The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients

Naz, İlknur; Şahin, Hülya; Varol, Yelda; Kömürcüoğlu, Berna

doi:10.1177/1479972318809472

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…A large retrospective analysis found that multiple co‐morbidities and selected conditions such as heart and metabolic diseases adversely affected gains in exercise capacity and QOL following PR . However, other retrospective and prospective studies suggest the total number of co‐morbidities does not clearly adversely impact PR outcomes . Among 316 patients enrolled in PR, 62% reported co‐morbidities, and 45% of those had gains equal to or greater than the published MCID values for 6MWD, MRC dyspnoea scores and QOL .…”

Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 97%

Patient assessment and selection for pulmonary rehabilitation

Rochester

2019

Respirology

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Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co‐morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of ‘responsiveness to PR’, to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health‐related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self‐efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.

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Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 97%

Patient assessment and selection for pulmonary rehabilitation

Rochester

2019

Respirology

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“…Exercise capacity. Nineteen studies (20 reports) (35,40,41,43,(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77) reported measures of exercise capacity with clinically significant improvements following exercise rehabilitation in 6MWD (35,67,68), VO 2 peak (62, 64, 66, 70, 75, 76), metabolic equivalents (41,66,77), HR recovery (71), maximal symptom limited incremental cycle ergometer time (73) and peak HR (71).…”

Section: Exercise Rehabilitation In Cohort/quasi-experimental Studiesmentioning

confidence: 99%

“…Symptoms. Three studies (62,65,69) reported symptom measures with no clinically significant improvements following exercise rehabilitation.…”

Section: Exercise Rehabilitation In Cohort/quasi-experimental Studiesmentioning

confidence: 99%

Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review

Barker

Holland

Skinner

et al. 2023

JRM

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Objective: To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outcomes, and adverse events.Data sources: A search was conducted in MEDLINE, CINHAL, EMBASE, and Cochrane Central Register of Controlled Trials databases. Study selection and extraction: Randomized and non-randomized controlled trials and cohort studies of exercise rehabilitation vs any comparison in people with multimorbidity.Data synthesis: Forty-four reports (38 studies) were included. Rehabilitation ranged from 8 weeks to 4 years, with 1–7 sessions of rehabilitation weekly. Exercise included aerobic and resistance, limb training, aquatic exercises and tai chi. Compared with usual care, exercise rehabilitation improved 6-min walk distance (weighted mean difference (WMD) 64 m, 95% CI 45–82) and peak oxygen consumption (WMD 2.74 mL/kg/min, 95% CI –3.32 to 8.79). Effects on cardiometabolic outcomes and health-related quality of life also favoured rehabilitation; however; few data were available for other secondary outcomes.Conclusion: In people with multimorbidity, exercise rehabilitation improved exercise capacity, health-related quality of life, and cardiometabolic outcomes. LAY ABSTRACTChronic disease is a common health problem worldwide. It is increasingly common for people to have more than 1 chronic disease, which is called multimorbidity, and the interaction of their multiple health problems may worsen their health outcomes. Exercise rehabilitation is an effective and established treatment to improve health for people with different chronic diseases, such as heart and lung disease; however, the benefit of structured rehabilitation in people with multimorbidity has not been systematically reviewed. A literature search was performed to investigate the clinical outcomes following exercise rehabilitation in people with multimorbidity. Compared with usual medical care, the results showed that exercise rehabilitation improved exercise capacity, measured by walking distance in a formal test, health-related quality of life and the body’s ability to use oxygen, in people with multimorbidity. There were few data regarding the benefit of rehabilitation on other outcomes, and more well-designed robust trials are needed.

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