Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT

Abstract Background Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. Methods A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. Results Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. Conclusions In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

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Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil

BMJ Global Health ◽

10.1136/bmjgh-2019-001921 ◽

2019 ◽

Vol 4 (6) ◽

pp. e001921

Author(s):

Max Oscar Bachmann ◽

Eric D Bateman ◽

Rafael Stelmach ◽

Alvaro A Cruz ◽

Matheus Pacheco de Andrade ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Primary Care ◽

Pulmonary Disease ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Link Type ◽

To Receive

IntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates.ResultsAsthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms.ConclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.Trial registrationNCT02786030 (https://clinicaltrials.gov/).

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Individualized, Low-Cost And Accessible Pulmonary Rehabilitation Program Based On Functional Clinical Tests For Individuals With Copd– A Study Protocol Of A Randomized Controlled Trial

10.21203/rs.3.rs-146768/v1 ◽

2021 ◽

Author(s):

Marcela Maria Carvalho da SILVA ◽

JULIANO FERREIRA ARCURI ◽

VALERIA AMORIM PIRES DI LORENZO

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Pulmonary Rehabilitation ◽

Low Cost ◽

Controlled Trial ◽

Rehabilitation Program ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Positive Effects ◽

Rehabilitation Programs

Abstract Backgroud:Patients with Chronic Obstructive Pulmonary Disease (COPD) present pulmonary and extrapulmonary impairments. In order to mitigate these impairments, pulmonary rehabilitation programs (PRP) it is an important strategy but the access to PRP in specialized center is limited and the studied of low-cost home rehabilitation programs had non-individualized prescription, which might have led to insignificant positive effects. So, it is important to develop new low-cost protocols that involves individualized prescription, and the influence of physiotherapist supervision. The aim of this study was to describe an accessible, low-cost and individualized pulmonary rehabilitation protocol and compare its results when performing it with or without a weekly physiotherapist-supervised session on patients with COPD. Methods: This is a descriptive protocol of a clinical trial with parallel equivalent groups, conducted at the Spirometry and Respiratory Physical Therapy Laboratory of the Federal University of São Carlos (UFSCar). The trial was registered at Brazilian Clinical Trials Registry (ReBec) URL: http://www.ensaiosclinicos.gov.br/rg/RBR-533hht/ with Register Number RBR-533hht. The sample size was 40 patients and was calculated using the results of a pilot study.Discussion- potencial impact and significance of the study: It is expected that the low cost and new supervised rehabilitation program complemented with home exercises will present positive results especially on exercise capacity, which will make available a more accessible and effective PRP for patients with COPD.Trial registration: The name of the registry was Responsibility of functional tests on supervised rehabilitation program and education program in patients with chronic obstructive pulmonary disease,with registration number: RBR-533hht. The date of registration and start data was September 20, 2018.

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