Pulmonary rehabilitation is beneficial for patients with chronic lung disease. However, long-term maintenance has been difficult to achieve after short-term treatment. We evaluated a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates. Subjects were randomly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions (n = 87) or standard care (n = 85) and followed for 24 months. Except for a slight imbalance between sexes, experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation. During the 12-month intervention, exercise tolerance (maximum treadmill workload and 6-minute walk distance) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days. There were no group differences for other measures of pulmonary function, dyspnea, self-efficacy, generic and disease-specific quality of life, and health care use. By 24 months, there were no significant group differences. Patients returned to levels close to but above prerehabilitation measures. We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation.
Mean left ventricular wall force was determined with a calibrated transmural auxotonic strain gauge in the left ventricle of six anesthetized, open-chest dogs with intact circulation. The gauge was oriented in the plane of the minor left ventricular equator, midway between the papillary muscles. Left ventricular internal volume was derived from the passive pressure-volume curve of the arrested heart and calculated mean wall stress was derived both from spherical and ellipsoidal reference figures for the left ventricle and compared with measured forces. Control left ventricular end-diastolic pressure averaged 3.0 ± 0.6 mm Hg (SE). At this level of end-diastolic pressure, measured peak wall stress averaged 97.2 ± 14.4 g/cm 2 , whereas calculated peak wall stress averaged 79.3 ± 9.9 and 118.6 ± 12.9 g/cm 2 for the spherical and ellipsoidal models, respectively. Measured end-diastolic wall force values averaged 9.4 ± 4.5 and 29.2 ±8.1 g/cm 2 at an end-diastolic pressure of 3.0 and 12.3 mm Hg, respectively. In all cases, stress values calculated from spherical reference figures for the left ventricle were significantly lower than those measured directly. In four other experiments, using right heart bypass, the ventricular septum was exposed and active wall force was determined at two or more sites on the left ventricular minor equator. Wall stress at these sites differed by an average of 15.3%, indicating that stresses around the minor equator are relatively uniform. These studies lend validity to the application of geometric models in the calculation of mean wall stress and favor the application of an ellipsoid for the geometric reference figure. KEY WORDS auxotonic force gauge average left ventricular wall force Laplace relationship major axis stress ellipsoid of revolution• The recent interest in assessing cardiac performance in terms of muscle function has provided a stimulus for attempting to evaluate stress and strain within the left ventricular wall. Various techniques have been used to
Social support has been shown to be an important mediator of health status and survival in chronic illness but little information is available in patients with lung diseases. We used the Social Support Questionnaire (SSQ) to examine the relationships of number of persons (SSQ-N) and satisfaction (SSQ-S) with other measures of health status, treatment changes, and survival in 110 patients with chronic obstructive pulmonary disease (COPD) participating in a randomized, controlled clinical trial of pulmonary rehabilitation (PR). Included in the analyses were measures of lung function (FEV1.0), exercise tolerance (maximum and endurance), symptoms ratings, age, self-efficacy, depression, and gender. At baseline, SSQ-N and SSQ-S were correlated positively with self-efficacy and negatively with depression and self-reported shortness of breath (SOB). SSQ-N was also correlated with disease severity and maximum exercise tolerance (FEV1.0 and VO2 max). Using the Cox Proportional Hazard Model, SSQ-S was significantly related to improved survival up to six years. However, in multivariate analysis, after adjusting for FEV1.0 and SOB which were better predictors of survival, SSQ-S was marginally significant. SSQ-S and survival were computed separately for males and females across treatment groups. SSQ-S was significantly related to mortality for women but not for men. We conclude that social support is related to measures of physical and psychological function in patients with COPD and may influence improvement and survival after pulmonary rehabilitation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.