Lessons from negative dyspnoea studies: arguments for the multidimensional evaluation of multidirectional therapeutic approaches

Similowski, Thomas; Serresse, Laure

doi:10.1183/13993003.02471-2018

Cited by 13 publications

(6 citation statements)

References 33 publications

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“…This may be due to the delay between the initial screening and the start of the intervention or the fact that the former was completed by the respiratory physician and the latter by a researcher. Further studies should also include validated multi-dimensional dyspnea scales 33 , such as the Multidimensional Dyspnea Profile 32 , as a multidimensional outcome would be ideal.…”

Section: Discussionmentioning

confidence: 99%

Virtual reality intervention alleviates dyspnoea in patients recovering from COVID-19 pneumonia

Betka,

Kannape,

Fasola

et al. 2023

ERJ Open Res

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BackgroundImmersive virtual reality (iVR)-based digital therapeutics (DTx) are gaining clinical attention in the field of pain management. Based on known analogies between pain and dyspnea, we investigated the effects of visual-respiratory feedback, on persistent dyspnea in patients recovering from COVID-19 pneumonia.MethodsWe performed a controlled, randomized, single-blind, cross-over proof-of-concept study (feasibility and initial clinical-efficacy) to evaluate an iVR-based intervention to alleviate dyspnea in patients recovering from COVID-19 pneumonia. Included patients reported persistent dyspnea (≥5 on a 10-point scale) and preserved cognitive function (MoCA>24). Assignment was random and concealed. Patients received synchronous (intervention) or asynchronous (control) feedback of their breathing, embodiedviaa gender-matched virtual body. The virtual body flashed in a waxing and waning visual effect which could be synchronous or asynchronous to the patient's respiratory movements. Outcomes were assessed using questionnaires and breathing recordings.ResultsStudy enrollment was open between November 2020 and April 2021. Twenty-six patients were enrolled (27% women; age: median=55, interquartile range (IQR)=18). Data were available for 24 of 26 patients. The median (IQR) rating on a 7-point Likert-scale of breathing comfort improved from 1(2) at baseline, to 2(1) for synchronous feedback, but remained unchanged at 1(1.5) for asynchronous feedback (p<0.05) between iVR conditions). Moreover, 91.2% of all patients were satisfied with the intervention (p<0.0001) and 66.7% perceived it as beneficial for their breathing (p<0.05).ConclusionOur iVR-based DTx presents a feasible and safe respiratory rehabilitation tool that improves breathing comfort in patients recovering from COVID-19 infection presenting with persistent dyspnea. Future research should investigate the intervention's generalizability to persistent dyspnea with other etiologies and its potential for preventing chronification.

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Section: Discussionmentioning

confidence: 99%

Virtual reality intervention alleviates dyspnoea in patients recovering from COVID-19 pneumonia

Betka,

Kannape,

Fasola

et al. 2023

ERJ Open Res

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“…Evaluating caregiver burden in relation to the patients’ active treatment for breathlessness and function would align with the multi-dimensional nature of this disabling symptom to help inform a more effective, evidence-based practice. 25…”

Section: Discussionmentioning

confidence: 99%

The impact of regular, low-dose, sustained-release morphine for chronic breathlessness on caregiver burden: An exploratory analysis of the BEAMS trial

Kochovska,

Ferreira,

Chang

et al. 2023

Palliat Med

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Background: Chronic breathlessness adversely impacts people with chronic obstructive pulmonary disease and their caregivers (family and friends), who may, in turn, experience significant burden due to their caregiving role. Sustained-release morphine may reduce chronic breathlessness in some patients, which may have an impact on caregivers’ perceived burden. Aim: To explore the impact on caregiver burden of active treatment of people with chronic breathlessness (modified Medical Research Council (mMRC) ⩾ 3) and chronic obstructive pulmonary disease (COPD) with regular, low-dose, sustained-release morphine within a multi-site, double-blind, randomised, placebo-controlled trial. Design: Exploratory analysis of self-reported caregiver burden at baseline and end of week 3 in a randomised, double-blind, placebo-controlled study. Caregiver measures included: demographics and perceived burden (Zarit Burden Interview 12-item short-form questionnaire). Patient measures included: worst breathlessness and FitBitR-measures. Setting/participants: All consenting caregivers of trial patient participants in a multi-site study recruiting from palliative care and respiratory services. Results: Caregivers ( n = 49; 59% women; median age 68 years [IQR 50–75]) reported median baseline caregiver burden 12 [IQR 5–17], with 53% reporting high burden (⩾13). Eighty-four percent of caregivers reported no change in burden. In people whose worst breathlessness improved, caregiver burden moved in the same direction, though the correlation was not significant ( rs = 0.25, p = 0.17). Conversely, caregiver burden worsened as patients’ minutes lightly active increased, with the correlation being significant ( rs = 0.56, p = 0.04). Conclusions: Caregivers reported high levels of caregiver burden, but patients’ response to treatment in terms of their symptom and function may influence change in caregiver burden over a three-week period.

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“…Adding the data of our study to a recently conducted meta-analysis of five trials (n=420) the overall body of evidence assessing the effectiveness of breathlessness support services increases considerably, yielding a greater precision of effect estimates (36,37). The outcome measurements chosen in our study are widely used in studies on the effectiveness of interventions for chronic breathlessness in advanced disease and reflect the multidimensional effects of chronic breathlessness (38,39). Notably, the CRQ Mastery domain relates to important psychological outcomes, such as appraisal and a feeling of control whereas other measures capture physical changes (NRS) and psychological distress (HADS) (40,41).…”

Section: Locating Findings In the Literaturementioning

confidence: 99%

Effectiveness of a specialised breathlessness service for patients with advanced disease in Germany: a pragmatic fast-track randomised controlled trial (BreathEase)

Schunk

Syunyaeva

et al. 2021

Eur Respir J

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BackgroundThe effectiveness of the Munich Breathlessness Service (MBS), integrating palliative care, respiratory medicine and physiotherapy, was tested in the BreathEase trial in patients with chronic breathlessness in advanced disease and their carers.MethodsBreathEase was a single-blinded randomised controlled fast-track trial. The MBS was attended for 5–6 weeks; the control group started the MBS after 8 weeks of standard care. Randomisation was stratified by cancer and the presence of a carer. Primary outcomes were patients’ mastery of breathlessness (Chronic Respiratory Disease Questionnaire (CRQ) Mastery), quality of life (CRQ QoL), symptom burden (Integrated Palliative care Outcome Scale (IPOS)) and carer burden (Zarit Burden Interview (ZBI)). Intention-to-treat (ITT) analyses were conducted with hierarchical testing. Effectiveness was investigated by linear regression on change scores, adjusting for baseline scores and stratification variables. Missing values were handled with multiple imputation.Results92 patients were randomised to the intervention group and 91 patients were randomised to the control group. Before the follow-up assessment after 8 weeks (T1), 17 and five patients dropped out from the intervention and control groups, respectively. Significant improvements in CRQ Mastery of 0.367 (95% CI 0.065–0.669) and CRQ QoL of 0.226 (95% CI 0.012–0.440) score units at T1 in favour of the intervention group were seen in the ITT analyses (n=183), but not in IPOS. Exploratory testing showed nonsignificant improvements in ZBI.ConclusionsThese findings demonstrate positive effects of the MBS in reducing burden caused by chronic breathlessness in advanced illness across a wide range of patients. Further evaluation in subgroups of patients and with a longitudinal perspective is needed.

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Lessons from negative dyspnoea studies: arguments for the multidimensional evaluation of multidirectional therapeutic approaches

Abstract: Dyspnoea-targeted interventions should probably combine multiple approaches (multidirectional) and their evaluation should take the complex nature of dyspnoea into account (multidimensional) http:// ow.ly/tLaM30ndprk

Cited by 13 publications

References 33 publications

Virtual reality intervention alleviates dyspnoea in patients recovering from COVID-19 pneumonia

Virtual reality intervention alleviates dyspnoea in patients recovering from COVID-19 pneumonia

The impact of regular, low-dose, sustained-release morphine for chronic breathlessness on caregiver burden: An exploratory analysis of the BEAMS trial

Effectiveness of a specialised breathlessness service for patients with advanced disease in Germany: a pragmatic fast-track randomised controlled trial (BreathEase)

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