Closing the Gap between Inpatient and Outpatient Settings: Integrating Pulmonary Rehabilitation and Technological Advances in the Comprehensive Management of Frail Patients

Abstract

Pulmonary rehabilitation (PR) is a well-established intervention supported by strong evidence that is used to treat patients affected by chronic respiratory diseases. However, several barriers still affect its spreading in rehabilitation clinical practices. Although chronic respiratory diseases are common age-related disorders, there is still a gap of knowledge regarding the implementation of sustainable strategies integrating PR in the rehabilitation management of frail patients at high risk of respiratory complications. Therefore, in the present study, we characterized the effects of PR in frail patients, highlighting the evidence supporting its role in improving the complex rehabilitative management of these patients. Moreover, we propose a novel organizational model promoting PR programs for frail patients in both inpatient and outpatient settings. Our model emphasizes the role of interdisciplinary care, specifically tailored to patients and environmental characteristics. In this scenario, cutting-edge technology and telemedicine solutions might be implemented as safe and sustainable strategies filling the gap between inpatient and outpatient settings. Future research should focus on large-scale sustainable interventions to improve the quality of life and global health of frail patients. Moreover, evidence-based therapeutic paths should be promoted and taught in training courses promoting multiprofessional PR knowledge to increase awareness and better address its delivery in frail patients.

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

“…Furthermore, it is mandatory to consider all the potential approaches of rehabilitation (e.g., physical exercise, oxygen-ozone therapy, instrumental physical therapies, nutraceuticals, etc.) for the reduction in inflammation that could be confirmed by the lower serum levels of inflammatory cytokines [ 5 , 63 , 64 , 65 , 66 ]. In this context, it should also be considered the key role of the awareness about the benefits and the safety of physical exercise in the context of a personalized educational approach for patients with musculoskeletal disorders and COPD [ 5 , 63 , 64 , 65 , 66 ].…”

“…for the reduction in inflammation that could be confirmed by the lower serum levels of inflammatory cytokines [ 5 , 63 , 64 , 65 , 66 ]. In this context, it should also be considered the key role of the awareness about the benefits and the safety of physical exercise in the context of a personalized educational approach for patients with musculoskeletal disorders and COPD [ 5 , 63 , 64 , 65 , 66 ]. The benefits and the safety of individualized exercise intervention should be emphasized to promote the maximum compliance with the exercise programs [ 65 ].…”

“…The benefits and the safety of individualized exercise intervention should be emphasized to promote the maximum compliance with the exercise programs [ 65 ]. Lastly, home-based exercise programs might be proposed, with recent reports underlining that telemedicine solutions might have a role in telemonitoring the therapeutic effects and personalizing the rehabilitation approach to patients needs [ 5 ]. Further details about digital innovation and telemedicine solutions have been characterized in the Section 7 .…”

“…In particular, COPD represents the 6th cause of increased global disability-adjusted life-years [ 3 ]. Moreover, given the functional consequences related to physical impairment and the high prevalence of comorbidities affecting these patients, it is not surprising that COPD might be frequently associated with both osteoporosis and physical frailty [ 2 , 4 , 5 ].…”

“…Although a precise identification of the risk factors for fragility fractures should be the cornerstone of osteoporosis management [ 16 ], there is still a gap of knowledge in the current literature about the role of a comprehensive approach targeting the multilevel mechanisms underpinning osteoporosis in COPD patients [ 5 ].…”