Thigh muscle strength and endurance in patients with COPD compared with healthy controls

SummaryThe aim of this study was to evaluate thigh muscle strength and endurance in patients with COPD compared with healthy controls. Forty-two patients (26 women; 16 men) with moderate to severe COPD and 53 (29 women; 24 men) age-matched healthy controls participated in the study. The subjects were tested for maximum voluntary contractions (MVC), endurance and fatigue of the thigh muscles on an isokinetic dynamometer (KinCom®). Endurance was expressed as the number of attained repetitions of knee extension and muscle fatigue as a fatigue index (FI).MVC in knee extension was 17% lower in female patients (P=0.017) but no difference was found in male patients (P=0.56) compared to controls. MVC in knee flexion was lower both in female (51%) (P<0.001) and male patients (40%) (P<0.001) compared to controls. Both female and male patients had significantly lower muscle endurance compared to controls. Female patients had a higher FI (22.5%) than female controls (10%) (P=0.001) while no difference was found regarding FI between male patients (15%) and male controls (10%) (P=0.103). The level of self-reported everyday physical activity did not differ between groups.The results showed impaired skeletal muscle function in COPD, except for MVC in knee extension in male patients. Female patients seemed to be more prone to decrease in thigh muscle function. More focus on improving muscle strength and muscle endurance should be considered when designing pulmonary rehabilitation programs. Patients with preserved level of physical activity can be included in exercise programs and gender-related differences should be taken into account

Telehealthcare in COPD: A systematic review and meta-analysis on physical outcomes and dyspnea

SummaryBackgroundOnly a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used.MethodsRandomized controlled trials were identified through database searches, reference lists and included authors. Articles were reviewed based on eligibility criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data visually.ResultsNine studies (982 patients) were included. For physical activity level, there was a significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4–74.9). No difference between groups was found for physical capacity (MD, −1.3 m; 95% CI, −8.1–5.5) and dyspnea (SMD, 0.088; 95% CI, −0.056–0.233). Telehealthcare was promoted through phone calls, websites or mobile phones, often combined with education and/or exercise training. Comparators were ordinary care, exercise training and/or education.ConclusionsThe use of telehealthcare may lead to improvements in physical activity level, although the results should be interpreted with caution given the heterogeneity in studies. This is an important area of research and further studies of the effect of telehealthcare for patients with COPD would be beneficial.RegistrationIn PROSPERO 2012: CRD42012003294. Study protocol: http://www.crd.york.ac.uk/PROSPEROFILES/3294_PROTOCOL_20121016.pdf

A scoping review of co-creation practice in the development of non-pharmacological interventions for people with Chronic Obstructive Pulmonary Disease: a health CASCADE study

Background: Incorporating co-creation processes may improve the quality of outcome interventions. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for people with Chronic Obstructive Pulmonary Disease (COPD), that could inform future co-creation practice and research for rigorously improving the quality of care. Objective: This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD. Methods: This review followed Arksey and O'Malley scoping review framework and was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science Core Collection. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included. Results: 13 articles complied with the inclusion criteria. Limited creative methods were reported in the studies. Facilitators described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report including implementation considerations as a discussion point in their co-creation workshops. Conclusion: Evidence-based co-creation in COPD care is critical for guiding future practice and improving the quality of care delivered by NPIs. This review provides evidence for improving systematic and reproducible co-creation. Future research should focus on systematically planning, conducting, evaluating, and reporting co-creation practices in COPD care

Efficient internalization into low-passage glioma cell lines using adenoviruses other than type 5: an approach for improvement of gene delivery to brain tumours

There is a need for improvement of the commonly used adenovirus vectors based on serotype 5. This study was performed on three adenovirus serotypes with a CAR-binding motif (Ad4p, Ad5p and Ad17p) and three non-CAR-binding serotypes (Ad11p, Ad16p and Ad21p). The capacity of these alternative adenovirus vector candidates to deliver DNA into low-passage glioma cell lines from seven different donors was evaluated. The non-CAR-binding serotype Ad16p was the most efficient serotype with regard to import of its DNA, as well as initiation of hexon protein expression. Ad16p established hexon expression in 60–80 % of the cell population in gliomas from all donors tested. The other non-CAR-binding serotypes, Ad11p and Ad21p, showed hexon expression in 25–60 and 40–80 % of cells, respectively. The corresponding figure for the best CAR-binding serotype, Ad5p, was only 25–65 %, indicating greater variability between cells from different donors than serotype Ad16p had. The other CAR-binding serotypes, Ad4p and Ad17p, were refractory to some of the gliomas, giving a maximum of only 45 and 40 % hexon expression, respectively, in the most permissive cells. Interestingly, the transduction capacity of the CAR-binding serotypes was not correlated to the level of CAR expression on the cells

Physical training in patients with chronic obstructive pulmonary disease - COPD

Chronic obstructive pulmonary disease, COPD, places a substantial burden of disability on the growing number of patients and causes large costs for the society. Tobacco smoke is the most important risk factor. Progressive exertional dyspnea is the major symptom which leads to diminished physical and social activities, reduced physical capacity and decreased health related quality of life, HRQoL. The aim of this thesis was to evaluate different physical training modalities in patients with COPD with regard to physical capacity and HRQoL. Patients with moderate to severe COPD were included in the studies. In the first intervention, 20 patients trained on a treadmill with or without supplemental oxygen, three times per week, during eight weeks. In the second intervention, 30 patients were randomised to high-intensity group training either in water or on land, and 13 patients were included in a control group. The patients in the water and land groups trained three times per week during three months and once a week during the following six months. Oxygen supplementation during physical training did not enlarge the positive effects of the same training with air in patients with exercise-induced hypoxaemia. Both groups improved the distance walked after training. High-intensity group training in water and on land was found to be effective with regard to walking distance and HRQoL compared to the control group. Training in water seemed to be of greater benefit compared to training on land concerning walking distance and experienced physical health when the training was accomplished three times per week. The thigh muscle strength increased after training in both the water and the land group. The muscle endurance in knee extension was low in the majority of the patients and was not improved after the training intervention. An evaluation of the long-term effects of physical group training and the effects of decreased training frequency showed that training with low frequency (once a week) during six months did not seem to be sufficient to maintain the level achieved after a three months period of higher frequency training (three times per week). However, the two periods combined seemed to prevent decline in physical capacity and HRQoL compared to baseline. The conclusion is that physical training is of benefit for patients with COPD with regard to physical capacity and HRQoL. Training can be performed individually or in groups, with high intensity, in water and on land. It is also concluded that the training can, under controlled conditions, be performed without supplemental oxygen even in patients with exercise-induced hypoxaemia