Self-management interventions for people with pulmonary fibrosis: A scoping review

Introduction/Aim: Self-management is considered important in people with pulmonary fibrosis (PF);however, components of self-management that are relevant to PF are not well defined. This study aimed to identify the common self-management components used in PF. Method(s): A scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The protocol was registered with Open Science Framework database (doi: https://doi.org/10.17605/OSF.IO/EUZ6S). A systematic search was conducted on August 16, 2022, using five electronic databases (Medline, Embase, PsychInfo, CINAHL and the Cochrane central register of controlled trials). Search results were screened and studies were included if they (i) described any educational, behavioural and support components that aimed at facilitating self-management;(ii) involved adults with PF;and (iii) employed quantitative, qualitative or mixed methods. Two researchers performed record screening and data extraction independently followed by discussions of discrepancies. Result(s): Of the 27081 records screened, 87 studies were included (39% observational studies, 26% randomised controlled trials). The most common self-management components were patient education (78%), information or support for managing physical symptoms (66%) and enhancing psychosocial wellbeing (54%). Majority of the included studies (71%) were rehabilitation programs with evidence of self-management training such as home exercise program and breathing training. Other studies included palliative care programs consisting of components such as patient education and care goal setting (12%), support programs for managing medication (4%), home-based self-monitoring training (4%), disease management programs (4%), mindfulness-focused stress reduction program (1%), telemedicine service delivered during the COVID-19 outbreak that included strategies to prevent infections and self-monitoring of clinical parameters (1%) and PF-specific educational and support website (1%). Over half of the interventions were provided by a multidisciplinary team. Conclusion(s): This review identified the common components used to promote self-management in PF. These findings help to guide the development of optimal interventions to support self-management in PF.

Comparison between in-person and remote assessment of four field tests for people with chronic lung diseases

Introduction: COVID-19 pandemic has driven an abrupt shift from centre-based pulmonary rehabilitation to home-based or telerehabilitation models in order to safely deliver this important treatment. However, functional capacity assessment is still carried out with in-person supervision. Aim(s): To compare remote and in-person assessment of four field tests for patients with chronic lung diseases. Method(s): People with chronic respiratory diseases underwent timed up and go test (TUG), 5-repetitions sit-to-stand test (5-repStS), 1-minute STS (1-minStS), and modified incremental step test (MIST). Tests were carried out at participants' home with in-person or remote (Skype or WhatsApp) assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation centre. The order of the tests was also randomized and was the same for in-person and remote supervision. Each test was performed twice and the test with best performance was used for comparison between remote and in-person supervision. A kit containing a finger pulse oximeter, tape measure, and a step was provided. Pair t -test expressed as mean difference (95% CI), intraclass correlation coefficient (ICC 2:1), and Bland-Altman method were used for analysis. Result(s): Forty-four participants (23 COPD, 18 bronchiectasis, three cystic fibrosis, FEV 1 47 +/- 19%, 56 +/- 15 years old) were assessed. There was no difference between in-person and remote supervision for all tests (TUG 0.04(-0.2-0.2) s, 5-repStS: 0.3(-0.1-0.7) s, 1-minStS: -0.9 (-1.9-0.1) repetitions, and MIST: -3.1 (-9.9-3.7) steps). High reproducibility was observed by ICC (95% CI) (TUG: 0.94 (0.89-0.97), 5-repStS: 0.96 (0.92-0.98), 1-minStS: 0.87 (0.77-0.93), and MIST: 0.94 (0.88-0.96). Limits of agreement were narrow for TUG (-0.8-1.7), 5-repStS (-2.3-2.9), and 1-minStS (-7.4-5.5), but wide for MIST (-46-40). Conclusion(s): Remote assessment provides similar results to in-person assessment for four field tests commonly used in people with chronic lung diseases.

Validity and test-retest reliability of field tests carried out by teleassessment of children and adolescents with cystic fibrosis

Background: The COVID-19 pandemic led to the rapid adoption of alternative evaluation methods for measuring functional capacity in people with cystic fibrosis, who are at high risk for severe COVID-19 outcomes. Teleassessment may be an alternative to conducting in-person field tests in this population. Objectives : To investigate the validity, reliability, and safety of field tests conducted by teleassessment in children and adolescents with cystic fibrosis. Method(s): Participants underwent three functional tests: 3-min step test (3-min ST), 1-min sit-to-stand test (1-min StS), and a timed up-and-go (TUG) test performed in their homes with in-person and remote assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation center. The order of the tests was randomized and the same in both assessments. For validity, main outcomes were compared between in-person and remote supervision by Wilcoxon test for 3-min ST and TUG, expressed as median (IQR), and pair t -test for 1-min StS, expressed as mean (SD). For test-retest reliability (test 1 vs. test 2) of the remote tests, intraclass correlation coefficient (ICC 2,1) and Bland-Altman analysis were used. Result(s): Thirty-two participants (15 boys, 11 +/- 3 years, FEV 1 73 +/- 17% of predicted) were included. No significant difference was observed between in-person and remote supervision (3-min ST: 88 [83.5-90] vs. 88 [82.5-90] steps;1-min StS: 33(7) vs. 32(8) repetitions;TUG: 6.5 [5.6-8.0] vs. 6.6 [5.7-7.9] s). Test-retest of remote supervision demonstrated very good to excellent reliability for all field tests (ICC (95%CI) 3-min ST: 0.88 [0.65-0.95], 1-min StS: 0.86 [0.67-0.94], and TUG: 0.76 [0.41-0.89]). Mean difference (lower-upper limits of agreement) were 3-min-ST: -3.6 (-13.9-6.7) steps, 1-min StS: -1.9 (-8.6-4.7) repetitions, and TUG: 0.8 (-1.4-2.9) s. No adverse events were reported. Conclusion(s): In children and adolescent with cystic fibrosis, 3-min ST, 1-min StS, and TUG are valid, reliable and safe when carried out by teleassessment.

Telerehabilitation in the 'real-world': Implementation of remotely delivered pulmonary rehabilitation

Introduction: Pulmonary rehabilitation (PR) is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. Home-based telerehabilitation achieves similar clinical outcomes to centre-based PR in clinical trials. We aimed to evaluate the clinical implementation of telerehabilitation. Method(s): Suitable individuals with respiratory disease referred for PR at Alfred Health have been offered the option of an 8-week home-based telerehabilitation program (one home visit followed by twice-weekly exercise training sessions, with real time supervision, for 8-weeks). Equipment was provided to patients, as necessary. Standard PR assessments were conducted pre and post program. Program completion was defined as undertaking >=70% of prescribed sessions. Real-world implementation was evaluated against the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Result(s): Reach: Across 2-years (Sept 2020-22), 269 people were referred with 55 (21%) undertaking telerehabilitation (25 female, mean (SD) age 61 (11) years, 6-min walk distance (6MWD) 430 (120) metres, Chronic Respiratory Questionnaire Dyspnoea (CRQD) domain 16 (6)). Participant diagnoses included COPD (n = 11), ILD (n = 15), bronchiectasis (n = 5), asthma (n = 2), post COVID-19 (n = 9), and pulmonary hypertension (n = 4). Forty participants (73%) completed >=70% of prescribed sessions. Effectiveness: Significant and clinically meaningful improvements were demonstrated (CRQD MD 4 (95% CI 1, 6);6MWD MD 24 m (95% CI 8, 41)). Adoption: Training to deliver telerehabilitation and perform home visits was completed by PR clinicians (n = 7 and n = 4 respectively). Implementation: All participants independently supplied Wi-Fi, and 40% used their own exercise equipment or internet-enabled device. Most participants had an in-person home visit (n = 45), and undertook cycle-based training (n = 46). Fifteen participants required additional support for iPad or videoconferencing navigation. There were no serious adverse advents. Maintenance will be evaluated following this pilot period. Conclusion(s): 'Real-world' telerehabilitation achieves clinically meaningful outcomes for patients and provided access to an effective model of PR particularly when centre-based programs were unavailable due to COVID-19 restrictions.

WEB-BASED YOGA-PILATES REDUCES STRESS URINARY INCONTINENCE

Introduction: Stress urinary incontinence (SUI) occurs in part due to a weakened urethral rhabdosphincter. Yoga and Pilates are low-impact workouts that use bodyweight as resistance, and limited evidence shows these exercises improve pelvic muscle strength and decrease incontinence episodes. Objective: The study objective was to evaluate the effect of an 8-week web-based yoga-Pilates exercise program on SUI severity as measured by the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and secondarily to evaluate the potential mechanism of action for yoga-Pilates through ultrasound measurement of the urethral rhabdosphincter cross-sectional area (CSA). We hypothesized that yoga-Pilates would decrease SUI severity and cause hypertrophy of the urethral rhabdosphincter. Methods: This was a prospective interventional cohort study from November 2020 through September 2021. The intervention was an 8-week home yogaPilates web-based video that tracked and prompted participation. Participants with SUI underwent in-person visits pre/post-intervention during which they completed quality of life and severity surveys and underwent pelvic exam, including POP-Q, cough stress test, Brink pelvic floor strength score, and resting 3-dimensional transperineal ultrasound [1]. Ultrasound images were masked and measured post-collection. The rhabdosphincter is located in the middle third of the urethra, so 5 CSA measurements were taken: at the midpoint and then at 2.5 mm and 5 mm cranial and caudal from the midpoint [1]. The urethral CSA was determined by subtracting luminal/submucosal area from total urethral area (Figure 1). Pre/post 24-hour voiding diaries and an automated video viewing log were also collected. The study was powered to detect a mean change of 2.0 ± 4.0 ICIQ UI-SF score units and a mean CSA increase of 0.25 ± 0.6 cm2 with 48 compliant participants. All pre/post- intervention changes were analyzed using paired t-tests with a null change of zero. Results: 78 women, ages 46.6 + 10.4 years, enrolled. 60 women completed the study. The cohort was predominantly premenopausal (67%), vaginally parous (65%), and had done yoga (76%) and/or Pilates (44%) in the past. 73% of the completers performed the exercises at least 3x/week. The ICIQ-UI SF score improved from 9.5 (95% CI 8.7-10.4) to 7.1 (95% CI 6.3-7.9) post-intervention (P < 0.001). The number of incontinence episodes decreased post-intervention from 1 (IQR 1-3) to 1 (IQR 0-1) (P < 0.001). The Brink score also improved from 7.1 (95% CI 6.6-7.7) to 7.7 (95% CI 7.2-8.2) (P = 0.013). Participants were very satisfied with the online exercises. The majority (83%) of completers also reported they were “a little better”, “much better”, or “very much better” on patient global impression of improvement. There were no significant changes in urethral measurements from pre- to post-intervention. Conclusions: Although there were no changes in the urethral rhabdosphincter, this web-based yoga-Pilates exercise program improved symptoms of SUI and decreased number of incontinence episodes in women with SUI over 8 weeks. Web-based yoga-Pilates offers women with SUI a nonsurgical treatment that can be performed at home, which is beneficial in the ongoing COVID-19 pandemic.

Public health measures for preventing exacerbations of chronic lung disease

Introduction/Aim: Fewer exacerbations of chronic lung disease during the COVID-19 pandemic may be due to the introduction of measures to prevent SARS-CoV-2 transmission and the associated lower prevalence of other respiratory viruses. Our aim was to determine the acceptability of continuing with (COVID-19) infection control measures to lower future exacerbation risk. Methods: Adults with chronic lung disease in Australia were asked via an online survey to specify the infection control measures and policies that should continue, during the flu season or at all times, once most of the population have received the COVID-19 vaccine. Pre-specified thresholds: general support for measure: ≥66% of respondents;absence of significant support: ≤33%;meaningful difference between lung disease groups: ≥10%. Results: 137 people (asthma = 29, bronchiectasis = 29, COPD = 58, ILD = 21) from all Australian states and territories participated. Mean (SD) MRC breathlessness score was 2.4(1.0) and 75% were Female. 94% and 85% reported COVID-19 (86% two doses) and flu vaccination respectively. The table summarizes all survey responses. Responses were generally consistent across lung disease groups, except those with bronchiectasis were more supportive of continuation of face coverings on public transport (66%) and people with asthma would continue to physically distance outdoors (69%). People with ILD did not support (30%) face coverings outdoors during flu season but were supportive (75%) of healthcare staff wearing masks. People with bronchiectasis (24%) did not support a policy of physically distancing outdoors for everyone at all times. Conclusion: Adults with chronic lung diseases in Australia are supportive of physically distancing indoors and hand hygiene as measures to reduce exacerbations. There was lack of support for widespread continuation of face coverings but policies for use on public transport during the flu season were acceptable. Avoidance of busy places and friends/ family who are unwell with colds/flu are strategies they will adopt when majority of the population are vaccinated for COVID-19. (Figure Presented).

The presentation, course and outcome of COVID-19 infection in people with Prader-Willi syndrome: unexpected findings from an international survey.

BACKGROUND: Prader-Willi syndrome (PWS), is a genetically determined neurodevelopmental disorder, associated with intellectual disabilities and a high incidence of obesity, diabetes mellitus, and respiratory disorders. We hypothesised that COVID-19, a viral infection which more severely affects people with these conditions, would, in people with PWS, present atypically and result in severe outcomes. METHOD: A structured on-line questionnaire was piloted with parents and professionals at the International Prader-Willi Syndrome Organization (IPWSO) and promoted internationally through their global network. Family members/other carers were asked to complete if someone they cared for with PWS was strongly suspected or confirmed as having COVID-19. RESULTS: Over 1 year of the pandemic 72 responses were received, 47 adults, 25 children. The following underlying conditions were present: 16 people with PWS were overweight and 18 obese, five had diabetes mellitus and 18 sleep apnoea. Main presenting symptoms were raised temperature, fatigue/daytime sleepiness, dry cough, headache/pain, and feeling unwell, with illnesses generally lasting less than a week. Length of illness was not significantly related to age, BMI, sex, or genetic subtype. No one was ventilated or in an intensive care unit or died, one person was in hospital for four days needing oxygen. CONCLUSIONS: Contrary to our hypothesis, the PWS cohort had asymptomatic infection or mild illness. A possible explanation, supported by anecdotal evidence from parents and professional carers, is that people with PWS have a degree of innate immunity to viral infections. However, likely selection effects and a relatively low number of responses means that further evidence is needed to test this hypothesis.

Early rehabilitation during extracorporeal membrane oxygenation has minimal impact on physiological parameters: A pilot randomised controlled trial.

BACKGROUND: Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to their severity of illness along with the care required to maintain the position and integrity of the ECMO cannula. Many patients on ECMO receive passive exercises, and rehabilitation is often delayed owing to medical instability, with a high proportion of patients demonstrating severe muscle weakness. The physiological effects of an intensive rehabilitation program started early after ECMO commencement remain unknown. OBJECTIVES: The primary objective of this study was to describe the respiratory and haemodynamic effects of early intensive rehabilitation compared with standard care physiotherapy over a 7-d period in patients requiring ECMO. METHODS: This was a physiological substudy of a multicentre randomised controlled trial conducted in one tertiary referral hospital. Consecutive adult patients undergoing ECMO were recruited. Respiratory and haemodynamic parameters, along with ECMO settings, were recorded 30 min before and after each session and continuously during the session. In addition, the minimum and maximum values for these parameters were recorded outside of the rehabilitation or standard care sessions for each 24-h period over the 7 d. The number of minutes of exercise per session was recorded. RESULTS: Fifteen patients (mean age = 51.5 ± standard deviation of 14.3 y, 80% men) received ECMO. There was no difference between the groups for any of the respiratory, haemodynamic, or ECMO parameters. The minimum and maximum values for each parameter were recorded outside of the rehabilitation or standard care sessions. The intensive rehabilitation group (n = 7) spent more time exercising per session than the standard care group (n = 8) (mean = 28.7 versus 4.2 min, p < 0.0001). Three patients (43%) in the intensive rehabilitation group versus none in the standard care group mobilised out of bed during ECMO. CONCLUSIONS: In summary, early intensive rehabilitation of patients on ECMO had minimal effect on physiological parameters.

Canadian university students' perceptions of COVID-19 severity, susceptibility, and health behaviours during the early pandemic period.

OBJECTIVES: We surveyed university students to assess their demographic factors, perceived severity, personal susceptibility, and the adoption of health behaviours in relation to COVID-19. STUDY DESIGN: Ethics approval was obtained from the University of Toronto's Research Ethics Board (#39169). Responses were collected between March 20 and April 17, 2020, capturing the first month of government-mandated social distancing in Ontario, Canada. METHODS: We distributed the online survey to the University of Toronto student population, yielding a total convenience sample of 592 participants. We summarised the results and conducted Mann-Whitney U and Kruskal-Wallis tests to explore relationships between demographic data and perceived severity of COVID-19. Pearson's Chi-square tests were used to explore the relationship between demographic variables and perceived susceptibility, with phi being used to explore the strength of the association. A value of p â€‹< â€‹0.05 was used to determine significance. RESULTS: The majority of participants (60.1%) judged COVID-19 to be Very Severe; there was a significant relationship between being female and the adoption of new health behaviours. 57.4% indicated they felt susceptible to COVID-19, while 40.9% did not. Feeling susceptible was associated with studying a healthcare field or being personally affected by COVID-19. Individuals who stated they were not susceptible to COVID-19 declared mitigating factors such as new health behaviours to be a major driver in their perception. CONCLUSION: University students believe COVID-19 is a severe disease and have adopted new and increased health behaviours to mitigate the spread. While this study demonstrates differing health behaviour adoption rates based upon demographic factors, overall this research finds young adults supportive and accepting of government policy as a protective and susceptibility-mitigating measure.

Late Breaking Abstract - Telerehabilitation compared to centre-based pulmonary rehabilitation: a randomised controlled equivalence trial

Background: Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease, but is delivered to <5% of eligible individuals. Due to COVID-19 remote rehabilitation models may be critical for future delivery of services. Aims: To compare the efficacy of home-based telerehabilitation (TR) and centre-based pulmonary rehabilitation (PR) in people with chronic respiratory disease. Methods: Assessor blinded, multi-centre RCT, powered for equivalence. Participants were randomised to centre-based PR or home-based TR. Both programs were 2 sessions/week for 8 weeks. Telerehabilitation used a stationary cycle and group videoconferencing to enable social interaction and real time monitoring. The primary outcome was change in chronic respiratory disease questionnaire dyspnea domain (CRQ-D) at end rehabilitation, with a pre-specified equivalence margin of 2.5 points. Results: We randomised 142 participants to PR (n=72) orTR (n=72). Both groups had clinically important improvements in CRQ-D following rehabilitation (TR mean (95%CI) 4 (2 to 5) vs PR 5 (3 to 7)), however equivalence of TR was not confirmed (mean difference between groups (MD) -1 point (-3 to 1)), with similar findings at 12 month followup (MD -1 point (-4 to 1)). The 6-minute walk distance (6MWD) was equivalent at end rehabilitation (MD -6 metres (-26 to 15) and at 12 months superiority of TR could not be excluded (MD 14 metres (-10 to 38). The proportion of participants who completed >70% of prescribed sessions was high (84% TR vs 79% PR). Conclusions: Home-based TR achieved clinically important gains in health-related quality of life, but equivalence to centre-based PR was not confirmed.

[Recommendations for Performing Bronchoscopy in Times of the COVID-19 Pandemic - Update 12/2020]. / Empfehlungen zur Durchführung einer Bronchoskopie in Zeiten der COVID-19-Pandemie: Update 12/2020.

The SARS-CoV-19 pandemic continues to be globally related with significant morbidity and mortality, making protective measures to prevent transmission of the virus still necessary. Healthcare employees are exposed to a higher risk of infection and this is particularly true when performing aerosol-generating procedures such as bronchoscopy.Since the publication of recommendations for performing a bronchoscopy in the times of COVID-19 more than six months ago, the risk situation has not changed significantly, but due to the considerable gain in knowledge in the meantime, an update of the recommendations was necessary.The updated recommendations include the reduction of aerosol formation, the personal protection of the people involved in the procedure, as well as measures to better organize the processes in the endoscopy suite in order to perform bronchoscopic procedures securely even in times of COVID-19.

[Recommendations for Performing Bronchoscopy in Times of the COVID-19 Pandemic]. / Empfehlungen zur Durchführung einer Bronchoskopie in Zeiten der COVID-19-Pandemie.

COVID-19, caused by coronavirus SARS-CoV-2 is a new and ongoing infectious disease affecting healthcare systems worldwide. Healthcare worker are at high risk for COIVD-19 and many have been infected or even died in countries severely affected by COVID-19 like China or Italy. Bronchoscopy causes cough and aerosol production and has to be considered a significant risk for the staff to get infected. Particular recommendations should guide to prevent spreading COVID-19 and to protect healthcare worker when performing a bronchoscopy.