov (United States)

    Wilbur, Joellen; Vassalo, Annemarie; Chandler, Peggy; McDevitt, Judith; Miller, Arlene Michaels

    2005-01-01

    Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

  6. Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Determination of the minimal important difference in COPD

    Directory of Open Access Journals (Sweden)

    Vaidya T

    2016-10-01

    Full Text Available Trija Vaidya,1,2 Claire de Bisschop,2 Marc Beaumont,3,4 Hakima Ouksel,5 Véronique Jean,6 François Dessables,7 Arnaud Chambellan,1,8 On behalf of IRSR RéhaEffort cohort group 1Explorations Fonctionnelles Respiratoires, l’institut du thorax, CHU de Nantes, 2Université de Poitiers, Laboratoire MOVE EA 6314, F-86000 Poitiers, 3Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, 4European University of Occidental Brittany, EA3878, Brest, 5Service de Pneumologie, CHU d’Angers, Angers, 6Service de Réhabilitation Respiratoire, Soins de Suite et Rééducation, CHU de Nantes, 7Service de Réhabilitation Respiratoire, la Tourmaline, UGECAM, 8Université de Nantes, Laboratory EA 4334 “Mouvement, Interactions, Performance,” Nantes, France Background: The 1-minute sit-to-stand (STS test could be valuable to assess the level of exercise tolerance in chronic obstructive pulmonary disease (COPD. There is a need to provide the minimal important difference (MID of this test in pulmonary rehabilitation (PR.Methods: COPD patients undergoing the 1-minute STS test before PR were included. The test was performed at baseline and the end of PR, as well as the 6-minute walk test, and the quadriceps maximum voluntary contraction (QMVC. Home and community-based programs were conducted as recommended. Responsiveness to PR was determined by the difference in the 1-minute STS test between baseline and the end of PR. The MID was evaluated using distribution and anchor-based methods.Results: Forty-eight COPD patients were included. At baseline, the significant predictors of the number of 1-minute STS repetitions were the 6-minute walk distance (6MWD (r=0.574; P<10-3, age (r=-0.453; P=0.001, being on long-term oxygen treatment (r=-0.454; P=0.017, and the QMVC (r=0.424; P=0.031. The multivariate analysis explained 75.8% of the variance of 1-minute STS repetitions. The improvement of the 1-minute STS repetitions at the end of PR was 3.8±4.2 (P<10-3. It was mainly

  7. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    Directory of Open Access Journals (Sweden)

    Peng Qingchao

    2016-01-01

    Full Text Available Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

  8. Content validity of a home-based person-environment interaction assessment tool for visually impaired adults.

    Science.gov (United States)

    Carignan, Mathieu; Rousseau, Jacqueline; Gresset, Jacques; Couturier, Julie-Anne

    2008-01-01

    Home-based assessments require in-depth analyses of daily living difficulties. No assessment tool that has been validated with visually impaired adult subjects has allowed such analysis. This research adapted a home-based person-environment interaction assessment tool designed for persons who are visually impaired. The Model of Competence, an explanatory model of the person-environment relationship, served as the conceptual framework. A qualitative study was conducted with professionals, visually impaired persons, and informal caregivers. Focus groups and semistructured individual interviews were used for data collection. The content and form had to be modified to adapt the assessment tool for use with visually impaired adults. This qualitative study documents the content validity of the Home Assessment of Person-Environment Interaction-Visual Version. The assessment tool will provide vision rehabilitation professionals better screens and explanations of handicap-created situations faced by visually impaired persons at home. By using a structured analysis based on a person-environment theoretical model, this new assessment tool fills a scientific and clinical gap, optimizes the evaluation process, and documents the intervention plan by providing an understanding of the home context.

  9. Cross Cultural Differences in Managers’ Support for Home-based Telework: A Theoretical Elaboration

    OpenAIRE

    Peters, Pascale; Dulk, Laura den

    2003-01-01

    Home-based telework is one of the arrangements organizations can introduce to facilitate a better balance between employees’ professional and private lives. This article focuses on the question of under what conditions managers grant a subordinate’s request to telework and what role national cultures play herein. By looking into managers’ willingness to delegate power and to trust home-based teleworkers we try to explain the slow adoption of home-based telework and the reported differences ac...

  10. Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial.

    Science.gov (United States)

    Ostwald, Sharon K; Godwin, Kyler M; Cron, Stanley G; Kelley, Carolyn P; Hersch, Gayle; Davis, Sally

    2014-01-01

    This randomized trial compared 6- and 12-month outcomes of a home-based psychoeducational program to mailed information provided to 159 survivors of stroke (SS) and their spousal caregivers (CG). SS (age 50+) and CG were recruited as dyads post-discharge from inpatient rehabilitation. All dyads received mailed information for 12 months. Dyads randomized to the home-based group received an average of 36.7 h of psychoeducation over 6 months. Health status, depression, stress, burden, coping, support, mutuality and function were obtained on all dyads. Repeated measures analysis with linear mixed models was used to compare the groups for change over time in the outcome variables. Both groups demonstrated less depression and stress over time. Compared to the mailed information group, SS in the home-based group demonstrated significantly improved self-reported health and cognitive function; CG demonstrated significantly improved self-reported health and coping strategies. Mutuality and social support decreased in both groups. The home-based intervention was effective in improving self-reported health, coping skills in CG and cognitive functioning in SS. However, the finding that dyads in both groups demonstrated decreased depression and stress suggests that providing repeated doses of relevant, personalized information by mail may result in positive changes. A stroke affects both the stroke survivor and the spousal caregiver, so nurses and therapists should use multicomponent strategies to provide education, support, counseling and linkages to community resources to ease the transition from hospital to home. Stroke may have a negative impact on the dyad's relationship with each other and also on the availability of support people in their lives during the 12 months after hospital discharge. Comprehensive stroke programs should encourage dyads to attend support groups and to seek individual and group counseling, as needed. Establishing an ongoing relationship with

  11. Automated Clinical Assessment from Smart home-based Behavior Data

    Science.gov (United States)

    Dawadi, Prafulla Nath; Cook, Diane Joyce; Schmitter-Edgecombe, Maureen

    2016-01-01

    Smart home technologies offer potential benefits for assisting clinicians by automating health monitoring and well-being assessment. In this paper, we examine the actual benefits of smart home-based analysis by monitoring daily behaviour in the home and predicting standard clinical assessment scores of the residents. To accomplish this goal, we propose a Clinical Assessment using Activity Behavior (CAAB) approach to model a smart home resident’s daily behavior and predict the corresponding standard clinical assessment scores. CAAB uses statistical features that describe characteristics of a resident’s daily activity performance to train machine learning algorithms that predict the clinical assessment scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from 18 smart homes over two years using prediction and classification-based experiments. In the prediction-based experiments, we obtain a statistically significant correlation (r = 0.72) between CAAB-predicted and clinician-provided cognitive assessment scores and a statistically significant correlation (r = 0.45) between CAAB-predicted and clinician-provided mobility scores. Similarly, for the classification-based experiments, we find CAAB has a classification accuracy of 72% while classifying cognitive assessment scores and 76% while classifying mobility scores. These prediction and classification results suggest that it is feasible to predict standard clinical scores using smart home sensor data and learning-based data analysis. PMID:26292348

  12. Rehabilitation in patients with chronic respiratory disease other than chronic obstructive pulmonary disease: exercise and physical activity interventions in cystic fibrosis and non-cystic fibrosis bronchiectasis.

    Science.gov (United States)

    Burtin, Chris; Hebestreit, Helge

    2015-01-01

    A relevant proportion of children and adults with cystic fibrosis (CF) have a marked decrease in exercise tolerance, which can be partly related to impaired muscle function and decreased physical activity levels in daily life, in addition to lung disease. Preliminary findings suggest that patients with non-CF bronchiectasis face the same problems. These patients might be excellent candidates for exercise and physical activity interventions. This review elaborates on the rationale for exercise training and activity behaviour changes and summarizes the existing evidence for these rehabilitation strategies in patients with bronchiectasis, both CF and non-CF bronchiectasis. Furthermore, practical considerations and safety aspects are discussed.

  13. Adherence to commonly prescribed, home-based strength training exercises for the lower extremity can be objectively monitored using the Bandcizer

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Thorborg, Kristian; Rode, Line Abraham

    2015-01-01

    The purpose of this study was to investigate the validity of automatically stored exercise-data from the elastic band sensor© compared to a gold-standard stretchsensor during exercises commonly used for rehabilitation of the hip and knee. The design was a concurrent validity study. Participants....... The elastic band sensor© is a valid measure of: date, time-of-day, number of repetitions and sets, total TUT, and total single repetition TUT during commonly used home-based strength training exercises. However, the elastic band sensor© seems unable to validly measure TUT for specific contraction-phases....

  14. Home-Based Reinforcement: Behavioral Covariation between Academic Performance and Inappropriate Behavior.

    Science.gov (United States)

    Witt, Joseph C.; And Others

    1983-01-01

    Describes the effects of a home-based reinforcement program (designed to modify classroom behaviors) on the academic performance and behavior of three fourth-grade boys. Results demonstrated the effectiveness of home-based reinforcement intervention in improving the academic performance of underachieving children while simultaneously reducing…

  15. Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles

    Science.gov (United States)

    Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy

    2008-01-01

    Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis…

  16. Employees' views on home-based, after-hours telephone triage by Dutch GP cooperatives.

    Science.gov (United States)

    Backhaus, Ramona; van Exel, Job; de Bont, Antoinette

    2013-11-04

    Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage.

  17. A home-based clothing manufacturing: the owner and the business

    African Journals Online (AJOL)

    S Blignaut

    Department of Business Management, PU for CHE. INTRODUCTION. The recent revival of home-based businesses, ... Women in home-based enterprises have more control over their lives and are able to spend more time with ... small enterprises in the USA. Women own approxi- mately one third of all businesses, 50% of ...

  18. Entrepreneurial Checklist Tool for Beginning Farm and Home-Based Businesses

    Science.gov (United States)

    Rafie, A. R.; Nartea, Theresa

    2012-01-01

    Extension educators entertain frequent questions on beginning a farm or starting a home-based business. Retired, unemployed, and displaced workers consider starting a small farm or home-based business. Determining educational needs or individual business aptitude is time consuming. Lengthy and comprehensive skill-based checklists exist for…

  19. Influence of home-based care on the quality of life of people living ...

    African Journals Online (AJOL)

    Home based care is seen as one of the strategies to enhance the quality of life of PLWHA. Therefore, the main purpose of the study was to ascertain the relationship between home-based care and quality of life of PLWHA in support groups in. Calabar South Local Government Area. A correlational design was utilized and a ...

  20. Rehabilitation Engineering: What is Rehabilitation Engineering?

    Science.gov (United States)

    ... Parents/Teachers Resource Links for Students Glossary Rehabilitation Engineering What is rehabilitation engineering? How can future rehabilitation ... the area of rehabilitation engineering? What is rehabilitation engineering? Powered prosthetic leg. Source : M. Goldfarb, Vanderbilt U. ...

  1. Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care.

    Science.gov (United States)

    Ritchie, Christine S; Leff, Bruce

    2017-10-12

    With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial.

    Science.gov (United States)

    Mortensen, Jesper; Figlewski, Krystian; Andersen, Henning

    2016-01-01

    To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH). A double-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n = 8) or sham (n = 7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen-Taylor test (JTT). Both groups improved JTT over time (p occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor impairment. It is well tolerated by patients and can easily be applied for home-based training. Larger studies with long-term follow-up are needed to further explore possible effects of tDCS in patients with ICH. Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is well tolerated by patients and can easily be applied for home-based rehabilitation.

  3. Ex vivo water exchange performance and short-term clinical feasibility assessment of newly developed heat and moisture exchangers for pulmonary rehabilitation after total laryngectomy.

    Science.gov (United States)

    van den Boer, Cindy; Muller, Sara H; Vincent, Andrew D; Züchner, Klaus; van den Brekel, Michiel W M; Hilgers, Frans J M

    2014-02-01

    Laryngectomized patients suffer from respiratory complaints due to insufficient warming and humidification of inspired air in the upper respiratory tract. Improvement of pulmonary humidification with significant reduction of pulmonary complaints is achieved by the application of a heat and moisture exchanger (HME) over the tracheostoma. The aim of this study was to determine whether the new Provox HMEs (XM-HME and XF-HME) have a better water exchange performance than their predecessors (R-HME and L-HME, respectively; Atos Medical, Hörby, Sweden). The other aim was to assess the short-term clinical feasibility of these HMEs. The XM-HME and XF-HME were weighed at the end of inspiration and at the end of expiration at different breathing volumes produced by a healthy volunteer. The associations between weight changes, breathing volume and absolute humidity were determined using both linear and non-linear mixed effects models. Study-specific questionnaires and tally sheets were used in the clinical feasibility study. The weight change of the XM-HME is 3.6 mg, this is significantly higher than that of the R-HME (2.0 mg). The weight change of the XF-HME (2.0 mg) was not significantly higher than that of the L-HME (1.8 mg). The absolute humidity values of both XM- and XF-HME were significantly higher than that of their predecessors. The clinical feasibility study did not reveal any practical problems over the course of 3 weeks. The XM-HME has a significantly better water exchange performance than its predecessor (R-HME). Both newly designed HMEs did succeed in the clinical feasibility study.

  4. Home-Based Physical Activity Coaching, Physical Activity, and Healthcare Utilization in COPD: COPD-SMART Secondary Outcomes.

    Science.gov (United States)

    Coultas, David B; Jackson, Bradford E; Russo, Rennie; Peoples, Jennifer; Singh, Karan P; Sloan, John; Uhm, Minyong; Ashmore, Jamile A; Blair, Steven N; Bae, Sejong

    2017-12-28

    Physical inactivity among patients with chronic obstructive pulmonary disease (COPD) is associated with exacerbations requiring high-cost healthcare utilization including urgent, emergent, and hospital care. To examine the effectiveness of a behavioral lifestyle physical activity intervention combined with COPD self-management education to prevent high-cost healthcare utilization. This was an analysis of secondary outcomes of the Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial, a two-arm randomized trial of stable adult outpatients with COPD recruited from primary care and pulmonary clinics. Following a six-week self-management education run-in period, participants were randomized to usual care or to a telephone-delivered home-based health coaching intervention over 20 weeks. Secondary outcomes of physical activity and healthcare utilization were determined by self-report at 6-, 12-, and 18-months after randomization. Associations between treatment allocation arm and these secondary outcomes were examined using log-binomial and Poisson regression models. A total of 325 outpatients with stable COPD were enrolled in the trial. The average age of 70.3 years (standard deviation 9.5), and 50.5% were female; 156 were randomized to usual care and 149 to the intervention. A greater proportion of participants reported being persistently active over the 18-month follow-up period in the intervention group (73.6%) compared to the usual care group (57.8%) (mean difference=15.8%, 95% confidence interval [CI] 4.0%-27.7%)). This association varied by severity of FEV1 impairment (p for interaction = 0.09). Those in the intervention group with moderate impairment(FEV1=50%-70% predicted), more frequently reported being persistently active compared to the usual care (86.0% vs. 65.1%, mean difference=20.9%, 95% CI 5.7%-36.1%). Patients with severe and very severe FEV1 impairment (FEV1 home-based coaching intervention may decrease sedentary behavior and

  5. Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis.

    Science.gov (United States)

    Huang, Hui-Chuan; Huang, Yi-Chieh; Lin, Mei-Feng; Hou, Wen-Hsuan; Shyu, Meei-Ling; Chiu, Hsiao-Yean; Chang, Hsiu-Ju

    2017-08-01

    To examine the effects of home-based supportive care on improvements in physical function and depressive symptoms in home-dwelling patients after stroke. Seven electronic databases (eg, MEDLINE, PubMed, CINAL, EMBASE, the Cochrane Central Register of Controlled Trials, ProQuest, and Google Scholar) and 4 Chinese databases (eg, WANFANG MED ONLINE, Chinese Electronic Periodical Services, China Academic Journals Full-text Database, and National Central Library) were fully searched for all relevant articles up to June 25, 2016. Randomized controlled trials examining the effects of home-based supportive care on physical function and depressive symptoms in home-dwelling patients after stroke were included. Finally, 16 articles in Chinese (n=4) and English (n=12) met the inclusion criteria. Data on patient characteristics, study characteristics, intervention details, and outcome were extracted. Two reviewers independently extracted data and assessed methodological quality using the Cochrane risk of bias tool. Home-based supportive care had a small size effect on physical function (Hedges' g=.17; 95% confidence interval, .09-.26) and a moderate size effect on depressive symptoms (Hedges' g=-.44; 95% confidence interval, -.83 to -.05) in home-dwelling patients after stroke. The moderator analysis revealed that some components of study participants and intervention programs improved the effects on physical function and depressive symptoms; however, no significant moderators were further identified to have superiorly improved physical function and depressive symptoms. Regular performance of home-based supportive interventions should be considered for inclusion as routine care for managing and improving physical function and depressive symptoms in home-dwelling patients after stroke. The present findings provide further evidence with which to design appropriate supportive interventions for home-dwelling stroke survivors. Copyright © 2017 American Congress of Rehabilitation

  6. Home Based Care as an Approach to Improve the Efficiency of treatment for MDR Tuberculosis: A Quasi-Experimental Pilot Study.

    Science.gov (United States)

    Taneja, Neha; Chellaiyan, Vinoth Gnana; Daral, Shailaja; Adhikary, Mrinmoy; Das, Timiresh Kumar

    2017-08-01

    Multi Drug Resistant Tuberculosis (MDR TB) has emerged as a significant public health problem in India. The prolonged treatment duration in MDR TB is a challenge in achieving treatment completion and poses a threat to TB control in the country. Home based care is an approach accepted by patients because it helps in ameliorating their understanding of TB, improving the compliance and reducing stigma in the community. To assess the outcome of Home-Based Care (HC) versus No Home-Based Care (NHC) on the treatment of MDR TB patients registered at two chest clinics in Eastern Delhi. A quasi-experimental study was done among diagnosed MDR TB patients receiving Category IV regimen under Revised National Tuberculosis Control Programme (RNTCP) from two government chest clinics in Eastern Delhi during May 2014 to May 2016. In the control arm, 50 MDR TB patients at one of the chest clinics were offered the standard Category IV regimen under RNTCP; while in the intervention arm, 50 MDR TB patients at the second chest clinic were provided home based care (counselling, support for completion of treatment, rehabilitation, and nutritional support) along with the standard treatment. The primary outcome assessed was outcome of treatment, while secondary outcomes included stigma faced due to the disease, and impact of disease on family and community life. The primary outcome data was available for 32 (64%) participants in the intervention arm, and 38 (76%) participants in control arm. The treatment was significantly more successful in the intervention arm (pMDR TB treatment holds potential in improving treatment outcomes of patient.

  7. Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

    Science.gov (United States)

    Güell, Maria Rosa; Cejudo, Pilar; Rodríguez-Trigo, Gema; Gàldiz, Juan Bautista; Casolive, Vinyet; Regueiro, Mônica; Soler-Cataluña, Juan Jose

    2012-11-01

    Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection. Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.

  8. An evaluation of the implementation of integrated community home-based care services in Vhembe District, South Africa

    Directory of Open Access Journals (Sweden)

    Gandi J Moetlo

    2011-01-01

    Conclusion: Community home-based caregivers are largely able to implement home-based care services but would need more support (training, financial, career structure, and health system to improve on their services.

  9. A home-based individualized information communication technology training program for older adults: a demonstration of effectiveness and value.

    Science.gov (United States)

    Arthanat, Sajay; Vroman, Kerryellen G; Lysack, Catherine

    2016-01-01

    To demonstrate the effectiveness and value of a home-based information communication technology (ICT) training program for older adults. Thirteen older adults were provided in-home ICT training by graduate occupational therapy students using an iPad. The breadth and frequency of ICT use, perspectives on technology, and perceived independence were recorded at baseline, during the 3-month training and at follow-up, along with an end-of-study questionnaire. Non-parametric Friedman analysis was conducted to verify trends in the outcome measures. The qualitative data were examined by content analysis. Participants' breadth of ICT activities showed a significant trend across 6 months. Leisure accounted for the significant increase, while health management and social connections activities increased modestly. A positive trend in participants' perspectives on technology was evident along with a marginal increase in perceived independence. Participants' perspectives were thematically categorized as technology experiences, interactions with coach, training approach, and specific activities. As reflection of the training program's value, 12 of the 13 participants took ownership of the iPad at the end of the study. Building capacity of older adults to utilize the multifaceted potential of ICT is critical in addressing declines in health, impending disabilities, and social isolation. Implications for Rehabilitation A one-on-one home-based individualized information communication technology (ICT) training program for older adults could result in a progressive increase in the breadth of online activities carried out by them. Specifically, the increase in their usage of ICT could be expected in leisure-based online activities. Individualized training programs designed based on needs, priorities, and learning style of older adults could have a positive impact on their technological perspectives and intrinsic motivation to adopt ICT.

  10. Pulmonary tuberculosis

    Science.gov (United States)

    TB; Tuberculosis - pulmonary; Mycobacterium - pulmonary ... Pulmonary TB is caused by the bacterium Mycobacterium tuberculosis (M tuberculosis) . TB is contagious. This means the bacteria is easily spread from an infected person ...

  11. Disability and rehabilitation in the dizzy patient.

    Science.gov (United States)

    Cohen, Helen S

    2006-02-01

    This review focuses on prospective studies of vertigo and balance therapy in the past 3 years, including advances in vertigo-habituation exercises for adults, pediatric intervention, and virtual reality techniques, and, in more depth, the literature pertinent to driving motor vehicles. Increased support has been generated for the efficacy of a minimal, home-based vertigo-habituation program for adults with peripheral vestibular disorders. Vestibular rehabilitation has been shown to be associated with improvements in independence and dynamic visual acuity. Community-based vestibular rehabilitation has been shown to be efficacious for selected patients, after careful screening, when trained personnel provide intervention. Vestibular rehabilitation has been incorporated into the rehabilitation program for head-injured military personnel who will be returned to duty, and multifactorial balance rehabilitation has been shown to be useful for children with hearing and balance impairments. Virtual reality techniques have made significant advances, so immersive environments have potential for rehabilitation for patients with vestibular disorders and for developing training regimens for astronauts to ameliorate some effects of exposure to microgravity. Driving skill, in general, is affected by use of benzodiazepines. For many patients with vestibular impairments driving is a particularly problematic activity of daily living. Progress has been made in studies of acute care, community-based, and pediatric vestibular rehabilitation. Work on simulator-based paradigms has moved toward readiness for implementation. Studies of driving have provided some insight into the problems of these patients. More work remains to be done on all of these problems.

  12. How to start a home-based mobile app developer business

    CERN Document Server

    Brooks, Chad

    2014-01-01

    With the app market exploding, app designers will need a solid how-to guide to help them start their home-based business. This book will guide the reader through all the steps from design to marketing.

  13. Impact of Home-Based Management of malaria combined with other ...

    African Journals Online (AJOL)

    based interventions: what do we learn from Rwanda? ... Introduction: This study aimed to evaluate the impact of home-based management of malaria (HBM) strategy on time to treatment and reported presumed malaria morbidity in children ...

  14. Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study.

    Science.gov (United States)

    Facchinetti, Lívia D; Araújo, Abelardo Q; Silva, Marcus Tt; Leite, Ana Claudia C; Azevedo, Mariana F; Chequer, Gisele L; Oliveira, Raquel Vc; Ferreira, Arthur S; Lima, Marco Antonio

    2017-04-01

    To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (TSP/HAM.

  15. Assessing health status differences between Veterans Affairs home-based primary care and state Medicaid Waiver Program clients.

    Science.gov (United States)

    Wharton, Tracy C; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E

    2013-04-01

    Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P Affairs Medical Center were more burdened by chronic disease and had higher degrees of loneliness than their MWP counterparts- factors, which may increase their likelihood of hospitalizations. MWP participants had more cases of cerebrovascular accident (z = 2.1; P = .039), as well as a higher rate of diagnosed dementias (z = 2.7; P = .006). Though not different, stress among caregivers in both groups, and depression in clients of both groups were substantial. Overall, sleep, pain, coronary artery disease, chronic obstructive

  16. Who Receives Home-Based Perinatal Palliative Care: Experience from Poland

    OpenAIRE

    Aleksandra Korzeniewska-Eksterowicz; Łukasz Przysło; Bogna Kędzierska; Małgorzata Stolarska; Wojciech Młynarski

    2013-01-01

    Context. The current literature suggests that perinatal palliative care (PPC) programs should be comprehensive, initiated early, and integrative. So far there have been very few publications on the subject of home-based PC of newborns and neonates. Most publications focus on hospital-based care, mainly in the neonatal intensive care units. Objective. To describe the neonates and infants who received home-based palliative care in Lodz Region between 2005 and 2011. Methods. A retrospective rev...

  17. Economic Evidence for U.S. Asthma Self-Management Education and Home-Based Interventions

    OpenAIRE

    Hsu, Joy; Wilhelm, Natalie; Lewis, Lillianne; Herman, Elizabeth

    2016-01-01

    The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existin...

  18. Palliative home-based technology from a practitioner's perspective: benefits and disadvantages

    OpenAIRE

    Johnston BM

    2014-01-01

    Bridget M Johnston Sue Ryder Care Centre for the Study of Supportive, Palliative, and End of Life Care, School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK Abstract: This critical review paper explores the concept of palliative home-based technology from a practitioner's perspective. The aim of the critical review was to scope information available from published and unpublished research on the current state of palliative home-based tec...

  19. TO A QUESTION OF FEASIBILITY OF APPLICATION OF 100 HZ VIBRATION IN TREATMENT AND REHABILITATION OF THE PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    Directory of Open Access Journals (Sweden)

    T. N. Zaripova

    2016-01-01

    Full Text Available The aim of this research is study of feasibility of application of instrumental 100 Hz vibration of the thorax for rehabilitation of COPD patients.Materials and methods. This aim is achieved by clinical observation of 43 COPD patients of 1st and 2nd severity, 77.4 % from which were patients with low risk of exacerbations. Research has been carried out during the stable period of disease. The following parameters have been analyzed: dynamics of the clinical state, spirometry data, clinical - biochemical indicators of blood reflecting presence of the inflammatory process activity, a number of indicators of immune system. Two groups of patients, which were equivalent in an initial state on age, disease severity, expressiveness of functional violations, have been isolated. The 1st group contained 20 persons was the main one. It received 100 Hz vibration impact on the thorax on the background of exercises with physical therapy and inhalations of physiological solution. The 2nd group contained 23 persons obtained in addition sea-buckthorn paste.Results. It has been revealed that the course of 100 Hz vibration impact on the thorax is accompanied, mainly, with positive subjective dynamics in the form of decrease of frequency and expressiveness of complaints. At that it has been noted improvement of bronchial passability due to improved drainage of bronchial tubes, but only at the patients with initial violations of ventilation. Only additional reception of sea-buckthorn paste on the background of vibrotherapy contributes to decrease of subclinical inflammation activity and strengthening of immunological protection. Essential positive results of treatment have been reached only for a half of the surveyed patients that allows to speak about non-expediency or low expediency of use of 100 Hz vibration for CODT patients even 1st and 2nd severity in the stable period of course of the disease.

  20. Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Menadue, C.; Piper, A.J.; Hul, A.J. van 't; Wong, K.K.

    2014-01-01

    BACKGROUND: Exercise training as a component of pulmonary rehabilitation improves health-related quality of life (HRQL) and exercise capacity in people with chronic obstructive pulmonary disease (COPD). However, some individuals may have difficulty performing exercise at an adequate intensity.

  1. Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

    Science.gov (United States)

    Altenburg, Wytske A; Duiverman, Marieke L; Ten Hacken, Nick H T; Kerstjens, Huib A M; de Greef, Mathieu H G; Wijkstra, Peter J; Wempe, Johan B

    2015-02-19

    Although the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR. Data were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen's effect size was used as distribution based method. The estimated MID of the ESWT with the different anchors ranged from 186-199 s, 76-82% and 154-164 m. Using the distribution based method the MID was 144 s, 61% and 137 m. Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186-199 s, 76-82% or 154-164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions. ClinicalTrials.Gov (ID NCT00135538).

  2. Cardiac Rehabilitation.

    Science.gov (United States)

    Thoreson, Richard W.; And Others

    1981-01-01

    Describes rehabilitation implications associated with psychosocial factors, patient reaction, and family adjustment to coronary heart disease. Patient education and counseling must stress specific long-term care and follow-up and deal with family anxiety and depression. The rehabilitation counselor can help patients incorporate medical…

  3. Coronary Rehabilitation

    OpenAIRE

    Dworkind, Michael

    1986-01-01

    This paper describes a team approach to coronary rehabilitation in a tertiary care hospital and the unique role of the family physician in a shared, multi-disciplinary service for in- and out-patients. Primary care physicians facilitate and supplement the work of the coronary-unit team in establishing an optimal rehabilitative program for MI patients and their families.

  4. Influência do tabagismo atual na aderência e nas respostas à reabilitação pulmonar em pacientes com DPOC Influence of current smoking on adherence and responses to pulmonary rehabilitation in patients with COPD

    Directory of Open Access Journals (Sweden)

    Vivian T. S. Santana

    2010-02-01

    Full Text Available OBJETIVO: Investigar o possível efeito modulador do tabagismo atual na aderência e nos efeitos da reabilitação pulmonar (RP em pacientes com doença pulmonar obstrutiva crônica (DPOC. MÉTODOS: Em um estudo prospectivo, 18 pacientes ex-tabagistas e 23 tabagistas atuais (GOLD estádios II-IV foram incluídos num programa multidisciplinar de RP com duração de 12 semanas. Os pacientes foram submetidos à avaliação clínica e à de variáveis subjetivas (dispneia e qualidade de vida e objetivas (composição corporal, função pulmonar e teste da caminhada de 6 minutos. Nos pacientes tabagistas, obteve-se o nível de dependência da nicotina pela escala de Fagerström. A interrupção da RP antes do término previsto foi considerada indicativa de não aderência ao programa. RESULTADOS: A proporção de pacientes não-aderentes à RP foi maior nos tabagistas do que nos ex-tabagistas (30,4% vs 11,1%, respectivamente; razão de chance=2,9 (1,6-4,1; pOBJECTIVE: To investigate the modulating effects of current smoking on adherence and responses to pulmonary rehabilitation (PR in patients with chronic obstructive pulmonary disease (COPD. METHODS: In a prospective study, 18 ex-smokers and 23 current smokers (GOLD stages II-III were enrolled in a 12-week multidisciplinary, supervised PR program. The patients were assessed clinically and as to subjective variables (dyspnea and health-related quality of life and objective variables (body composition, pulmonary function and 6-min walking distance. The degree of nicotine dependence in current smokers was assessed by the Fagerström test. Program completion defined PR "adherence". RESULTS: There was a significant association between current smoking and non-adherence to PR with 30.4% vs. 11.1% and odds ratio=2.9 (1.6-4.1; p<0.01. However, the current smokers who completed the program (n=16 had a similar absentee rate to the ex-smokers, as well as similar gains in the subjective (quality of life and

  5. Arbejdsrettet Rehabilitering

    DEFF Research Database (Denmark)

    Labriola, Merete; Thielen, Karsten; Eplov, Lene Falgaard

    2014-01-01

    Work is known to be one of the main sources of human identity. It might be threatened when ill-health impairs individual labour market participation. Vocational rehabilitation, which is based on the bio-psycho-social model of health and function, is the systematic approach to improve employability...... for those who suffer from health-related disabilities. This article gives a short historical overview about vocational rehabilitation in Denmark, describes the current structural and political framework and gives practice examples of local multidisciplinary and intersectoral rehabilitation efforts....

  6. Arbejdsrettet rehabilitering

    DEFF Research Database (Denmark)

    Labriola, Merete; Thielen, Karsten; Eplov, Lene Falgaard

    2014-01-01

    Work is known to be one of the main sources of human identity. It might be threatened when ill-health impairs individual labour market participation. Vocational rehabilitation, which is based on the bio-psycho-social model of health and function, is the systematic approach to improve employability...... for those who suffer from health-related disabilities. This article gives a short historical overview about vocational rehabilitation in Denmark, describes the current structural and political framework and gives practice examples of local multidisciplinary and intersectoral rehabilitation efforts....

  7. Vocational rehabilitation

    DEFF Research Database (Denmark)

    Labriola, Merete; Thielen, Karsten; Eplov, Lene Falgaard

    2014-01-01

    Work is known to be one of the main sources of human identity. It might be threatened when ill-health impairs individual labour market participation. Vocational rehabilitation, which is based on the bio-psycho-social model of health and function, is the systematic approach to improve employability...... for those who suffer from health-related disabilities. This article gives a short historical overview about vocational rehabilitation in Denmark, describes the current structural and political framework and gives practice examples of local multidisciplinary and intersectoral rehabilitation efforts....

  8. Effectiveness of a home-based exercise program on anthropometric and metabolic changes among school cooks

    Directory of Open Access Journals (Sweden)

    Mauro Felippe Felix Mediano

    2015-12-01

    Full Text Available Abstract The scope of this study was to evaluate the anthropometric and metabolic changes after low intensity home-based exercise. In the school year of 2007, 95 school cooks in the city of Niteroi (State of Rio de Janeiro, Brazil were randomly assigned to one of the following groups: home-based exercise (n = 47 or control group (n = 48. The home-based exercise program was performed three times a week, during 40 minutes at moderate intensity. Anthropometric variables were collected at the baseline and after 4 and 8 months, whereas biochemical and individual food intake were measured at the baseline and after 8 months. Energy expenditure was evaluated only at the baseline. The home-based exercise group exhibited a greater weight loss (-0.9 vs. -0.2; p = 0.05 in comparison with controls during the follow-up and the same pattern was found for BMI (-0.1 vs. +0.1; p = 0.07, although without statistical significance. Exercise showed no effects on waist circumference, lipid profile and glucose. In conclusion, greater weight loss was observed in the group that performed low intensity home-based exercise and this strategy can assist in body weight control even without alterations in terms of lipids and glucose.

  9. Home-based exercise may not decrease the insulin resistance in individuals with metabolic syndrome.

    Science.gov (United States)

    Chen, Chiao-Nan; Chuang, Lee-Ming; Korivi, Mallikarjuna; Wu, Ying-Tai

    2015-01-01

    This study investigated the differences in exercise self-efficacy, compliance, and effectiveness of home-based exercise in individuals with and without metabolic syndrome (MetS). One hundred and ten individuals at risk for diabetes participated in this study. Subjects were categorized into individuals with MetS and individuals without MetS. Metabolic risk factors and exercise self-efficacy were evaluated for all subjects before and after 3 months of home-based exercise. Univariate analysis of variance was used to compare the effectiveness of a home-based exercise program between individuals with and without MetS. The home-based exercise program improved body mass index and lipid profile in individuals at risk for diabetes, regardless of MetS status at baseline. Individuals without MetS had higher exercise self-efficacy at baseline and performed greater exercise volume compared with individuals with MetS during the intervention. The increased exercise volume in individuals without MetS may contribute to their better control of insulin resistance than individuals with MetS. Furthermore, baseline exercise self-efficacy was correlated with exercise volume executed by subjects at home. We conclude that home-based exercise programs are beneficial for individuals at risk for diabetes. However, more intensive and/or supervised exercise intervention may be needed for those with MetS.

  10. Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial.

    Science.gov (United States)

    Street, Alexander J; Magee, Wendy L; Bateman, Andrew; Parker, Michael; Odell-Miller, Helen; Fachner, Jorg

    2018-01-01

    To assess the feasibility of a randomized controlled trial to evaluate music therapy as a home-based intervention for arm hemiparesis in stroke. A pilot feasibility randomized controlled trial, with cross-over design. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes. Participants' homes across Cambridgeshire, UK. Eleven people with stroke and arm hemiparesis, 3-60 months post stroke, following discharge from community rehabilitation. Each participant engaged in therapeutic instrumental music performance in 12 individual clinical contacts, twice weekly for six weeks. Feasibility was estimated by recruitment from three community stroke teams over a 12-month period, attrition rates, completion of treatment and successful data collection. Structured interviews were conducted pre and post intervention to establish participant tolerance and preference. Action Research Arm Test and Nine-hole Peg Test data were collected at weeks 1, 6, 9, 15 and 18, pre and post intervention by a blinded assessor. A total of 11 of 14 invited participants were recruited (intervention n = 6, waitlist n = 5). In total, 10 completed treatment and data collection. It cannot be concluded whether a larger trial would be feasible due to unavailable data regarding a number of eligible patients screened. Adherence to treatment, retention and interview responses might suggest that the intervention was motivating for participants. ClinicalTrials.gov identifier NCT 02310438.

  11. Cardiac Rehabilitation

    Science.gov (United States)

    Cardiac rehabilitation (rehab) is a medically supervised program to help people who have A heart attack Angioplasty or coronary artery bypass grafting for coronary heart disease A heart valve repair or replacement A ...

  12. Cardiac rehabilitation

    Science.gov (United States)

    ... ncbi.nlm.nih.gov/pubmed/25503364 . Balady GJ, Williams MA, Ades PA, et al. Core components of ... ncbi.nlm.nih.gov/pubmed/22070836 . Thompson PD. Exercise-based, comprehensive cardiac rehabilitation. In: Mann DL, Zipes ...

  13. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

    Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

  14. Rehabilitation robotics.

    Science.gov (United States)

    Krebs, H I; Volpe, B T

    2013-01-01

    This chapter focuses on rehabilitation robotics which can be used to augment the clinician's toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual's functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. Rehabilitation robotics

    Science.gov (United States)

    KREBS, H.I.; VOLPE, B.T.

    2015-01-01

    This chapter focuses on rehabilitation robotics which can be used to augment the clinician’s toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual’s functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We will provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we will then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We will present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. PMID:23312648

  16. A home-based, nurse-led health program for postoperative patients with early-stage cervical cancer: A randomized controlled trial.

    Science.gov (United States)

    Li, Jue; Huang, Jiliang; Zhang, Jun; Li, Yajie

    2016-04-01

    To investigate the effect of a home-based, nurse-led health program on quality of life and family function for postoperative patients with early-stage cervical cancer. 226 cervical cancer patients, from two hospitals between December 2012 and April 2014, were randomly divided into intervention and control groups. Patients in the intervention group received an individual home-based, nurse-led health program (family-care team provision, physiological rehabilitation, emotion-release management, informal social support system, and follow-up monitoring), in addition to conventional nursing education. Patients in the control group only received conventional nursing education. The Functional Assessment Cancer Therapy-Cervix, Female Sexual Function Index, and the Family Adaptability and Cohesion Scale were used for assessment before and after the intervention. After the intervention, significant improvements were found for the quality of life total scores (t=-7.650, p=0.000), sexual function scores (t=-6.465, p=0.000), cohesion scores (t=-8.417, p=0.001) and adaptability scores (t=-10.735, p=0.000) in the intervention group. Moreover, proportions of family types were also improved (χ2 = 17.77, p=0.000). However, for the control group, no significant differences were found except for a decrease in sexual function scores (t = -4.035, p=0.000). Significant differences in change scores between groups were also found for quality of life (F=41.980, p=0.000), Sexual function (F=37.380, p=0.000), cohesion (F=15.268, p=0.000) and adaptability (F=16.998, p=0.000). A home-based, nurse-led health promotion program improves the quality of life, sexual function and family function in postoperative patients with early-stage cervical cancer. Copyright © 2015. Published by Elsevier Ltd.

  17. Performance Improvement Strategic Home Based Manufacturer Tahu And Tempe Groups Based In The District Of Jember

    Directory of Open Access Journals (Sweden)

    Istatuk Budi Yuswanto

    2017-04-01

    Full Text Available Tahu dan tempe is a product of the soybean meal that has been known since long in Indonesia. Tahu is a Chinese food products in contrast to tempe an authentic Indonesian food . As tempe tahu also favored by the people of Indonesia because it has a taste that delicious nutritious and affordable price.Industries that produce tahu dan tempe are generally small-scale home-based businesses with the number of workers a little less than 2-6 people and investments that are not too large. The use of technology in small business home-based producer of tahu dan tempe quite simple and easy to learn so it can be run by anyone. The success of small business home-based manufacturers to survive and evolve toward more advanced by knowing their strengths weaknesses opportunities that can be taken by small business home-based and threat or better known as the SWOT Strength Weakness Opportunity Threath that can be retrieved strategies that affect the success and development of small business home-based manufacturer of tahu dan tempe.Constraints faced by small businesses and home-based manufacturers know that the soybean Tepe that include budget constraints limited access to banking limited human resources marketing only the scope of Jember and lack of good management. No group or cooperative does not have a good recording making it difficult to make financial reports manufacturing planning and operational supervision and finances into this industry employers group lemah.Pembentukan help solve problems and maximize its potential.

  18. Fatigue and Mood States in Nursing Home and Nonambulatory Home-Based Patients with Multiple Sclerosis.

    Science.gov (United States)

    Younus, Zilfah; Vaughn, Caila B; Sanai, Shaik Ahmed; Kavak, Katelyn S; Gupta, Sahil; Nadeem, Muhammad; Teter, Barbara E; Noyes, Katia; Zivadinov, Robert; Edwards, Keith; Coyle, Patricia K; Goodman, Andrew; Weinstock-Guttman, Bianca

    2017-01-01

    Multiple sclerosis (MS) is a chronic, progressively disabling condition of the central nervous system. We sought to evaluate and compare mood states in patients with MS with increased disability residing in nursing homes and those receiving home-based care. We conducted a cross-sectional analysis of the New York State Multiple Sclerosis Consortium to identify patients with MS using a Kurtzke Expanded Disability Status Scale (EDSS) score of 7.0 or greater. The nursing home group was compared with home-based care patients regarding self-reported levels of loneliness, pessimism, tension, panic, irritation, morbid thoughts, feelings of guilt, and fatigue using independent-samples t tests and χ 2 tests. Multivariate logistic regression analyses were used to investigate risk-adjusted differences in mood states. Ninety-four of 924 patients with EDSS scores of at least 7.0 lived in a nursing home (10.2%). Nursing home patients were less likely to use disease-modifying therapy and had higher mean EDSS scores compared with home-based patients. However, nursing home patients were less likely than home-based patients to report fatigue (odds ratio [OR] for no fatigue, 3.8; 95% CI, 2.1-7.2), feeling tense (OR for no tension, 1.7; 95% CI, 1.1-2.7), and having feelings of pessimism (OR for no pessimism, 1.8; 95% CI, 1.2-2.8). The nursing home patients with MS were less likely to report fatigue, pessimism, and tension than those receiving home-based care. Further studies should examine ways of facilitating a greater degree of autonomy and decision-making control in MS patients receiving home-based care.

  19. Rehabilitation and Prosthetic Services

    Science.gov (United States)

    ... Sensory Aids Service » Prosthetic & Sensory Aids Service (PSAS) Rehabilitation and Prosthetic Services Menu Menu Rehabilitation and Prosthetics Rehabilitation and Prosthetic Services Home Amputation ...

  20. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial.

    Science.gov (United States)

    Monticone, Marco; Ferrante, Simona; Rocca, Barbara; Salvaderi, Stefano; Fiorentini, Roberta; Restelli, Maddalena; Foti, Calogero

    2013-02-01

    To compare the improvement in disability, kinesiophobia, pain, and quality of life obtained by means of home-based functional exercises aimed at managing kinesiophobia with that obtained by giving subjects undergoing total knee arthroplasty (TKA) advice to stay active after discharge from a rehabilitation unit. Randomized controlled trial with 6-months' follow-up. Patients' homes. Patients (N=110; 40 men; mean age, 67y) at the end of a 15-day period of in-hospital rehabilitation after undergoing primary TKA. In the experimental group, before returning home, the patients were asked to continue the functional exercises learned during hospitalization in twice-weekly 60-minute sessions for 6 months, and were given a book containing theoretical information about the management of kinesiophobia. In the control group, the patients were advised to stay active and gradually recover their usual activities. Repeated-measures analysis of covariance with baseline values as the covariates (Pkinesiophobia was useful in changing the course of disability, fear-avoidance beliefs, pain, and the quality of life in patients with TKA. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. [Successful preoperative respiratory rehabilitation in patients with aortic valve stenosis associated with severe respiratory dysfunction].

    Science.gov (United States)

    Sato, Mitsuru; Motoyoshi, Naotaka; Akiyama, Masatoshi; Kumagai, Kiichirou; Kawamoto, Shunsuke; Kurosawa, Hajime; Kohzuki, Masahiro; Saiki, Yoshikatsu

    2011-08-01

    We describe 2 cases of aortic valve stenosis with severe pulmonary dysfunction. Preoperative respiratory rehabilitation programmed by the rehabilitation doctors was cautiously undertaken to improve their exercise tolerance and respiratory reserve. These 2 patients underwent aortic valve replacement eventually. Postoperative course in each patient was uneventful without respiratory complication. Preoperative respiratory rehabilitation can be performed in the high risk patient with severe pulmonary dysfunction as long as careful risk management is guaranteed.

  2. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient

  3. Pulmonary Edema

    Science.gov (United States)

    ... by viral infections such as the hantavirus and dengue virus. Lung injury. Pulmonary edema can occur after ... it may be fatal even if you receive treatment. Prevention Pulmonary edema is not always preventable, but ...

  4. Pulmonary atresia

    Science.gov (United States)

    As with most congenital heart diseases, there is no known cause of pulmonary atresia. The condition is linked with another type of congenital heart defect called a patent ductus arteriosus (PDA). Pulmonary atresia may occur with or without a ventricular ...

  5. Pulmonary Embolism

    Science.gov (United States)

    A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in the ... and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can cause Permanent ...

  6. Pulmonary Fibrosis

    Science.gov (United States)

    Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This ... blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue ...

  7. Pulmonary Hypertension

    OpenAIRE

    Goetting, Michael; Schwarzer, Mario; Gerber, Alexander; Klingelhoefer, Doris; David A. Groneberg

    2017-01-01

    Pulmonary hypertension (PH) is characterized by the increase of the mean pulmonary arterial pressure in the lung circulation. Despite the large number of experimental and clinical studies conducted on pulmonary hypertension, there is no comprehensive work that analyzed the global research activity on PH so far. We retrieved the bibliometric data of the publications on pulmonary hypertension for two periods from the Web of science database. Here, we set the first investigation period from 1900...

  8. Impact of exercise capacity on dyspnea and health-related quality of life in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Frølich, Anne; Godtfredsen, Nina S

    2012-01-01

    To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD)....

  9. Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

    Science.gov (United States)

    Lalmolda, C; Coll-Fernández, R; Martínez, N; Baré, M; Teixidó Colet, M; Epelde, F; Monsó, E

    2017-01-01

    Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P=0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P=0.014, and R2=0.219). A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

  10. A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians

    National Research Council Canada - National Science Library

    Shah, Vallabh O; Carroll, Casey; Mals, Ryan; Ghahate, Donica; Bobelu, Jeanette; Sandy, Phillip; Colleran, Kathleen; Schrader, Ronald; Faber, Thomas; Burge, Mark R

    2015-01-01

    .... We describe a home-based educational intervention using Community Health Representatives (CHRs), leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control...

  11. Emerging bronchoscopic treatments for chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    van Geffen, Wouter H.; Kerstjens, Huib A. M.; Slebos, Dirk-Jan

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by pathophysiological factors including airflow limitation, hyperinflation and reduced gas exchange. Treatment consists of lifestyle changes, lung rehabilitation and pharmacological therapies such as long acting

  12. Burn Rehabilitation

    Directory of Open Access Journals (Sweden)

    Koray Aydemir

    2011-07-01

    Full Text Available Burn injuries are important in terms of causing serious disability and threatening life. With the establishment of modern burn treatment units and advances in acute care management contributed to a reduced mortality rate over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive burn rehabilitation program. Burn rehabilitation is a process that starts from day of admission and continues for months or sometimes years after the initial event. The term ‘burn rehabilitation’ incorporates the physical, physiological and social aspects of care. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Burn rehabilitation aims to prevent the possible complications, minimalize joint contractures and deformities, increase range of motion, control hypertrophic scarring, achieve the best possible functional capacity and to regain the patients vocational and recreational activities. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 70-7

  13. A Machine-to-Machine protocol benchmark for eHealth applications - Use case: Respiratory rehabilitation.

    Science.gov (United States)

    Talaminos-Barroso, Alejandro; Estudillo-Valderrama, Miguel A; Roa, Laura M; Reina-Tosina, Javier; Ortega-Ruiz, Francisco

    2016-06-01

    M2M (Machine-to-Machine) communications represent one of the main pillars of the new paradigm of the Internet of Things (IoT), and is making possible new opportunities for the eHealth business. Nevertheless, the large number of M2M protocols currently available hinders the election of a suitable solution that satisfies the requirements that can demand eHealth applications. In the first place, to develop a tool that provides a benchmarking analysis in order to objectively select among the most relevant M2M protocols for eHealth solutions. In the second place, to validate the tool with a particular use case: the respiratory rehabilitation. A software tool, called Distributed Computing Framework (DFC), has been designed and developed to execute the benchmarking tests and facilitate the deployment in environments with a large number of machines, with independence of the protocol and performance metrics selected. DDS, MQTT, CoAP, JMS, AMQP and XMPP protocols were evaluated considering different specific performance metrics, including CPU usage, memory usage, bandwidth consumption, latency and jitter. The results obtained allowed to validate a case of use: respiratory rehabilitation of chronic obstructive pulmonary disease (COPD) patients in two scenarios with different types of requirement: Home-Based and Ambulatory. The results of the benchmark comparison can guide eHealth developers in the choice of M2M technologies. In this regard, the framework presented is a simple and powerful tool for the deployment of benchmark tests under specific environments and conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. What to Expect Before Pulmonary Rehabilitation

    Science.gov (United States)

    ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... air you can breathe in and out, how fast you can breathe air out, and how well ... ask about your food intake and general nutrition, and recommend a blood ...

  15. Gender discrepancies in the HIV/AIDS Community Home-Based ...

    African Journals Online (AJOL)

    Gender discrepancies in the HIV/AIDS Community Home-Based Care Programme in Kanye, Botswana. ... mainstreaming and analysis in all the institutions of social development, as well as poverty mitigation measures and education to surmount the effects of gender imbalances, gender inequality and gender inequity.

  16. Comparison of clinic-based versus home-based balance and agility ...

    African Journals Online (AJOL)

    Objective. To compare clinic-based (CB) and home-based (HB) deliveries of a knee osteoarthritis (OA) exercise programme. Methods. Outcomes from a CB exercise study (N=6) utilising kinesthesia, balance and agility (KBA) exercises were compared with those from a HB KBA study (N=6). Both conditions trained 30 ...

  17. Dutch home-based pre-reading intervention with children at familial risk of dyslexia

    NARCIS (Netherlands)

    van Otterloo, S.G.; van der Leij, A.

    2009-01-01

    Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected

  18. Perceptions of Personal Well-Being among Youth Accessing Residential or Intensive Home-Based Treatment

    Science.gov (United States)

    Preyde, Michele; Watkins, Hanna; Ashbourne, Graham; Lazure, Kelly; Carter, Jeff; Penney, Randy; White, Sara; Frensch, Karen; Cameron, Gary

    2013-01-01

    The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental…

  19. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

    Science.gov (United States)

    Lawrence, Sharmila; Stephens, Samuel A.

    2016-01-01

    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  20. Employees' views on home-based, after-hours telephone triage by Dutch GP cooperatives

    NARCIS (Netherlands)

    R. Backhaus (Ramona); N.J.A. van Exel (Job); A.A. de Bont (Antoinette)

    2013-01-01

    markdownabstract__Abstract__ __Background:__ Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for

  1. The provision of home-based palliative care for those with advanced heart failure.

    Science.gov (United States)

    Enguidanos, Susan; Portanova, Jaclyn

    2014-03-01

    Although widely recognized as best practice for advanced heart failure patients, palliative care is underused by this population. The purpose of this brief review is to highlight recent findings related to home-based palliative care among patients with advanced heart failure. This review considers new models of home-based palliative care and reports recent evidence on the effectiveness, and burden of these models for patients with advanced heart failure and their caregivers. New models currently under investigation and gaps in current research are presented. New models integrating home-based palliative care and standard heart failure care have shown to be effective in reducing both physical and psychological symptoms in patients. Recent evidence suggests that home-based palliative care reduces hospitalizations and decrease the probability of 30-day re-admissions in patients with advanced heart failure; thus, potentially reducing costs of care and increasing likelihood of dying at home. However, caregiver burden for families of those with heart failure remains an issue. Research that addresses caregiver burden and the challenges of providing palliative care to patients with the uncertain disease trajectory seen in advanced heart failure require further research.

  2. Teaching Math Skills to At-Risk Students Using Home-Based Peer Tutoring

    Science.gov (United States)

    Mayfield, Kristin H.; Vollmer, Timothy R.

    2007-01-01

    Home-based peer tutoring was used to teach math skills to 4 girls with deficits in mathematics and histories of abuse or neglect. Girls living in the same home formed tutoring dyads, and each participant served as both the peer tutor and the tutee during the course of the study. At the initiation of the tutoring intervention, an expert tutor…

  3. Latino Parents Utilizing Home-Based Activities to Support Algebra-Readiness Skills

    Science.gov (United States)

    Molinar, Soledad Marie

    2010-01-01

    This dissertation involved a series of training sessions where parents from a Title I middle school participated in the learning and practice of Algebra Readiness skills. The project was based on a series of six weekly trainings for parents to learn home-based activities to increase their child's Algebra Readiness. I administered an initial…

  4. Home-based alcohol prevention program for parents and children: A randomized controlled trial

    NARCIS (Netherlands)

    Mares, S.H.W.; Lichtwarck-Aschoff, A.; Verdurmen, J.E.E.; Schulten, I.G.H.; Engels, R.C.M.E.

    2016-01-01

    Objective: To evaluate the effectiveness of a home-based alcohol prevention program to delay initiation of alcohol use in children. Methods: In 2011, a total of 1349 sixth-grade children (M = 12.15, SD = 0.47) and their mothers who could read and write Dutch were recruited from primary schools in

  5. The social construction of identity in HIV/AIDS home-based care ...

    African Journals Online (AJOL)

    Home-based care volunteer (HBCV) identity and how it is shaped was the main focus of the study. Fifteen HBCVs were interviewed about their work and personal life stories and then interviewed reflectively using a narrative interviewing style. Specific attention was paid to contextual meta-narratives and social field ...

  6. Home-based care for people living with AIDS in Zimbabwe ...

    African Journals Online (AJOL)

    Home-based care for people living with AIDS in Zimbabwe: voluntary caregivers' motivations and concerns. ... In Zimbabwe, improvement of voluntary caregiving programmes requires better integration with the national healthcare system at the clinic level as well as collaboration with NGOs, community leaders and church ...

  7. Gendered home-based care in South Africa: more trouble for the ...

    African Journals Online (AJOL)

    This study investigates the experiences of informal caregivers of people living with HIV in two semi-rural communities in South Africa. Ethnographic methods were used to collect and analyse data on the gendered nature and consequences of home-based care from 21 primary caregivers and 20 volunteer caregivers as well ...

  8. socio-cultural factors influencing male involvement in home-based

    African Journals Online (AJOL)

    2011-08-08

    Aug 8, 2011 ... in home-based care variables were negatively correlated with socio-cultural variables. For example, there was a significant strong negative relationship between taboo for married man to cook with men cook and feed HIV patients (r =- 0.69, P=0.01). Conclusion: Full participation of males' in HIV home care ...

  9. Home based care practices by caregivers of under five children with ...

    African Journals Online (AJOL)

    Background: Home treatment for childhood febrile illness is a common practice among caregivers in Nigeria as well as some other countries in sub- Saharan Africa. The aim of the study was to assess the home based care practices of caregivers of under- five children with febrile illnesses as seen in the general paediatric ...

  10. The cost of home-based terminal care for people with AIDS in South ...

    African Journals Online (AJOL)

    Objectives. To describe the costs of establishing and operating a home-based care (HBC) project providing palliative care for people with AIDS CPWA), and to project the full costs to the health care system of extending this care model. Design. Data were collected from seven sites participating in the Hospice Association of ...

  11. Caring for home-based care workers | de Saxe Zerden | Southern ...

    African Journals Online (AJOL)

    Home-based care has emerged as a service delivery model to cope with the devastation caused by the HIV/AIDS epidemic in sub-Saharan Africa, where medical and traditional care infrastructures have been overwhelmed. In these communities homebased care workers provide critical services, which include physical, ...

  12. Cross Cultural Differences in Managers’ Support for Home-based Telework : A Theoretical Elaboration

    NARCIS (Netherlands)

    Peters, Pascale; Dulk, Laura den

    2003-01-01

    Home-based telework is one of the arrangements organizations can introduce to facilitate a better balance between employees’ professional and private lives. This article focuses on the question of under what conditions managers grant a subordinate’s request to telework and what role national

  13. Impact of home-based exercise on quality of life of women with ...

    African Journals Online (AJOL)

    While medical treatments are available for primary dysmenorrhoea, exercise is accepted as an effective intervention. This study aimed to investigate the impact of home-based exercise on pain intensity and quality of life in women with primary dysmenorrhoea. Of 45 women with primary dysmenorrhoea included in the study, ...

  14. Home-based therapy for severe acute malnutrition with ready-to-use food

    Science.gov (United States)

    Severe acute malnutrition is a devastating condition afflicting children under 5 years in many developing countries, but concentrated in sub-Saharan Africa. This paper examines the development of home-based lipid-nutrient therapeutic foods for the treatment of acute malnutrition in sub-Saharan Afric...

  15. Home-based and institutional early childhood education and care services

    NARCIS (Netherlands)

    Fukkink, R.; Blok, H.; Peterson, P.; Baker, E.; McGaw, B.

    2010-01-01

    Early-childhood education and care is oriented toward stimulating the development of young children in preparation for the primary-school period. The various programs can be divided into three types, according to the chosen manner of entry into the ecological system of the young child. Home-based

  16. Experiences of HIV/AIDS home-based caregivers in Vhembe district of the Limpopo Province

    Directory of Open Access Journals (Sweden)

    N.S. Mashau

    2009-09-01

    Full Text Available The purpose of this study was to explore and describe the experiences of HIV and AIDS home-based caregivers in the Vhembe district of Limpopo Province. A qualitative research design which was exploratory, descriptive and contextual was executed with a sample of purposively selected participants who provided home-based care to people living with HIV and AIDS in the Vhembe district of Limpopo Province. Data saturation occurred after in-depth interviews with fifteen participants. In-depth individual interviews and field notes were also used during data collection. The findings reveal that HIV/AIDS home-based caregivers express pain and despair when caring for HIV/AIDS patients. The theme was supported by the following categories and subcategories: problems related to stigma when caring for patients at their homes; stress, burnout, frustration and feelings of helplessness when caring for patients. Recommendations that are described focus on building a working relationship between the home-based caregivers, community and the family.

  17. Home-based Education Increases Knowledge, Communication and Living Donor Kidney Transplantations

    NARCIS (Netherlands)

    S.Y. Ismail (Sohal)

    2014-01-01

    markdownabstract__Abstract__ A focus group approach was used to disclose transplant candidates’ view on patient-tailored interventions that could target modifiable hurdles to LDKT. A majority would appreciate an home-based educational intervention (chapter 2). Solving knowledge insufficiencies

  18. Palliative home-based technology from a practitioner's perspective: benefits and disadvantages

    Directory of Open Access Journals (Sweden)

    Johnston BM

    2014-11-01

    Full Text Available Bridget M Johnston Sue Ryder Care Centre for the Study of Supportive, Palliative, and End of Life Care, School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK Abstract: This critical review paper explores the concept of palliative home-based technology from a practitioner's perspective. The aim of the critical review was to scope information available from published and unpublished research on the current state of palliative home-based technology, practitioner-focused perspectives, patient-focused perspectives, quality of life, and the implications for clinical practice. Published and unpublished studies were included. An example of one UK patient-centered home-based technology is explored as an exemplar. The evidence suggests that despite the challenges, there are numerous examples of good practice in relation to palliative home-based technology. Improvements in technology mean that telehealth has much to offer people being cared for at home with palliative needs. However, some of the evaluative evidence is limited, and further rigor is needed when evaluating future technology-based solutions innovations. Keywords: technology, telehealth, telemedicine, information technology, palliative care, hospice, terminal illness

  19. Beyond Self-Monitoring: Understanding Non-functional Aspects of Home-based Healthcare Technology

    DEFF Research Database (Denmark)

    Grönvall, Erik; Verdezoto, Nervo

    2013-01-01

    -technical complexities in home-based healthcare technologies through three case studies of self-monitoring: 1) pre-eclampsia (i.e. pregnancy poisoning), 2) heart conditions, and 3) preventive care. Through the analysis seven themes emerged (people, resources, places, routines, knowledge, control and motivation) that can...

  20. Socio-cultural factors influencing male involvement in home-based ...

    African Journals Online (AJOL)

    Objective: To investigate socio-cultural factors that influence male involvement in home-based HIV and AIDS care in Western Kenya. Design: Cross-sectional, descriptive study. Setting: Maseno division Western Kenya. Subjects: Two hundred and fourty eight (248) caregivers selected fromregistered support groups in ...

  1. An Overview of Home-Based Primary Care: Learning from the Field.

    Science.gov (United States)

    Klein, Sarah; Hostetter, Martha; McCarthy, Douglas

    2017-06-01

    ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers. Practices participating in Medicare's Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program. The experience of a risk-based medical group that contracts with health plans and health systems to provide home-based care suggests similar potential to reduce health care spending under capitated or value-based payment arrangements. Making effective home-based primary care more widely available would require a better-prepared workforce, appropriate financial incentives to encourage more clinicians to provide house calls to their home-limited patients, and relevant quality measures to ensure that value-based payment is calibrated to meet the needs of patients and their families.

  2. Vestibular rehabilitation strategies and factors that affect the outcome.

    Science.gov (United States)

    Eleftheriadou, Anna; Skalidi, Nikoleta; Velegrakis, Georgios A

    2012-11-01

    Ever since the introduction of Cawthorne-Cooksey exercises, vestibular rehabilitation (VR) has been gaining popularity in the treatment of the dizzy patient. Numerous studies support the effectiveness of VR in improving balance/walking skills, eye-head coordination and the quality of life of the patient. Different rehabilitation protocols have been used to treat patients with peripheral and central vestibular disorders. Assessment of the patients' progress is based on the patients' selfperception of dizziness and their functional skills. Factors such as age, medication, time of onset of vertigo and home based VR have been evaluated on their effect on the rehabilitation's outcome. The aim of this review is to evaluate rehabilitation strategies and discuss the factors that affect the outcome.

  3. A systematic review of home-based childhood obesity prevention studies.

    Science.gov (United States)

    Showell, Nakiya N; Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F; Cheskin, Lawrence J; Bleich, Sara N; Wu, Yang; Lau, Brandyn; Wang, Youfa

    2013-07-01

    Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences.

  4. Home-based specialized palliative care in patients with advanced cancer: A systematic review.

    Science.gov (United States)

    Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per; Kurita, Geana Paula

    2016-12-01

    Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. A PICO process search strategy consisting of terms related to cancer, palliation, and home care was employed. The search was conducted in PubMed, EMBASE, and Cochrane from January 1, 2000, to January 27, 2015. A hand search of the reference lists of the included studies was also performed. A total of 5 articles (out of 2080 abstracts) were selected for analysis. Three additional studies were added by the hand search. Six observational and two interventional studies were evaluated. In all of these studies, the description of the SPC service was limited to the composition of the staff-no other organizational aspects were detailed. From 44 to 90% of the patients receiving home-based SPC died at home. Studies including survival and quality of life had divergent outcomes, and overall performance status did not improve. However, symptom control did improve over time. There is a lack of controlled clinical trials and organizational descriptions regarding home-based SPC for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required.

  5. A Systematic Review of Home-Based Childhood Obesity Prevention Studies

    Science.gov (United States)

    Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F.; Cheskin, Lawrence J.; Bleich, Sara N.; Wu, Yang; Lau, Brandyn; Wang, Youfa

    2013-01-01

    BACKGROUND AND OBJECTIVES: Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. RESULTS: We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. CONCLUSIONS: The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences. PMID:23753095

  6. Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease.

    Science.gov (United States)

    Cubo, E; Mariscal, N; Solano, B; Becerra, V; Armesto, D; Calvo, S; Arribas, J; Seco, J; Martinez, A; Zorrilla, L; Heldman, D

    2017-02-01

    Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.

  7. Behavioural modes of adherence to inspiratory muscle training in people with chronic obstructive pulmonary disease: a grounded theory study.

    Science.gov (United States)

    Sørensen, Dorthe; Christensen, Marie Ernst

    2018-01-05

    Our aim was to develop a theoretical account of the behavioural pattern of adherence to home-based inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD), performed as two daily sessions of 30 breaths with mechanical threshold loading. This was a qualitative study based on the classic grounded theory method. We conducted interviews with people living with COPD recruited after completion of 6 weeks of outpatient pulmonary rehabilitation program in 2015. Concurrently, we generated data and performed analyses by means of constant comparative analysis and theoretical sampling that focused on the behavioural characteristics of adherence to IMT. We achieved theoretical saturation of substantive codes with 33 interviews, nine of which were with men. The participants' mean age and forced expired volume in the first second were 65 (SD 8) years and 59.1 (SD 13.9) percent of predicted, respectively. Seventeen participated in face-to-face interviews, and 16 participated in telephone interviews. The core category "Preserving Integrity" emerged as representative of the primary pattern of behaviour related to the inspiratory muscle-training regimen. Through this pattern, the participants resolved the main concern of losing integrity. Preserving Integrity involved three behavioural modes of adherence to home-based IMT: evading, misgiving, and involving modes. The participants' behavioural modes regarding adherence revealed patterns of both intended and unintended nonadherence. In particular, support offered by healthcare professionals should target people with unintended nonadherence and scepticism about the effects of IMT to maximise the possibility of adherence. Implications for rehabilitation When implementing inspiratory muscle training, healthcare professionals should be prepared to spend considerable time providing attention and support to participants who feel challenged during the execution of inspiratory muscle training. Support

  8. A systematic review of economic evaluations of cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Wong Wai

    2012-08-01

    Full Text Available Abstract Background Cardiac rehabilitation (CR, a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI, revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF. This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR. Methods Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist. Results A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1 supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2 home-based CR was no different from centre-based CR; (3 no difference existed

  9. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    Science.gov (United States)

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  10. Child Temperament and Home-Based Parent Involvement at Kindergarten Entry: Evidence from a Low-Income, Urban Sample

    Science.gov (United States)

    Han, Jinjoo; O'Connor, Erin E.; McCormick, Meghan P.; McClowry, Sandee G.

    2017-01-01

    Research Findings: Home-based involvement--defined as the actions parents take to promote children's learning outside of school--is often the most efficient way for low-income parents to be involved with their children's education. However, there is limited research examining the factors predicting home-based involvement at kindergarten entry for…

  11. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care

    Science.gov (United States)

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

    2013-01-01

    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  12. A randomized trial of two home-based exercise programmes to improve functional walking post-stroke.

    Science.gov (United States)

    Mayo, Nancy E; MacKay-Lyons, Marilyn J; Scott, Susan C; Moriello, Carolina; Brophy, James

    2013-07-01

    To estimate the relative effectiveness in improving walking ability and other mobility and health outcomes post-stroke of two home-based exercise programmes - stationary cycling and an exercise and walking programme. An observer-blinded, randomized, pragmatic, trial with repeated measures. Hospital centers in two Canadian cities. People within 12 months of acute stroke who were able to walk >10 meters independently and healthy enough to engage in exercise. Two dose-equivalent interventions, one involving stationary cycling and the other disability-targeted interventions were tested. Both protocols required daily moderate intensity exercise at home building up to 30 minutes per day. One group exercised on a stationary bicycle, the second group carried out mobility exercises and brisk walking. The primary outcome was walking capacity as measured by the six-minute walk test (6MWT). Secondary outcomes were physical function, role participation, health-related quality of life exercise adherence, and adverse events. The study failed to meet recruitment targets: 87 participants (cycle group, n = 43; exercise group, n = 44) participated. No significant effects of group or time were revealed for the 6MWT, which was approximately 320 m at randomization. A significant effect for role participation was found in favor of the exercise group (global odds ratio (OR) for cycling vs. exercise was 0.51; 95% confidence interval (CI), 0.27-0.95). Change in the 6MWT between highest and lowest adherence categories was statistically significant (p = 0.022). Both programmes were equally effective in maintaining walking capacity after discharge from stroke rehabilitation; or were equally ineffective in improving walking capacity. Clinical Trials Gov number: NCT00786045.

  13. An international randomized study of a home-based self-management program for severe COPD: the COMET

    Directory of Open Access Journals (Sweden)

    Bourbeau J

    2016-06-01

    Full Text Available Jean Bourbeau,1 Pere Casan,2 Silvia Tognella,3 Peter Haidl,4 Joëlle B Texereau,5,6 Romain Kessler7 On behalf of the COMET investigators 1Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; 2Hospital Universitario Central de Asturias, Facultad de Medicina, Oviedo, Spain; 3Lung Department, Ospedale Orlandi, Bussolengo VR, Italy; 4Krankenhaus Kloster Grafschaft, Schmallenberg, Germany; 5Air Liquide Healthcare, Medical Research and Development, Jouy-en-Josas, 6Assistance Publique-Hôpitaux de Paris, Service de Physiologie Clinique, Hôpital Cochin, Paris, 7Department of Pulmonary Medicine, Translational Medicine Federation of Strasbourg, University Hospital of Strasbourg, Strasbourg, France Introduction: Most hospitalizations and costs related to COPD are due to exacerbations and insufficient disease management. The COPD patient Management European Trial (COMET is investigating a home-based multicomponent COPD self-management program designed to reduce exacerbations and hospital admissions.Design: Multicenter parallel randomized controlled, open-label superiority trial.Setting: Thirty-three hospitals in four European countries.Participants: A total of 345 patients with Global initiative for chronic Obstructive Lung Disease III/IV COPD.Intervention: The program includes extensive patient coaching by health care professionals to improve self-management (eg, develop skills to better manage their disease, an e-health platform for reporting frequent health status updates, rapid intervention when necessary, and oxygen therapy monitoring. Comparator is the usual management as per the center’s routine practice.Main outcome measures: Yearly number of hospital days for acute care, exacerbation number, quality of life, deaths, and costs. Keywords: COPD, disease management, exacerbations, hospitalization, home care, clinical trial

  14. Pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Lauro Martins Júnior

    2014-12-01

    Full Text Available Pulmonary hypertension is a pathological condition associated with various diseases, which must be remembered by the physicians, since early diagnosis may anticipate and avoid dangerous complications and even death if appropriate measures were not taken. The relationship with chronic obstructive pulmonary disease (COPD, important pathological process that is in increasing prevalence in developing countries, and leading position as cause of death, emphasizes its importance. Here are presented the classifications, pathophysiology, and general rules of treatment of pulmonary hypertension.

  15. [Interdisciplinary rehabilitation in patients with ankylosing spondylitis].

    Science.gov (United States)

    Hegedűs, Béla; Varga, János; Somfay, Attila

    2016-07-01

    Complex pulmonary assessment related to respiratory manifestation in patients with ankylosing spondylitis may contribute to adaptation of an appropriate rehabilitation program. To examine the relationship between lung function, exercise physiological variables and change in quality of life after rehabilitation in patients with ankylosing spondylitis. 5 patients in Seyfried's Stage 2 and 11 patients in Stage 3 underwent spinal physiotherapy, ultrasound, massage and paraffin Pack, 15 times each, followed by a high-intensity cycling 3 times a week for 8 weeks. The Bath Ankylosing Spondylitis Disease Activity and Bath Ankylosing Spondylitis Functional Indexes were recorded before and after rehabilitation. Lung function with exercise physiological variables were examined after rehabilitation. Both indexes showed a post-treatment significant improvement compared to the initial scores (pankylosing spondylitis. Orv. Hetil., 2016, 157(28), 1126-1132.

  16. Twenty weeks of home-based interactive training of children with cerebral palsy improves functional abilities

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Greve, Line Z; Kliim-Due, Mette

    2015-01-01

    BACKGROUND: Home-based training is becoming ever more important with increasing demands on the public health systems. We investigated whether individualized and supervised interactive home-based training delivered through the internet improves functional abilities in children with cerebral palsy...... (CP). METHODS: Thirty four children with CP (aged 9-16; mean age 10.9 ± 2.4 years) (GMFCS I-II; MACS I-II) were included in this non-randomized controlled clinical training study. 12 children (aged 7-16; mean age: 11.3+/-0.9 years) were allocated to a control group in which measurements were performed...... home training of children with CP is an efficient way to deliver training, which can enable functional motor improvements and increased activity to perform daily activities. TRIAL REGISTRATION: ISRCTN13188513 . Date of registration: 04/12/2014....

  17. Older persons' experiences of a home-based exercise program with behavioral change support.

    Science.gov (United States)

    Arkkukangas, Marina; Sundler, Annelie J; Söderlund, Anne; Eriksson, Staffan; Johansson, Ann-Christin

    2017-12-01

    It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons. This descriptive study used a qualitative inductive approach to describe older persons' experiences of a fall-preventive, home-based exercise program with support for behavioral change. Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed. Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise. With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age.

  18. Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care

    DEFF Research Database (Denmark)

    von Heymann-Horan, Annika B.; Puggaard, Louise B.; Nissen, Kathrine G.

    2017-01-01

    and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members. Significance of Results:: Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs......Objective:: Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological...... support. We present a psychological intervention for patient–caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility. Method:: The Domus model of SPC for patients...

  19. Home-based specialized palliative care in patients with advanced cancer

    DEFF Research Database (Denmark)

    Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per

    2016-01-01

    on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care......OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information...... was employed. The search was conducted in PubMed, EMBASE, and Cochrane from January 1, 2000, to January 27, 2015. A hand search of the reference lists of the included studies was also performed. RESULTS: A total of 5 articles (out of 2080 abstracts) were selected for analysis. Three additional studies were...

  20. Clinics and home-based care organisations: an interface between theformal and informal health sectors.

    Science.gov (United States)

    Boros, Adam Kenneth

    2010-12-01

    The article outlines the findings of a study designed to explore the working relationship between home-based caregivers and clinic nurses at locations in two informal settlements in Johannesburg, South Africa. By considering the views and experiences of both sponsored and unsponsored caregivers, the research focused on how degrees of informality affect this relationship. The nurse/caregiver relationship represents a primary interface between the formal and informal health sectors and is an important part of the country's primary healthcare system. Despite the attention given to linking home-based care (HBC) with the formal health system, very little research has examined the functionality of this link at the ground level. Through a number of qualitative, semi-structured interviews with nurses, home-based caregivers, and staff from the Department of Health, information was collected to better understand what systems are in place to facilitate the relationship between clinics and HBC organisations, and whether these systems are helping to create the desired results. Do the formal and informal health sectors complement and strengthen or do they distract and damage each other? By examining the influence of degrees of informality, the research also lends insight into how this distinction plays a role in healthcare provision. For instance, how does state support impact the link between the formal and informal health sectors and the ultimate quality of care? And what steps can be taken to improve the health system in this regard, as a whole? The findings point to a number of problems and challenges with integrating HBC into the formal health sector. Degrees of informality are found to have a profound impact on the work of home-based caregivers in some respects, but a surprising lack of impact in others. These issues need to be confronted in order to improve the existing system and, ultimately, health outcomes in South Africa.

  1. Using Child-Parent Psychotherapy in a Home-Based Program Model

    Science.gov (United States)

    Ball, Jennifer; Smith, Mae

    2015-01-01

    This article tells the story of a single mother, Maria, who has a history of trauma, and her 2-year-old daughter, Lina, as they learn, play, and heal together through the use of Child-Parent Psychotherapy, an evidenced-based, trauma-informed therapeutic intervention in a home-based program model. Through the power of play, Maria and Lina are able…

  2. The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction

    OpenAIRE

    Lee, Hyuk; Seo, Min Jae; Choi, Tae Young

    2016-01-01

    Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The...

  3. Muscle Strength Enhancement Following Home-Based Virtual Cycling Training in Ambulatory Children with Cerebral Palsy

    Science.gov (United States)

    Chen, Chia-Ling; Hong, Wei-Hsien; Cheng, Hsin-Yi Kathy; Liaw, Mei-Yun; Chung, Chia-Ying; Chen, Chung-Yao

    2012-01-01

    This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n = 13) or a…

  4. Home-based primary care practices in the United States: current state and quality improvement approaches.

    Science.gov (United States)

    Leff, Bruce; Weston, Christine M; Garrigues, Sarah; Patel, Kanan; Ritchie, Christine

    2015-05-01

    To describe the characteristics of home-based primary care practices: staffing, administrative, population served, care practices, and quality of care challenges. Survey of home-based primary care practices. Home-based primary care practices in the United States. Members of the American Academy of Home Care Medicine and nonmember providers identified by surveyed members. A 58-item questionnaire that assessed practice characteristics, care provided by the practice, and how the quality of care that the practice provided was assessed. Survey response rate was 47.9%, representing 272 medical house calls practices. Mean average daily census was 457 patients (median 100 patients, range 1-30,972 patients). Eighty-eight percent of practices offered around-the-clock coverage for urgent concerns, 60% held regularly scheduled team meetings, 89% used an electronic medical record, and one-third used a defined quality improvement process. The following factors were associated with practices that used a defined quality improvement process: practice holds regularly scheduled team meetings to discuss specific patients (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.02-4.21), practice conducts surveys of patients (OR=8.53, 95% CI=4.07-17.88), and practice is involved in National Committee for Quality Assurance patient-centered medical home (OR=3.27, 95% CI=1.18-9.07). Ninety percent of practices would or might participate in quality improvement activities that would provide them timely feedback on patient and setting-appropriate quality indicators. There is a substantial heterogeneity of home-based primary care practice types. Most practices perform activities that lend themselves to robust quality improvement efforts, and nearly all indicated interest in a national registry to inform quality improvement. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  5. Caring Relationships in Home-Based Nursing Care - Registered Nurses’ Experiences

    Science.gov (United States)

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person’s genuine needs. The aim of this study was to explore registered nurses’ experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person’s position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology. PMID:23894261

  6. Home-based treadmill training improved seminal quality in adults with type 2 diabetes.

    Science.gov (United States)

    Rosety-Rodriguez, M; Rosety, J M; Fornieles, G; Rosety, M A; Diaz, A J; Rosety, I; Rodríguez-Pareja, A; Rosety, M; Ordonez, F J; Elosegui, S

    2014-11-01

    This was the first study conducted to determine the influence of home-based treadmill training on seminal quality in adults with type 2 diabetes. Sixty sedentary adults with type 2 diabetes volunteered for the current study. Thirty were randomly allocated to the intervention group and performed a a 14-week, home-based, treadmill training program, 3 sessions per week, consisting of a warm-up (10-15min), 40min treadmill exercise at a work intensity of 55-70% of peak heart rate (increasing by 2.5% each two weeks) measured during a maximal treadmill test, and cooling-down (5-10min). The control group included 30, age and BMI matched adults with type 2 diabetes who did not take part in any training program. Seminal quality analysis included semen volume, sperm concentration, motility and normal morphologic features. Furthermore, total antioxidant status (TAS) as well as glutathione peroxidase (GPX) activity were assessed in seminal plasma. This protocol was approved by an Institutional Ethics Committee. The home-based treadmill training significantly increased sperm concentration as well as percentages of total sperm motility and normal spermatozoa. Furthermore, TAS and GPX activity were increased after the completion of the training program. No significant changes in any of the measured variables were found in the control group. Home-base