Effects of nurse home visits on compliance to long-term oxygen therapy. 14 months follow-up

Introduction: Long-term oxygen therapy (LTOT) is the only treatment that improves prognosis in patients with chronic respiratory failure in the course of chronic obstructive pulmonary disease (COPD). This effect depends on the duration of oxygen use during the day and night. The aim of this study was to evaluate the daily use of oxygen concentrator and to analyze factors that promote patient compliance. Material and methods: The study enrolled patients seen at the Long-Term Oxygen Therapy Center of the Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, Poland. Qualification for LTOT was in accordance with the guidelines of the Polish Respiratory Society and the European Respiratory Society (ERS). All patients were instructed to use oxygen therapy for at least 15 hours a day using a stationary oxygen concentrator. The duration of oxygen concentrator use was evaluated on the basis of the concentrator counter reading performed by visiting nurses. The visits were run on the monthly basis. Results: The study group involved 30 subjects (77% of COPD patients). The mean age was 67 &#177; 9 years, mean FEV1 was 46 &#177; 18% predicted, RV/TLC was 64 &#177; 16% and PaO2 was 50 &#177; 6 mm Hg. The mean duration of the daily oxygen therapy for the entire study group was 12.5 &#177; 4.6 hours. Eleven (37%) patients complied with the treatment during the follow-up period with the mean duration of daily oxygen therapy 17.4 &#177; 2.6 hours. The mean oxygen therapy use in the non-compliant group of patients averaged 9.6 &#177; 2.7 hours. We found that highest percentage of patients (48%) used oxygen for an appropriate period of time in the # first month of the treatment. The second month the number decreased to about 30% and remained at this level until the end of the follow-up period. The analysis of the COPD patients showed that in case of the compliant subjects the values of total lung capacity (TLC) (100 &#177; 19% predicted v. 152 &#177; 36% predicted, p = 0.001) and PaCO2 (38 &#177; 6 mm Hg v. 47 &#177; 8 mm Hg, p < 0.05) were significantly lower in comparison to the group of patients who used the oxygen therapy for less than 15 hours a day. Fourteen (47%) patients reported a considerable increase in electricity consumption and seven (23%) patients complained about the noise of the oxygen concentrator. The daily oxygen use of this group was significantly lower in comparison to the patients who were not annoyed with the sound of the concentrator (9.0 &#177; 3.7 h/24 h v. 13.5 &#177; 4.4 h/24 h, p = 0.02). Conclusions: Our study show that the patients&#8217; compliance was the highest during the first month of the treatment only, and that the monthly home visit did not influence the patients&#8217; self-discipline to use LTOT properly. The use of an alternative source of oxygen, such as liquid oxygen, which would not generate any noise or electricity consumption, may positively influence the patient&#8217;s compliance.Wstęp: Tlenoterapia w warunkach domowych jest jedynym sposobem leczenia, który poprawia rokowanie pacjentów z przewlekłą niewydolnością oddechową w przebiegu przewlekłej obturacyjnej choroby płuc (POChP). Efekt ten jest zależny od czasu stosowania tlenoterapii w ciągu doby. Celem badania była ocena dobowego korzystania z koncentratora tlenu oraz analiza czynników sprzyjających stosowaniu się pacjentów do zaleceń lekarskich. Materiał i metody: Do badania zakwalifikowano pacjentów pozostających pod opieką ośrodka domowego leczenia tlenem (DLT) przy Katedrze i Klinice Chorób Wewnętrznych, Pneumonologii i Alergologii Warszawskiego Uniwersytetu Medycznego. Chorych do DLT kwalifikowano zgodnie z wytycznymi Polskiego Towarzystwa Chorób Płuc (PTChP) i Europejskiego Towarzystwa Oddechowego (ERS). Wszystkim pacjentom zalecano co najmniej 15-godzinną tlenoterapię w ciągu doby przy użyciu stacjonarnego koncentratora tlenu. Ocena czasu korzystania z koncentratora była dokonywana na podstawie odczytów licznika koncentratora przez wizytujące pielęgniarki. Wizyty odbywały się raz na miesiąc. Wyniki: Badana grupa liczyła 30 pacjentów (77% chorych na POChP) w średnim wieku 67 &#177; 9 lat, ze średnią FEV1 46 &#177; 18% normy, RV% TLC 64 &#177; 16%, PaO2 50 &#177; 6 mm Hg. Średni czas dobowej tlenoterapii dla całej grupy wyniósł 12,5 &#177; 4,6 godziny. Jedenastu pacjentów (37%) stosowało się do zaleceń podczas okresu obserwacji. Średni czas tlenoterapii w tej grupie to 17,4 &#177; 2,6 godziny. Średnie korzystanie z tlenoterapii w grupie chorych nieprzestrzegających zaleceń wynosiło 9,6 &#177; 2,7 godziny. Stwierdzono, że największy odsetek pacjentów (48%) korzystał z tlenu odpowiednią ilość czasu w ciągu pierwszego miesiąca leczenia. W drugim miesiącu odsetek ten zmniejszył się do około 30% i na tym poziomie utrzymywał się do końca czasu obserwacji. Analizując grupę chorych na POChP, stwierdzono, że pacjenci stosujący się do zaleceń mają istotnie niższą całkowitą pojemność płuc (TLC) (100 &#177; 19% normy v. 152 &#177; 36% normy, p = 0,001) i niższe PaCO2 (38 &#177; 6 mm Hg v. 47 &#177; 8 mm Hg, p < 0,05) w porównaniu z grupą pacjentów korzystających z tlenu mniej niż 15 godzin na dobę. Czternastu pacjentów (47%) skarżyło się na zauważalny wzrost zużycia energii elektrycznej. Natomiast 7 pacjentom (23%) przeszkadzał hałas wytwarzany przez koncentrator tlenu. Dobowe korzystanie z tlenu w tej grupie było istotnie krótsze (9 &#177; 3,7 godz./dobę) w porównaniu z chorymi, którym nie przeszkadzał dźwięk pracy koncentratora (13,5 &#177; 4,4 godz./dobę; p = 0,02). Wnioski: Wyniki badania wskazują, że pacjenci najlepiej współpracują w pierwszym miesiącu leczenia. Comiesięczne wizyty domowe nie wpłynęły na poprawę stosowania się pacjentów do zaleceń DLT. Być może wykorzystanie alternatywnego źródła tlenu, jakim jest tlen ciekły, którego stosowanie nie wiąże się z wytwarzaniem hałasu i zużyciem energii elektrycznej, poprawiłoby stosowanie się do zaleceń

The Effects of Frequent Nurse Visits on Patient’s Compliance with Long-Term Oxygen Therapy (LTOT). A 14-Month Follow-Up

Introduction: Long-term oxygen therapy (LTOT) is the only treatment that improves prognosis in patients with chronic respiratory failure in the course of chronic obstructive pulmonary disease (COPD). This effect depends on the duration of oxygen use during the day and night. The aim of this study was to evaluate the daily use of oxygen concentrator and to analyze factors that promote patient compliance. Material and methods: The study enrolled patients seen at the Long-Term Oxygen Therapy Center of the Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, Poland. Qualification for LTOT was in accordance with the guidelines of the Polish Respiratory Society and the European Respiratory Society (ERS). All patients were instructed to use oxygen therapy for at least 15 hours a day using a stationary oxygen concentrator. The duration of oxygen concentrator use was evaluated on the basis of the concentrator counter reading performed by visiting nurses. The visits were run on the monthly basis. Results: The study group involved 30 subjects (77% of COPD patients). The mean age was 67 ± 9 years, mean FEV1 was 46 ± 18% predicted, RV/TLC was 64 ± 16% and PaO2 was 50 ± 6 mm Hg. The mean duration of the daily oxygen therapy for the entire study group was 12.5 ± 4.6 hours. Eleven (37%) patients complied with the treatment during the follow-up period with the mean duration of daily oxygen therapy 17.4 ± 2.6 hours. The mean oxygen therapy use in the non-compliant group of patients averaged 9.6 ± 2.7 hours. We found that highest percentage of patients (48%) used oxygen for an appropriate period of time in the # first month of the treatment. The second month the number decreased to about 30% and remained at this level until the end of the follow-up period. The analysis of the COPD patients showed that in case of the compliant subjects the values of total lung capacity (TLC) (100 ± 19% predicted v. 152 ± 36% predicted, p = 0.001) and PaCO2 (38 ± 6 mm Hg v. 47 ± 8 mm Hg, p &lt; 0.05) were significantly lower in comparison to the group of patients who used the oxygen therapy for less than 15 hours a day. Fourteen (47%) patients reported a considerable increase in electricity consumption and seven (23%) patients complained about the noise of the oxygen concentrator. The daily oxygen use of this group was significantly lower in comparison to the patients who were not annoyed with the sound of the concentrator (9.0 ± 3.7 h/24 h v. 13.5 ± 4.4 h/24 h, p = 0.02). Conclusions: Our study show that the patients’ compliance was the highest during the first month of the treatment only, and that the monthly home visit did not influence the patients’ self-discipline to use LTOT properly. The use of an alternative source of oxygen, such as liquid oxygen, which would not generate any noise or electricity consumption, may positively influence the patient’s compliance

Gait Symmetry Analysis in Patients after Treatment of Pilon Fractures by the Ilizarov Method

The aim of this study was to comprehensively assess the gait parameters in patients who had undergone treatment of pilon fractures by the Ilizarov method. We analyzed gait parameters in patients who had undergone treatment for pilon fractures by the Ilizarov method; 20 patients aged 47.0 years (25.2–78.6) were included in the study. The control group consisted of 32 healthy volunteers. Gait examination was performed using the pedobarographic platform. Statistically significant differences in the following gait parameters: maximum forefoot force (%), step length (cm), and step time (s) were found between the study group and the control group, between the nonoperated leg, and both the operated leg and the dominant limb. Statistically significant differences in the study group between the treated lower limb and the healthy lower limb were only observed in the case of the maximum forefoot force parameter (%). Healthy subjects from the control group obtained significantly higher values during locomotion for stride time, cadence step, and velocity than the patients, with stride time being statistically significantly shorter and the velocity and the cadence step higher. We observed symmetry in the gait parameters after treating pilon fractures by the Ilizarov method. This method of stabilization allows the restoration of gait parameters, with results similar to those obtained after the treatment of other motor organ pathologies described in the literature, although different from those observed in healthy subjects. In particular, the biomechanics of the lower limbs remain disturbed

Kinematic Parameters Following Pilon Fracture Treatment with the Ilizarov Method

Background: The purpose of our study was to analyze kinematic parameters following pilon fracture treatment with the Ilizarov method. Methods: Our study assessed kinematic parameters of gait in 23 patients with pilon fractures treated with the Ilizarov method. Patients had completed their treatment 24–48 months prior to measurements. The range-of-motion values in the non-operated limb (NOL) and operated limb (OL) were compared. Kinematic parameters were measured using the Noraxon MyoMOTION System. Results: We observed no significant differences in hip flexion, hip abduction, or knee flection between the OLs and NOLs in patients after treatment with the Ilizarov method. We observed significant differences in the ranges of ankle dorsiflexion, inversion, and abduction (p p p < 0.003, respectively) between the OLs and the NOLs. Conclusion: Following pilon fracture treatment with the Ilizarov method, we observed no differences in terms of knee or hip joint mobility between the OL and the NOL, whereas the range of motion in the ankle joint of the OL was significantly limited. The treatment of pilon fractures with the Ilizarov method does not ensure the complete normalization of ankle joint kinematic parameters. Therefore, intense personalized rehabilitation of the ankle joint is recommended