Older persons can be susceptible to respiratory-related conditions, particularly pneumonia. This study examined the effects of breathing training on respiratory function, swallowing function, and quality of life in community-dwelling frail older persons with musculoskeletal disorders. The participants were divided into 2 groups. One group performed a regular rehabilitation programme, and the other group performed breathing training exercises, including a coughing exercise, respiratory muscle stretching exercise, and respiratory muscle training using a hand-held resistance device. The exercises improved respiratory function, swallowing, and quality of life. Such breathing training might be effective in helping to prevent pneumonia in frail older patients with musculoskeletal disorders. Objective: To investigate the effects of respiratory rehabilitation on respiratory function, swallowing in community-dwelling frail older patients with musculoskeletal disorders. Design: Randomized open-label controlled trial. Setting: Day-care facility in a rehabilitation hospital in Japan. Subjects: A total of 63 participants with musculoskeletal disorders (intervention group: n = 31; control group: n = 32) completed the randomized controlled trial. Interventions: All participants received 12 20-min sessions twice a week for 6 weeks of either typical rehabilitation (control) or typical rehabilitation with respiratory rehabilitation (intervention). Main measures: Outcome measures were assessed prior to rehabilitation and after 12 sessions. The measures included: respiratory function, swallowing function, exercise tolerance, 6-min walk distance, thorax flexibility, muscle strength (grip and abdominal), activities of daily living, and quality of life. Results: Participants in the intervention group showed significantly greater improvement in respiratory function (95% confidence interval (CI), 3.8-6.6; p = 0.01), swallowing function (95% CI-1.8-0.6; p = 0.01), and quality of life (SF8 Physical Summary Score) (95% CI 2.4-7.1; p = 0.01) compared with those in the control group. Conclusion: Addition of respiratory rehabilitation to a typical rehabilitation programme could improve not only respiratory and swallowing function, but also quality of life, in frail older patients.
Objective: To analyze the effects of respiratory rehabilitation on the activities of daily living (ADL) and quality of life (QOL) in community-dwelling frail elderly.Design: Pilot intervention study after a one-year period of observation.Setting: Day care facility in a rehabilitation hospital.Subjects: Thirty community-dwelling frail elderly using rehabilitation services Intervention: After a one-year observation period of usual rehabilitation, 30 participants were given 12 rehabilitation sessions that included respiratory rehabilitation (three sessions a week for four weeks). Journal of General and Family Medicine 2016, vol. 17, no. 4, p. 289-298. Original Articles -289 -evaluation), prior to training (pre-training evaluation), and after the sessions (post-training evaluation). Primary outcome measures included: respiratory function, swallowing function, ADL, and QOL. Secondary outcome measures included: depressive score, exercise tolerance, 6-minute walk distance, thorax flexibility, and muscle strength (knee extension, grip, and abdominal). QOL were estimated using questionnaires.Results: Swallowing function, ADL, QOL (SF8 physical and mental summary score), respiratory function, and physical function were significantly reduced during usual rehabilitation (between the initial evaluation and pre-training evaluation), whereas swallowing function, ADL, QOL (SF8 physical component summary score [PCS]), respiratory function, exercise tolerance, 6-minute walk distance, thorax flexibility, and muscle strength (knee extension) were significantly improved during respiratory rehabilitation (between the pre-training evaluation and post-training evaluation). Conclusions:Our results suggest that a usual rehabilitation program without respiratory training is not sufficient for the frail elderly to maintain their ADL and QOL, and furthermore that respiratory rehabilitation can help improve their ADL and QOL as well as their swallowing and respiratory function.
Background Decreased pulmonary function and poor deglutition are a major risk factor for poststroke aspiration pneumonia. We analyzed the benefits of pulmonary training on pulmonary function, deglutition, and quality of life (QOL) in community‐dwelling, frail elderly people with chronic stroke. Method This study was designed as an open, randomized, controlled pilot trial. The participants, who were frail older adults with a history of stroke, were randomized to 2 rehabilitation groups: intervention group (n = 15) and control (n = 15). All participants (65–94 years) attended twelve 20‐min sessions twice a week for 6 weeks of either standard rehabilitation (control group) or standard rehabilitation with pulmonary training including home pulmonary exercise (intervention group). The main outcome measures were pulmonary function (%MIP), deglutition (DRACE), and QOL (SF8・PCS), while secondary outcomes were muscle strength (grip and abdominal), thorax flexibility, 6‐min walk distance, and activities in daily living. All outcomes were measured both prior to training and after the 12 sessions. Results The intervention group showed significant improvement in %MIP (95% CI, 2.9–31.6; p < 0.01), DRACE (95% CI, −4.1–0.1; p < 0.01), and SF8・PCS (95% CI, 2.5–7.2; p < 0.01) compared with controls. There were no cognitive function decline and higher brain dysfunction. Conclusions These results suggest that the addition of pulmonary training including home pulmonary exercise to a standard rehabilitation program could improve pulmonary function, deglutition, and QOL in frail elderly people with chronic stroke.
Background The preoperative predictors of quality of life (QOL) in patients who undergo lung resection for lung cancer are poorly known. Here, we investigated these predictors in such patients using two QOL measures. Methods In this single‐institutional prospective cohort study, we administered the EQ‐5D‐5 levels (EQ‐5D‐5L) from January 2015, and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire with 30 items from April 2015 to April 2018 preoperatively (Pre) and at one month postoperatively (M1), and one year postoperatively (Y1). General health status was measured by the EQ‐5D visual analogue scale (VAS) and EORTC global health status/QOL (GHS) scores. Multivariable linear regression analyses were used to explore the preoperative predictors of QOL at Y1. Results A total of 223 patients were included in the study. The EQ‐5D VAS and EORTC GHS scores, at Pre, M1, and Y1, were 80 ± 15, 77 ± 15, and 84 ± 11; and 74 ± 19, 65 ± 20, and 78 ± 17, respectively. In the multivariable analyses, the albumin level, preoperative VAS score, and preoperative pain/discomfort and anxiety/depression were identified as predictors by the EQ‐5D VAS score. The preoperative EORTC GHS score, absence of diabetes mellitus, preoperative cognitive function score, and preoperative symptom score of pain were identified as predictors by the EORTC GHS score. Conclusions The EQ‐5D VAS and EORTC GHS scores traced similar trajectories of QOL. In both QOL measures, preoperative pain was found as a common predictor. These predictors may help improve patient/survivor care in the future.
Background. Air leakage still remains a major problem in lung resection despite the introduction of surgical sealants. We have developed a novel sealant based on hydrophobically modified Alaska pollock-derived gelatin (ApGltn), which showed high adhesive quality in vitro. In this study, we evaluated the adhesive quality and conformability of our ApGltn sealant compared with a fibrin sealant.Methods. The adhesive quality of the sealants was evaluated using excised porcine lungs with ventilation. Pleural defects were created, to which the ApGltn sealant or fibrin sealant was applied. Pressure resistance was assessed using a stepwise increase of airway pressure. Conformability was evaluated by measuring the area of the sealant for its maximum conformity on the gradually inflated lung surface.Results. Leak and burst pressures of the ApGltn sealant were significantly higher than those of the fibrin
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