Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases: a systematic review protocol

IntroductionChronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care.Methods and analysisWe will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for ‘Chronic Respiratory Disease’ AND ‘Pulmonary Rehabilitation’ AND ‘Home-PR’, and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR?Ethics and disseminationResearch ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences.PROSPERO registration numberCRD42020220137.

Functional exercise capacity in rheumatoid arthritis unrelated to lung injury: A comparison of women with and without rheumatoid disease

BACKGROUND: Rheumatoid arthritis (RA) mainly affects the joints of the upper and lower limbs, so evaluating functional exercise capacity in individuals with RA via dynamic tests of the locomotor system is essential. OBJECTIVES: To compare functional exercise capacity using the Glittre-activities of daily living (ADL) test (G-AT) in women with and without RA in the absence of RA pulmonary disease (RA-PD) and to correlate the findings with hand functioning, physical functioning, handgrip strength (HGS), and quadriceps strength (QS). METHODS: This cross-sectional pilot study evaluated 35 women with RA and 25 healthy controls by assessing hand functioning using the Cochin Hand Functional Scale (CHFS), physical functioning with the Health Assessment Questionnaire Disability Index (HAQ-DI), muscle functioning using HGS and QS, and G-AT results. RESULTS: Compared to the women in the control group, the women with RA presented higher scores for the CHFS (p< 0.0001) and HAQ-DI (p< 0.0001) and lower HGS (p< 0.0001) and QS (p= 0.013) values. The median G-AT time was higher in the RA patients than in the healthy controls [300 (295–420) vs. 180 (155–203) s], p< 0.0001), and the greatest difficulty reported by patients after the G-AT was squatting to perform the shelving tasks. G-AT time was positively correlated with the HAQ-DI (rs= 0.668, p< 0.0001) and CHFS (rs= 0.586, p= 0.0007) and negatively correlated with QS (rs=-0.429, p= 0.037). There was no significant correlation between the G-AT time and HGS. CONCLUSIONS: Women with RA take longer to perform G-AT tasks. Moreover, G-AT time was associated with hand functioning, physical functioning and QS, but not with HGS.

Pulmonary Function, Functional Exercise Capacity and Quality of Life in Chemical Dependents in Rehabilitation Process

The use of illicit substances can lead to several changes in physical and mental health, which can directly reflect on functional capacity and quality of life. However, there is a lack in the literature on the comparison of these variables between drug addicts and healthy individuals. To compare lung function, functional exercise capacity and quality of life of chemical dependents in rehabilitation process (CDRP) and apparently healthy individuals (AHI). Cross-sectional study that evaluated two groups (CDRP and AHI) matched by gender, age and BMI. Both groups were assessed for lung function (spirometry), quality of life (Short Form 36 questionnaire - SF-36), functional exercise capacity (6-minute walk test - 6MWT, 4-meter gait speed, Timed-up-and-go, Sit-to-Stand and Short Physical Performance Battery). Fifteen men in the CDRP group (31[26-39] years; BMI 23±3 kg/m2) and fifteen men in the AHI group (30[22-34] years; BMI 24±3 kg/m2) were analyzed. The CDRP group had a shorter distance covered in the 6MWT in meters (P=0.0002) and percentage of predicted (P=0.005). There was no difference in the performance of the other functional tests (P≥0.20) and in the pulmonary function (P≥0.46). The CDRP group had worse results in the functional capacity, pain, social aspects and mental health domains of SF-36 (P≤0.04), while in the domains general status, vitality, emotional and physical aspects there was no difference (P≥0.08). CDRP present similar lung function to AHI. However, the first have impaired functional exercise capacity, as well as some aspects of quality of life. Keywords: Drug Users. Motor Activity. Spirometry. Walk Test. Quality of Life. ResumoO uso de substâncias ilícitas pode levar a diversas alterações da saúde física e mental, o que pode refletir diretamente na capacidade funcional e na qualidade de vida. Porém, há uma escassez na literatura sobre a comparação dessas variáveis entre dependentes químicos e indivíduos saudáveis. Comparar função pulmonar, capacidade funcional de exercício e qualidade de vida de dependentes químicos em processo de reabilitação (DQPR) e indivíduos aparentemente saudáveis (AS). Estudo transversal que avaliou dois grupos (DQPR e AS) pareados por gênero, idade e IMC. Ambos os grupos foram avaliados quanto à função pulmonar (espirometria), qualidade de vida (questionário Short Form 36 – SF-36), capacidade funcional de exercício (Teste de Caminhada de 6 minutos - TC6, 4-metre gait speed, Timed-up-and-go, Sit-to-Stand e Short Physical Performace Battery). Foram analisados 15 homens no grupo DQPR (31[26-39] anos; IMC 23±3 kg/m2) e 15 homens no grupo AS (30[22-34] anos; IMC 24±3 kg/m2). O grupo DQPR apresentou uma menor distância percorrida no TC6 em metros (P=0,0002) e porcentagem do predito (P=0,005). Não houve diferença no desempenho dos demais testes funcionais (P≥0,20) e na função pulmonar (P≥0,46). O grupo DQPR apresentou piores resultados nos domínios capacidade funcional, dor, aspectos sociais e saúde mental do SF-36 (P≤0,04), enquanto que nos domínios estado geral, vitalidade, aspectos emocionais e físicos não houve diferença (P≥0,08). Homens dependentes químicos em processo de reabilitação apresentam função pulmonar semelhante a indivíduos aparentemente saudáveis. Entretanto, apresentam capacidade funcional de exercício prejudicada, assim como alguns aspectos da qualidade de vida. Palavras-chave: Usuários de Drogas. Atividade Motora. Espirometria. Teste de Caminhada. Qualidade de Vida.