Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: A systematic review

Souto-Miranda, Sara; Rodrigues, Guilherme; Spruit, Martijn A.; Marques, Alda

doi:10.1016/j.rehab.2021.101564

Cited by 23 publications

(13 citation statements)

References 258 publications

(18 reference statements)

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“…The most frequent crucial outcomes identified in this study were exercise capacity, dyspnoea and anxiety and depression. It is likely they will end up in the final COS since these are also some of the most measured outcomes in PR trials [5]. This is partly in line with a recent expert consensus that advised exercise capacity, dyspnoea, quality of life, nutritional status and occupational status as the essential components to be assessed in PR [22], and with a COS developed for COPD in primary care physiotherapy practices which included exercise capacity, muscle strength, physical activity, dyspnoea and quality of life as core outcomes [23].…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review identified 163 outcomes and 217 measures reported in the literature, revealing high heterogeneity in outcome measurement during PR [5]. This is of most importance as measuring different outcomes and using different measures between centres and studies hinders benchmarking PR efficacy, an effective evidence synthesis, and effective marketing strategies to foster PR amongst payers, clinicians, and patients [6,7].…”

Section: Introductionmentioning

confidence: 99%

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International perspectives on outcome measurement in pulmonary rehabilitation of people with COPD: A qualitative study

Souto-Miranda¹,

Vaes²,

Gloeckl³

et al. 2022

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

International perspectives on outcome measurement in pulmonary rehabilitation of people with COPD: A qualitative study

Souto-Miranda¹,

Vaes²,

Gloeckl³

et al. 2022

Respiratory Medicine

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“…Universal access is, however, an intangible goal. Most PR is conducted in hospital-based outpatient settings [7,8]; increased involvement of primary care is fundamental to expanding access to PR, according to the levels of disease complexity [6], and to overcoming the barrier of distance from home. Models of PR referral using criteria based on disease stability, burden and physical capacity/activity have been proposed [3].…”

Section: Physiotherapist Female 33 Years Of Agementioning

confidence: 99%

Access, access, access: the Three A's of pulmonary rehabilitation – perspectives of patients, loved ones and healthcare professionals

et al. 2022

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Improving access to pulmonary rehabilitation (PR) is a worldwide priority [1]. Evidence suggests that those who are more symptomatic, with frequent hospitalisations and whose health status and ability to exercise and perform activities of daily living is worse, are also the ones who respond better [2] and should be referred/prioritised to PR [3]. We explored whether these criteria are aligned with the perspectives of people with chronic respiratory diseases (CRDs), their loved ones (LOs) and healthcare professionals (HCPs).We conducted seven focus groups with people with CRDs (n=29), LO (n=5) and HCPs (n=16) recruited using purposive/snowballing sampling strategies from two hospitals, two primary healthcare centres and one institutional practice. Ethical approvals were obtained (UAI F 83/2019; P517-08/2018 and 086892). People with CRDs were eligible if they were adults with CRDs and had participated in PR at least once. LOs were eligible if they were adults having a significant/personal relationship with the person with a CRD and provided physical/practical, social, financial and/or emotional support [4]. HCPs were eligible if they had been involved in at least one PR programme. Participants were approached face-to-face and informed consents were obtained. Data collection occurred separately with each stakeholder in a different setting; no prior relationship with the interviewer existed; a semi-structured, pilot-tested interview guide was used; interviews were audio-recorded; and field notes were taken. Data were analysed with inductive thematic analysis. An external researcher reviewed the interview guide, code descriptions, themes/ subthemes and participant quotations. Findings were: confirmed by two researchers, triangulating the method of collection (interviews and field notes); validated by participants (two people with CRDs and two HCPs); and discussed among team members and with the external researcher.People with CRDs had a mean±SD age of 68±8 years, were mostly male (76%) and had a diagnose of COPD (82%) or interstitial lung disease (ILD) (17%). LOs were on average 67±8 years of age, female (100%), mostly spouses (80%) and had been caring for >4 years (80%). HCPs were on average 38±9 years, mostly female (75%) and had been working in hospitals for >14 years (63%). Focus groups lasted on average 47±15 min. Three common core themes were identified (figure 1).All stakeholders felt that, in a favourable scenario, having criteria to access PR was somewhat unfair, and having a mix of less and more disabled people would be beneficial to their social experience. Nevertheless, HCPs felt it to be easier to work with homogeneous groups. They recognised the importance of comprehensive assessment and discussion with a multidisciplinary team, to guide personalised PR. Both HCPs and people with CRDs felt that it was important to start PR as early as possible (i.e. when diagnosed). HCPs also suggested that this would allow the opportunity to prompt a change in daily habits and behaviours, although adherence challenges w...

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“…The 6MWT is a valid assessment of functional exercise capacity and can be carried out across the clinical spectrum of the disease [ 20 ]. It is used frequently both in routine clinical practice and as a primary end point for research in patients with COPD [ 20 , 21 ]. The 6MWT can be used to assess the response to therapy, as it is sensitive to commonly used therapies in COPD, including pulmonary rehabilitation [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Performance Score (T2D)—A New Perspective in the Assessment of Six-Minute Walking Tests in Pulmonary Rehabilitation

et al. 2022

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Because absolute changes in outcomes are difficult to interpret and the minimal clinically important difference (MCID) is not suitable to address this challenge, a novel method of classifying outcomes by relating changes to baseline values is warranted. We used the “performance score” (T2D), which reflects individual performance, enabling us to consider the functional status at the beginning of rehabilitation without dealing with the problems of mathematical coupling or regression effects, as encountered in ANCOVA. To illustrate the T2D, we retrospectively analyzed changes in the six-minute walking test (6MWT) in COPD patients undergoing outpatient pulmonary rehabilitation and compared the results with absolute differences related to a predetermined MCID. We evaluated a total of 575 COPD patients with a mean age of 61.4 ± 9.2 years. 6MWT improved significantly, with a mean change of 32.3 ± 71.2. A total of 105/311 participants who had reached the MCID were still classified as “below average” by the T2D. Conversely, 76/264 patients who had not reached the MCID were classified as “above average”. This new performance measure accounts for the patient’s current status and for changes over time, potentially representing a simple and user-friendly tool that can be used to quantify a patient’s performance and response to rehabilitation.

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Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: A systematic review

Cited by 23 publications

References 258 publications

International perspectives on outcome measurement in pulmonary rehabilitation of people with COPD: A qualitative study

International perspectives on outcome measurement in pulmonary rehabilitation of people with COPD: A qualitative study

Access, access, access: the Three A's of pulmonary rehabilitation – perspectives of patients, loved ones and healthcare professionals

Performance Score (T2D)—A New Perspective in the Assessment of Six-Minute Walking Tests in Pulmonary Rehabilitation

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