Minimizing the evidence-practice gap – a prospective cohort study incorporating balance training into pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease

Abstract

BackgroundWe have recently demonstrated the efficacy of balance training in addition to Pulmonary Rehabilitation (PR) at improving measures of balance associated with an increased risk of falls in individuals with Chronic Obstructive Pulmonary Disease (COPD). Few knowledge translation (KT) projects have been conducted in rehabilitation settings. The goal of this study was to translate lessons learnt from efficacy studies of balance training into a sustainable clinical service.MethodsHealth care professionals (HCPs) responsible for delivering PR were given an hour of instruction on the principles and practical application of balance training and the researchers offered advice regarding; prescription, progression and practical demonstrations during the first week. Balance training was incorporated three times a week into conventional PR programs. Following the program, HCPs participated in a focus group exploring their experiences of delivering balance training alongside PR. Service users completed satisfaction surveys as well as standardized measures of balance control. At six month follow-up, the sustainability of balance training was explored.ResultsHCPs considered the training to be effective at improving balance and the support provided by the researchers was viewed as helpful. HCPs identified a number of strategies to facilitate balance training within PR, including; training twice a week, incorporating an interval training program for everyone enrolled in PR, providing visual aids to training and promoting independence by; providing a set program, considering the environment and initiating a home-based exercise program early. Nineteen service users completed the balance training [ten male mean (SD) age 73 (6) y]. Sixteen patients (84 %) enjoyed balance training and reported that it helped them with everyday activities and 18 (95 %) indicated their wish to continue with it. Scores on balance measures improved following PR that included balance training (all p < 0.05). At six month follow-up balance training is being routinely assessed and delivered as part of standardised PR.ConclusionsImplementing balance training into PR programs, with support and training for HCPs, is feasible, effective and sustainable.Trail registrationClinical Trials ID: NCT02080442 (05/03/2014)Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0067-2) contains supplementary material, which is available to authorized users.

Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study

“…Because 87%–90% of elderly fractures result from falls (Dargent-Molina et al, 1996; Fife & Barancik, 1985), strategies to prevent falls should be implemented in at-risk patients, such as medication review, environmental adjustment, and exercise training. Previous studies have shown that balance training in COPD patients has utility in improving important fall-related factors, such as function, muscle strength, and balance performance (Beauchamp et al, 2013; Harrison et al, 2015). Thus, introducing balance training component into currently existing exercise programs for COPD patients may be of more value in OTPF prevention.…”

Peer Review #1 of "Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study (v0.1)"

“…Because 87%-90% of elderly fractures result from falls (Dargent-Molina et al 1996;Fife & Barancik 1985), strategies to prevent falls should be implemented in at-risk patients, such as medication review, environmental adjustment, and exercise training. Previous studies have shown that balance training in COPD patients has utility in improving important fall-related factors, such as function, muscle strength, and balance performance (Beauchamp et al 2013;Harrison et al 2015 Manuscript to be reviewed protocols or tools. However, we excluded outpatients claiming less than two times per year without an inpatient record to increase accuracy.…”

Bewegungstraining bei Patienten mit chronischen Atemwegserkrankungen: Werden kardiovaskuläre Komorbiditäten und Outcomes berücksichtigt? Eine systematische Übersichtsarbeit

“…Von diesen waren belastungseinschränkende Erkrankungen [34, 36, 40, 53, 60, 61, 89, 92, 104, 114, 125, 134, 135, 138, 148, 157, 166-170, 173, 174, 179, 181, 183, 184] (n = 27; 17,3%) das am häufigsten berichtete Ausschlusskriterium, gefolgt von allgemeiner kardiovaskulärer Erkrankung [32, 39, 44, 70, 74, 75, 94, 100, 103, 107, 109, 112, 130, 152, 153, 160, 164, 171] (n = 18; 11,5%) und instabiler kardiovaskulärer Erkrankung 38, 47, 53, 65, 66, 98, 99, 101, 108, 116–119, 133, 137, 146, 147, 180] (n = 18; 11,5%). Vierunddreißig Studien (21,8%) [23, 48, 50, 55, 63, 67, 69, 73, 77-80, 83, 84, 86, 88, 91, 95, 97, 110, 111, 115, 122, 126, 127, 132, 142, 149, 150, 155, 161, 165, 175, 185] enthielten keine Angaben zu den Eignungskriterien für kardiovaskuläre Komorbiditäten.…”