scholarly journals A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: development and evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ning Deng ◽  
Leiyi Sheng ◽  
Wangshu Jiang ◽  
Yongfa Hao ◽  
Shuoshuo Wei ◽  
...  
Keyword(s):  
Behavior Change ◽  
Technology Acceptance ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Exercise Prescription ◽  
Chronic Obstructive ◽  
Pilot Studies ◽  
Home Based ◽  
Copd Patients ◽  
Significant Difference

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a lifestyle which is long-term physically active. This study aimed to develop a home-based rehabilitation mHealth system incorporating behavior change techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility. Methods Guided by the medical research council (MRC) framework the process of this study was divided into four steps. In the first step, the prescription was constructed. The second step was to formulate specific intervention functions based on the behavior change wheel theory. Subsequently, in the third step we conducted iterative system development. And in the last step two pilot studies were performed, the first was for the improvement of system functions and the second was to explore potential clinical benefits and validate the acceptance and usability of the system. Results A total of 17 participants were enrolled, among them 12 COPD participants completed the 12-week study. For the clinical outcomes, Six-Minute Walk Test (6MWT) showed significant difference (P = .023) over time with an improvement exceeded the minimal clinically important difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P = .031) with a greater decrease of − 3. The mMRC levels reduced overall and showed significant difference. The overall compliance of this study reached 82.20% (± 1.68%). The results of questionnaire and interviews indicated good technology acceptance and functional usability. The participants were satisfied with the mHealth-based intervention. Conclusions This study developed a home-based PR mHealth system for COPD patients. We showed that the home-based PR mHealth system incorporating BCTs is a feasible and acceptable intervention for COPD patients, and COPD patients can benefit from the intervention delivered by the system. The proposed system played an important auxiliary role in offering exercise prescription according to the characteristics of patients. It provided means and tools for further individuation of exercise prescription in the future.

A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: Development and evaluation (Preprint)

2021 ◽  
Author(s):  
Ning Deng ◽  
Leiyi Sheng ◽  
Yongfa Hao ◽  
Wangshu Jiang ◽  
Qingdong Huang ◽  
...  
Keyword(s):  
Technology Acceptance ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Research Council ◽  
Medical Research Council ◽  
Exercise Prescription ◽  
Home Based ◽  
Copd Patients ◽  
Significant Difference ◽  
Over Time

BACKGROUND Patients with Chronic Obstructive Pulmonary Disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a long-term physically active lifestyle. OBJECTIVE This study aimed to develop a home-based rehabilitation mHealth system incorporating Behavior Change Techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility. METHODS Guided by the Medical Research Council (MRC) framework the process of this study is divided into four steps. In the first step the prescription was constructed. The second step is to formulate specific intervention functions based on the Behavior Change Wheel (BCW) theory. Subsequently, in the third step iterative system development was conducted. And in the last step two polit studies were performed, the first is for the improvement of system functions and the second is to validate the acceptance and usability. Primary outcomes were the exercise capacity measured by Six-Minute Walk Test (6MWT). Secondary clinical outcomes included changes in disease specific health status measured by COPD Assessment Test (CAT), measure of breathlessness indicated by mMRC (modified British medical Research Council) and indicators of mental health such as Hospital Anxiety and Depression Scale (HAD). Compliance, technology acceptance, and feasibility of the system were also used as outcome indicators. RESULTS Two-stage study was conducted to evaluate the proposed system. A total of 17 patients was enrolled. 12 patients completed the 12-week study. At the end of the first study, the 6MWT showed significant increase over time (P=0.028). Participants reported that this app had a positive effect on promoting exercise at home. The results of the second stage study is the final result of this study. For the clinical outcomes, 6MWT scores showed significant difference (P=.023) over time with an improvement exceeded the Minimal Clinically Important Difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P=.023) with a greater decrease of -3.17 points that exceeded the MCID. The mMRC levels reduced overall and showed significant difference. HAD did not show statistically significant difference in this study but non-inferiority. The overall compliance of this study reached 82.20% (±1.68%). CONCLUSIONS This study developed a home-based PR mHealth system for COPD patients. The use of BCW in the intervention developing process offers a systematic method for designing a theory-driven intervention. The pilot study in Yinchuan verified the technical acceptance and availability of the system, and demonstrated the benefits of applying mHealth technology and BCT to Home-based PR for COPD patients. The proposed system plays an important auxiliary role in the process of prescribing exercise prescription according to the characteristics of patients. And it provides means and tools for further individuation of exercise prescription in the future.

scholarly journals Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD

2021 ◽  
Vol 18 (8) ◽  
pp. 4207
Author(s):  
Jose L. Gonzalez-Montesinos ◽  
Jorge R. Fernandez-Santos ◽  
Carmen Vaz-Pardal ◽  
Jesus G. Ponce-Gonzalez ◽  
Alberto Marin-Galindo ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Rehabilitation Programme ◽  
Group Differences ◽  
Control Group ◽  
Chronic Obstructive ◽  
Maximum Value ◽  
Copd Patients ◽  
Significant Difference ◽  
Pulmonary Rehabilitation Programme ◽  
Positive Increment

Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = −435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, −8.5 L/min, BF10 = 25), respiratory rate (RR, −3.3 breaths/min, BF10 = 2), heart rate (HR, −13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, −183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, −3.8 L/min, BF10 = 1.1) and compared to CG in VE (−8.3 L/min, BF10 = 3.6), VCO2 (−215.9 L/min, BF10 = 3.0), EqCO2 (−3.7 L/min, BF10 = 1.1) and HR (−12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (−4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

scholarly journals Using Telehealth Technology to Deliver Pulmonary Rehabilitation to Patients with Chronic Obstructive Pulmonary Disease

2011 ◽  
Vol 18 (4) ◽  
pp. 216-220 ◽  
Author(s):  
Michael K Stickland ◽  
Tina Jourdain ◽  
Eric YL Wong ◽  
Wendy M Rodgers ◽  
Nicholas G Jendzjowsky ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Exercise Capacity ◽  
Pulmonary Rehabilitation ◽  
Primary Outcome Measure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

BACKGROUND: Pulmonary rehabilitation (PR) is an effective therapeutic strategy to improve health outcomes in patients with chronic obstructive pulmonary disease (COPD); however, there is insufficient PR capacity to service all COPD patients, thus necessitating creative solutions to increase the availability of PR.OBJECTIVE: To examine the efficacy of PR delivered via Telehealth (Telehealth-PR) compared with PR delivered in person through a standard outpatient hospital-based program (Standard-PR).METHODS: One hundred forty-seven COPD patients participated in an eight-week rural PR program delivered via Telehealth-PR. Data were compared with a parallel group of 262 COPD patients who attended Standard-PR. Education sessions were administered two days per week via Telehealth, and patients exercised at their satellite centre under direct supervision. Standard-PR patients viewed the same education sessions in person and exercised at the main PR site. The primary outcome measure was change in quality of life as evaluated by the St George’s Respiratory Questionnaire (SGRQ). A noninferiority analysis was performed using both intention-to-treat and per-protocol approaches.RESULTS: Both Telehealth-PR and Standard-PR resulted in clinically and statistically significant improvements in SGRQ scores (4.5±0.8% versus 4.1±0.6%; P<0.05 versus baseline for both groups), and the improvement in SGRQ was not different between the two programs. Similarly, exercise capacity, as assessed by 12 min walk test, improved equally in both Telehealth-PR and Standard-PR programs (81±10 m versus 82±10 m; P<0.05 versus baseline for both groups).CONCLUSION: Telehealth-PR was an effective tool for increasing COPD PR services, and demonstrated improvements in quality of life and exercise capacity comparable with Standard-PR.

Application of the Modified Incremental Step Test for Pulmonary Rehabilitation

2021 ◽  
Author(s):  
A T Burge ◽  
J C Rodrigues ◽  
M J Abramson ◽  
N S Cox ◽  
J Bondarenko ◽  
...  
Keyword(s):  
Exercise Training ◽  
Exercise Capacity ◽  
Effect Size ◽  
Pulmonary Rehabilitation ◽  
Exercise Prescription ◽  
Intraclass Correlation ◽  
Step Test ◽  
Home Based ◽  
Walking Tests ◽  
Incremental Step

Abstract Objective A modified incremental step test (MIST) performed in the home may facilitate entirely home-based pulmonary rehabilitation programs. The aims of this study were to investigate the reliability and responsiveness, and the utility of the MIST for exercise prescription in people with stable chronic lung disease. Methods The MIST was undertaken at the centre and home in random order, before and after pulmonary rehabilitation, with two tests at each time point. Reliability was assessed using intraclass correlation coefficient. Responsiveness was evaluated as effect size. The minimal important difference was appraised using distribution and anchor-based methods. In a sub-study, physiological responses to MIST were measured by a portable metabolic system, followed by a constant step rate test at 60% of peak oxygen uptake (v̇O2peak), to evaluate utility for exercise prescription. Results Forty-six participants were recruited (29% of eligible candidates). There was excellent reliability for number of steps recorded in home and centre-based settings (intraclass correlation coefficient 0.954, 95%CI 0.915 to 0.976). A small-moderate effect size was demonstrated following pulmonary rehabilitation (0.34) and the minimal detectable change was 7 steps. All participants in the sub-study achieved 60% of v̇O2peak and achieved steady state by the 4th minute, with 60% of v̇O2 peak corresponding to mean 37% (95%CI 29 to 44) of the MIST final level. Conclusions The MIST is reliable and responsive to pulmonary rehabilitation in people with stable chronic respiratory disease. It provides new opportunities to assess exercise capacity, prescribe exercise training and reassess exercise program outcomes in environments where established field walking tests are not feasible. Impact Pulmonary rehabilitation is a highly effective treatment that is underutilised worldwide. Home-based pulmonary rehabilitation may improve access for patients and deliver equivalent clinical outcomes, but is limited by the availability of a robust exercise test that can be used at home to assess exercise capacity and prescribe training intensity. This study tested the clinimetric properties of the modified incremental step test and demonstrated a new way to assess exercise capacity, prescribe exercise training of an appropriate intensity and reassess exercise capacity in environments where established field walking tests are not feasible.

scholarly journals The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

2020 ◽  
Vol 148 (5-6) ◽  
pp. 344-349
Author(s):  
Miroslav Ilic ◽  
Ivan Kopitovic ◽  
Danijela Kuhajda ◽  
Biljana Zvezdin ◽  
Nensi Lalic ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Multivariate Logistic Regression Analysis ◽  
Chronic Obstructive ◽  
Observation Study ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Significant Difference ◽  
Seasonal Flu

Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 ?} 8.45, current or ex-smokers 94.9%; 21 ? BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307?0.577); p < 0.001) and BMI ? 21kg/m2 (RR 0.605; 95% CI (0.380?0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720?3.280); p < 0.001) and FEV1 < 80% (RR 2.021; 95% CI (1.303?3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion. Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.

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

2010 ◽  
Vol 5 ◽  
Author(s):  
Julio C. Mendes de Oliveira ◽  
Fernando S. Studart Leitão Filho ◽  
Luciana M. Malosa Sampaio ◽  
Ana C. Negrinho de Oliveira ◽  
Raquel Pastrello Hirata ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Financial Burden ◽  
Lower Limbs ◽  
Outpatient Rehabilitation ◽  
Control Group ◽  
Chronic Obstructive ◽  
Home Based ◽  
Outpatient Group ◽  
Significant Difference ◽  
At Home

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, psychologi- cal 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 rou- tine 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 strength- ening of upper and lower limbs 3 times a week for 12 weeks. Results: There was a significant difference in the distance cov- ered on the six-minute walk test (p < 0.05) and BODE index (p < 0.001) in the outpatient and at-home groups after partici- pating in the rehabilitation program compared to baseline. Conclusion: A home-based self-monitoring pulmonary reha- bilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.

scholarly journals The role of phenotype on ventilation and exercise capacity in patients affected by COPD: a retrospective study

2020 ◽  
Vol 15 ◽  
Author(s):  
Rocco F. Rinaldo ◽  
Michele Mondoni ◽  
Sofia Comandini ◽  
Pietro Lombardo ◽  
Beatrice Vigo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Exercise Capacity ◽  
Treatment Strategies ◽  
Cardiopulmonary Exercise Test ◽  
Peak Oxygen Consumption ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Exercise Limitation ◽  
Copd Patients ◽  
Significant Difference

Background: The idea of phenotype in chronic obstructive pulmonary disease (COPD) has evolved in the last decades, and the importance of peculiar treatment strategies has now been acknowledged. Although dyspnea and exercise limitation are hallmarks of COPD, this aspect has never been fully explored in literature in terms of disease phenotype. The aim of the present study was to explore the relevance of clinical COPD phenotypes on exercise ventilation and maximal capacity.Methods: In this observational cohort retrospective study we analyzed the data of 50 COPD patients who underwent cardiopulmonary exercise test, categorized as emphysematous (n=29), and non-emphysematous (n=21) according to a previously validated model.Results: We found a significant difference in terms of VE/VCO2 slope (median values 32.4 vs 28.0, p=0.015) and VE/VCO2 ratio at nadir (median values 37 vs 33, p=0.004), which resulted higher in emphysematous patients, who also presented lower PETCO2 values (median values 32.6 vs 35.6, p=0.008). In a subgroup of 31 tests which met the maximality criteria, emphysematous patients presented a significantly lower work rate at peak (median value 51 vs 72 % predicted, p=0.016), and showed a lower peak oxygen consumption, although at the limit of significance (median values of 63 vs 85 % predicted, p=0.051).Conclusions: This study extends our knowledge about the characterization of the COPD phenotypical expression of disease, showing that patients affected by emphysema are more prone to ventilatory inefficiency during exercise, and that this is likely to be an important cause of their overall reduced exercise capacity.

Maintaining Effects of Pulmonary Rehabilitation at Home in Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

2021 ◽  
pp. 108482232199037
Author(s):  
Duarte Pinto ◽  
Lissa Spencer ◽  
Soraia Pereira ◽  
Paulo Machado ◽  
Paulino Sousa ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Literature Review ◽  
Pulmonary Rehabilitation ◽  
Rehabilitation Program ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Maintenance Strategies ◽  
Rehabilitation Programs ◽  
Home Based ◽  
Pulmonary Rehabilitation Program

To systematize strategies that may support patients with Chronic Obstructive Pulmonary Disease to maintain the effects of pulmonary rehabilitation over time. This systematic literature review was conducted, and the evidence was electronically searched in the Web of Science, Scopus, and EBSCO databases. This review included randomized controlled clinical trials, published until September 2019, that addressed components of an unsupervised home-based pulmonary rehabilitation program, maintenance strategies following outpatient pulmonary rehabilitation programs, as well as data on outcomes for quality of life, exercise performance, and dyspnea. A final sample of 5 articles was obtained from a total of 1693 studies. Data for final synthesis were grouped into 2 categories: components of unsupervised home-based pulmonary rehabilitation programs and maintenance strategies. An unsupervised home-based pulmonary rehabilitation program should consist of an educational component, an endurance training component, and a strength training component. When patients are transferred to the home environment, it is important to include more functional exercises specifically adapted to the patient’s condition, goals, and needs.

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