Occupational Therapy and Pulmonary Rehabilitation of Disabled COPD Patients

Abstract

Background: Occupational therapy (OT) has been defined as a task of rehabilitation for disabled patients, giving them maximal function and independence to sustain specific activities of daily living. Objectives: To evaluate the effectiveness of OT as an adjunctive measuring during pulmonary rehabilitation (PR) of hospitalized COPD patients. Methods: A prospective clinical trial with parallel groups was undertaken in severely disabled COPD patients (n = 71, age 73 ± 5 years). They were assigned to either OT+PR (n = 47, FEV₁ 46 ± 21%pred.) or PR (n = 24, FEV₁ 44 ± 12%pred.). PR consisted of eighteen 3-hour daily sessions, whilst OT (domestic activities) was added 3 times a week up to nine 1-hour sessions. Six-min walk (6MWD) with evaluation of BORG dyspnea (D) and leg fatigue (F) scores at end of effort, breathlessness sensation (B) by means of the MRC scale as well as the number of functions lost in the Basic Activity of Daily Living (BADL) categories were assessed as outcomes before (T₀) and after (T₁) rehabilitation. Results: 6MWD (from 165 ± 63 to 233 ± 66 and from 187 ± 52 to 234 ± 65 m in the OT+PR and PR groups, respectively), D (from 4.9 ± 2.1 to 3.2 ± 1.6 and from 5.3 ± 2.1 to 3.4 ± 2.1), F (from 6.1 ± 0.5 to 4.5 ± 1.7 and from 5.9 ± 0.8 to 4.3 ± 0.8) and B (from 4.3 ± 0.9 to 3.0 ± 0.9 and from 4.2 ± 1.0 to 3.2 ± 0.8) had similarly improved (p < 0.01) in both groups at T₁. The percentage distribution of patients across the BADL categories significantly changed (p = 0.004) in OT+PR (from 17 to 61%, from 70 to 34% and from 23 to 5% in categories A, B and C, respectively) but not in the PR group. Conclusions: The addition of OT to comprehensive PR is able to specifically improve the outcome of severely disabled COPD inpatients.

Functional and Economic Outcomes of Cardiopulmonary Patients

“…Benefits of postacute rehabilitation in cardiovascular and pulmonary patients can be obtained in either the IRF [12][13][14][15][16][17] or SNF 18 setting, as observed here. However, one important distinction is that large, clinically meaningful improvements were made in the IRF in less than half the time of that in the SNF, with lower mortality, but at a greater cost.…”

Differences in Response to Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and Chronic Obstructive Pulmonary Disease

“…This should include provision of supplementary oxygen [39], specific occupational therapy interventions [40], and energy conservation strategies may be useful to control dyspnea and exercise-induced hypoxemia. Further, the optimal timing for rehabilitation in the disease trajectory requires consideration.…”

Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease

“…Our findings should help to delineate a subset of COPD patients that could benefit best from an active interventional program [29,30,31,32] with the aim of lowering hospital readmission rates and costs. A prospective interventional study incorporating these premises is warranted.…”