Effect of Home-based Pulmonary Rehabilitation on Fatigue, Dyspnea, and Activities of Daily Living of COVID-19 Patients

Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P < 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P < 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P < 0.001) stages and the mean dyspnea scores (P < 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P < 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.

Impact of Pulmonary Rehabilitation Services in Patients with Different Lung Diseases

Background: the effect of pulmonary rehabilitation (PR) services, beyond research contexts, on patients with lung diseases other than COPD requires further study. Objectives: to (i) assess the impact of a publicly funded PR on patients’ exercise capacity, self-efficacy, and health-related quality of life (HRQoL), and (ii) explore whether the effects vary across lung diseases. Methods: this retrospective pre–post study analyzed data from the Winnipeg Regional Health Authority PR program between 2016 and 2019. Results: 682 patients completed the full PR program. Pooled analyses found significant improvements in the patients’ exercise capacity (six-minute walk test (6MWT) (13.6%), fatigue (10.3%), and dyspnea (6.4%)), Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD6) (11.6%), and HRQoL (Clinical COPD Questionnaire (CCQ) (18.5%) and St George’s Respiratory Questionnaire (SGRQ) (10.9%)). The analyses conducted on sub-groups of patients with chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, interstitial lung diseases (ILDs), other restrictive lung diseases (e.g., obesity, pleural effusion, etc.), lung cancer, and pulmonary hypertension (PH) indicated that, except for patients with PH, all the patients improved in the 6MWT. Fatigue decreased in patients with COPD, ILDs, and other restrictive lung diseases. Dyspnea decreased in patients with COPD, asthma, and lung cancer. SEMCD6 scores increased in COPD, ILDs and PH patients. CCQ scores decreased in all lung diseases, except lung cancer and PH. SGRQ scores only decreased in patients with COPD. Conclusion: PR services had a significant impact on patients with different lung diseases. Therefore, publicly funded PR should be available as a critical component in the management of patients with these diseases.

The Effects of Exercise Therapy Moderated by Sex in Rehabilitation of COVID-19

BackgroundPulmonary rehabilitation serves as a key component in the recovery of COVID-19 and standardized exercise therapy programs in pulmonary rehabilitation have been shown to significantly improve physical performance and lung function parameters in post-acute COVID-19 patients. However, it has not been investigated if these positive effects are equally beneficial for both sexes, especially considering a more severe physical impact of COVID-19 in men when compared to women. Therefore, the purpose of this study was to analyze outcomes of a pulmonary rehabilitation program with respect to sex differences, in order to identify sex-specific pulmonary rehabilitation requirements.MethodsData of 233 patients (40.4% females) were analyzed before and after a three-week standardized pulmonary rehabilitation program. Patients were admitted to rehabilitation due to post-acute COVID-19 illness and staged using the COVID-19 Severity Scale by Huang et al. (2021). Lung function parameters were assessed as part of the clinical routine using spirometry (ICmax, maximal inspiratory capacity) and body plethysmography (FVC, forced vital capacity; FEV1, forced expiratory volume in the first second) and functional exercise capacity was measured by the Six-Minute Walk Test (6MWT). For the comparison of lung function and walking parameters by sex, Welch-ANOVA was used, as results of Levene's test suggested significant heteroscedasticity regarding the investigated parameters (p > 0.05). When comparing post-treatment 6MWT, FEV1 and FCV to corresponding reference values, paired t-tests were used.ResultsAt post-rehabilitation, ICmax, FVC, FEV1 and 6MWT has been improved in both sexes. Females showed a significantly smaller improvement in FEV1 and ICmax (F = 5.86, ω2 = .02; p < 0.05) than males. There was no statistically significant difference in FVC and 6MWT performance improvements between men and women. After the rehabilitation stay, females made greater progress towards reference values of 6MWT (T(231) = -3.04; p < 0.01) and FEV1 (T(231) = 2.83; p < 0.01) than males.ConclusionsSex differences in the improvement of lung function parameters seem to exist when completing a three-week pulmonary rehabilitation program and should be considered when personalizing standardized exercise therapies in pulmonary rehabilitation.Trial registrationthis study was registered in the German Clinical Trials Register (DRKS00026936) on 2021/10/19.

Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis

Objective To determine the effects of neuromuscular electrical stimulation on disabilities and activity limitation of individuals affected by chronic obstructive pulmonary disease. Data sources MEDLINE, PEDro database, Cochrane Controlled Trials Register, and SciELO, were searched from inception until October 2021. Review methods Inclusion criteria were patients with COPD, randomized controlled trials comparing neuromuscular electrical stimulation alone or combined conventional pulmonary rehabilitation and neuromuscular electrical stimulation versus control or sham or pulmonary rehabilitation in disabilities and activity limitation in COPD. There were no mandatory language or publication date restrictions. Two reviewers selected studies independently. Weighted mean differences and 95% confidence intervals were calculated. Results 32 studies met the study criteria, including 1.269 participants. Neuromuscular electrical stimulation improved exercise capacity (MD 1.10, 95% CI: 0.33, 1.86, N = 147), and muscle strength (0.53, 95% CI: 0.20, 0.87, N = 147) compared to sham group. Combined neuromuscular electrical stimulation and conventional rehabilitation improved exercise capacity (MD 34.28 meters, 95% CI: 6.84, 61.73, N = 262) compared to conventional rehabilitation alone. No adverse events were reported. Conclusions Neuromuscular electrical stimulation resulted in small improvement in disabilities and activity limitation (below the MCID) in COPD. Thus, the inclusion of neuromuscular electrical stimulation in rehabilitation programs must consider the cost Because of inadequate methodological conduction and reporting of methods, some studies were of low quality.

Long-Term Maintenance Strategies after Pulmonary Rehabilitation: Perspectives of People with Chronic Respiratory Diseases, Informal Carers, and Healthcare Professionals

Pulmonary rehabilitation (PR) is an effective intervention for people with chronic respiratory diseases (CRD); however, its effects fade after 6–12 months. Community-based strategies might be valuable to sustain PR benefits, but this has been little explored. People with CRD, informal carers, and healthcare professionals (HCPs) were recruited from pulmonology appointments of two local hospitals, two primary care centres, and one community institutional practice and through snowballing technique. Focus groups were conducted using a semi-structured guide. Data were thematically analysed. Twenty-nine people with CRD (24% female, median 69 years), 5 informal carers (100% female, median 69 years), and 16 HCPs (75% female, median 36 years) were included. Three themes were identified: “Maintaining an independent and active lifestyle” which revealed common strategies adopted by people with “intrinsic motivation and professional and peer support” as key elements to maintain benefits, and that “access to information and partnerships with city councils’ physical activities” were necessary future steps to sustain active lifestyles. This study suggests that motivation, and professional and peer support are key elements to maintaining the benefits of PR in people with CRD, and that different physical activity options (independent or group activities) considering peoples’ preferences, should be available through partnerships with the community, namely city councils.

Women's COPD

Chronic obstructive pulmonary disease (COPD) is no longer a respiratory disease that predominantly affects men, to the point where the prevalence among women has equaled that of men since 2008, partly due to their increasing exposure to tobacco and to biomass fuels. Indeed, COPD has become the leading cause of death in women in the USA. A higher susceptibility of female to smoking and pollutants could explain this phenomenon. Besides, the clinical presentation appears different among women with more frequent breathlessness, anxiety or depression, lung cancer (especially adenocarcinoma), undernutrition and osteoporosis. Quality of life is also more significantly impaired in women. The theories advanced to explain these differences involve the role of estrogens, smaller bronchi, impaired gas exchange in the lungs and smoking habits. Usual medications (bronchodilators, ICS) demonstrated similar trends for exacerbation prevention and lung function improvement in men and women. There is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate global improvements in disease management (smoking cessation, pulmonary rehabilitation…) in half of the population. Nevertheless, important limitations to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. In conclusion there is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate globally improvements in disease management in this specific population.