Effecten van geriatrische COPD-revalidatie op ziekenhuisopnames en inspanningstolerantie: een retrospectief observationele studie

Blindenbach, Stephanie; Vrancken, J.; Zeijden, Hans van der; Reesink, Herre J.; Brijker, Folkert; Smalbrugge, Martin; Wattel, E.

doi:10.1007/s12439-017-0214-8

Cited by 5 publications

(9 citation statements)

References 22 publications

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“…Of four randomised trials, three tested the effectiveness of exercise-based interventions (a hospital-based pedal exercise intervention, 45 pulmonary rehabilitation with or without electrical muscle stimulation, 46 and home-based pulmonary rehabilitation 47 ); one trial tested whether the severity of respiratory disability affected outcomes of centre-or homebased pulmonary rehabilitation. 48 Of 12 cohort studies, most assessed the impact of pulmonary rehabilitation on frailty or frailty components, [49][50][51][52][53][54] three assessed the feasibility or outcomes of geriatric rehabilitation, [55][56][57] and three assessed how baseline characteristics (e.g. dyspnoea severity, exercise tolerance, frailty) affect pulmonary rehabilitation outcomes.…”

Section: Focus Of Included Studiesmentioning

confidence: 99%

“…Once people felt supported to engage with exercise-based interventions, articles suggested experiencing subsequent improvements could also motivate participants going forwards. 58,65 Authors also signalled the need to take a more wholeperson approach, 1,19,48,55,56,60,61,63,64,[68][69][70]74 including having appropriate staffing and resources to do so. 55,56,64,69 Both service user and professional stakeholders perceived a holistic approach as essential.…”

Section: Factors Affecting Participation and Outcomesmentioning

confidence: 99%

“…This included choosing appropriate locations and timing to support engagement with exercise-based interventions, 19,45,47,48,60,63,75 and appropriate tailoring of services for individuals. 1,46,48,50,55,60,62,64,66,69,70,73 Stakeholders acknowledged that people with COPD and frailty may benefit from a modified or more flexible service structure. However, this was less often considered in existing practice.…”

Section: Factors Affecting Participation and Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercisebased interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

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Section: Focus Of Included Studiesmentioning

confidence: 99%

Section: Factors Affecting Participation and Outcomesmentioning

confidence: 99%

Section: Factors Affecting Participation and Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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“…Yet, our study demonstrates how characteristics and correlates of frailty (e.g., low energy, weakness, vulnerability to health events) can create specific challenges to participation. Considering the potential benefits of pulmonary rehabilitation for people with COPD and frailty described by our participants and in previous quantitative studies ( 11 , 19 , 20 ), efforts to address these challenges should be prioritized. Such initiatives may need to build reserves and resilience by better addressing multidimensional needs, working flexibly around their fluctuating health, and engendering empathetic and supportive communication around this intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Participating in exercise improves outcomes for people with COPD ( 13 , 14 ) or frailty ( 15 , 16 ) and is recommended by clinical guidelines for each condition ( 17 , 18 ). For people with both COPD and frailty, pulmonary rehabilitation is associated with improvements in frailty status ( 11 , 19 ), breathlessness, exercise performance, physical activity levels, and health status ( 11 , 20 ). However, people with COPD and frailty are less likely to start, and complete, pulmonary rehabilitation ( 11 ).…”

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confidence: 99%

Experiences of Pulmonary Rehabilitation in People Living with Chronic Obstructive Pulmonary Disease and Frailty. A Qualitative Interview Study

et al. 2020

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Rationale: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from pulmonary rehabilitation but face challenges completing programs. However, research to understand ways to optimize participation in this group is lacking. Objectives: To explore the experiences, needs, and preferences of people with COPD and frailty referred for outpatient pulmonary rehabilitation. Methods: Semistructured interviews with people with COPD and physical frailty, purposively sampled by age, living status, level of frailty, and completion of pulmonary rehabilitation. Thematic analysis with a critical realist perspective was used, involving relevant stakeholders with clinical, academic, and lived experience for interpretive rigor. Results: Nineteen people with COPD and frailty were interviewed, with a median age of 78 years (range, 58–88). Nine did not complete their pulmonary rehabilitation program. Four themes were identified: striving to adapt to multidimensional loss, tensions of balancing support with independence, pulmonary rehabilitation as a challenge worth facing, and overcoming unpredictable disruptions to participation. Participants described constantly adapting to their changing health and resulting multidimensional losses (e.g., functional abilities, relationships, confidence). This involved traversing between independence and seeking support, set against a mismatch between their needs and what support is available. People with COPD and frailty can be highly motivated to participate in pulmonary rehabilitation, despite the physical and mental demands it entails, and report a range of benefits. Yet in the context of changeable health, they must often overcome multiple unpredictable disruptions to completing rehabilitation programs. Participant determination and flexibility of services can facilitate ongoing attendance, but for some, these unpredictable disruptions erode their motivation to attend. Conclusions: People with COPD and frailty experience accumulating, multidimensional loss. This group are motivated to complete pulmonary rehabilitation but often require additional support and flexibility owing to fluctuating and unpredictable health. Person-centered approaches should be considered to minimize disruptive health events and support pulmonary rehabilitation participation and completion. Service adaptations could allow more flexibility to meet the changing needs of this group and enable communication around how pulmonary rehabilitation might align with their priorities.

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Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study

Geerars-van der Veen,

Ballemans,

Bongers

et al. 2024

Gerontology and Geriatric Medicine

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Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens’ feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.

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Effecten van geriatrische COPD-revalidatie op ziekenhuisopnames en inspanningstolerantie: een retrospectief observationele studie

Abstract: Geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.

Cited by 5 publications

References 22 publications

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Experiences of Pulmonary Rehabilitation in People Living with Chronic Obstructive Pulmonary Disease and Frailty. A Qualitative Interview Study

Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study

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