Effects of Respiratory Therapist-Directed Protocol on Prescription and Outcomes of Pulmonary Rehabilitation in COPD Inpatients

Tramacere, A.; Rizzardi, Roberta; Cilione, Carmela; Serri, Barbara; Florini, Fabio; Lorenzi, María Cristina; Clini, Enrico

doi:10.1159/000075650

Cited by 6 publications

(4 citation statements)

References 14 publications

(24 reference statements)

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“…Our PR was a hospital-based, inpatient, multidisciplinary program, held in 18 consecutive sessions, which had been previously described [13, 14]; each session included both endurance and strength training of the limbs. Briefly, it included the optimization of pharmacologic treatment, endurance training delivered in order to achieve 70–80% of the maximal load reached at the baseline test, upper and lower limbs’ muscle strength exercises lifting weights (increased gradually from 300 to 1,000 g, based upon the ability to reach 10 consecutive repetitions), twice weekly disease education sessions as well as behavioral, nutritional and psychosocial counseling.…”

Section: Methodsmentioning

confidence: 99%

Repeated Pulmonary Rehabilitation in Severe and Disabled COPD Patients

et al. 2006

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Background: The optimal frequency of delivering a pulmonary rehabilitation program (PR) is not yet a well established issue. It is still unclear whether repeated PR at established intervals will result in effective maintenance or further improvement in the patient’s health status. Objectives: To investigate whether more frequently repeated PR in patients with COPD (1) leads to similar short and long-term physiological gains, and (2) decreases the burden due to hospitalization. Methods: Thirty-five disabled COPD patients (FEV₁ below 50% predicted, MRC score 3) in a stable state were studied in a randomized controlled trial. After completing an initial inpatient PR program, they were randomly assigned to either group 1 (performing a second and a third PR after 6 and 12 months) or group 2 (performing only a second PR after 12 months). Results: Lung functions, exercise capacity (by means of a timed walk test – 6MWT), peak-effort dyspnea (D) and leg fatigue (F), and health-related quality of life by means of SGRQ were assessed prior to (T1, T3, T5) and after (T2, T4, T6) each PR program: the same measures were taken on an outpatient basis at T3 in group 2. The number of hospital admissions (HA) and days spent in the hospital (DH) were also recorded over the year. The two groups did not differ in any parameter at baseline. 6MWD, D, F and SGRQ improved to the same level (p = 0.05) after each PR in both groups. However, the baseline level of D, F and SGRQ symptoms and impact scores progressively improved over time in group 1 but not in group 2. After 12 months, a larger amount of patients in Group 1, as compared to Group 2, reported H10 DH/year (p < 0.0001). Conclusions: In severe and disabled COPD, a more frequently repeated inpatient PR may lead to some additional physiological and clinical benefits over 1 year.

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Section: Methodsmentioning

confidence: 99%

Repeated Pulmonary Rehabilitation in Severe and Disabled COPD Patients

et al. 2006

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“…4,7,8 In addition, Tramacere et al 11 showed that RT delivered by protocol results in more timely implementation of therapy. To our knowledge, no previous studies have addressed the effect of therapist-directed protocols on 30-d readmission rate and hospital stay for COPD subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, protocol RT results in more timely therapy than non-protocol RT. 11 This study addresses the effectiveness of protocol RT in COPD subjects admitted for exacerbations of their disease. Although Tramacere et al 11 studied the effectiveness of therapist-directed protocols in COPD in-patients, they focused on pulmonary rehabilitation outcomes.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia

2014

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BACKGROUND: The purpose of this retrospective medical record review was to compare the effects of therapist-directed (protocol RT) and physician-directed (non-protocol RT) respiratory therapy on hospital stay and 30-d post-discharge readmission in COPD subjects with acute bacterial pneumonia. METHODS: We reviewed 320 medical records; 244 records were usable. Information gathered included gender, age, RT protocol type (protocol RT or non-protocol RT), hospital stay, 30-d post-discharge readmission, and disease severity score. A 3-way analysis of variance and post hoc analysis were performed to determine the possible effects of disease severity, age, and RT protocol type on hospital stay and the possible interaction effects among these independent variables. A chi-square test for independence was computed to determine whether there was an association between RT protocol type and 30-d readmission. RESULTS: There were no significant interaction effects among RT protocol type, age, and disease severity on hospital stay. In addition, there were no significant effects of either RT protocol type (P ‫؍‬ .41) or age (P ‫؍‬ .85) on hospital stay in our subject sample. However, as expected, disease severity had a significant effect on hospital stay, increasing it by a mean of 2.6 d (95% CI 0.77-4.4, P ‫؍‬ .005). The chi-square test for independence revealed that the frequency of 30-d readmission was significantly associated with RT protocol type (P ‫؍‬ .02); fewer 30-d readmissions were associated with protocol RT. CONCLUSIONS: We interpreted the finding of no difference in mean hospital stay between protocol and nonprotocol RT to indicate that protocol RT did not confer a disadvantage to subjects in terms of hospital stay. Additionally, the results suggest that treatment efficacy is not sacrificed when RT is directed by respiratory therapists rather than by physicians regardless of disease severity and that therapist-directed protocols may have been of some benefit in reducing 30-d post-discharge readmission.

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“…[4][5][6][7] EBP has been proposed as a useful means to improve healthcare outcomes for RTs. [8][9][10][11] Therefore it is essential to assess how RTs implement EBP in clinical decision-making. A number of studies have illustrated that, although a majority of medical, nursing, pharmacologic, and allied health professions hold positive attitudes toward EBP, their knowledge and skill pertaining to EBP implementation are relatively insufficient.…”

Section: Introductionmentioning

confidence: 99%

Profile of Evidence-Based Practice Among Respiratory Therapists in Taiwan

et al. 2013

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BACKGROUND: Evidence-based practice (EBP) has been proposed as a core competence to improve healthcare quality. The profile of EBP among respiratory therapists (RTs) has not been explored. We investigated how RTs in Taiwan perceive the implementation of EBP. METHODS: We surveyed RTs in Taiwan's regional hospitals during a 4-month period in 2011. RESULTS: A majority of RTs were aware of EBP (88.0%). Although most RTs held a favorable impression of EBP, their knowledge of and skill in EBP implementation were deficient. Only half of the RTs had implemented EBP. Insufficient convenient kits (59.1%), deficient designated personnel (50.0%), and lack of time (45.5%) were major barriers to implementing EBP. RTs rated MEDLINE as the most commonly used evidence-based retrieval database, followed by UpToDate, IntroductionEvidence-based practice (EBP) means clinical practice that is consistent with the current best evidence. EBP integrates clinical epidemiology, biostatistics, research methods, and informatics into healthcare. 1,2 The process of EBP mainly involves 4 steps: framing a clear question based on a clinical problem; finding relevant evidence in the literature; critically appraising the validity of the research; and applying the findings to clinical decision-making. 3 Respiratory care is increasingly utilized, with the associated respiratory therapists (RTs) playing an important role in supporting related clinical services. [4][5][6][7] proposed as a useful means to improve healthcare outcomes for RTs. [8][9][10][11] Therefore it is essential to assess how RTs implement EBP in clinical decision-making. A number of studies have illustrated that, although a majority of medical, nursing, pharmacologic, and allied health professions hold positive attitudes toward EBP, their knowledge and skill pertaining to EBP implementation are relatively insufficient. 12-18 Whether or not RTs practice with evidence, and, if so, how, has been unclear. 19 RTs have to deal with a broad range of medical problems in clinical practice. 20 RTs play an important role in the prevention and management of respiratory diseases. 21 Timely acquired relevant information is important for their clinical practice. Access to evidence-based information can help facilitate effective management. Therefore, how to obtain current evidence-based knowledge is a critical skill. Nevertheless, only a few studies surveyed the behavior of RTs in searching for evidence-based information.We surveyed RTs in Taiwan regarding their awareness of EBP related to beliefs, attitudes, knowledge, skills, and implementation. MethodsThe ethical review board of the Taiwan National Health Research Institutes approved the study protocol. The survey was accompanied by an introductory letter stating the purpose of this study and promising confidentiality. Return of the completed questionnaire was considered consent for participation.

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Effects of Respiratory Therapist-Directed Protocol on Prescription and Outcomes of Pulmonary Rehabilitation in COPD Inpatients

Cited by 6 publications

References 14 publications

Repeated Pulmonary Rehabilitation in Severe and Disabled COPD Patients

Repeated Pulmonary Rehabilitation in Severe and Disabled COPD Patients

Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia

Profile of Evidence-Based Practice Among Respiratory Therapists in Taiwan

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