Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors. It has been proven beneficial in reducing dyspnea and improving functional capacity and quality of life for patients with stable chronic respiratory disease. However, recent randomized clinical trials reported conflicting results on the timing of intervention, protocol and effectiveness of acute exacerbation or intensive care unit pulmonary rehabilitation to improve patient outcomes. We should find a balance between " dynamic” and " static” to maximize the benefit of patients from early pulmonary rehabilitation.
Objective To investigate the knowledge level about pulmonary rehabilitation in respiratory physicians in Shanghai. Methods A self-designed questionnaire about pulmonary rehabilitation was sent to respiratory physicians in 18 tertiary-care referral hospitals of Shanghai from June to September 2011. Results A total of 237 valid questionnaires were collected. Accuracy rate of single-answer questions was(62.1±18.3)% , while correct rate of multiple-answer questions ( more than one answer) was ( 35.5±15.6) % . Neither working years nor doctor rank had correlation with accuracy of questionnaires. Conclusion The knowledge about pulmonary rehabilitation in respiratory physicians of Shanghai was poor. We need to strengthen the relevant training and continuing education.
ObjectiveTo investigate the effects of pulmonary rehabilitation on the exercise capacity and quality of life in patients with stable chronic obstructive pulmonary disease (COPD) for a optimal strategy for pulmonary rehabilitation. MethodsOne hundred and six patients with COPD in stable stage were divided into group B (n=37), group C (n=36), and group D(n=33) based on GOLD 2011.Each group of patients were randomly subdivided into a control group(usual care), a pulmonary rehabilitation strategy group 1 (breathing training), and a pulmonary rehabilitation strategy group 2 (breathing training and exercise training), and they were intervened for 24 weeks.Pulmonary function(FEV1%pred), COPD Assessment Test (CAT), modified British Medical Research Council dyspnea scale(mMRC), BODE index and 6-minute walking distance(6MWD) were compared before and after intervention. ResultsAfter pulmonary rehabilitation intervening for 24 weeks, in group B and group C, pulmonary rehabilitation strategy group 2 showed the best effect, CAT, mMRC, BODE index, and 6MWD were proved significantly different before and after pulmonary rehabilitation (P < 0.05).In group D, all indexes had no significant difference between pulmonary rehabilitation strategy group 1 and group 2 before and after pulmonary rehabilitation (P > 0.05), but they were better than those of the control group.Correlation analysis showed that CAT score had significant correlation with FEV1 % pred, mMRC, BODE index and 6MWD (P < 0.01). ConclusionPatients with different subgroup of COPD based on GOLD 2011 may take different pulmonary rehabilitation strategies to achieve the optimal effect.
Objective To examine the effects of pulmonary rehabilitation training on pulmonary function in patients post-stroke. Methods We searched Cochrane Library, PubMed, ProQuest, Embase, China National Knowledge Infrastructure, Wangfang Database, Chinese Biomedical Database, and VIP Chinese Science and Technology Journal Database for randomized controlled trials of investigating the effects of pulmonary rehabilitation training on pulmonary function in stroke patients published before September 2018. The patients in the training group were treated with pulmonary rehabilitation, including respiratory muscle training, chest breathing, or abdominal breathing training, with or without respiratory training device. The patients in the control group received conventional stroke rehabilitation. The outcome indicators included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 percentage predicted (FEV1%pred), peak expiratory flow rate, maximal inspiratory pressure (PImax), maximal expiratory pressure, exercise endurance, and quality of life. Two researchers independently carried out literature retrieval and data extraction, using Physiotherapy Evidence Database scale, and standard data extraction forms adapted from Cochrane Collaboration model to evaluate the studies quality. The Meta-analysis was performed using Review Manager Version 5.3. Results Eleven studies met the study criteria with a total of 500 stroke patients, including 274 patients in the training group and 226 patients in the control group, respectively. The Meta-analysis showed that after pulmonary rehabilitation training, the values of FVC [mean difference (MD)=0.30 L, 95% confidence interval (CI)(0.26, 0.34) L, P<0.000 01], FEV1 [MD=0.28 L, 95%CI (0.25, 0.32) L, P<0.000 01], and 6-minute walking test [MD=43.43 m, 95%CI (7.92, 78.95) m, P=0.02] in the training group were significantly higher than those in the control group, as well as the change of PImax [MD=6.49 cm H2O (1 cm H2O=0.098 kPa), 95%CI (3.67, 9.32) cm H2O, P<0.000 1]. The advantages of pulmonary rehabilitation training had not been found in improving FEV1/FVC and FEV1%pred (P>0.05). Conclusions The implementation of pulmonary rehabilitation training in the way of respiratory muscle training combined with conventional rehabilitation therapy could improve two kinds of indicators of pulmonary function referring to FVC and FEV1, inspiratory muscle strength and 6-minute waking distance. The long-term effect of pulmonary rehabilitation training on stroke patients, the respiratory training mode of different prescriptions, the endurance of exercise and the quality of life need further study.
Objective To determine if supervised hospital-based exercise can maintain the benefits of functional exercise ability and quality of life gained from a pulmonary rehabilitation program in COPD.Methods A prospective and randomized study was carried out. Following completion of an eight-week pulmonary rehabilitation program in hospital, 43 COPD patients were recruited and randomized into either a supervised group ( supervised, every 10 days, hospital-based exercise, 22 cases ) or a control group ( unsupervised home exercise,21 cases) and followed for 12 months. Measurements were taken at baseline and 12 months later. Exercise measurements include six-minute walk test( 6MWT) and pulmonary function test. Quality of life was measured using the Chronic Respiratory Questionnaire ( CRQ) . Results After 12 months of different exercise program,6MWT in the supervised group was significantly longer than that in the unsupervised group[ ( 532. 0 ±168. 4) m vs ( 485. 0 ±151. 6) m, P lt; 0. 05] . There was no significant difference in pulmonary function between the two groups. The quality of life of the supervised group was higher than that of the unsupervised group( 114. 6 ±20. 8 vs 105. 6 ±21. 7, P lt;0. 05) . Conclusions After the completion of pulmonary rehabilitation program, a supervised, every 10 days, hospital-based following exercise program can maintain better functional exercise capacity and quality of life compared to home exercise in COPD patients.
ObjectiveTo investigate the feasibility and effect of early pulmonary rehabilitation (PR) in patients after acute exacerbation of chronic obstructive pulmonary disease (COPD) in a district hospital. MethodsA single-centre prospective study was conducted. The COPD patients after an episode of acute exacerbation and referred to the outpatient department were recruited from January 2013 to December 2014. They were randomized to a group with PR (PR group) and a group without PR (wPR group). The following data were recorded and evaluated including age, gender, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1 as a percentage of the predicted value (FEV1% pred).The baseline and the post-PR medical research council scale (MRC), St. George's respiratory questionnaire (SGRQ), and six-minute walk distance (6MWD) were also compared. ResultsA total of 91 cases were enrolled with 46 cases in the PR group and 45 cases in the wPR group. The age, gender, the severity of COPD were similar in two groups (P > 0.05). The MRC score and SGRQ score of the PR group were significantly improved 3 months later compare with the baseline (P < 0.05), and did not changed significantly in the wPR group (P > 0.05). There were 26 patients whose SGRQ scores decreased > 4 in the PR group (26/46, 56.5%), which was significantly higher than the wPR group (7/45, 15.6%) (P < 0.05). The 6MWD of the PR group was significantly increased 3 months later compare with the baseline (P < 0.05), and did not changed significantly in the wPR group (P > 0.05). There were 22 patients whose 6MWD increased > 54 meters in the PR group (22/46, 47.8%), which was significantly higher than the wPR group (9/45, 20.0%) (P < 0.05). ConclusionsIt is feasible and safety to perform early PR in patients after acute exacerbation of COPD in the district hospital. The early PR can improve the MRC score, SGQR score, and 6MWD in COPD patients.
Abstract: Objective To evaluate the impact of shortterm preoperative pulmonary rehabilitation (PR) on the exercise capacity of lung cancer patients with moderate to severe chronic obstructive pulmonary disease（COPD）. Methods Between March 2009 and August 2010, 30 lung cancer patients with moderate or severe COPD were treated with preoperative comprehensive PR for two weeks in Department of Thoracic Surgery, West China Hospital. The sample was comprised of 18 males and 12 females with an average age of 62.5±7.7 years. Twelve of the patients had moderate COPD, while 18 had severe COPD. We collected information on the length of postoperative hospital stay for each patient,as well as any pulmonary complications. Results (1) The forced expiratory volume in one second (FEV1), forced expiratory volume in one second % (FEV1%), forced expiratory volume in/ forced vital capacity (FEV1/FVC),and maximal ventilatory volume (MVV) (1.30±0.30 L, 59.19±18.00 L, 47.74±1200 L, 56.63±13.00 L) values after PR were slightly better than those before PR(1.24±0.40 L, 51.89±14.00 L, 46.59±10.00 L, 49.67±13.00 L), but not significantly so(Pgt;0.05). The results for carbon monoxide diffusion capacity were similar. (2) The sixminute walking distance (before: 502.67±157.00 m, after: 594.87±116.00 m), peak expiratory flow (before: 209.33±66.00 L/min, after: 255.33±70.00 L/min), dyspnea index (Borg index) (before: 0.26±0.20, after: 0.12±0.10), and fatigue index (before:0.24±0.20, after: 0.12±0.10) all improved significantly aftercomprehensive PR (Plt;0.05). (3) All 30 patients underwent surgery, and none died during the perioperative period. Eight patients experienced cardiopulmonary complications. The average hospitalization time after surgery was 8.0±2.4 days. Conclusion Preoperative comprehensive PR appears to significantly improve exercise capacity and reduce the rate of postoperative lung complications in lung cancer, patients with lower cardiopulmonary function.
ObjectiveTo systematically evaluate the factors affecting the curative effect of pulmonary rehabilitation in COPD patients,and to provide theoretical basis for the implementation of rehabilitation. MethodsLiterature on the influencing factors of pulmonary rehabilitation efficacy in COPD patients was systematically searched in PubMed,Web of Science,Medline,ProQuest,Embase,CNKI and Wanfang databases from August 30,2023. According to the inclusion and exclusion criteria of the literature,the factors influencing the pulmonary rehabilitation effect of COPD patients were analyzed based on the 5 dimensions of the new implementation comprehensive framework. ResultsA total of 2620 COPD patients with 18 literatures were included in this study. Based on the new CFIR framework,11 promoting factors and 10 hindering factors of pulmonary rehabilitation efficacy were extracted and coded into 5 fields:innovation field,external factor field,internal factor field,individual characteristics field and implementation process field. ConclusionBy applying the new implementation comprehensive framework to evaluate the factors affecting the pulmonary rehabilitation effect of COPD patients,it provides an important reference for the development of rehabilitation strategies for COPD patients. It is suggested to adopt the comprehensive rehabilitation strategy of interdisciplinary,wide field and multi-team in order to promote the best benefit of both individual and social medical system in the pulmonary rehabilitation process of COPD patients.
ObjectiveTo observe the curative effect of pulmonary rehabilitation in patients with stable moderate to severe chronic obstructive pulmonary disease (COPD).MethodsSixty-four patients with stable moderate to severe COPD who visited during January 2016 and December 2017 were recruited in the study. They were randomly divided into an observation group and a control group, with 32 cases in each group. The spirometry was conducted in all patients. The right deep inspiratory end diaphragm thickness and the quiet end expiratory diaphragm thickness were measured by ultrasound, and the diaphragm thickness fraction (DTF) was calculated. The routine drug treatment was given in both groups. The comprehensive pulmonary rehabilitation treatment was given in the observation group (include breath training, exercise training, health education and nutrition guide). The pulmonary function, diaphragm function, severity and quality of life were evaluated before and 6 months later after the treatment.ResultsIn the observation group, the predicted value of forced expiratory volume in one second (FEV1%pred), FEV1/FVC ratio and DTF were all significantly improved compare with before treatment and the control group (all P<0.05). While the BODE index was significantly declined compare with before treatment and the control group (all P<0.05).ConclusionPulmonary rehabilitation treatment can help improve pulmonary function, diaphragm function, condition of the disease and quality of life.
Objective To investigate the effect of aerobic combined with resistance training on exercise capacity and quality of life in patients with severe or very severe chronic obstructive pulmonary disease (COPD). Methods Thirty patients with severe or very severe COPD were randomly divided into the control group (n=15) and the exercise group (n=15) from January 2011 to January 2013. The control group was given health education and routine drug treatment. The exercise group was given muscle relaxation and 6-week aerobic combined resistance exercise training on the basis of the control group. Pulmonary function, 6-minute walk test (6MWT), 30-second sit-to-stand (30-STS), 30-second arm curl test (30-ACT), Medical Research Council Dyspnea Scale (MRC), COPD Assessment Test (CAT), Beck Anxiety and Depression Scale were performed before and after intervention in both groups. Results After intervention, compared with those in the control group, the 6MWT, 30-STS and 30-ACT in the exercise group increased significantly [(518.44±84.62) vs. (412.93±82.53) m, (24.53±3.98) vs. (16.87±3.91) times, (26.07±3.41) vs. (17.93±3.39) times, P<0.05], while the CAT score, Beck anxiety and depression scores decreased significantly (4.87±3.68vs. 26.10±10.18, 2.47±1.81 vs. 11.50±4.89, 2.27±2.49 vs. 12.20±6.35, P<0.05), and MRC score also decreased significantly [1.0 (1.0, 2.0)vs. 2.0 (2.0, 4.0), P<0.05]. There was no statistical difference in pulmonary function between the two groups before or after intervention (P>0.05). Conclusion Exercise-based pulmonary rehabilitation can significantly improve the treatment outcomes in Chinese patients with severe or very severe COPD.