Giving Voice to People – Experiences During Mild to Moderate Acute Exacerbations of COPD

Machado, Ana; Almeida, Sara; Burtin, Chris; Marques, Alda

doi:10.15326/jcopdf.2022.0283

Cited by 7 publications

(5 citation statements)

References 56 publications

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“…The clinical presentation of ECOPD is heterogeneous. 22 The present study aimed to determine 30-day re-exacerbation in patients with ECOPD after discharge, and it was observed that patients with repeated 30-day re-exacerbation had more severe respiratory symptoms and poorer clinical prognosis at the 30-day and 12-month follow-ups.…”

Section: Discussionmentioning

confidence: 92%

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Wang,

He,

Dong

et al. 2023

BMJ Open Resp Res

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BackgroundExacerbation of chronic obstructive pulmonary disease (ECOPD) is a complex phenomenon, with marked heterogeneity in the aetiology, pathophysiology and clinical manifestations. This study aimed to evaluate the clinical characteristics and long-term outcomes of patients with 30-day exacerbation among those hospitalised with ECOPD in China.MethodsData from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry were used in this study. The patients were divided into re-event and non-event groups based on the incidence of re-exacerbation within 30 days of discharge. Exacerbation, severe exacerbation and all-cause readmissions in the following 12 months were the outcomes of interest. The cumulative incidence rates and incidence densities were calculated. Multivariate hazard function models were used to determine the association between 30-day re-exacerbation and the long-term outcomes after accounting for the competing risk of death.ResultsRe-exacerbation within 30 days of discharge was observed in 4.9% (n=242) of the patients (n=4963). The cumulative incidence rates and incidence densities of exacerbation, severe exacerbation and all-cause readmissions in the event group were significantly higher than those in the non-event group. After adjustment, re-exacerbation within 30 days of discharge was associated with increased risks of exacerbation, severe exacerbation and all-cause readmissions in the following 12 months (adjusted HR: 3.85 (95% CI: 3.09 to 4.80), 3.46 (2.66 to 4.50) and 3.28 (2.52 to 4.25) accordingly).ConclusionRe-exacerbation of COPD within 30 days of discharge is a significant predictor of long-term prognosis. In clinical practice, short-term re-exacerbation is a significant clinical phenotype of ECOPD that requires careful management at the earliest.

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Section: Discussionmentioning

confidence: 92%

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Wang,

He,

Dong

et al. 2023

BMJ Open Resp Res

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“…Given the clinical relevance of functioning in these patients, and its ability to be identifiable, measurable and treatable [19], it is essential to develop a toolkit to assess the main functioning traits with good quality and to adequately measure patients' impairments and limitations during and after an ECOPD. To achieve this, it is important to involve patients and the public, which has a potential benefit that the protocol will represents people with lived experiences [32] and will ensure the research is relevant and reflect the needs of those affected. In this context, a previous systematic review OLIVEIRA and MARQUES [33] identified the most frequent outcome measures in patients with ECOPD.…”

Section: Discussionmentioning

confidence: 99%

Development of a performance-based toolkit of the treatable traits of functioning in hospitalised patients with exacerbation of COPD: a survey-based study protocol

Leonardi,

Kawakami,

Cruz

et al. 2024

ERJ Open Res

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BackgroundThe management of COPD has been based on the premise of identifying problems that guide personalised treatment based on a multidimensional assessment, known as treatable traits. Exacerbation of COPD (ECOPD) results in physical and functional impairments, limitation of daily activities and negative impact on patients’ quality of life and prognosis. In this context, identifying treatable traits in patients with ECOPD is essential to properly guide individualised patient care. There is a need to develop a performance-based toolkit to identify the main treatable traits of functioning in hospitalised patients with ECOPD.Methods and analysisThis is a study protocol of a survey method observational study to develop a performance-based toolkit. The study will include the following steps: 1) definition of treatable traits by both physiotherapists who provide or have provided care to hospitalised patients with ECOPD on a regular basis, and patients who have experienced at least one ECOPD which required hospitalisation; 2) selection of the most appropriate measures (markers) for each treatable trait based on established criteria and a previous systematic review; and 3) implementation of the toolkit in a pilot/feasibility study with hospitalised patients with ECOPD.ConclusionThe development of a feasible performance-based toolkit with the best markers for each key treatable trait of functioning in hospitalised patients with ECOPD will make it possible to create individualised patient care for the specific demands of these patients.

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“…Although upper limb function is not commonly addressed, both in assessment and intervention, in patients with COPD, especially inpatients, it may affect activities of daily living [ 62 ]. Thus, patient participation in clinical decision-making is essential to properly choose the performance-based outcome measure and rehabilitation focus [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the setting, to achieve an assertive and personalised diagnosis and rehabilitation management, it is crucial to apply performance-based outcome measures with good measurement properties. The choice of an instrument to assess the functionality should take into consideration the patients’ needs, hospital space, need for equipment, time, validity and accuracy of measure, and professional experience [ 63 ]. This review is helpful for practitioners and researchers to point out the current knowledge on performance-based outcome measures.…”

Section: Discussionmentioning

confidence: 99%

Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties

et al. 2023

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IntroductionHospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD.MethodsA systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach.Results13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties.ConclusionMeasurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management.

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Giving Voice to People – Experiences During Mild to Moderate Acute Exacerbations of COPD

Cited by 7 publications

References 56 publications

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Development of a performance-based toolkit of the treatable traits of functioning in hospitalised patients with exacerbation of COPD: a survey-based study protocol

Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties

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