The Experts below are selected from a list of 16230 Experts worldwide ranked by ideXlab platform
R. Zuwallack - One of the best experts on this subject based on the ideXlab platform.
-
There’s no place like home: Integrating Pulmonary Rehabilitation into the home setting
Monaldi Archives for Chest Disease, 2017Co-Authors: Madalina Macrea, R. Zuwallack, L. NiciAbstract:Traditional, outpatient Pulmonary Rehabilitation provided to stable COPD patients leads to significant improvements in dyspnea, exercise capacity and health related quality of life. Also, when started during or shortly after a hospitalization for a COPD exacerbation, Pulmonary Rehabilitation improves these patient-centered outcomes and arguably reduces subsequent health care utilization and mortality. Despite these benefits, the uptake of traditional Pulmonary Rehabilitation remains disappointingly poor. Home-based Pulmonary Rehabilitation, a safe and effective alternative to traditional, center-based programs, can broaden access. While proven improvements in dyspnea, exercise capacity and health status justify implementation of home-based Pulmonary Rehabilitation, it would be helpful to know whether it can also decrease health care utilization and be cost-effective.
-
Pulmonary Rehabilitation: Future Directions
Clinics in Chest Medicine, 2014Co-Authors: L. Nici, R. ZuwallackAbstract:Pulmonary Rehabilitation is now an established standard of care for patients with chronic obstructive Pulmonary disease (COPD). Although Pulmonary Rehabilitation has no appreciable direct effect on static measurements of lung function, it arguably provides the greatest benefit of any available therapy across multiple outcome areas important to the patient with respiratory disease, including dyspnea, exercise performance, and health-related quality of life. It also appears to be a potent intervention that reduces COPD hospitalizations, especially when given in the periexacerbation period. The role of Pulmonary Rehabilitation within the larger schema of integrated care represents a fruitful area for further research.
-
Pulmonary Rehabilitation: Definition, Concept, and History
Clinics in Chest Medicine, 2014Co-Authors: L. Nici, R. ZuwallackAbstract: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.
-
Clinical competency guidelines for Pulmonary Rehabilitation professionals: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.
Journal of Cardiopulmonary Rehabilitation and Prevention, 2014Co-Authors: Eileen G. Collins, R. Zuwallack, Trina Limberg, Lana Hilling, Chris Garvey, Brian W. Carlin, Gerene S. Bauldoff, Rebecca Crouch, Charles F. Emery, L. NiciAbstract:The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that interdisciplinary health care professionals providing Pulmonary Rehabilitation services need to have certain core competencies. This statement updates the previous clinical competency guidelines for Pulmonary Rehabilitation professionals, and it complements the AACVPR's Guidelines for Pulmonary Rehabilitation Programs. These competencies provide a common core of 13 professional and clinical competencies inclusive of multiple academic and clinical disciplines. The core competencies include patient assessment and management; dyspnea assessment and management; oxygen assessment, management, and titration; collaborative self-management; adherence; medication and therapeutics; non-chronic obstructive Pulmonary diseases; exercise testing; exercise training; psychosocial management; tobacco cessation; emergency responses for patient and program personnel; and universal standard precautions.
-
Differences in content and organisational aspects of Pulmonary Rehabilitation programmes
European Respiratory Journal, 2013Co-Authors: Martijn A. Spruit, R. Zuwallack, Eileen G. Collins, Chris Garvey, Roger S. Goldstein, Fabio Pitta, C. Michael Roberts, Renae J. Mcnamara, Pascale Surpas, Kawagoshi AtsuyoshiAbstract:The aim was to study the overall content and organisational aspects of Pulmonary Rehabilitation programmes from a global perspective in order to get an initial appraisal on the degree of heterogeneity worldwide. A 12-question survey on content and organisational aspects was completed by representatives of Pulmonary Rehabilitation programmes that had previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Rehabilitation and Chronic Care and/or Physiotherapists Scientific Groups, all members of the American Association of Cardiovascular and Pulmonary Rehabilitation, and all American Thoracic Society Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings. The survey has been completed by representatives of 430 centres from 40 countries. The findings demonstrate large differences among Pulmonary Rehabilitation programmes across continents for all aspects that were surveyed, including the setting, the case mix of individuals with a chronic respiratory disease, composition of the Pulmonary Rehabilitation team, completion rates, methods of referral and types of reimbursement. The current findings stress the importance of future development of processes and performance metrics to monitor Pulmonary Rehabilitation programmes, to be able to start international benchmarking, and to provide recommendations for international standards based on evidence and best practice.
Anne E. Holland - One of the best experts on this subject based on the ideXlab platform.
-
Telehealth in Pulmonary Rehabilitation
Textbook of Pulmonary Rehabilitation, 2017Co-Authors: Michele Vitacca, Anne E. HollandAbstract:A wide range of telehealth interventions could be used to optimize Pulmonary Rehabilitation delivery and patient outcomes. This includes monitoring of physiological signals or symptoms, early notification of clinical deterioration, telephone support, web-based education programmes; case management via videoconferencing and direct supervision of Rehabilitation sessions. Telehealth interventions could enhance the delivery of comprehensive care, as well as improving access to Pulmonary Rehabilitation services for those cannot travel to centre-based programmes. This chapter reviews current evidence and existing models for telemonitoring, tele-assistance and teleRehabilitation in chronic respiratory conditions. Tele-assistance has proved most successful for long-term, intensive management of the sickest patients, using sophisticated monitoring systems with high level support from an experienced clinical team. Effects of telemonitoring alone have been inconsistent across studies and the clinical, economic and organizational benefits are not yet clear. TeleRehabilitation shows promise for delivery of effective Pulmonary Rehabilitation either to satellite centres or directly into the patient’s home, using a variety of approaches including telephone calls, videoconferencing, internet platforms and smart phones, although well controlled data are lacking. Future challenges include identifying the best candidates for telehealth-enhanced Pulmonary Rehabilitation across the spectrum of chronic lung disease; deciding when it should be delivered and for how long; standardizing models of telehealth to allow consistent implementation and meaningful comparison of outcomes; and articulating the health economic benefits of telehealth services.
-
Pulmonary Rehabilitation for interstitial lung disease
Cochrane Database of Systematic Reviews, 2014Co-Authors: Leona Dowman, Catherine J. Hill, Anne E. HollandAbstract:Background Interstitial lung disease (ILD) is characterised by reduced functional capacity, dyspnoea and exercise-induced hypoxia. Pulmonary Rehabilitation, an intervention that includes exercise training, is beneficial for people with other chronic lung conditions; however its effects in ILD have not been well characterised. Objectives • To determine whether Pulmonary Rehabilitation in patients with ILD has beneficial effects on exercise capacity, symptoms, quality of life and survival compared with no Pulmonary Rehabilitation in patients with ILD. • To assess the safety of Pulmonary Rehabilitation in patients with ILD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 6), MEDLINE (Ovid), EMBASE (Ovid), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) and the Physiotherapy Evidence Database (PEDro) (all searched from inception to June 2014). We also searched the reference lists of relevant studies, international clinical trial registries and respiratory conference abstracts to look for qualifying studies. Selection criteria Randomised and quasi-randomised controlled trials in which Pulmonary Rehabilitation was compared with no Pulmonary Rehabilitation or with other therapy in people with ILD of any origin were included. Data collection and analysis Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. Study authors were contacted to provide missing data and information regarding adverse effects. A priori subgroup analyses were specified for participants with idiopathic Pulmonary fibrosis (IPF) and participants with severe lung disease (low diffusing capacity or desaturation during exercise). We planned to subgroup according to training modality applied, but there were insufficient data. Main results Nine studies were included, six of which were published as abstracts. Five studies were included in the meta-analysis (86 participants who undertook Pulmonary Rehabilitation and 82 control participants). One study used a blinded assessor and intention-to-treat analysis. No adverse effects of Pulmonary Rehabilitation were reported. Pulmonary Rehabilitation improved the six-minute walk distance with weighted mean difference (WMD) of 44.34 metres (95% confidence interval (CI) 26.04 to 62.64 metres) and improved oxygen consumption (VO2) peak with WMD of 1.24 mL/kg/min-1 (95% CI 0.46 to 2.03 mL/kg/min-1). Improvements in six-minute walk distance and VO2 peak were also seen in the subgroup of participants with idiopathic Pulmonary fibrosis (IPF) (WMD 35.63 metres, 95% CI 16.02 to 55.23 metres; WMD 1.46 mL/kg/min-1, 95% CI 0.54 to 2.39 mL/kg/min-1, respectively). Reduced dyspnoea (standardised mean difference (SMD) -0.66, 95% CI -1.05 to -0.28) following Pulmonary Rehabilitation was also seen in the IPF subgroup (SMD -0.68, 95% CI -1.12 to -0.25). Quality of life improved following Pulmonary Rehabilitation for all participants on a variety of measures (SMD 0.59, 95% CI 0.20 to 0.98) and for the subgroup of people with IPF (SMD 0.59, 95% CI 0.14 to 1.03). Two studies reported longer-term outcomes, with no significant effects of Pulmonary Rehabilitation on clinical variables or survival at three or six months. Available data were insufficient to allow examination of the impact of disease severity or exercise training modality. Authors' conclusions Pulmonary Rehabilitation seems to be safe for people with ILD. Improvements in functional exercise capacity, dyspnoea and quality of life are seen immediately following Pulmonary Rehabilitation, with benefits also evident in IPF. Because of inadequate reporting of methods and small numbers of included participants, the quality of evidence was low to moderate. Little evidence was available regarding longer-term effects of Pulmonary Rehabilitation.
-
The Cochrane Library - Pulmonary Rehabilitation for interstitial lung disease
Cochrane Database of Systematic Reviews, 2014Co-Authors: Leona Dowman, Catherine J. Hill, Anne E. HollandAbstract:Background Interstitial lung disease (ILD) is characterised by reduced functional capacity, dyspnoea and exercise-induced hypoxia. Pulmonary Rehabilitation, an intervention that includes exercise training, is beneficial for people with other chronic lung conditions; however its effects in ILD have not been well characterised. Objectives • To determine whether Pulmonary Rehabilitation in patients with ILD has beneficial effects on exercise capacity, symptoms, quality of life and survival compared with no Pulmonary Rehabilitation in patients with ILD. • To assess the safety of Pulmonary Rehabilitation in patients with ILD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 6), MEDLINE (Ovid), EMBASE (Ovid), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) and the Physiotherapy Evidence Database (PEDro) (all searched from inception to June 2014). We also searched the reference lists of relevant studies, international clinical trial registries and respiratory conference abstracts to look for qualifying studies. Selection criteria Randomised and quasi-randomised controlled trials in which Pulmonary Rehabilitation was compared with no Pulmonary Rehabilitation or with other therapy in people with ILD of any origin were included. Data collection and analysis Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. Study authors were contacted to provide missing data and information regarding adverse effects. A priori subgroup analyses were specified for participants with idiopathic Pulmonary fibrosis (IPF) and participants with severe lung disease (low diffusing capacity or desaturation during exercise). We planned to subgroup according to training modality applied, but there were insufficient data. Main results Nine studies were included, six of which were published as abstracts. Five studies were included in the meta-analysis (86 participants who undertook Pulmonary Rehabilitation and 82 control participants). One study used a blinded assessor and intention-to-treat analysis. No adverse effects of Pulmonary Rehabilitation were reported. Pulmonary Rehabilitation improved the six-minute walk distance with weighted mean difference (WMD) of 44.34 metres (95% confidence interval (CI) 26.04 to 62.64 metres) and improved oxygen consumption (VO2) peak with WMD of 1.24 mL/kg/min-1 (95% CI 0.46 to 2.03 mL/kg/min-1). Improvements in six-minute walk distance and VO2 peak were also seen in the subgroup of participants with idiopathic Pulmonary fibrosis (IPF) (WMD 35.63 metres, 95% CI 16.02 to 55.23 metres; WMD 1.46 mL/kg/min-1, 95% CI 0.54 to 2.39 mL/kg/min-1, respectively). Reduced dyspnoea (standardised mean difference (SMD) -0.66, 95% CI -1.05 to -0.28) following Pulmonary Rehabilitation was also seen in the IPF subgroup (SMD -0.68, 95% CI -1.12 to -0.25). Quality of life improved following Pulmonary Rehabilitation for all participants on a variety of measures (SMD 0.59, 95% CI 0.20 to 0.98) and for the subgroup of people with IPF (SMD 0.59, 95% CI 0.14 to 1.03). Two studies reported longer-term outcomes, with no significant effects of Pulmonary Rehabilitation on clinical variables or survival at three or six months. Available data were insufficient to allow examination of the impact of disease severity or exercise training modality. Authors' conclusions Pulmonary Rehabilitation seems to be safe for people with ILD. Improvements in functional exercise capacity, dyspnoea and quality of life are seen immediately following Pulmonary Rehabilitation, with benefits also evident in IPF. Because of inadequate reporting of methods and small numbers of included participants, the quality of evidence was low to moderate. Little evidence was available regarding longer-term effects of Pulmonary Rehabilitation.
-
New horizons for Pulmonary Rehabilitation
Physical Therapy Reviews, 2011Co-Authors: Anne E. Holland, Catherine J. HillAbstract:Background: Pulmonary Rehabilitation is a cornerstone of management for people with chronic obstructive Pulmonary disease (COPD). Recent studies suggest that the traditional model for Pulmonary Rehabilitation, which focuses on centre-based programs for stable patients, could be broadened. Objectives: To examine evidence for inclusion of new patient populations, different settings and updated outcomes in Pulmonary Rehabilitation. Major findings: Pulmonary Rehabilitation that is commenced early following an acute exacerbation of COPD results in fewer hospital readmissions and reduced mortality. This calls for program models that allow recovering patients to participate without delay. Patients with interstitial lung disease achieve modest benefits from Pulmonary Rehabilitation and participation should be encouraged in clinically stable patients. Advances in medical therapies for Pulmonary arterial hypertension allow patients to achieve clinical stability, providing opportunity to safely engage in exercise tr...
L. Nici - One of the best experts on this subject based on the ideXlab platform.
-
There’s no place like home: Integrating Pulmonary Rehabilitation into the home setting
Monaldi Archives for Chest Disease, 2017Co-Authors: Madalina Macrea, R. Zuwallack, L. NiciAbstract:Traditional, outpatient Pulmonary Rehabilitation provided to stable COPD patients leads to significant improvements in dyspnea, exercise capacity and health related quality of life. Also, when started during or shortly after a hospitalization for a COPD exacerbation, Pulmonary Rehabilitation improves these patient-centered outcomes and arguably reduces subsequent health care utilization and mortality. Despite these benefits, the uptake of traditional Pulmonary Rehabilitation remains disappointingly poor. Home-based Pulmonary Rehabilitation, a safe and effective alternative to traditional, center-based programs, can broaden access. While proven improvements in dyspnea, exercise capacity and health status justify implementation of home-based Pulmonary Rehabilitation, it would be helpful to know whether it can also decrease health care utilization and be cost-effective.
-
Pulmonary Rehabilitation: Future Directions
Clinics in Chest Medicine, 2014Co-Authors: L. Nici, R. ZuwallackAbstract:Pulmonary Rehabilitation is now an established standard of care for patients with chronic obstructive Pulmonary disease (COPD). Although Pulmonary Rehabilitation has no appreciable direct effect on static measurements of lung function, it arguably provides the greatest benefit of any available therapy across multiple outcome areas important to the patient with respiratory disease, including dyspnea, exercise performance, and health-related quality of life. It also appears to be a potent intervention that reduces COPD hospitalizations, especially when given in the periexacerbation period. The role of Pulmonary Rehabilitation within the larger schema of integrated care represents a fruitful area for further research.
-
Pulmonary Rehabilitation: Definition, Concept, and History
Clinics in Chest Medicine, 2014Co-Authors: L. Nici, R. ZuwallackAbstract: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.
-
Clinical competency guidelines for Pulmonary Rehabilitation professionals: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.
Journal of Cardiopulmonary Rehabilitation and Prevention, 2014Co-Authors: Eileen G. Collins, R. Zuwallack, Trina Limberg, Lana Hilling, Chris Garvey, Brian W. Carlin, Gerene S. Bauldoff, Rebecca Crouch, Charles F. Emery, L. NiciAbstract:The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that interdisciplinary health care professionals providing Pulmonary Rehabilitation services need to have certain core competencies. This statement updates the previous clinical competency guidelines for Pulmonary Rehabilitation professionals, and it complements the AACVPR's Guidelines for Pulmonary Rehabilitation Programs. These competencies provide a common core of 13 professional and clinical competencies inclusive of multiple academic and clinical disciplines. The core competencies include patient assessment and management; dyspnea assessment and management; oxygen assessment, management, and titration; collaborative self-management; adherence; medication and therapeutics; non-chronic obstructive Pulmonary diseases; exercise testing; exercise training; psychosocial management; tobacco cessation; emergency responses for patient and program personnel; and universal standard precautions.
-
Scope, background and definition of Pulmonary Rehabilitation.
European journal of physical and rehabilitation medicine, 2011Co-Authors: L. Nici, R. ZuwallackAbstract:The optimal therapy of an individual with chronic respiratory disease usually requires a combination of pharmacologic and non-pharmacologic therapies. A case of a 68-year-old man with advanced chronic obstructive Pulmonary disease is given to illustrate this point. He is a recent ex-smoker with severe chronic obstructive Pulmonary disease by spirometric criteria, frequent exacerbations of this disease, considerable recent health care utilization, dyspnea with minimal activities, severe functional status limitation, prominent systemic effects of the disease (e.g., weight loss) and substantial comorbidities. The primary respiratory disease cannot be isolated from and treated independently of these important factors. Pulmonary Rehabilitation is an important therapeutic option in situations like this, providing a mode of integrating care, complementing otherwise standard medical therapy, and producing significant gains across multiple outcome areas of importance to the patient. Pulmonary Rehabilitation has been defined by the American Thoracic Society and European Respiratory Society as: "an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, Pulmonary Rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease". Its components include comprehensive assessment, education, exercise training, and psychosocial intervention. Outcomes assessment is usually performed for quality assessment. Pulmonary Rehabilitation produces the greatest improvements of any available therapy in dyspnea, exercise capacity, and health-related quality of life. These gains are realized despite the fact that Pulmonary Rehabilitation has no direct effect on lung function. It works primarily through reducing the impact of the systemic manifestations of the disease and frequent comorbidity. Pulmonary Rehabilitation also leads to substantial reductions in subsequent health care utilization, possibly through collaborative self-management strategies emphasized in the program. Although Pulmonary Rehabilitation has been utilized by astute clinicians for many years, its science has been developed over the past two decades.
Thierry Troosters - One of the best experts on this subject based on the ideXlab platform.
-
Identifying Candidates for Pulmonary Rehabilitation
Textbook of Pulmonary Rehabilitation, 2017Co-Authors: Thierry TroostersAbstract:Pulmonary Rehabilitation is an evidence-based treatment option for patients with respiratory disorders. The numbers needed to treat in order to have one successful participant on a particular outcome are estimated to be around three. Such low numbers are surely speaking for themselves in terms of the overall effectiveness of Rehabilitation, but still a number of patients do not benefit from Pulmonary Rehabilitation, never start the program, or drop out. In this chapter, we will summarize the current state of the art in terms of patient selection for Rehabilitation.
-
Pulmonary Rehabilitation following exacerbations of chronic obstructive Pulmonary disease
Cochrane Database of Systematic Reviews, 2016Co-Authors: Milo A Puhan, Elena Gimenosantos, Christopher J Cates, Thierry TroostersAbstract:BACKGROUND: Pulmonary Rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of Pulmonary Rehabilitation in these patients. However, in unstable COPD patients who have recently suffered an exacerbation, the effects of Pulmonary Rehabilitation are less established. OBJECTIVES: To assess the effects of Pulmonary Rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other patient-important outcomes (mortality, health-related quality of life and exercise capacity). SEARCH STRATEGY: Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO and the Cochrane Airways Group Register of Trials. Searches were current as of March 2010. SELECTION CRITERIA: Randomized controlled trials comparing Pulmonary Rehabilitation of any duration after exacerbation of COPD with conventional care. Pulmonary Rehabilitation programmes needed to include at least physical exercise. Control groups received conventional community care without Rehabilitation. DATA COLLECTION AND ANALYSIS: We calculated pooled odds ratios and weighted mean differences (MD) using random-effects models. We requested missing data from the authors of the primary studies. MAIN RESULTS: We identified nine trials involving 432 patients. Pulmonary Rehabilitation significantly reduced hospital admissions (pooled odds ratio 0.22 [95% CI 0.08 to 0.58], number needed to treat (NNT) 4 [95% CI 3 to 8], over 25 weeks) and mortality (OR 0.28; 95% CI 0.10 to 0.84), NNT 6 [95% CI 5 to 30] over 107 weeks). Effects of Pulmonary Rehabilitation on health-related quality of life were well above the minimal important difference when measured by the Chronic Respiratory Questionnaire (MD for dyspnea, fatigue, emotional function and mastery domains between 0.81 (fatigue; 95% CI 0.16 to 1.45) and 0.97 (dyspnea; 95% CI 0.35 to 1.58)) and the St. Georges Respiratory Questionnaire total score (MD -9.88; 95% CI -14.40 to -5.37); impacts domain (MD -13.94; 95% CI -20.37 to -7.51) and for activity limitation domain (MD -9.94; 95% CI -15.98 to -3.89)). The symptoms domain of the St. Georges Respiratory Questionnaire showed no significant improvement. Pulmonary Rehabilitation significantly improved exercise capacity and the improvement was above the minimally important difference (six-minute walk test (MD 77.70 meters; 95% CI 12.21 to 143.20) and shuttle walk test (MD 64.35; 95% CI 41.28 to 87.43)). No adverse events were reported in three studies. AUTHORS' CONCLUSIONS: Evidence from nine small studies of moderate methodological quality, suggests that Pulmonary Rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients who have recently suffered an exacerbation of COPD.
-
exercise training and Pulmonary Rehabilitation new insights and remaining challenges
European Respiratory Review, 2010Co-Authors: Thierry Troosters, Wim Janssens, Rik Gosselink, Marc DecramerAbstract:Pulmonary Rehabilitation is now regarded as an evidence-based treatment for symptomatic patients with chronic obstructive Pulmonary disease. It has been shown to enhance exercise tolerance, improve symptoms and health-related quality of life, and reduce exacerbations in patients with recurrent exacerbations. In this article we review the mechanisms through which exercise training results in beneficial effects. We also review three challenges that currently remain: 1) the fine tuning of exercise training and multidisciplinary programmes; 2) the timing of Rehabilitation; and 3) efforts to enhance the accessibility and adherence to Pulmonary Rehabilitation programmes. Further research is needed in order to apply the now well-established principles of Pulmonary Rehabilitation to unusual patient populations, or patient populations that are unlikely to participate in conventional outpatient programmes.
-
Chapter 58 – Pulmonary Rehabilitation
Asthma and COPD, 2009Co-Authors: Thierry Troosters, Wim Janssens, Marc DecramerAbstract:Publisher Summary Pulmonary Rehabilitation is nowadays a recognized evidence-based therapy, which can be applied to patients with lung diseases who are symptomatic and have reduced activities of daily living, despite optimal medical therapy. Unlike most drugs, Pulmonary Rehabilitation does not target the lungs directly, but aims at reversing or stabilizing the extra-Pulmonary effects of lung diseases. To be successful, Pulmonary Rehabilitation is typically designed as a comprehensive intervention offered by a team of health-care providers over a substantial period of time. Typically, Rehabilitation programs are carried out for 6 weeks to 6 months, with longer programs yielding more substantial effects. Several other interventions may complement the program to maximize its effectiveness. Pulmonary Rehabilitation may serve many goals, which depend on the perspective one takes. It is important to realize that patients suffering from other respiratory diseases, such as Pulmonary sarcoidosis, cystic fibrosis, or after lung transplantation, equally present systemic consequences of their disease. Consequently, Pulmonary Rehabilitation programs should not be restricted to patients with COPD, but should be open to any patient suffering from extra-Pulmonary consequences of lung diseases in general. To establish the indication for a Rehabilitation program, a formal exercise test should be carried out. Exercise intolerance is indeed an important reason to refer a patient for Rehabilitation. Rehabilitation programs are oriented toward patients who are symptomatic and have reduced activities of daily life, encouraging assessment of symptoms and health-related quality of life, and physical activity.
Jean Bourbeau - One of the best experts on this subject based on the ideXlab platform.
-
Facilitating education in Pulmonary Rehabilitation using the Living Well with COPD programme for Pulmonary Rehabilitation: a process evaluation
BMC Pulmonary Medicine, 2013Co-Authors: Denise Cosgrove, Joseph Macmahon, Jean Bourbeau, Judy M Bradley, Brenda O’neillAbstract:Background Standardised evidenced-based materials and mechanisms to facilitate the delivery of the education component of Pulmonary Rehabilitation are not widely available. The aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in Pulmonary Rehabilitation; and, 2) to conduct a process evaluation of the adapted programme. Methods The adaptations to the LWWCOPD programme were informed by focus groups, current practice, relevant research and guideline documents. Pulmonary Rehabilitation sites used the adapted programme, the LWWCOPD programme for Pulmonary Rehabilitation, to deliver the education component of Pulmonary Rehabilitation. A process evaluation was conducted: elements included reach (patients’ attendance rates), dose delivered (amount of programme delivered), dose received (health professional and patient satisfaction) and fidelity (impact on patients’ knowledge, understanding and self-efficacy on the Understanding COPD questionnaire). Descriptive statistics (mean, SD) were used to summarise demographics and key data from the feedback questionnaires. Qualitative feedback on the programme was collated and categorised. Changes in the Understanding COPD questionnaire were examined using paired t-tests. Results The LWWCOPD programme for Pulmonary Rehabilitation was delivered in eleven hospital- and community-based programmes (n=25 health professionals, n=57 patients with COPD). It consisted of six weekly 30–45 minute sessions. The process evaluation showed positive results: 62.3% of patients attended ≥ 4 education sessions (reach); mean (SD) 90 (10)% of the session content were delivered (dose delivered); the majority of sessions were rated as excellent or good by health professionals and patients. Patients’ satisfaction was high: mean (SD) Section B of the Understanding COPD questionnaire: 91.67 (9.55)% (dose received). Knowledge, understanding and self-efficacy improved significantly: mean change (95% CI): Section A of the Understanding COPD questionnaire: 26.75 (21.74 to 31.76)%, BCKQ 10.64 (6.92 to 14.37)% (fidelity). Conclusion This rigorous process evaluation has demonstrated that the LWWCOPD programme for Pulmonary Rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based Pulmonary Rehabilitation. This programme is now available worldwide ( http://www.livingwellwithcopd.com/living-well-and-Pulmonary-Rehabilitation.html ). Trial registration This study was registered with clinicaltrials.gov (reference number: NCT01226836 )
-
Facilitating education in Pulmonary Rehabilitation using the Living Well with COPD programme for Pulmonary Rehabilitation: a process evaluation
BMC Pulmonary Medicine, 2013Co-Authors: Denise Cosgrove, Joseph Macmahon, Judy Bradley, Jean Bourbeau, Brenda O'neillAbstract:Standardised evidenced-based materials and mechanisms to facilitate the delivery of the education component of Pulmonary Rehabilitation are not widely available. The aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in Pulmonary Rehabilitation; and, 2) to conduct a process evaluation of the adapted programme. The adaptations to the LWWCOPD programme were informed by focus groups, current practice, relevant research and guideline documents. Pulmonary Rehabilitation sites used the adapted programme, the LWWCOPD programme for Pulmonary Rehabilitation, to deliver the education component of Pulmonary Rehabilitation. A process evaluation was conducted: elements included reach (patients’ attendance rates), dose delivered (amount of programme delivered), dose received (health professional and patient satisfaction) and fidelity (impact on patients’ knowledge, understanding and self-efficacy on the Understanding COPD questionnaire). Descriptive statistics (mean, SD) were used to summarise demographics and key data from the feedback questionnaires. Qualitative feedback on the programme was collated and categorised. Changes in the Understanding COPD questionnaire were examined using paired t-tests. The LWWCOPD programme for Pulmonary Rehabilitation was delivered in eleven hospital- and community-based programmes (n=25 health professionals, n=57 patients with COPD). It consisted of six weekly 30–45 minute sessions. The process evaluation showed positive results: 62.3% of patients attended ≥ 4 education sessions (reach); mean (SD) 90 (10)% of the session content were delivered (dose delivered); the majority of sessions were rated as excellent or good by health professionals and patients. Patients’ satisfaction was high: mean (SD) Section B of the Understanding COPD questionnaire: 91.67 (9.55)% (dose received). Knowledge, understanding and self-efficacy improved significantly: mean change (95% CI): Section A of the Understanding COPD questionnaire: 26.75 (21.74 to 31.76)%, BCKQ 10.64 (6.92 to 14.37)% (fidelity). This rigorous process evaluation has demonstrated that the LWWCOPD programme for Pulmonary Rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based Pulmonary Rehabilitation. This programme is now available worldwide ( http://www.livingwellwithcopd.com/living-well-and-Pulmonary-Rehabilitation.html ). This study was registered with clinicaltrials.gov (reference number: NCT01226836 )
-
home based Pulmonary Rehabilitation in chronic obstructive Pulmonary disease patients
Current Opinion in Pulmonary Medicine, 2010Co-Authors: Danielle Soares Rocha Vieira, François Maltais, Jean BourbeauAbstract:Purpose of reviewHome-based Pulmonary Rehabilitation programs have been proposed as an alternative to hospital-based programs for patients with chronic obstructive Pulmonary disease (COPD). We undertook a systematic review of randomized studies on home-based Pulmonary Rehabilitation in patients with
