16 research outputs found
Long-term exercise maintenance in COPD via telerehabilitation: a two-year pilot study
Submitted manuscript version. Published version available at https://doi.org/10.1177/1357633X15625545. Introduction - Pulmonary rehabilitation (PR) is an integral part of the management of chronic obstructive pulmonary disease
(COPD). However, many patients do not access or complete PR, and long-term exercise maintenance has been difficult to
achieve after PR. This study aimed to investigate feasibility, long-term exercise maintenance, clinical effects, quality of life and use
of hospital resources of a telerehabilitation intervention.
Methods - Ten patients with COPD were offered a two-year follow-up via telerehabilitation after attending PR. The intervention consisted of home exercise, telemonitoring and self-management via a webpage combined with weekly videoconferencing
sessions. Equipment included a treadmill, a pulse oximeter and a tablet. Data collected at baseline, one year and two years were
six-minute walking distance (6MWD), COPD assessment test (CAT), EuroQol 5 dimensions (EQ-5D), hospitalisations and
outpatient visits.
Results - No dropout occurred. Physical performance, lung capacity, health status and quality of life were all maintained at two
years. At one year, 6MWD improved by a mean of 40 metres from baseline, CAT decreased by four points and EQ visual
analogue scale (EQ VAS) improved by 15.6 points.
Discussion - Long-term exercise maintenance in COPD via telerehabilitation is feasible. Results are encouraging and suggest
that telerehabilitation can prevent deterioration and improve physical performance, health status and quality of life.<p
Long-term integrated telerehabilitation of COPD patients:a multicentre randomised controlled trial (iTrain)
SPIRIT checklist. (DOC 121 kb
Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study
COPD in primary lung cancer patients: prevalence and mortality
Background: Previous studies have relied on international spirometry criteria to diagnose COPD in patients with lung cancer without considering the effect lung cancer might have on spirometric results. The aim of this study was to examine the prevalence of COPD and emphysema at the time of primary lung cancer diagnosis and to examine factors associated with survival.
Materials and methods: Medical records, pulmonary function tests, and computed tomography scans were used to determine the presence of COPD and emphysema in patients diagnosed with primary lung cancer at the University Hospital of North Norway in 2008–2010.
Results: Among the 174 lung cancer patients, 69% had COPD or emphysema (39% with COPD, 59% with emphysema; male:female ratio 101:73). Neither COPD nor emphysema were significantly associated with lung cancer mortality, whereas patients with non-small-cell lung cancer other than adenocarcinoma and squamous cell carcinoma had a risk of lung cancer mortality that was more than four times higher than that of patients with small-cell lung cancer (hazard ratio [HR] 4.19, 95% confidence interval [CI] 1.56–11.25). Females had a lower risk of lung cancer mortality than males (HR 0.63, 95% CI 0.42–0.94), and patients aged ≥75 years had a risk that was twice that of patients aged <75 years (HR 2.48, 95% CI 1.59–3.87). Low partial arterial oxygen pressure (4.0–8.4 kPa) increased the risk of lung cancer mortality (HR 2.26, 95% CI 1.29–3.96). So did low partial arterial carbon dioxide pressure (3.0–4.9 kPa) among stage IV lung cancer patients (HR 2.23, 95% CI 1.29–3.85). Several patients with respiratory failure had previously been diagnosed with COPD.
Conclusion: The observed prevalence of COPD was lower than that in previous studies. Neither COPD nor emphysema were significantly associated with lung cancer mortality
Long-term telerehabilitation of COPD patients in their homes: Interim results from a pilot study in Northern Norway
We investigated the feasibility of a long-term telerehabilitation service for COPD patients comprising exercise training at home, telemonitoring and education/self-management. The service was offered as a 2-year follow-up programme by a physiotherapist. Equipment included a treadmill, a pulse oximeter and a tablet computer. Participants had weekly videoconference sessions with the physiotherapist. A website was used to access a training programme and to fill in a daily diary and a training diary. Ten patients with moderate or severe COPD participated in a pilot study in Northern Norway. After more than one year, all participants were still participating actively and no drop-outs had occurred. On average, there were 2.0 training sessions/week, 3.3 measurements/week registered via the website and 0.5 videoconference contacts/week. There was a reduction of 27% in the COPD-related hospital costs. Feedback from the participants was very positive. Long-term telerehabilitation of COPD patients at home is feasible and interim results suggest that it reduces healthcare utilization
Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study
Background: Telemedicine may increase accessibility to pulmonary rehabilitation in chronic obstructive pulmonary
disease (COPD), thus enhancing long-term exercise maintenance. We aimed to explore COPD patients’ adherence
and experiences in long-term telerehabilitation to understand factors affecting satisfaction and potential for service
improvements.
Methods: A two-year pilot study with 10 patients with COPD was conducted. The intervention included treadmill
exercise training at home and a webpage for telemonitoring and self-management combined with weekly
videoconferencing sessions with a physiotherapist. We conducted four separate series of data collection.
Adherence was measured in terms of frequency of registrations on the webpage. Factors affecting satisfaction
and adherence, together with potential for service improvements, were explored through two semi-structured
focus groups and an individual open-ended questionnaire. Qualitative data were analysed by systematic text
condensation. User friendliness was measured by the means of a usability questionnaire.
Results: On average, participants registered 3.0 symptom reports/week in a web-based diary and 1.7 training
sessions/week. Adherence rate decreased during the second year. Four major themes regarding factors
affecting satisfaction, adherence and potential improvements of the intervention emerged: (i) experienced
health benefits; (ii) increased self-efficacy and independence; and (iii) emotional safety due to regular
meetings and access to special competence; (iv) maintenance of motivation. Participants were generally
highly satisfied with the technical components of the telerehabilitation intervention.
Conclusions: Long-term adherence to telerehabilitation in COPD was maintained for a two-year period.
Satisfaction was supported by experienced health benefits, self-efficacy, and emotional safety. Maintenance
of motivation was a challenge and might have affected long-term adherence. Four key factors of potential
improvements in long-term telerehabilitation were identified: (i) adherence to different components of the
telerehabilitation intervention is dependent on the level of focus provided by the health personnel
involved; (ii) the potential for regularity that lies within the technology should be exploited to avoid
relapses after vacation; (iii) motivation might be increased by tailoring individual consultations to support
experiences of good health and meet individual goals and motivational strategies; (iv) interactive
functionalities or gaming tools might provide peer-support, peer-modelling and enhance motivation
Retrospective survival in elderly COPD patients receiving pulmonary rehabilitation; a study including maintenance rehabilitation
BACKGROUND: The aim of this study was to examine retrospective survival in elderly chronic obstructive pulmonary disease (COPD) patients receiving three different pulmonary rehabilitation (PR) programs. RESULTS: 193 patients [m / f 92 / 101, mean age 69.2 (standard deviation 8.6)] receiving PR were studied with lifetable and Cox regression analyses. Forced expiratory volume in 1 second (FEV(1)) % pred. was significantly different in the in-patient (n = 72), out-patient (n = 72), and maintenance group (n = 49) [mean 54.5 (21.8), 52.2 (17.7), and 42.9 (15.0), respectively (p = 0.004)]. PR days were 30.3 (20.4), 18.9 (10.4) and 30.0 (20.3), respectively (p < 0.001). Median survival rate was nine years in the in-patient, eight years in the out-patient and seven years in the maintenance group. Hospital stays and days were significantly increased in the maintenance group compared with the other groups (p = 0.003 and 0.010, respectively). The impact of evaluated variables on survival in the three PR groups was significant for age, FEV(1) as well as the use of long-term oxygen therapy (LTOT) (HR 1.06, for five years, p < 0.001, HR 0.98, p = 0.01, and HR 2.18, p = 0.005, respectively). CONCLUSIONS: The COPD patients in the maintenance group showed a worse survival, but after correction for gender, age and severity of obstruction, the difference was not statistically significant
Long-term exercise maintenance in COPD via telerehabilitation: a two-year pilot study
Introduction - Pulmonary rehabilitation (PR) is an integral part of the management of chronic obstructive pulmonary disease
(COPD). However, many patients do not access or complete PR, and long-term exercise maintenance has been difficult to
achieve after PR. This study aimed to investigate feasibility, long-term exercise maintenance, clinical effects, quality of life and use
of hospital resources of a telerehabilitation intervention.
Methods - Ten patients with COPD were offered a two-year follow-up via telerehabilitation after attending PR. The intervention consisted of home exercise, telemonitoring and self-management via a webpage combined with weekly videoconferencing
sessions. Equipment included a treadmill, a pulse oximeter and a tablet. Data collected at baseline, one year and two years were
six-minute walking distance (6MWD), COPD assessment test (CAT), EuroQol 5 dimensions (EQ-5D), hospitalisations and
outpatient visits.
Results - No dropout occurred. Physical performance, lung capacity, health status and quality of life were all maintained at two
years. At one year, 6MWD improved by a mean of 40 metres from baseline, CAT decreased by four points and EQ visual
analogue scale (EQ VAS) improved by 15.6 points.
Discussion - Long-term exercise maintenance in COPD via telerehabilitation is feasible. Results are encouraging and suggest
that telerehabilitation can prevent deterioration and improve physical performance, health status and quality of life.<p
Seasonal variations in objectively assessed physical activity among people with COPD in two Nordic countries and Australia: a cross-sectional study
Purpose: Seasons and weather conditions might influence participation in physical activity and contribute to differences between countries. This study aimed at investigating whether there were differences in physical activity levels between Norwegian, Danish and Australian people with chronic obstructive pulmonary disease (COPD), and establishing if any variations in physical activity were attributable to seasons.
Patients and methods: A cross-sectional study where study subjects were people with COPD who participated in two separate clinical trials: the iTrain study (Norway, Denmark, and Australia) and the HomeBase study (Australia). Physical activity was objectively assessed with an activity monitor; variables were total energy expenditure, number of daily steps, awake sedentary time, light, and moderate-to-vigorous intensity physical activity. Differences in physical activity between countries and seasons were compared, with adjustment for disease severity.
Results: In total, 168 participants were included from Norway (N=38), Denmark (N=36) and Australia (N=94). After controlling for disease severity, time spent in awake sedentary time was greater in Danish participants compared to the other countries (median 784 minutes/day [660–952] vs 775 minutes/day [626–877] for Norwegians vs 703 minutes/day [613–802] for Australians, P=0.013), whilst time spent in moderate to vigorous physical activity was lower (median 21 minutes/day [4–73] vs 30 minutes/day [7–93] for Norwegians vs 48 minutes/day [19–98] for Australians, P=0.024). Participants walked more during summer (median 3502 [1253–5407] steps/day) than in spring (median 2698 [1613–5207] steps/day), winter (median 2373 [1145–4206] steps/day) and autumn (median 1603 [738–4040] steps/day), regardless of geography. The median difference between summer and other seasons exceeded the minimal clinically important difference of 600 steps/day. However, the differences were not statistically significant (P=0.101).
Conclusion: After controlling for disease severity, Danish participants spent more time in an awake sedentary state and less time in moderate to vigorous physical activity than their counterparts in Norway and Australia. People with COPD increased their physical activity in summer compared to other seasons. Weather conditions and seasonal variations may influence outcomes in clinical trials and health registries measuring physical activity over time, irrespective of the interventions delivered, and should be taken into account when interpreting results.<p