Discrepancies between patients' and partners' perceptions of unsupportive behavior in chronic obstructive pulmonary disease

The literature on chronic diseases indicates that partner support, as perceived by patients, contributes to well-being of patients in either a positive or a negative way. Previous studies indicated that patients' and partners' perceptions of unsupportive partner behavior are only moderately related. Our aim was (1) to investigate whether discrepancies between patients' and partners' perceptions of two types of unsupportive partner behavior-overprotection and protective buffering-were associated with the level of distress reported by patients with chronic obstructive pulmonary disease (COPD) and (2) to evaluate whether the direction of the differences between patients' and partners' perceptions was associated with distress (i.e., whether patient distress was associated with greater patient or greater partner reports of unsupportive partner behavior). A cross-sectional study was performed using the data of a sample of 68 COPD patients and their spouses. Distress was assessed using the Hopkins Symptom Checklist-25. Patients' and partners' perceptions of unsupportive partner behavior were assessed with a questionnaire measuring overprotection and protective buffering. Distress was independently associated with patients' perceptions of protective buffering and discrepancies in spouses' perceptions of overprotection. Regarding the direction of the discrepancy, we found that greater partner reports of overprotection as compared with patient reports were related to more distress in COPD patients. Our study showed that patients' distress was associated not only with patients' perceptions, but also with discrepancies between patients' and partners' perceptions of unsupportive partner behavior

RehabMove 2018: THE IMPLEMENTATION OF VO2 KINETICS TO EVALUATE TRAINING EFFECTS IN CANCER PATIENTS

PURPOSE: Oxygen uptake (V̇O2) kinetics can be used to measure exercise capacity. A constant work rate (CWR) test at moderate intensity measuring V̇O2 on-kinetics may be more suitable for a deconditioned patient population and a valuable source of information on training effects in addition to the regular exercise tests. The main goal of this study was to compare the sensitivity of V̇O2 on-kinetics during a rest-to-submaximal exercise transition to the regular variables measured in an incremental cardiopulmonary exercise test (CPET): ventilatory threshold (VT), V̇O2peak and peak work rate (WRpeak) to exercise induced changes, and to evaluate the usefulness of V̇O2 on-kinetics in determining an improved exercise capacity with respect to CPET in cancer patients. METHODS: Ten cancer patients (7 females) with a variety of cancer types aged between 39 and 64 years were enrolled in a 12-week rehabilitation program, in which they performed combined cycle-ergometer and strength training for two times a week. At initial and final evaluations, V̇O2 on-kinetics were measured breath-by-breath during a CWR test of moderate intensity, and V̇O2peak and VT were measured with a CPET. RESULTS: Comparisons between pre- and post-intervention showed large effect sizes for V̇O2peak (r = .59) and oxygen uptake at VT (r = .56). V̇O2 on-kinetics did not change after the training program. CONCLUSION: The current results suggest that V̇O2 on-kinetics is not more sensitive to exercise-induced adaptations compared to V̇O2peak and VT. However, V̇O2 on-kinetics did increase in eight of the ten subjects, and can serve as a source of information on training progress, especially when other information is lacking due to a non-maximal CPET or an unreliable VT

Repeatability and validity of the combined arm-leg (Cruiser) ergometer

The measurement of physical fitness of lower limb amputees is difficult, as the commonly used ergometer tests have limitations. A combined arm-leg (Cruiser) ergometer might be valuable. The aim of this study was to establish the repeatability and validity of the combined arm-leg (Cruiser) ergometer. Thirty healthy volunteers carried out three incremental exercise tests, once on the bicycle ergometer and twice on the Cruiser ergometer. The repeatability of the Cruiser ergometer was assessed by studying the mean values of the test-retest and the validity by studying the mean values of the bicycle and the two Cruiser ergometer tests. The intraclass correlation coefficient for repeated measurements on the Cruiser ergometer was 0.84 for the maximal oxygen consumption (V-O2max), and 0.71 for the maximal heart rate (HRmax). The intraclass correlation coefficient for the measurements on the bicycle ergometer and the Cruiser ergometer was 0.86 for the V-O2max and 0.73 for HRmax. Bland and Altman plots for V-O2max and HRmax showed a bias close to zero and a great accuracy. The conclusion of this study is that the Cruiser ergometer provides a repeatable and valid measurement of physical fitness in healthy volunteers. Its value in clinical practice for lower limb amputees needs to be further established

Hyperresponsiveness as a Determinant of the Outcome in Chronic Obstructive Pulmonary Disease

A better outcome of patients with chronic obstructive pulmonary disease (COPD) appears to be determined by higher FEV1, smoking cessation, lower airway hyperresponsiveness, and, at least in the presence of therapy, with a higher reversibility of airflow obstruction. In our opinion, these findings provide a firm ground for smoking cessation and most likely for institution of early treatment directed at both the reversible part of airflow obstruction and airway hyperresponsiveness in patients with COPD. But there are large gaps in our understanding of the effects of bronchodilator and antiinflammatory drugs on airway hyperresponsiveness. After acute administration, sympathomimetics cause a larger reduction of airway hyperresponsiveness than do anticholinergics, both in asthma and in COPD. What happens after longer periods of treatment is not yet clear in COPD, whereas in asthma there may occur a deterioration of airway responsiveness. Corticosteroids appear to have a beneficial effect on lung function and the severity of airway hyperresponsiveness in asthma. In COPD, however, no definite conclusion can be drawn as to the beneficial effect of corticosteroids, but short-term effects are not promising. The available data from the literature strongly suggest the need for long-term studies with large groups of patients in order to assess a potential treatment effect. In this way, also, a subgroup of patients with COPD who improve with corticosteroids and/or bronchodilators may be found. It seems advisable to include both subjective (i.e., quality of life, complaints, symptoms) and objective (i.e., hospitalization, survival, FEV1, PEFR, PC20, and reversibility) data as investigational tools for outcome analysis

Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine the relationship between general anxiety and dyspnea on exertion in patients with COPD. Ninety patients with stable COPD participated; 44 men, mean age 61 (standard deviation (SD) 10.4), and mean forced expiratory volume in 1 second (%pred.) 40.5 (SD 16.9). All participants performed pulmonary function tests and an incremental cycle ergometry. The Modified Borg Scale was used to measure the level of dyspnea on exertion. Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale. Data were analyzed using Spearman's correlations and multivariate regression. Dyspnea on exertion was correlated with general anxiety (r = .31), age (r = -.30), and exercise capacity (r = .27). Regression analysis showed that general anxiety was associated with dyspnea on exertion, adjusted for sex, age, baseline dyspnea, and exercise capacity. Consequently, it is reasoned that results of exercise training and activities in daily living may be influenced negatively by anxiety-worsened dyspnea. Attention should be given to anxiety management in patients with COPD to optimize exercise training

Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD

Background: Long-term non-invasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure. A study was undertaken to investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation improves health-related quality of life, functional status and gas exchange compared with pulmonary rehabilitation alone in patients with COPD with chronic hypercapnic respiratory failure. Methods: 72 patients with COPD were randomly assigned to nocturnal NIPPV in addition to rehabilitation (n = 37) or rehabilitation alone (n = 35). Outcome measures were assessed before and after the 3-month intervention period. Results: The Chronic Respiratory Questionnaire total score improved 15.1 points with NIPPV + rehabilitation compared with 8.7 points with rehabilitation alone. The difference of 7.5 points was not significant (p = 0.08). However, compared with rehabilitation alone, the difference in the fatigue domain was greater with NIPPV + rehabilitation (mean difference 3.3 points, p<0.01), as was the improvement in the Maugeri Respiratory Failure questionnaire total score (mean difference -10%, p<0.03) and its cognition domain (mean difference -22%, p<0.01). Furthermore, the addition of NIPPV improved daytime arterial carbon dioxide pressure (mean difference -0.3 kPa; p<0.01) and daily step count (mean difference 1269 steps/day, p<0.01). This was accompanied by an increased daytime minute ventilation (mean difference 1.4 l; p<0.001). Conclusion: Non-invasive ventilation augments the benefits of pulmonary rehabilitation in patients with COPD with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life, functional status and gas exchange

The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study

Objective: To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation. Methods: Twenty-one chronic obstructive pulmonary disease (COPD) patients were randomized to an experimental group that followed a regular rehabilitation program plus the counseling intervention or to a control group that only followed rehabilitation. The primary outcome was daily physical activity assessed by pedometers. Secondary outcomes were physical fitness, health-related quality of life, activities of daily living, depression and self-efficacy. Results: The experimental group showed an increase of 1430 steps/day (+69% from baseline), whereas the control group showed an increase of 455 steps/day (+19%) (p = 0.11 for group x time interaction). The secondary outcomes showed no differences. Conclusion and practice implications: This study showed that the use of the pedometer, in combination with exercise counseling and the stimulation of lifestyle physical activity, is a feasible addition to pulmonary rehabilitation which may improve outcome and maintenance of rehabilitation results. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

Objective: Perceptions of mastery and self-efficacy may be related to better outcomes in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). This study examined (1) whether patients with COPD improved during a rehabilitation programme with respect to quality of life (QoL) and perceptions of self-efficacy and mastery, and (2) whether increased perceptions of mastery and self-efficacy contributed to a higher QoL after rehabilitation. Methods: Thirty-nine consecutive CCPD patients (aged 60.5 +/- 9.0) were included from a rehabilitation centre and completed self-report questionnaires assessing symptoms, QoL, and perceptions of personal control. Results: COPID patients improved during rehabilitation in overall QoL and self-efficacy, although no significant changes were found in QoL domains and mastery. Changes in self-efficacy during rehabilitation contributed to the explanation of the social and psychological functioning QoL domains. Conclusion: Even in seriously impaired COPD patients in advanced stages of illness, positive changes in self-efficacy and overall well-being can be established during rehabilitation. Changes in self-efficacy were related to a better QoL, suggesting the importance of personal control in the adjustment to CCPD. Practice implications: Focussing more explicitly on the enhancement of perceptions of personal control in CCPD patients may be an important aim of pulmonary rehabilitation. (c) 2005 Elsevier Ireland Ltd. All rights reserved