Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease

Lacasse, Yves; Wong, Eric; Guyatt, Gordon; King, Derek; Cook, Deborah J.; Goldstein, Roger

doi:10.1016/s0140-6736(96)04201-8

Cited by 715 publications

(476 citation statements)

References 26 publications

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“…If the criteria of the COPD guidelines were applied to recommend rehabilitation [1,22] to the patients in the study, >90% should have been included in a rehabilitation programme. Although the direct effect of respiratory rehabilitation on the use of the health services remains controversial, it has been found to be effective in reducing dyspnoea and improving the quality of life [9]. The low rate of rehabilitation is due to the lack of provision in the study hospitals during the recruitment year.…”

Section: Discussionmentioning

confidence: 99%

“…Certain known risk factors for the exacerbation of COPD were found: no influenza vaccination [7] and high air pollution exposure [8]. In addition, other factors were found, related to the poor progress of the disease, that could be considered potential risk factors for exacerbation: no respiratory rehabilitation [9], underprescription of LTOT and noncompliance with it [10,11], current [12] and passive [13] smoking and occupational exposure [14]. Other potentially relevant factors as suggested by members of the study group were: poor inhaler manoeuvres, no pneumococcal vaccination, consumption of alcohol and sedatives, and no physical activity.…”

Section: Methodsmentioning

confidence: 99%

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Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

et al. 2000

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There is little information available concerning the extent to which chronic obstructive pulmonary disease (COPD) patients are satisfactorily managed, especially, regards factors supposedly related to COPD exacerbation. The present study assessed the prevalence rates of potentially modifiable risk factors of COPD exacerbation in patients hospitalized for this reason.A systematic sample of one out of two patients admitted for COPD exacerbation, during 1 yr, in four tertiary hospitals in the Barcelona area, Spain, was performed. Patients answered a questionnaire and underwent anthropometric measurements, spirometric tests and arterial blood gas sampling. Prevalence rates and 95% confidence intervals (95% CI) for risk factors were obtained, and the generalized estimating equation (GEE) method was used to allow for patients to provide information on different admissions.The study recruited 353 patients (29 female) with a total of 404 admissions age (mean SD) 69 9, median forced expiratory volume in one second (FEV1) 31% of predicted and mean partial pressure of oxygen (PO 2 ) 63 13 mmHg. Of these, 28% had not received an influenza vaccination; a high number (86%) did not attend rehabilitation programmes; 28% of patients with PO 2 #55 mmHg were not using long-term oxygen therapy (LTOT); among LTOT users, 18% used it <15 h a day; 43% of the total failed in some of the essential inhaler manoeuvres; 26% were current smokers; 21% of noncurrent smokers were exposed to passive smoking at home; current occupational exposure was low (5%).In summary, the authors found a moderate to high prevalence of potentially modifiable risk factors in a large representative sample of patients hospitalized for a chronic obstructive pulmonary disease exacerbation, suggesting unsatisfactory features in their management. Eur Respir J 2000; 16: 1037±1042. Chronic obstructive pulmonary disease (COPD) is characterized by a chronic slowly progressive limitation of the airflow. As the damage is largely irreversible, the major goals of COPD management are to lessen airflow limitation, prevent and decrease symptoms, prevent and treat medical complications and improve daily living and quality of life [1]. The acute exacerbation of COPD is among the relevant events in the progression of the disease, and its occurrence has been related to the lower survival [2] and decrease in the quality of life [3] of COPD patients. Acute exacerbations are also an important cause of health expenditure, due to hospitalization, outpatient care and drug consumption [1].Although respiratory infection is assumed to be the main risk factor for the exacerbation of COPD [4], other factors are also involved. Health education of patients, smoking cessation, pulmonary rehabilitation, good nutritional status, and early medical intervention are all considered helpful in preventing exacerbations [5]. Information concerning the extent to which COPD patients are satisfactorily managed with regards these factors, although likely to show strong local variations, is relevant ...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

et al. 2000

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“…The multidisciplinary pulmonary rehabilitation programme in our study may differ to a certain extent from other programmes in this respect that it has a longer duration and a higher intensity [33]. The basic part of the rehabilitation programme in our study concerns physical support, consisting of pharmacological treatment (optimalisation of medication by a pulmonologist, mostly consisting of bronchodilator therapy), strength and endurance training, breathing retraining, and dietary interventions.…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

Arnold

Ranchor

Koëter

et al. 2006

Patient Education and Counseling

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“…1996–2015 meta-analyses from Lacasse et al [6–9] and McCarthy et al [10] have added to the body of evidence reporting that pulmonary rehabilitation involving exercise therapy/physical activity as one of the components relieves dyspnoea and fatigue, improves emotional functions, enhances the sense of individual control, benefits health-related quality of life and increases exercise and functional capacity. However, in spite of strong evidence, it appears to be very difficult to recruit people with COPD to attend pulmonary rehabilitation [11], and participation in pulmonary rehabilitation is reported to be uniformly low all over the world [12].…”

Section: Introductionmentioning

confidence: 99%

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Østergaard

Sritharan

Kristiansen

et al. 2018

European Clinical Respiratory Journal

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Background: In Denmark, few people with Chronic Obstructive Pulmonary Disease (COPD) engage in physical activity although it is evident that pulmonary rehabilitation has positive effects on physical activity, dyspnoea, anxiety, fatigue and quality of life. Objective: The purpose of this pilot study was to explore why people with COPD do not engage in physical activity and to explore motivational factors and barriers towards physical activity. Furthermore, to explore the role general practitioners have in this matter. Design: We conducted fieldwork among five people with COPD and three general practitioners using qualitative semi-structured interviews. We made a thematic analysis and our analytical perspective was based on The Health Belief Model and Self Determination Theory. Results: Findings revealed that people with COPD was not active because they did not receive the necessary information from the general practitioners about the benefits of physical activity neither about the negative consequences of an inactive lifestyle. Motivational factors were knowledge about COPD and benefits of physical activity. Experiencing the benefits on their own bodies, feeling that it was not dangerous to feel breathless and being successful coping with breathlessness were motivational. Functional tests like walking tests were very important and motivational for the participants because they outlined the progress achieved during activity and provided evidence of progress that was easy to comprehend compared with spirometry tests. General practitioners did not inform about the benefits of physical activity because they felt that medication was more important than physical activity and that people with COPD would not be motivated to be active. Conclusions: The main reason for people with COPD not being physically active in our study was lack of sufficient information from their general practitioners. This study described some barriers, enablers and motivational factors for a physically active lifestyle and the general practitioners’ role in this. Thus, it is important that people with COPD receive early information about physical activity - and it should start with the general practitioners, who are the gate keepers in the health care system. We recommend that lung function test results are never used as a single indicator of disease progression and that more focus should be paid to functional tests like The Shuttle Walking Test or The Six Minute Walking Test.Further studies to identify barriers to, and facilitators for referral people with COPD to physical activity in daily life from the perspective of Danish general practitioners are required.

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Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease

Cited by 715 publications

References 26 publications

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

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