A novel approach to long-term respiratory care: Results of a community-based post-rehabilitation maintenance program in COPD

Beauchamp, Marla K.; Francella, Susan; Romano, Julia; Goldstein, Roger; Brooks, Dina

doi:10.1016/j.rmed.2013.04.014

Cited by 38 publications

(39 citation statements)

References 33 publications

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“…Previous studies have reported similar preferences for delivering educational intervention programs, including web-based methods, use of text messaging, and video formats [39]; however, challenges akin to those identified in this study were also noted, such as difficulty navigating websites or using available technology [40, 41]. In addition, patients and family members in this study strongly recommended aligning new programs with existing programs within communities; this is consonant with literature showing that health promotion programs which are developed in collaboration with a community-based organization tend to enjoy high participation rates [42, 43]. …”

Section: Discussionsupporting

confidence: 67%

An investigation of the colorectal cancer experience and receptivity to family-based cancer prevention programs

Breitkopf

Asiedu

Egginton

et al. 2014

Support Care Cancer

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Purpose Cancer is a shared family experience and may provide a “teachable moment” to motivate at-risk family members to adopt cancer prevention and health promotion behaviors. This study explored how a diagnosis of colorectal cancer (CRC) is experienced by family members and may be used to develop a family-based CRC prevention program. Preferences regarding content, timing, and modes of program delivery were examined. Social cognitive theory provided the conceptual framework for the study. Methods This study employed mixed methodology (semi-structured interviews and self-report questionnaires). Participants included 73 adults (21 patients, 52 family members) from 23 families (two patients were deceased prior to being interviewed). Most patients (n=14; 67 %) were interviewed 1–5 years post-diagnosis. Individual interviews were audio-recorded, transcribed, and content analyzed. Results For many, a CRC diagnosis was described as a shared family experience. Family members supported each other’s efforts to prevent CRC through screening, exercising, and maintaining a healthy diet. Teachable moments for introducing a family-based program included the time of the patient’s initial cancer surgery and post-chemotherapy. Reported willingness to participate in a family-based program was associated with risk perception, self-efficacy, outcome expectancies, and the social/community context in which the program would be embedded. Program preferences included cancer screening, diet/nutrition, weight management, stress reduction, and exercise. Challenges included geographic dispersion, variation in education levels, generational differences, and scheduling. Conclusions CRC patients and family members are receptive to family-based programs. Feasibility concerns, which may be mitigated but not eliminated with technological advances, must be addressed for successful family-based programs.

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Section: Discussionsupporting

confidence: 67%

An investigation of the colorectal cancer experience and receptivity to family-based cancer prevention programs

Breitkopf

Asiedu

Egginton

et al. 2014

Support Care Cancer

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“…This is consistent with previous findings over 18–24 months . This clinical decline over the longer term may be due to reduced adherence to ongoing exercise, with difficulty in transitioning from institution‐based rehabilitation . The lack of a positive approach to exercise may also impair adherence .…”

Section: Discussionsupporting

confidence: 91%

Repeating pulmonary rehabilitation: Prevalence, predictors and outcomes

2014

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Background and objective Pulmonary rehabilitation (PR) is a cornerstone of care in chronic respiratory diseases; yet its benefits diminish over time. Repeating PR may be beneficial; however, little is known about the characteristics and outcomes of repeaters. This study aimed to establish the proportion of repeaters, identify characteristics that predict repetition and compare the magnitude of benefits achieved between initial and subsequent programmes. Methods Patients with stable chronic respiratory diseases who attended PR over a 9‐year period were included. Outcome measures included the 6‐min walk distance (6MWD) and the Chronic Respiratory Disease Questionnaire‐Self‐Reported (CRDQ‐SR). Independent predictors of repeating were identified. Results Of 296 patients, 59 (20%) repeated PR, most within 1–3 years. Following the initial programme, repeaters had significant decline in 6MWD (−96.1 ± 84.6 m; P < 0.001) and CRDQ‐SR scores (mean decline −3.6 points, range −0.1 to −7.9 points; P < 0.005). The improvement in 6MWD was less in the repeat programme compared with the first (38.4 ± 50.7 m vs 67 ± 40.4 m; P = 0.005), while the change in CRDQ‐SR was similar in all domains. A chronic obstructive pulmonary disease diagnosis increased the odds of repeating PR (odds ratio (OR) 4.8; P = 0.005) while improved mastery in the initial programme reduced the odds (OR 0.9; P = 0.033). Conclusions One in five patients repeated PR, achieving clinically significant improvements in exercise tolerance and quality of life. Patients with small improvements in disease mastery after initial PR were more likely to repeat the programme and may benefit from earlier intervention or longer duration PR.

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“…Furthermore, individuals enrolled in the program had moderate to severe COPD (Table 1) and participated successfully with no adverse events without direct supervision from a health-care professional. 12 Participants expressed many positive experiences relating to community center staff and reported feeling safe as a result of their presence, in addition to other members of the community center. As the case manager was affiliated with the PR institution, the participants still felt part of the hospital community although they had successfully transitioned to a community setting, overcoming previously cited gaps in maintenance care.…”

Section: Discussionmentioning

confidence: 99%

Participant experiences of a community-based maintenance program post-pulmonary rehabilitation

et al. 2014

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The aim of the present study was to describe the perspectives of individuals with chronic obstructive pulmonary disease (COPD) who participated in a minimally supervised maintenance exercise intervention and identify the barriers and facilitators associated with participation. The intervention was delivered in a community center and was designed to maintain exercise capacity and quality of life following discharge from pulmonary rehabilitation. This study utilized qualitative focus groups (FGs) involving individuals with COPD (n ¼ 12) who had been attending the maintenance community program for at least 6 months. All individuals who met the inclusion criteria for the FGs consented to participate. Four themes were identified: (1) issues around attendance; (2) perceived benefits of the program; (3) perceived burdens of the program; and (4) recommendations for program improvement. Participants expressed more benefits than barriers, stating that their experience of improved function and quality of life facilitated their attendance. Barriers included exacerbations, fatigue, access to transportation, and weather. Participants endorsed the benefits of a community-based maintenance exercise program after pulmonary rehabilitation. Minimally supervised community-based programs with access to a case manager may provide a useful approach to enhancing adherence to exercise.

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A novel approach to long-term respiratory care: Results of a community-based post-rehabilitation maintenance program in COPD

Abstract: A community-based maintenance exercise program is feasible and can successfully preserve exercise capacity and health-related quality of life following institutionally-based PR in patients with moderate to severe COPD. A more formal evaluation of this approach is warranted.

Cited by 38 publications

References 33 publications

An investigation of the colorectal cancer experience and receptivity to family-based cancer prevention programs

An investigation of the colorectal cancer experience and receptivity to family-based cancer prevention programs

Repeating pulmonary rehabilitation: Prevalence, predictors and outcomes

Participant experiences of a community-based maintenance program post-pulmonary rehabilitation

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