Adherencia a un programa domiciliario de rehabilitación respiratoria / Adherence to a home-based pulmonary rehabilitation program

Desde 1996, el Hospital del Tórax Dr. Antonio A. Cetrángolo aplica un programa de rehabilitación respiratoria, el cual requiere la concurrencia al hospital, dos veces por semana, de los pacientes con enfermedad respiratoria crónica. En 2015, se desarrolló el programa domiciliario (PD) para pacientes que viven a más de 10 km del hospital, o necesitan más de 60 minutos de viaje, o trabajan y tienen incompatibilidad de horarios con el programa hospitalario. Se realizó un estudio retrospectivo con el objetivo de describir la adherencia al programa domiciliario de pacientes con enfermedad respiratoria crónica y explorar los factores relacionados. En 2017, 96 de 127 (75.6%) pacientes elegibles para rehabilitación respiratoria fueron asignados al programa domiciliario y se les indicó cumplimentar al menos tres sesiones semanales de ejercicios de resistencia aeróbica, fuerza segmentaria de miembros superiores e inferiores y flexibilidad; y concurrir al hospital cada 20 o 30 días; a la quinta visita se realizó la reevaluación. Se consideró "adherencia al PD" cuando el paciente completaba la misma. El 40.6% (n = 39) solo asistió a la evaluación inicial y un 23% (n = 22) adhirió al programa. El grupo adherente presentó, al inicio, mejor FVC (p = 0.013), menor score de disnea (p = 0.008), menos de dos o más exacerbaciones en los seis meses previos (p = 0.032). Un solo paciente necesitaba tres o más transportes para llegar al hospital (p = 0.006). Los resultados sugieren que la adherencia al programa domiciliario se relacionó con mejor situación clínica y mejor accesibilidad a la institución.

Since 1996, the Hospital del Tórax Dr. Antonio A. Centrángolo conducts a pulmonary rehabilitation program that requires patients with chronic pulmonary disease to attend the hospital twice a week. In 2015 the home-based program (HBP) was developed for patients living more than either 10 km or 60 minutes away from the hospital, or with conflicting working schedules. A retrospective study was conducted to describe the adherence to the home-based program by patients with chronic pulmonary disease, and explore adherence-related factors. In 2017, 96 (75.6%) of 127 patients eligible for pulmonary rehabilitation were assigned to the home-based program; they were instructed to complete at least three exercise sessions a week -including aerobic and resistance, segmental strength of upper and lower limbs, and flexibility-; and attend hospital visits every 20 to 30 days; "adherence to the HBP" was determined for patients who attended their final assessment on the fifth visit. A 40.6% (n = 39) of the patients only attended the first visit; 23% (n = 22) adhered to the program. This latter group of patients had shown, at their first assessment, better FVCs (p = 0.013), lower dyspnea scores (p = 0.008), and less than two or more exacerbations during the previous 6 months (p = 0.032). Only one patient needed to take three or more different transportation services to reach the hospital (p = 0.006). The results suggest that adherence to the home-based program was associated to a better clinical status and better access to the hospital.

Hospital-Based Pulmonary Rehabilitation was More Effective Than Home-Based Pulmonary Rehabilitation in Improving Quality of Life Among Chronic Obstructive Pulmonary Disease (COPD) / Jurnal Sains Kesihatan Malaysia

This study identified the effectiveness between home-based and hospital-based pulmonary rehabilitation program on the quality of life of chronic obstructive pulmonary disease (COPD) patients. Thirty five patients who met the inclusion criteria were referred by physicians and randomized to either hospital-based pulmonary rehabilitation (PRPH) or home-based pulmonary rehabilitation (PRPR). The PRPH program was scheduled twice a week for eight weeks at the Physiotherapy Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Whilst, the PRPR group was required to attend sessions at the Physiotherapy Department twice to learn the exercise regimens before carrying out the exercises themselves at home. Subjects were asked to record activitites in a diary and a telephone call was made once every two weeks to ensure compliance towards the exercise regimens. The SF-36 questionnaire and Geriatric Depression Scale were outcome measures used in assessing status of patients prior to treatment and after intervention at the 8th week Seventeen (48.6%) subjects completed the PRPH and 15 (43%), the PRPR. Results indicated that in the PRPH group there were significant improvements in some of the domains of SF-36, i.e., role physical (p = 0.012) body pain (p = 0.040), general health (p = 0.008) and role emotional (p = 0.012). In the PRPR group, the Geriatric Depression Scale mean score was 1.8 ± 0.41 at baseline compared to 1.69 ± 0.48 following intervention (p > 0.05). Whilst, among the PRPH group, the mean was 1.87 ± 0.35 at baseline and 1.53 ± 0.52 after eight week (p < 0.05). In conclusion, hospital-based pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the quality of life and reducing depression among patients with COPD.

Development of the Home-Based Pulmonary Rehabilitation Program for Patients with Chronic Lung Disease / 결핵

BACKGROUND:Even though it is well known that pulmonary rehabilitation (PR) improves exercise capacity, and the quality of life, in patients with chronic lung disease, not many patients can attend hospital based intensive PR in Korea. The purpose of this study was to develop a method for a home-based PR program, and study its effectiveness. METHODS:Twenty patients with chronic lung diseases were randomly divided into two groups : a home PR group comprising of 10 male patients, with a mean age of 70 years, and a control group comprisiong of 10 male patients, with a mean age of 65 years. We developed exercise programs, depending on the exercise capacity of each patient, which were easy to do at home. The PR program consisted of a 12 week period of enforced aerobic (mostly walking) and muscle strengthening exercises, as prescribed by the exercise specialist, in accordance with the functional capacity of the patient. In addition to the education, nutritional and psychiatric consultation was undertaken, and respiratory muscle training arranged. Patients visited hospital every 2 weeks for evaluation and exercise prescription. RESULTS: All patients finished the 12 week course of therapy. Following the home PR, the endurance times and work capacity of the upper and lower extremities were significantly increased in the treatment group in comparison to the controls. The six minute working (Eds note : should) 'working' read 'walking'?) distance was increased from 465+/-60m to 508+/-37m and the maximal inspiratory pressure from 72.8+/-27.2cmH2O to 91.4+/-30.9 cmH2O. The quality of life, as assessed by St Georges Respiratory Questionnaire (SGRQ), was also improved following PR. (Eds note : do you have figures for before and after, and a reference for the SGRQ? i.e. for the main paper.) CONCLUSION: The home PR program we developed seemed to be applicable, and effective, to most of the patients with chronic lung diseases in the study.

Development of the Home-Based Pulmonary Rehabilitation Program for Patients with Chronic Lung Disease / 결핵

BACKGROUND:Even though it is well known that pulmonary rehabilitation (PR) improves exercise capacity, and the quality of life, in patients with chronic lung disease, not many patients can attend hospital based intensive PR in Korea. The purpose of this study was to develop a method for a home-based PR program, and study its effectiveness. METHODS:Twenty patients with chronic lung diseases were randomly divided into two groups : a home PR group comprising of 10 male patients, with a mean age of 70 years, and a control group comprisiong of 10 male patients, with a mean age of 65 years. We developed exercise programs, depending on the exercise capacity of each patient, which were easy to do at home. The PR program consisted of a 12 week period of enforced aerobic (mostly walking) and muscle strengthening exercises, as prescribed by the exercise specialist, in accordance with the functional capacity of the patient. In addition to the education, nutritional and psychiatric consultation was undertaken, and respiratory muscle training arranged. Patients visited hospital every 2 weeks for evaluation and exercise prescription. RESULTS: All patients finished the 12 week course of therapy. Following the home PR, the endurance times and work capacity of the upper and lower extremities were significantly increased in the treatment group in comparison to the controls. The six minute working (Eds note : should) 'working' read 'walking'?) distance was increased from 465+/-60m to 508+/-37m and the maximal inspiratory pressure from 72.8+/-27.2cmH2O to 91.4+/-30.9 cmH2O. The quality of life, as assessed by St Georges Respiratory Questionnaire (SGRQ), was also improved following PR. (Eds note : do you have figures for before and after, and a reference for the SGRQ? i.e. for the main paper.) CONCLUSION: The home PR program we developed seemed to be applicable, and effective, to most of the patients with chronic lung diseases in the study.