Exploring a physiotherapy well-being review to deliver community-based rehabilitation in patients with pulmonary hypertension

Background: Highly structured, supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. Despite evidence of the effectiveness of community-based rehabilitation in other cardiopulmonary diseases there are limited data in patients with pulmonary hypertension. Methods: This prospective study evaluated the intervention of a physiotherapist well-being review in patients with pulmonary hypertension who had been established on targeted drug therapy for between 3 and 12 months. The intervention included a detailed consultation assessing functional, social and motivational status to identify individual patient rehabilitation goals and facilitate tailored referrals to community-based services. Results: One hundred and thirty eight patients (79% pulmonary arterial hypertension, 17% chronic thromboembolic disease), age 67±14 years, diagnosed over a one year period were evaluated between July 2017 and January 2018. Fifty-two percent of patients were referred to community-based pulmonary rehabilitation programmes, 19% received other forms of community rehabilitation, 17% were given exercise advice, 5% had an assessment of social support and 7% declined any intervention. At the end of the study 32% of patients were undertaking independent exercise. Conclusion: This study has identified that the majority of patients with pulmonary hypertension who are optimised on targeted drug therapy have rehabilitation needs. The use of a physiotherapy well-being review can identify this need and facilitate access to community-based rehabilitation. Further research is required to evaluate the efficacy of such interventions in pulmonary hypertension

Pulmonary hypERtension and measurement of exerciSe caPacIty REmotely: evaluation of the 1-minute sit to stand test (PERSPIRE): a cohort study

Background: Multi-parameter risk assessment is recommended to aid treatment decisions in patients with pulmonary arterial hypertension. The 1-minute sit-to-stand test has been validated for use in other respiratory illnesses. The aim of this study was to evaluate its safety in the hospital setting and potential utility in remote assessment in patients with pulmonary hypertension. Methods: In a prospective cohort study design patients performed the 1-minute sit-to-stand and Incremental Shuttle Walk tests on the same day. The primary aim of the study was to assess safety signals and correlations with other metrics used in risk assessment. Results: Sixty patients with pulmonary arterial hypertension and 15 with chronic thromboembolic pulmonary hypertension were enrolled. No adverse events were recorded. Post-test change in physiological parameters was lower for the 1-minute sit-to-stand than for the Incremental Shuttle Walk test in heart rate (+9.4(8.0)bpm versus +38.3(25.9)bpm (p<0.001)), oxygen saturation (−3.8(4.0)% versus −8.9(7.3)%, (p<0.01)) and systolic blood pressure (+10.1(10.5)mmHg versus +17.7(19)mmHg, p<0.001). There were significant correlations between the 1-minute-sit-to-stand and Incremental Shuttle Walking test (r= 0.702, p< 0.01), WHO FC (−0.449, p<0.01), emPHAsis-10 (−0.436, p<0.001) and NT-proBNP (−0.270, p=0.022). Ninety-seven percent of patients were willing to perform the test at home. Conclusion: This study has demonstrated the safety, sub-maximal characteristics of the 1-minute sit-to-stand test in pulmonary arterial hypertension chronic thromboembolic pulmonary hypertension in the hospital setting, its positive correlation with the Incremental Shuttle Walk test and potential role in remote risk assessment. Further evaluation of this exercise test is now warranted

Outcome Measures Used in Studies of Rehabilitation in Pulmonary Hypertension: A Systematic Review.

RATIONALE: The evidence base for rehabilitation in pulmonary hypertension is expanding but adoption in clinical practice is limited. OBJECTIVES: The World Health Organisation International Classification for Functioning, Disability and Health (ICF) identifies 3 health domains; Body Functions/Structures, Activity and Participation in society. To ensure that the wider impact of rehabilitation in pulmonary hypertension is accurately assessed it is important that study endpoints reflect all three domains. METHODS: A systematic review of the literature was conducted to identify studies of rehabilitation in patients with pulmonary hypertension from 2006 to 2019. RESULTS: Searches across five databases yielded 2564 articles of which 34 met eligibility criteria; 50 different outcome measures (mean=5, min=1, max=9) were identified. When mapped onto the World Health Organisation International Classification for Functioning, Disability and Health, 48% of instances of outcome usage were measures of Body Functions/Structure, 33% were measures of Activity and 18% were measures of Participation. Measures of Participation were not included in seven studies (21%). CONCLUSION: Studies of rehabilitation in pulmonary hypertension have focussed primarily on measures of Body Functions/Structure; the impact in other health domains is not well characterised. Greater inclusion of outcome measures reflecting Activity and Participation in society is needed to allow assessment of the wider impact of rehabilitation in patients with pulmonary hypertension