Article

Effect of Rollator Use on Health-Related Quality of Life in Individuals With COPD

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Abstract

The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. Randomized controlled trial. Thirty-one postrehabilitation patients with COPD were randomized to receive a rollator (n = 18) or usual care (n = 13) for 8 weeks and to record the frequency of rollator use. Outcome measures at baseline, 4 weeks, and 8 weeks included the Chronic Respiratory Questionnaire (CRQ) and the 6-min walk (6MW). During acute testing, subjects consistently walked further when assisted (baseline 6MW: 292 +/- 67 m vs 263 +/- 67 m; 8 weeks: 283 +/- 65 m vs 259 +/- 68 m [+/-SD]; p = 0.013). However, provision of a rollator at home was not associated with group differences in the CRQ (p > 0.08) or in the unassisted 6MW (p = 0.4) or the assisted 6MW (p = 0.5). Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week. Regular users demonstrated a consistent improvement in mastery compared with infrequent users (4 weeks: 4.7 +/- 0.6 vs 5.2 +/- 0.8, respectively; 8 weeks: 5.3 +/- 0.8 vs 4.7 +/- 0.4; p = 0.014). Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it.

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... The non-medical devices used was the fan in five studies (9)(10)(11)(12)17) and mobility aids in two (31,32). We decided to include two secondary analyses studies (10,17) in addition to the two primary papers included in the review as it permitted inclusion of fan data not published in the primary papers (11,12) and report an in-depth exploration of the benefits and factors associated with fan use (10). ...
... Both mobility aid studies recruited patients with COPD (n=58) (31,32). One study focused on moderate to severe COPD (32). ...
... Both mobility aid studies recruited patients with COPD (n=58) (31,32). One study focused on moderate to severe COPD (32). ...
Article
Background: Non-medical devices such as the handheld fan (fan), mobility aids (wheeled walkers with seats) and inspiratory muscle training (IMT) devices offer benefits for patient management of chronic breathlessness. We examined the published evidence regarding patient, carer and clinician use of the fan, mobility aids and IMT devices for chronic breathlessness management, and the potential barriers and facilitators to day-to-day use in a range of settings. Methods: MEDLINE, Embase, Scopus, EBSCO and the Cochrane Database of Systematic Reviews were searched. Papers were imported into EndNote and Rayyan for review against a priori eligibility criteria. Outcome data relevant to use were extracted and categorised as potential barriers and facilitators, and a narrative synthesis exploring reasons for similarities and differences conducted. Results: Seven studies met the inclusion criteria (n=5 fan, n=2 mobility aids and n=0 IMT devices). All of the studies presented patient use of non-medical devices only. Patients found the fan easy to use at home. Mobility aids were used mainly for outdoor activities. Outdoor use for both devices were associated with embarrassment. Key barriers included: appearance; credibility; self-stigma; technical specifications. Common facilitators were ease of use, clinical benefit and feeling safe with the device. Conclusion: The efforts of patients, carers and clinicians to adopt and use non-medical devices for the management of chronic breathlessness is impeded by lack of implementation research. Future research should improve knowledge of the barriers and facilitators to use. This would enhance understanding of how decision-making in patient-carer-clinician triads impacts on non-medical devices use for breathlessness management.
... An initial search and secondary searches yielded 31 articles, following removal of duplicates. After independent review by 2 researchers, 7 studies, 2 randomized controlled trials, 3,19 and 5 crossover trials 4,11,[25][26][27] of rollator use met the inclusion criteria ( Figure 1). Overall, 124 clinically stable individuals with COPD were included. ...
... Two studies reported different information from the same participants. 3,4 Two studies explored the impact of integrating rollator use into daily activities over 4 wk 19 and 8 wk. 3 One study prescribed the rollator in those who had recently completed pulmonary rehabilitation (PR) and were previously naive to rollator use and had a 6-min walk distance (6MWD) of <375 m. 3 The second study prescribed a rollator following completion of pulmonary rehabilitation for use during the following tasks: walking activities at home, walking within the home, walking outside, getting to and from the car, walking indoors in a location other than home, and other activities outside the home. 19 For use during exercise testing, 4 studies compared the effects of using a rollator with no aid during a 6-Minute Walk Test (6MWT), 4,11,25,26 with protocols originating from different sources [28][29][30] and one study explored the immediate effects during a 12-min walk test (12MWT). ...
... 3,4 Two studies explored the impact of integrating rollator use into daily activities over 4 wk 19 and 8 wk. 3 One study prescribed the rollator in those who had recently completed pulmonary rehabilitation (PR) and were previously naive to rollator use and had a 6-min walk distance (6MWD) of <375 m. 3 The second study prescribed a rollator following completion of pulmonary rehabilitation for use during the following tasks: walking activities at home, walking within the home, walking outside, getting to and from the car, walking indoors in a location other than home, and other activities outside the home. 19 For use during exercise testing, 4 studies compared the effects of using a rollator with no aid during a 6-Minute Walk Test (6MWT), 4,11,25,26 with protocols originating from different sources [28][29][30] and one study explored the immediate effects during a 12-min walk test (12MWT). ...
Article
Purpose: To determine the effects of using a rollator in people with chronic obstructive pulmonary disease (COPD). Methods: Studies were systematically identified from literature searches of MEDLINE, CINAHL, PEDro, PubMed, EMBASE, and the Cochrane Library databases and the reference lists of included studies. Two reviewers independently selected randomized controlled or crossover studies examining the effects of rollator usage compared with no aid in individuals with COPD. Methodologic quality was assessed by 2 reviewers independently using the Cochrane Risk of Bias tool. Two reviewers also used a customized form to extract characteristics of and outcomes for subjects related to exercise capacity, symptoms, health-related quality of life (HRQOL), physiological, and gait parameters. Weighted mean differences (WMD) with 95% CI were calculated using a fixed-effects model. Results: A total of 7 studies (126 participants) were included. Use of a rollator during a 6-Minute Walk Test (6MWT) improved distance walked (WMD = 13 m; 95% CI, 5-22) and lowered end-6MWT dyspnea rating (WMD = 0.97; 95% CI, 0.63-1.32). Longer-term use did not appear to impact exercise capacity or HRQOL, although this may be related to the frequency of use. Conclusions: When used in the short-term, rollators resulted in a small increase in 6MWT and a reduction in dyspnea. Details on patient adherence are required to accurately evaluate the longer-term effects of rollator usage.
... 3 , 4 Two studies explored the impact of integrating rollator use into daily activities over 4 wk 19 and 8 wk. 3 One study prescribed the rollator in those who had recently completed pulmonary rehabilitation (PR) and were previously naive to rollator use and had a 6-min walk distance (6MWD) of < 375 m. 3 The second study prescribed a rollator following completion of pulmonary rehabilitation for use during the following tasks: walking activities at home, walking within the home, walking outside, getting to and from the car, walking indoors in a location other than home, and other activities outside the home. 19 For use during exercise testing, 4 studies compared the effects of using a rollator with no aid during a 6-Minute Walk Test (6MWT), 4 , 11 , 25 , 26 with protocols originating from different sources [28][29][30] and one study explored the immediate effects during a 12-min walk test (12MWT). ...
... Two studies reported different information from the same participants. 3 , 4 Two studies explored the impact of integrating rollator use into daily activities over 4 wk 19 and 8 wk. 3 One study prescribed the rollator in those who had recently completed pulmonary rehabilitation (PR) and were previously naive to rollator use and had a 6-min walk distance (6MWD) of < 375 m. 3 The second study prescribed a rollator following completion of pulmonary rehabilitation for use during the following tasks: walking activities at home, walking within the home, walking outside, getting to and from the car, walking indoors in a location other than home, and other activities outside the home. 19 For use during exercise testing, 4 studies compared the effects of using a rollator with no aid during a 6-Minute Walk Test (6MWT), 4 , 11 , 25 , 26 with protocols originating from different sources [28][29][30] and one study explored the immediate effects during a 12-min walk test (12MWT). ...
... One study separated frequent (minimum use of 3 times per week) from infrequent rollator users. 3 Duration of use was 25 to 60 d among 10 frequent users (n = 10) and 5 to 15 d among 8 infrequent users. Frequent users had higher levels of mastery and lower levels of fatigue over the 8 wk than infrequent users. ...
... The efficacy of walking aids during an indoor 6MWT has been studied frequently, and their use has been associated with significant and clinically relevant improvements in 6MWD. [1][2][3]20,21 However, this may not reflect everyday walking, the most frequently reported problematic activity of daily life in COPD. 22 In addition, individuals with COPD reported to use their walking aids mostly during outdoor activities. ...
... 22 In addition, individuals with COPD reported to use their walking aids mostly during outdoor activities. 8,20 This study showed that individuals with COPD gained substantial benefit from a rollator during outdoor walking. While using the rollator, individuals with COPD walked on average 276 m further compared with an unaided SPOW (Table 2), whereas the use of a draisine resulted in a lower SPOW distance and time compared with the unaided SPOW. ...
Article
Walking aids, such as rollator or draisine, improve mobility and functional exercise performance in individuals with chronic obstructive pulmonary disease (COPD) during an indoor 6-min walk test. However, this test does not reflect everyday walking, which is the most frequently reported problematic activity of daily life in individuals with COPD. To date, efficacy of walking aids during self-paced outdoor walking remains unknown. Therefore, we aimed to determine the efficacy of a rollator and draisine on self-paced outdoor walking in individuals with COPD. Fifteen individuals with COPD (68% men; age: 63 ± 8 years; forced expiratory volume in 1 s: 40 ± 14% predicted) performed three self-paced outdoor walking tests on two consecutive days: test 1 unaided, and tests 2 and 3 with rollator or draisine in random order. Participants had to walk as long as possible at their own pace. The test ended when participants needed to stop, with a maximum duration of 30 min. The use of rollator resulted in the highest walk distance and time (P < 0.05 vs unaided and draisine). Furthermore, individuals with COPD walked significantly further and longer during an unaided test compared with a draisine aided test (P < 0.05). Moreover, use of draisine resulted in a significantly higher walking speed, fewer strides, greater stride length, and higher step and stride variability (P < 0.05 vs unaided and rollator). To conclude, a rollator improves the self-paced outdoor walk distance and time in individuals with moderate and advanced COPD and a poor functional exercise capacity, whereas the use of a draisine had a detrimental effect compared with unaided walking. © 2015 Asian Pacific Society of Respirology.
... Rollators are four-wheeled walkers commonly used in clinical practice in many patient groups (Gupta et al., 2006;Chee et al., 2013;Eggermont et al., 2006;Smith et al., 2012). The specific aims of rollator use vary depending on the patient diagnosis. ...
... For example, in the elderly or patients with neurological disease such as multiple sclerosis, rollators are used to increase walking endurance and muscle strength or to improve balance (Chee et al., 2013;Vogt et al., 2010;Braun et al., 2014). Following surgery, reduced weight bearing or pain may be treatment goals (Smith et al., 2012), whereas in patients with chronic obstructive pulmonary disease improvement of functional exercise capacity and reduction of dyspnoea can be the objectives (Gupta et al., 2006). ...
... Probst et al. observed improved respiration capacity and efficiency, indicated by increased ventilation volumes and reduced oxygen uptake, in walking with a rollator [109]. Gupta et al. examined longer-term effects of the use of a rollator on walking distance [48] and quality of life [49] in COPD patients following completion of a pulmonary rehabilitation program. The reduced dyspnea and increased walking distance benefits associated with using a rollator were confirmed to be consistent 4-and 8-weeks following rehabilitation [48]. ...
... The reduced dyspnea and increased walking distance benefits associated with using a rollator were confirmed to be consistent 4-and 8-weeks following rehabilitation [48]. Compared to a control group that did not receive a rollator following rehabilitation, the rollator intervention group demonstrated improved mastery, indicating a higher extent to which an individual feels they can cope with the limitations of their condition [49]. ...
... Im Cochrane-Review [443] zeigten vier randomisierte kontrollierte Studien mit COPD Patienten (n = 97) [453,[455][456][457] eine signifikante Abnahme der Atemnot unter Verwendung von Gehhilfen (Rollator oder Gehstock) bei längeren Strecken, zwei weitere randomisierte kontrollierte Studien mit COPD-Patienten (n = 41) konnten dies nicht bestätigen [458,459]. Die überwiegende Zahl der Studien wurde mit COPD-Patienten durchgeführt. Die Leitliniengruppe geht von einer Übertragbarkeit auf Krebspatienten aus. ...
... It is possible that the increase in step count was produced by an increase in walking speed, afforded, at least in part, by the reduced metabolic cost associated with walking when a WW is used [26]. The lack of change in HRQoL associated with WW use in the home was consistent with earlier work [27]. In the current study, given that all participants had recently completed a PRP, it is possible that further gains in HRQoL were unlikely. ...
Full-text available
Article
Purpose: To determine the effects of providing a wheeled walker (WW) for use in the home and community, on daily physical activity (PA) and sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD). Methods: A randomised cross-over study in which participants with COPD characterised by a 6-min walk distance ≤ 450 m, who had recently finished pulmonary rehabilitation, completed two 5-week phases. During one phase, participants were provided a WW to use, whereas during the other phase, the WW was not available. The order of the phases was randomised. For the final week of each phase, measures of PA and ST were collected using wearable devices and health-related quality of life was measured using the Chronic Respiratory Disease Questionnaire (CRDQ). Wheeled walker use was also measured using an odometer attached to the device. Results: 17 participants [FEV1 = median (interquartile range) 33 (25) % pred; ten males] aged mean (SD) 73 (9) years completed the study. Comparing the data collected when the WW was not available for use, the daily step count was greater (mean difference [MD] 707 steps/day (95% confidence interval [CI] 75 to 1340) and participants tended to report less dyspnoea during daily life (MD 0.5 points per item, 95% CI - 0.1 to 1.0) when WW was available. No differences were observed for ST, upright time or stepping time. The WW was used over 4504 m/week (95% CI 2746 to 6262). Conclusion: These data demonstrated that, when provided to selected patients with COPD, WWs increased daily step count. Clinical trial registration number: ACTRN12609000332224.
... Im Cochrane-Review [124] zeigten vier randomisierte kontrollierte Studien mit COPD Patienten (N = 97) [133][134][135][136] eine signifikante Abnahme der Atemnot unter Verwendung von Gehhilfen (Rollator oder Gehstock) bei längeren Strecken, zwei weitere randomisierte kontrollierte Studien mit COPD-Patienten (N = 41) konnten dies nicht bestä-tigen [137,138]. Die überwiegende Zahl der Studien wurde mit COPD-Patienten durchgeführt. Die Leitliniengruppe geht von einer Übertragbarkeit auf Krebspatienten aus. ...
Article
Symptome wie Atemnot, Schmerz, Übelkeit und Verstopfung sind für den sterbenden Patienten und seine Angehörigen sehr belastend. Jeder Arzt sollte deshalb wissen, wie sich diese Symptome möglichst gut kontrollieren lassen.
... (O'Brien, Furukawa, Kuzma, ; (Porto et al., 2009); (Sciurba et al., 2010); (Stefanelli et al., 2013); (Sterman et al., 2010); (Torchio et al., 1998); (Wijkstra et al., 2006) Comorbiditeiten ( (Giavedoni et al., 2012); (Mador et al., 2001); (Malaguti et al., 2006); (Napolis et al., 2011); (Neder et al., 2002); (Sillen et al., 2011); (Vivodtzev et al., 2012); (Zanotti, Felicetti, Maini, & Fracchia, 2003) Gebruik van supplementen ( (Bedard et al., 2012); (Beeh, Singh, Di Scala, & Drollmann, 2012;Beeh, Wagner, Khindri, & Drollmann, 2011); (Belman, Botnick, & Shin, 1996); (Berton, Barbosa, et al., 2010;Berton, Reis, et al., 2010); (Borghi-Silva et al., 2006); (Bourbeau, Rouleau, & Boucher, 1998) Chan et al., 1988); (Celli, ZuWallack, Wang, & Kesten, 2003); (Chatila, Nugent, Vance, Gaughan, & Criner, 2004); (Christensen, Ryg, Refvem, & Skjonsberg, 2000); (Cooper, Abrazado, Legg, & Kesten, 2010); (Coppoolse, Barstow, Stringer, Carithers, & Casaburi, 1997); (Dahl et al., 2009); (D'Angelo, Santus, Civitillo, Centanni, & Pecchiari, 2009); (Deacon et al., 2008); (Dean et al., 1992); (Delzell, 2013); (Di Marco et al., 2003); (Dreher et al., 2009); (Eguchi et al., 2007); (Emtner, Porszasz, Burns, Somfay, & Casaburi, 2003); (Eves, Petersen, Haykowsky, Wong, & Jones, 2006;Eves et al., 2009); (Faager et al., 2006); (Fuld et al., 2005); (Gagnon et al., 2012); (Garrod, Bestall, Paul, & Wedzicha, 1999;Garrod, Paul, & Wedzicha, 2000); (Gong, Shamoo, Anderson, & Linn, 1997); (Gosselin et al., 2004); (Gueli et al., 2011); (Guenette et al., 2011;Guenette, Webb, & O'Donnell, 2013); (Gupta, Brooks, Lacasse, & Goldstein, 2006); (Haas et al., 1990); (Hagarty et al., 1997); (Haidl et al., 2004); (Hay et al., 1992); (Heraud, Prefaut, Durand, & Varray, 2008); ; (Hussain et al., 2011); (Ikeda et al., 1996); (Teramoto et al., 1996); (Travers, Laveneziana, Webb, Kesten, & O'Donnell, 2007); ; (Tzani et al., 2011); (Vagaggini et al., 1996); (Voduc et al., 2012); (Vogelmeier et al., 2011); (Wassermann, Pothoff, Subbe, Bahra, & Hilger, 1994); (Weisberg et al., 2002); (Womble, Schwartzstein, Johnston, & Roberts, 2012); (Wongsurakiat et al., 2004); (Yang et al., 1996); (Prigatano, Wright, & Levin, 1984); (Schonhofer, Ardes, Geibel, Kohler, & Jones, 1997); (Starobin et al., 2006); (Stulbarg, Carrieri-Kohlman, Gormley, Tsang, & Paul, 1999); (Terziyski, Marinov, Hodgev, Tokmakova, & Kostianev, 2010); (Vagaggini et al., 2003); (Wolkove, Baltzan, Kamel, & Rotaple, 2004); (Woltjer, Bogaard, & de Vries, 1996); ...
Thesis
Chronisch obstructieve pulmonaire aandoening (COPD) is één van de belangrijkste oorzaken van chronische morbiditeit en mortaliteit. Hoewel revalidatie belangrijk is in de behandeling van COPD, is de impact van trainingsmodaliteiten op oefentolerantie (uithoudingsvermogen en spierkracht), gezondheidsgerelateerde levenskwaliteit (HRQOL) en éénseconde waarde (FEV1) onzeker. De gekozen trainingsmodaliteiten in de revalidatie van COPD-patiënten moet gekozen worden a.d.h.v. gewenste doelstelling(en). Type oefening (uithoudings-, kracht- of combinatietraining) blijkt geen verschil in effect te hebben op HRQOL, FEV1, wandelcapaciteit en spierkracht. Continu training heeft een groter klinisch effect voor HRQOL en werkbelasting, intervaltraining bij FEV1 en wandelcapaciteit. Hoog-intens trainen (> 75%) heeft een groter klinisch effect voor wandelcapaciteit en dyspneu, terwijl laag-intens (40%) trainen bij werkbelasting. Het programmaduur moet minstens 18 maanden duren. Graag hadden we het effect van de trainingsmodaliteiten op de beschreven parameters bij revalidatie van COPD nagegaan. Dit bleek echter niet mogelijk te ReGo met als gevolg een veranderde onderzoeksdoelstelling: Wat is de insulinegevoeligheid bij COPD-patiënten en de relatie tussen insulinegevoeligheid en oefentolerantie, VO2-kinetiek, metabole flexibiliteit, longfunctie en lichaamssamenstelling? COPD-patiënten vertonen vaak glucose intolerantie, daarom veronderstellen we dat ze insulineresistentie ontwikkelen. De oorzaak van insulineresistentie bij COPD is ongekend.
... Even when exercising to a symptom-limited maximum, the intensity of breathlessness will recover rapidly (<5 minutes). [8] Physical activity should be promoted and where relevant supported by the provision of appropriate mobility aids [9] and/or assistive equipment. [10] These can enhance functional exercise performance through an increased ventilatory capacity and/or walking efficiency. ...
... The use of a rollator supporting upper extremities and a stroller device for ambulatory oxygen (or in some cases a ventilator for NIMV) allows patient to walk with a reduced dyspnea and fatigue and with an improved exercise tolerance and sense of control. 46 Other measures supporting exercise such as neuromuscular electrical stimulation, biofeedback, or administration of gas mixtures (e.g. heliox) need further investigation to be recommended in the PR of COPD patients. ...
Article
According to the European Respiratory Society/American Thoracic Society (ERS/ATS) definition "Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, PR is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease". There is scientific evidence that PR improves dyspnea, exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) may be indicated also in other obstructive respiratory disorders such as bronchial asthma, cystic fibrosis, bronchiectasis, and conditions such as pre- post surgical treatment in major thoracic and abdominal surgery, prevention of complications in the respiratory intensive care unit. Optimal drug treatment and smoking cessation are important pre-requisites for starting PR. Physical training is the main component of any PR programme (A degree of evidence) with particular regard to exercise training of lower limbs. Interval training is preferable for patients with severe symptom limitation. Other important items of a PR programme are: upper extremity training, respiratory muscle training, breathing exercises, chest physiotherapy, health education, psychosocial support, occupational therapy, and nutrition. After a baseline functional assessment, a correct outcome measurement must compare end-of-programme versus baseline evaluation of exercise capacity with an ergometric test or a 6min walking test, evaluation of dyspnea during exercise (Borg or Visual Analogue Scale [VAS]) or in daily life activities (MRC, BDI/TDI) and quality of life with a specific questionnaire such as the Saint George's Respiratory Questionnaire (SGRQ).
... It is possible that the increase in step count was produced by an increase in walking speed, afforded, at least in part, by the reduced metabolic cost associated with walking when a WW is used [26]. The lack of change in HRQoL associated with WW use in the home was consistent with earlier work [27]. In the current study, given that all participants had recently completed a PRP, it is possible that further gains in HRQoL were unlikely. ...
... 18 Cependant, il existe un bon nombre d'études ayant exposés les probables inconvénients liés à l'utilisation du déambulateur: dépenses d'énergie élevées (Foley 1996), risque accru de chutes (Charron et al. 1995) et altérations des patterns cinématiques de la marche (Liu et al. 2009). D'autre part, puisque le processus de récupération dépend fortement de l'état moral du patient (Fredman et al. 2006), l'utilisation des aides-techniques a également été liée à des facteurs psychologiques, tels qu'une mauvaise perception propre de l'état de santé (et non la peur de chuter) (Andersen et al. 2007), les patients se sentant plus en sécurité avec le déambulateur (Gupta et al. 2006). En outre, certaines études concernant les aides robotisées (Rentschler et al. 2008), n'ont pas montré de résultats concluants sur de petits échantillons de patients utilisateurs ayant des troubles élevés de l'équilibre avec déficiences visuelles. ...
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Article
Due to the ongoing aging process (e.g. one over 10 people in France is more than 75 years old); loss of autonomy has become a major public health issue. This socio-economical problem may be explained by the continuous need of acute information on the balance of elderly. In this manner, a deep analysis of ankle musculotendinous stiffness and posture may provide new insights on the neuromuscular mechanisms involved in maintaining upright stance, by means of appropriate biomechanical parameters. This work was funded by the National Research Agency (ANR-08-TECS MIRAS-009-04), and aimed at characterizing the elastic properties (i.e. musculotendinous stiffness) and balance in elderly subjects recovering their autonomy. Therefore, a global description of population profiles in a geriatric rehabilitation care unit was first carried out. Then to verify and improve the existing methods for ankle musculotendinous stiffness estimation ("Quick-Release" approach), a new method for the calculation foot inertial parameters was proposed and validated. Finally, a study of ankle stiffness and balance through a stabilometric approach was conducted on a sample of elderly patients. The results of this work proved to be useful in improving the methods for calculating ankle musculotendinous stiffness, while contributing to a better understanding of balance mechanisms in the elderly.
... Im Cochrane-Review [125] zeigten vier randomisierte kontrollierte Studien mit COPD Patienten (N = 97) [134][135][136][137] eine signifikante Abnahme der Atemnot unter Verwendung von Gehhilfen (Rollator oder Gehstock) bei längeren Strecken, zwei weitere randomisierte kontrollierte Studien mit COPD-Patienten (N = 41) konnten dies nicht bestä-tigen [138,139]. Die überwiegende Zahl der Studien wurde mit COPD-Patienten durchgeführt. Die Leitliniengruppe geht von einer Übertragbarkeit auf Krebspatienten aus. ...
... Understandably, those who reported frequent use improved their exercise capacity and HRQOL. 79 In an attempt to explore this, Hill et al characterized the daily utility and satisfaction with rollators in patients with COPD who had been provided with one within the preceding 5-year period. 78 Just over half of the patients (59%) reported daily rollator use, mainly for walking outdoors. ...
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Article
Though the guidelines for the optimal management of chronic obstructive pulmonary disease (COPD) following an acute exacerbation (AE) are well established, issues associated with poor adherence to nonpharmacological interventions such as self-management advice and pulmonary rehabilitation will impact on hospital readmission rates and health care costs. Systems developed for clinically stable patients with COPD may not be sufficient for those who are post-exacerbation. A redesign of the manner in which such interventions are delivered to patients following an AECOPD is necessary. Addressing two or more components of the chronic care model is effective in reducing health care utilization in patients with COPD, with self-management support contributing a key role. By refining self-management support to incorporate the identification and treatment of psychological symptoms and by providing health care professionals adequate time and training to deliver respiratory-specific advice and self-management strategies, adherence to nonpharmacological therapies following an AE may be enhanced. Furthermore, following up patients in their own homes allows for the tailoring of advice and for the delivery of consistent health care messages which may enable knowledge to be retained. By refining the delivery of nonpharmacological therapies following an AECOPD according to components of the chronic care model, adherence may be improved, resulting in better disease management and possibly reducing health care utilization.
... The moderate loading levels demonstrated in the current study may reflect a compromise between the mechanical advantage afforded by the device and other factors such as fatigue or challenges in manoeuvring the rollator. Vertical load may also indicate upper limb use for other purposes, such as reducing dyspnea in chronic obstructive pulmonary disease (Gupta, Brooks, Lacasse, & Goldstein, 2006) contributions associated with additional tactile input when touching a vertical reference (Jeka, 1997), which includes a rollator frame. The lack of means to separate the tactile influences from the overall effects limits the specific examination of mechanical contributions. ...
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Article
While assisting with balance is a primary reason for rollator use, few studies have examined how the upper limbs are used for balance. This study examines upper limb contributions to balance control during rollator-assisted walking. We hypothesized that there would be an increased upper limb contribution, measured by mean vertical loading (Fz) and variation in frontal plane center-of-pressure (COPhigh), when walking balance is challenged/impaired. Experiment 1 compared straight-line and beam-walking in young adults (n = 11). As hypothesized, Fz and COPhighincreased in beam-walking compared to baseline (mean Fz: 13.7 vs. 9.1% body weight (BW), p < 0.001, RMS COPhigh: 1.35 vs. 1.07 cm, p < 0.001). Experiment 2 compared older adults who regularly use rollators (RU, n = 10) to older adult controls (CTL, n = 10). The predicted higher upper limb contribution in the RU group was not supported. However, when individuals were grouped by balance impairment, those with the lowest Berg Balance scores (< 45) demonstrated greater speed-adjusted COPhigh than those with higher scores (p = 0.013). Furthermore, greater COPhigh and Fz were correlated to greater reduction in step width, supporting the role of upper limb contributions to frontal plane balance. This work will guide studies assessing reliance on rollators by providing a basis for measurement of upper limb balance contributions.
... Because obese persons often have systemic hypertension, cardiovascular disease, diabetes mellitus, osteoarthritis, and other morbidities (397,398), and those with obesity hypoventilation syndrome and/or obstructive sleep apnea may have pulmonary hypertension, pulmonary function testing, assessment of gas exchange, echocardiography, and/or cardiopulmonary exercise testing or pharmacologic stress testing can be considered before initiation of pulmonary rehabilitation, to identify factors contributing to the patient's functional limitation. Specialized equipment such as wheelchairs, walkers, recumbent bicycles, or chairs may be needed to accommodate persons of extreme weight (244,399), and the weight limits of available exercise equipment must be considered. Walking, low-impact aerobics, and water-based exercise are suitable for persons too heavy to use a treadmill or cycle ergometer (400). ...
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Article
BACKGROUND: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
... Promising results come from studies testing the effect of walking aids such as rollators on breathlessness themenschwerpunkt [20][21][22][23][24][25]. Three studies showed a significant improvement [20,22,24] and two a non-significant improvement of breathlessness as well as an increased walking distance [23,25]. ...
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Breathlessness is a common and distressing symptom in advanced cancer. Management comprises non-pharmacological and pharmacological interventions, which are best combined. There is some evidence mainly derived from COPD studies for walking aids, neuro-muscular electrical stimulation, fan and breathlessness services. Opioids are the drugs of choice for pharmacological management of breathlessness. There is currently not enough evidence to support the routine use of benzodiazepines, other anxiolytics, antidepressants, phenothiazines, inhaled furosemide and oxygen.
... Because obese persons often have systemic hypertension, cardiovascular disease, diabetes mellitus, osteoarthritis, and other morbidities (397,398), and those with obesity hypoventilation syndrome and/or obstructive sleep apnea may have pulmonary hypertension, pulmonary function testing, assessment of gas exchange, echocardiography, and/or cardiopulmonary exercise testing or pharmacologic stress testing can be considered before initiation of pulmonary rehabilitation, to identify factors contributing to the patient's functional limitation. Specialized equipment such as wheelchairs, walkers, recumbent bicycles, or chairs may be needed to accommodate persons of extreme weight (244,399), and the weight limits of available exercise equipment must be considered. Walking, low-impact aerobics, and water-based exercise are suitable for persons too heavy to use a treadmill or cycle ergometer (400). ...
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The present study examined the reproducibility with which subjects with stable chronic obstructive pulmonary disease (COPD) scale the sense of effort involved in breathing during exercise. The sense of effort was assessed in 6 subjects with COPD during bicycle exercise continued to a symptom-limited maximal work load using a conventional category scale. Reproducibility of the sensory experience was assessed by comparing results obtained from 3 incremental work tests, 2 on the same day and a subsequent test performed within 1 to 10 days. During all trials in all subjects, sensory scores correlated closely with both minute ventilation and oxygen consumption (r greater than or equal to 0.92 for both VE and VO2). The average coefficients of variation for the maximal Borg Score and Borg Score at 2 min of exercise for the group as a whole were 3 +/- 1 and 3 +/- 2% (SE), respectively. Variability in sensory scores was not significantly different on exercise trials performed either within or between days. Furthermore, variability of sensory scores, oxygen consumption, heart rate, or minute ventilation were similar. We conclude that when using a category scale in subjects with COPD, the perceived sense of effort in breathing during exercise is highly reproducible, correlates closely with physiologic measures defining the intensity of exercise, and is no more variable than physiologic parameters typically measured during an exercise test.
... Because obese persons often have systemic hypertension, cardiovascular disease, diabetes mellitus, osteoarthritis, and other morbidities (397,398), and those with obesity hypoventilation syndrome and/or obstructive sleep apnea may have pulmonary hypertension, pulmonary function testing, assessment of gas exchange, echocardiography, and/or cardiopulmonary exercise testing or pharmacologic stress testing can be considered before initiation of pulmonary rehabilitation, to identify factors contributing to the patient's functional limitation. Specialized equipment such as wheelchairs, walkers, recumbent bicycles, or chairs may be needed to accommodate persons of extreme weight (244,399), and the weight limits of available exercise equipment must be considered. Walking, low-impact aerobics, and water-based exercise are suitable for persons too heavy to use a treadmill or cycle ergometer (400). ...
... These improvements are accompanied by patient preference for assisted walking in addition to reducing dyspnea and adding a greater sense of safety. Despite several reports on the short-term beneficial effects of rollators [74,75] , further evaluations of rollator effectiveness , including objective monitoring of usage , are required to establish longer-term benefits. ...
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Patients who have mild to severe chronic obstructive pulmonary disease may obtain improvement in dyspnea, exercise capacity, and health-related quality of life as a result of exercise training. The type and intensity of training is of key importance in determining outcomes. High-intensity aerobic training leads to physiologic gains in aerobic fitness. Nevertheless, extreme breathlessness or peripheral muscle fatigue may prevent some patients from performing high-intensity exercise; therefore, new tools are needed to improve the effectiveness of pulmonary rehabilitation.
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Purpose: Although it has been well documented that the progressive exercise limitation associated with chronic obstructive pulmonary disease can be helped with an assistive device, such as a rollator, many individuals use it infrequently. This study seeks to explore the views of individuals with chronic obstructive pulmonary disease regarding the use of rollators. Methods: A qualitative study design was used. Twelve individuals with moderate to very severe chronic obstructive pulmonary disease were recruited from an outpatient pulmonary rehabilitation program to participate in semistructured interviews. Inductive thematic analysis was applied. Results: Analysis revealed 5 themes: (1) "acquiring a rollator" reflecting the process of obtaining a device either via a health care professional or self-referral; (2) "acceptance versus resistance" describing opposing views regarding rollator usage; (3) "rollator roadblocks" describing practical barriers to use; (4) "participation" reflecting how rollators can promote reintegration into society; and (5) "revising perceptions" whereby participants embodied an eventual acceptance of rollators. Conclusion: Rollator acquisition appeared to be a unilateral, prescriptive process. Individuals described initial resistance to use, although in the long-term, negative perceptions were outweighed by the functional and social benefits of rollator use. Encouraging users to participate in deciding whether to use a rollator and providing adequate education on its indications, benefits, barriers, and facilitators are likely to promote optimal use of a rollator.
Chapter
Respiratoire revalidatie is vandaag de dag de aangewezen therapie voor patiënten met chronisch obstructief longlijden (COPD) die na optimale medicamenteuze behandeling nog last hebben van kortademigheid of vermoeidheid, beperkt zijn in hun fysieke activiteiten of een beperkte levenskwaliteit hebben. Belangrijke doelen van revalidatie zijn: de participatie van patiënten vergroten, de levenskwaliteit verbeteren en de medische consumptie verminderen. Aangezien de klachten van COPD zich vooral manifesteren vanaf de leeftijd van 50 à 60 jaar zijn het meestal oudere patiënten die voor respiratoire revalidatie verwezen worden. De gemiddelde leeftijd van COPD-patiënten die worden verwezen naar ons centrum ligt rond de 70 jaar. Leeftijd op zich is geen contra-indicatie voor het volgen van een revalidatieprogramma. Het programma moet wel afgestemd worden op de specifieke behoeften voor oudere personen. Enkele daarvan worden in dit overzichtsartikel besproken.
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Patient-reported outcome measures (PROMs) are intended to reflect outcomes relevant to patients. They are increasingly used for healthcare quality improvement. To produce valid measures, patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities. This potential exclusion raises concerns about whether these groups will be able to use these measures and participate in quality improvement practices. Taking PROMs for chronic obstructive pulmonary disease (COPD) as an exemplar condition, our review determined the inclusion of people with low literacy skills and learning disabilities in research developing, validating, and using 12 PROMs for COPD patients. The studies included in our review were based on those identified in two existing systematic reviews and our update of this search. People with low literacy skills and/or learning disabilities were excluded from the development of PROMs in two ways: explicitly through the participant eligibility criteria and, more commonly, implicitly through recruitment or administration methods that would require high-level reading and cognitive abilities. None of the studies mentioned efforts to include people with low literacy skills or learning disabilities. Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs. Given that implicit exclusion was most common, researchers and those who administer PROMs may not even be aware of this problem. Without effort to improve inclusion, unequal quality improvement practices may become embedded in the health system.
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Generally, the use of a rollator improves mobility in patients with COPD. Nevertheless, not all patients benefit from its use, and many patients feel embarrassed about using it. Therefore, other walking aids are worthwhile to consider. We compared the direct effects of a "new" ambulation aid (a modern draisine) with the effects of a rollator on 6-min walk distance (6MWD) in patients with COPD. Twenty-one patients with COPD performed two 6-min walk tests (6MWTs) during prerehabilitation assessment (best 6MWD: 369 ± 88 m). Additionally, two extra 6MWTs were performed on two consecutive days in random order: one time with a rollator and one time with a modern draisine. Walking pattern (n = 21) was determined using an accelerometer, and metabolic requirements (n = 10) were assessed using a mobile oxycon. Walking with the modern draisine resulted in a higher 6MWD compared with walking with the rollator (466 ± 189 m vs 383 ± 85 m). Moreover, patients had fewer strides (245 ± 61 vs 300 ± 49) and a greater stride length (1.89 ± 0.73 m vs 1.27 ± 0.14 m) using the modern draisine compared with the rollator (all P ≤ .001). Oxygen uptake, ventilation, heart rate, oxygen saturation, and Borg symptom scores were comparable between both walking aids. Ten percent of the patients felt embarrassed using the modern draisine compared with 19% for the rollator, and a significantly smaller proportion of patients would use the modern draisine in daily life. The mean difference in 6MWD between a modern draisine and a rollator seems clinically relevant, with the same metabolic requirements and symptom Borg scores. Therefore, this "new" ambulation aid could be a good alternative to the rollator to improve functional exercise performance in patients with COPD. The Netherlands National Trial Registry; No.: NTR1542; URL: www.trialregister.nl.
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To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister. Randomized crossover trial. Physiopathology laboratory of three rehabilitation centers. We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality). The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline. This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.
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Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD), and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts. The evidence supports the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in the individual patient with advanced COPD. Oxygen is recommended for COPD patients with resting hypoxemia, but its use for the targeted management of dyspnea in this setting should be reserved for patients who receive symptomatic benefit. There is insufficient evidence to support the routine use of anxiolytic medications, nebulized opioids, acupuncture, acupressure, distractive auditory stimuli (music), relaxation, hand-held fans, counselling programs or psychotherapy. There is also no evidence to support the use of supplemental oxygen to reduce dyspnea in nonhypoxemic patients with advanced COPD. Recognizing the current unfamiliarity with prescribing and dosing of opioid therapy in this setting, a potential approach for their use is illustrated. The role of opioid and other effective therapies in the comprehensive management of refractory dyspnea in patients with advanced COPD is discussed.
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This study aimed at assessing the profile of ambulation aid users among patients admitted for geriatric rehabilitation care. Retrospective chart review. Geriatric Rehabilitation Department of the Hôpital Albert Chenevier, Créteil, France. The sample comprised 206 records of patients aged 65 or older with no previous use of assistive device before admission and length of stay longer than 7 days. Ambulation levels were classified as independent ambulators (IA, reference category), ambulation aid users (AA), or nonambulatory patients (NA). we explored age, gender, purpose of initial admission, comorbidities, and past medical history as factors potentially associated with ambulation levels, using multinomial logistic regression. The study population (mean age 84 years [6.1 standard deviation], 68.5 % women) comprised 110 IA (53.4% of the overall population), 72 AA (34.9%), and 24 NA (11.6%). Factors independently associated with AA use were the following: older age (odds ratio = 1.17; [95% confidence interval 1.09-1.25]), previous history of lower limb surgery (2.15; [1.0-4.73]), and admission for hip surgery (8.14; [2.60-25.53]). Factors independently associated with NA were the following: older age (1.12 [1.02-1.23]) and low Mini-Mental State Exam score (0.77 [0.70-0.85]). A borderline association was observed for visual impairment (3.36 [0.93-12.95]). Cardiac disease, respiratory disease, falls, and dementia were not associated with ambulation aid use. History of lower-limb surgery, particularly recent hip surgery, and old age are the primary predictive factors of ambulation aid use in a geriatric rehabilitation hospital.
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Pulmonary rehabilitation has been demonstrated to improve symptoms and quality of life of patients with chronic respiratory diseases. These benefits are not necessarily associated with physiological improvement and have not been shown to improve mortality. In this sense, its goals are palliative. Rehabilitation programs assess patients' knowledge of their diseases, degree of symptoms such as dyspnea and fatigue, understanding of common therapies, and capacity for exercise. The exercise component of pulmonary rehabilitation improves function within the rehabilitation setting and may translate to increased activity at home for some patients. The programs also offer additional opportunities to identify for referring providers potentially undetected underlying comorbidities such as sleep disturbances, anxiety, and depression, which contribute to a poor quality of life for many patients. In addition, patients and their caregivers can be encouraged to ask questions about interventions during exacerbations, the meaning of advance care planning, and goals for end of life care with the intent that these dialogues will lead to further discussions with their doctors and families.
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To quantify the economic value of publicly provided four-wheeled walkers as judged by recipients in Queensland, Australia. Contingent valuation study using willingness-to-pay approach. A sample of 49 Australian older adults who received a publicly funded four-wheeled walker in the past 3 months completed the survey via telephone. A discrete choice bidding response format with a randomly selected starting bid was employed to glean valuations. This approach yielded only one non-response, and one zero dollar response. The mean (standard deviation) valuation provided was $A 290 ($ A 167), which was \$ A 84 in excess of the price paid by the public provider agency to purchase the equipment. Starting bid was significantly associated with values provided. The current public provision program of four-wheeled walkers is likely to generate net societal benefit. These findings coupled with arguments based on equity build a moderate case for the continuation of this program.
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We performed a two-site prospective, controlled interventional study of patients enrolled in pulmonary rehabilitation to assess effects of advance directive education on completion of (1) living wills, (2) durable powers of attorney for health care (DPAHC), (3) patient-physician discussions about advance directives, and (4) discussions about life support, in addition to (5) patient impressions that their physicians understood their end-of-life preferences. The educational group had an increase (p < 0.05) in all five study outcomes compared with baseline values; the control group had an increase in three of five outcomes. The effect strength was greater in the educational compared with the control group for completion of DPAHC (odds ratio [OR] = 3.6, 95% confidence interval [CI] 1.1 to 12.9), advance directive discussions (OR = 2.9, 95% CI 1.1 to 8.3), initiation of life-support discussions (OR = 2.7, 95% CI 1.0 to 7.7), and development of patient assurance that their physicians understand their preferences (OR = 3.7, 95% CI 1.3 to 13.4). The educational intervention was an independent explanatory factor by multivariate analysis. We conclude that patients enrolled in pulmonary rehabilitation are receptive to advance care planning, which is promoted by education on end-of-life issues.
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To determine the extent to which patients with Stage I COPD experience improvements in physical performance and quality of life as a result of exercise training, and to compare these improvements with those seen in Stage I and II patients, 151 patients with COPD underwent a 12-wk exercise program. Outcomes were measured at baseline and follow-up. Physical performance was evaluated by means of a 6-min walk, treadmill time, an overhead task, and a stair climb. General health-related quality of life was assessed in terms of the domains of Social Function, Health Perceptions, and Life Satisfaction. Disease-specific health-related quality of life was assessed with the Chronic Respiratory Disease Questionnaire (CRQ). Six-minute walk distance increased significantly in Stage I (200.5 ft [95% CI: 165.4, 235.7]), Stage II (238.3 ft [143.3, 333.3]), and Stage III (112.1 ft [34.6, 189.6]) participants. Treadmill time increased significantly in Stage I (0.42 min [0.20, 0.64]) and Stage II (0.64 min [0.14, 1.4]) participants. Time to complete the overhead task decreased significantly in Stage I (0.91 s [1.72, 0. 11]) and Stage II (1.39 s [2.66, 0.13]) participants. None of the measures of general health-related quality of life improved in any of the three groups. Participants in Stages I, II, and III all experienced improvements in the CRQ domains of dyspnea (0.72 [0.53, 0.91], 0.47 [0.02, 0.91], and 0.46 [0.05, 0.87], respectively) and fatigue (0.49 [0.33, 0.66], 0.54 [0.20, 0.87], and 0.55 [0.05, 1.05], respectively). These results suggest that all patients with COPD will benefit from exercise rehabilitation. Berry MJ, Rejeski WJ, Adair NE, Zaccaro D. Exercise rehabilitation and chronic obstructive pulmonary disease stage.
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Shortness of breath is a common and distressing symptom in incurable cancer and some other illnesses at the end of life. Overall shortness of breath towards the end of life is still difficult to treat. Appropriate treatment of this distressing symptom requires both drug and non-drug methods. We aimed to determine which non-drug methods relieve shortness of breath and which are the most effective. We found 47 studies that were first categorised in to two groups: methods with one clear described component and methods with a mixture of components. The two groups were then divided in to 12 subgroups. The following studies showed that these interventions can help to relieve shortness of breath: vibration of patient's chest wall, electrical stimulation of leg muscles, walking aids and breathing training. There are mixed results for the use of acupuncture/acupressure. Further interventions identified were counselling and support, either alone or in combination with relaxation-breathing training, music, relaxation, a hand-held fan directed at a patient's face, case management and psychotherapy. There are several non-drug methods available to relieve shortness of breath in incurable stages of cancer and other illnesses. There is currently not enough data to judge the evidence for these interventions. Most studies were conducted in participants with chronic lung disease. Only a few studies included participants with heart failure, cancer or neurological disease.
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To characterize the daily utility and satisfaction with rollators in patients with chronic obstructive pulmonary disease (COPD). Cross-sectional observational study. Community. COPD patients describing dyspnea during activities of living, who had been provided with a rollator by a health care professional within the preceding 5-year period. Not applicable. Three questionnaires were administered in random order. The St. George's Respiratory Questionnaire was used to measure health-related quality of life, version 2.0 of the Quebec User Evaluation of Satisfaction with Assistive Technology was used to assess satisfaction with the rollator, and a structured questionnaire was used to obtain information regarding daily utility of the device and barriers to its use. Demographic data were obtained through patient interview. Anthropometric data, measurements of resting lung function, and 6-minute walk distance were extracted from the medical records. Twenty-seven (10 men) patients (forced expiratory volume in 1 second, 35.1%+/-22.3% predicted) completed the study. Sixteen (59%) patients reported daily rollator use. All patients used the rollator to assist with ambulation outdoors, but 16 (59%) patients stated that they did not use the rollator for any activity in their home. Although satisfaction with the rollator was high, women were less satisfied with the weight of the device than men (P=.008). Thirteen (48%) patients reported being embarrassed while using the device. COPD patients provided with a rollator for use during daily life were most satisfied with its effectiveness and least satisfied with its weight. Daily use was generally high with over half the patients using the rollator on a daily basis. Rollators were more often used outdoors than indoors.
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Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society’s evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.
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Chronic obstructive pulmonary disease (COPD) is associated with primary respiratory impairment, disability and handicap, as well as with secondary impairments not necessarily confined to the respiratory system. Because the primary goals of managing patients with COPD include relief of dyspnea and the improvement of health-related quality of life (HRQL), a direct measurement of HRQL is important. Fourteen disease-specific and nine generic questionnaires (four health profiles and five utility measures) most commonly used to measure health status in patients with COPD were reviewed. The measures were classified according to their domain of interest, and their measurement properties - specifications, validity, reliability, responsiveness and interpretability - were described. This review suggests several findings. Currently used health status instruments usually refer to the patients’ perception of performance in three major domains of HRQL - somatic sensation, physical and occupational function, and psychological state. The choice of a questionnaire must be related to its purpose, with a clear distinction being made between its evaluative and discriminative function. In their evaluative function, only a few instruments fulfilled the criteria of responsiveness, and the interpretability of most questionnaires is limited. Generic questionnaires should not be used alone in clinical trials as evaluative instruments because of their inability to detect change over time. Further validation and improved interpretability of existing instruments would be of greater benefit to clinicians and scientists than the development of new questionnaires.
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Assessment of health-related quality of life (HRQL) of patients with chronic lung disease has become an important aspect of many clinical investigations. The authors examined the measurement properties of a disease-specific HRQL questionnaire, the Chronic Respiratory Questionnaire (CRQ), when used by independent investigators in clinical trials and observational studies. METHODS: All published papers citing the original 1987 CRQ publication were identified using the Science Citation Index, and abstracts presented at international conferences were found by hand search. Clinical trials and observational studies were included if they reported data bearing on the CRQ’s measurement properties. RESULTS: Of 90 papers and 20 abstracts, 32 met the inclusion criterion. CRQ domains of fatigue, mastery and emotional function have high reliability, and face, content and construct validity in differentiating among patients with better and worse HRQL. Because of its self-generated items, the dyspnea domain works less well in discriminating among patients with lesser and greater dyspnea. When CRQ has been used to evaluate treatment, all four domains have performed well in detecting small treatment effects. The minimal important difference in CRQ score (0.5 per item) provides guidance for both planning studies and interpreting results. To maximize CRQ interpretability, investigators should present results as the mean score per item within each domain on a seven-point scale. CONCLUSION: The CRQ has proved valid and responsive to change. Its standardization and continued wide use will enhance the understanding of the impact of treatments on patients’ HRQL.
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In recent years quality of life instruments have been featured as primary outcomes in many randomized trials. One of the challenges facing the investigator using such measures is determining the significance of any differences observed, and communicating that significance to clinicians who will be applying the trial results. We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change. Using this approach we have established a plausible range within which the minimal clinically important difference (MCID) falls. In three studies in which instruments measuring dyspnea, fatigue, and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item, when responses were presented on a seven point Likert scale. Furthermore, we have established ranges for changes in questionnaire scores that correspond to moderate and large changes in the domains of interest. This information will be useful in interpreting questionnaire scores, both in individuals and in groups of patients participating in controlled trials, and in the planning of new trials.
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Since the relationships between pulmonary function, exercise capacity, and functional state or quality of life are generally weak, a self report questionnaire has been developed to determine the effect of treatment on quality of life in clinical trials. One hundred patients with chronic airflow limitation were asked how their quality of life was affected by their illness, and how important their symptoms and limitations were. The most frequent and important items were used to construct a questionnaire evaluating four dimensions: dyspnoea, fatigue, emotional function, and the patient's feeling of control over the disease (mastery). Reproducibility, tested by repeated administration to patients in a stable condition, was excellent: the coefficient of variation was less than 12% for all four dimensions. Responsiveness (sensitivity to change) was tested by administering the questionnaire to 13 patients before and after optimisation of their drug treatment and to another 28 before and after participation in a respiratory rehabilitation programme. In both cases large, statistically significant improvements in all four dimensions were noted. Changes in questionnaire score were correlated with changes in spirometric values, exercise capacity, and patients' and physicians' global ratings. Thus it has been shown that the questionnaire is precise, valid, and responsive. It can therefore serve as a useful disease specific measure of quality of life for clinical trials.
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A primary goal of pulmonary rehabilitation is to improve health and life quality by encouraging participants to engage in exercise and to increase daily physical activity. The recent advent of motion sensors, including digital pedometers and accelerometers that measure motion as a continuous variable, have added precision to the measurement of free-living daily activity. Daily activity and exercise are variables of keen interest to proponents of the national health agenda, epidemiologists, clinical researchers, and rehabilitation interventionists. This paper summarizes issues related to conceptualizing and monitoring activity in the rehabilitation setting; reviews motion sensor methodology; compares motion-sensing devices; presents analysis issues and current and potential applications to the pulmonary rehabilitation setting; and gives practical applications and limitations.
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We analyzed the effects of the use of a rollator on walking distance and physiologic variables: pulmonary gas exchange, heart rate, minute ventilation (Ve), oxygen saturation, and symptoms during the 6-min walk test (6MWT) in patients with COPD. Outpatient clinic at university hospital. Fourteen patients with COPD in stable clinical condition. One patient had mild COPD, five patients had moderate COPD, six patients had severe COPD, and two patients had very severe COPD. Two 6MWTs were performed with a portable metabolic system (VmaxST 1.0; Viasys Healthcare; MEDA; Aartselaar, Belgium) with a rollator and without a rollator, in random order. In addition, maximal voluntary ventilation (MVV) was measured with and without a rollator, randomly. The median 6MWT distance increased significantly with a rollator: 416 m without a rollator (interquartile range [IQR], 396 to 435 m), vs 462 m with a rollator (IQR, 424 to 477 m) [p = 0.04]. Significant increases were also seen in oxygen uptake (0.04 L/min [IQR, - 0.002 to 0.09 L/min]); tidal volume (0.06 L/min [IQR, - 0.001 to 0.11 L/min]); and Ve (0.95 L/min [IQR, - 0.67 to 7.1 L/min]), recorded in the last minute of the 6MWT; as well as in MVV (3 L/min [IQR, 0 to 12 L/min]) [p < 0.05 for all]. Borg dyspnea scores tended to be lower with a rollator: 6 (IQR, 4 to 7) without a rollator, vs 5 (IQR, 4 to 7) with a rollator (p = 0.10). The variation in the 6MWT was explained by individual changes in walking efficiency (partial R(2) = 0.31) and changes in Ve (partial R(2) = 0.36) [p model < 0.04]. The use of a rollator improves walking distance of patients with COPD through an increased ventilatory capacity and/or better walking efficiency.
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Chronic obstructive pulmonary disease (COPD) is associated with primary respiratory impairment, disability and handicap, as well as with secondary impairments not necessarily confined to the respiratory system. Because the primary goals of managing patients with COPD include relief of dyspnea and the improvement of health-related quality of life (HRQL), a direct measurement of HRQL is important. Fourteen disease-specific and nine generic questionnaires (four health profiles and five utility measures) most commonly used to measure health status in patients with COPD were reviewed. The measures were classified according to their domain of interest, and their measurement properties - specifications, validity, reliability, responsiveness and interpretability - were described. This review suggests several findings. Currently used health status instruments usually refer to the patients' perception of performance in three major domains of HRQL - somatic sensation, physical and occupational function, and psychological state. The choice of a questionnaire must be related to its purpose, with a clear distinction being made between its evaluative and discriminative function. In their evaluative function, only a few instruments fulfilled the criteria of responsiveness, and the interpretability of most questionnaires is limited. Generic questionnaires should not be used alone in clinical trials as evaluative instruments because of their inability to detect change over time. Further validation and improved interpretability of existing instruments would be of greater benefit to clinicians and scientists than the development of new questionnaires.
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Purpose: The purpose of this study was to determine the ability of an assistive device to increase exercise tolerance in patients with severe chronic obstructive pulmonary disease (COPD), and to identify characteristics associated with benefit from use of the device. Methods: The sample consisted of 12 subjects (all male) who were diagnosed with severe COPD, (FEV1/FVC <60% of predicted) and who required continuous oxygen therapy. Mean age was 62.8 years, mean FEV1 was 33 \pm 12% of predicted and mean oxygen flow rate was 2.3 L/min (range 1-4 L/min). All patients performed two 12-minute walks: one while pushing an assistive device (NextStep, NobleMotion, Pittsburgh, PA), the assistive walk, and one without the device, the independent walk. The order of the walks was randomized and practice walks were performed before data collection. Oxygen saturation and pulse were measured during the walks using pulse oximetry. Results: Mean distance for the independent walk was 1,274 \pm 846.4 feet, and for the assisted walk 1,426 \pm 761 feet. This represented a mean increase of 151 feet or 10.2% However, distance for the patients who could not walk 1,000 feet (n = 6) was 491 \pm 183 feet without the device, and 717 \pm 157 feet with the device increased significantly (P <.0001). This represented a mean increase of 46%. Conclusions: Patients with severe COPD who were unable to walk 1,000 feet during a 12-minute walk increased walk distance significantly when allowed to push an assistive device. Further research is needed to determine if severely obstructed patients will obtain additional benefit from use of an assistive device in conjunction with a pulmonary rehabilitative/exercise program. (C) Lippincott-Raven Publishers.
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This chapter focuses on the bias in analytic research. Case-control studies are attractive. They can be executed quickly and at low cost, even when the disorders of interest are rare. The execution of pilot case-control studies is becoming automated; strategies have been devised for the “computer scanning” of large files of hospital admission diagnoses and prior drug exposures, with detailed analyses carried out in the same data set on an ad hoc basis. As evidence of their growing popularity, when one original article was randomly selected from each issue of The New England Journal of Medicine, The Lancet, and the Journal of the American Medical Association for the years 1956, 1966, and 1976, the proportion that reported case-control analytic studies increased fourfold over these two decades; however, the proportion reporting cohort analytic studies fell by half; a general trend toward fewer study subjects but more study authors was also noted.
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A walking aid enabled five patients with severe airways obstruction due to pulmonary emphysema to double their walking distance. When given 100% oxygen to breathe, the walking distance trebled; when walking aid and oxygen were combined, walking distance increased eightfold. The walking aid is a simple effective means of increasing exercise ability in room-bound patients with severe pulmonary emphysema.
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This study assessed the effect of a wheeled walking aid on disability, oxygenation, and breathlessness in patients with severe disability secondary to chronic irreversible airflow limitation. Eleven subjects with chronic irreversible airflow limitation, mean forced expired volume in 1 second (FEV1) 0.71 L +/- .33 L, were studied. Subjects performed four 6-minute walk tests, two on each of two study days, twice unaided and twice with the assistance of a wheeled walking aid. A randomized cross-over design was used. All subjects were oriented to 6-minute walk tests, use of bronchodilators was controlled, and standard encouragement was given during each walk test. Outcome measures were the distance walked in 6 minutes, change in oxyhemoglobin saturation during the walk, and breathlessness using a modified Borg Scale. The use of a wheeled walker resulted in a significant increase in 6-minute walking distance, a significant reduction in hypoxemia with walking and a significant reduction in breathlessness during the walk test. The use of a wheeled walker resulted in significant decreases in disability, hypoxemia, and breathlessness during a 6-minute walk test. By reducing disability and breathlessness, a wheeled walker may improve quality of life in individuals with severe impairment in lung function.
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This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use. Repeated-measures randomized crossover design using the 6-min walk test (6MWT) as the primary outcome measure. Respiratory rehabilitation center. Forty stable subjects who had received a diagnosis of COPD. Two 6MWTs were performed on each study day. One 6MWT was performed unaided, and the other was performed with a rollator. The order was randomized on the first day and reversed on the second day. Use of the rollator was associated with a significant reduction in dyspnea (p < 0.001) and duration of rest (reduction for the total group, 19 s; and reduction for those who walked < 300 m unaided, 40 s; p = 0.001) during the 6MWT. For subjects who walked < 300 m unaided, there was also a significant improvement in distance walked (p = 0.02). No changes were found for the measures of cardiorespiratory function or gait (p > 0.05). The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator (p < 0.005). The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided. Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD. Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea, reduced rest time, and improved distance walked.
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Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high- and low-intensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower- and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.
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To investigate whether the acute benefits of rollator use are consistent over time in individuals with moderate to severe chronic obstructive pulmonary disease. Thirty-one stable subjects with chronic obstructive pulmonary disease (13 men, 18 women), aged 68 +/- 8 years, with a forced expiratory volume in 1 second of 0.7 +/- 0.2 L (33% +/- 12% predicted) and a baseline 6-minute walk (6MW) of 261 +/- 68 m, were recruited from a respiratory clinic after completion of a pulmonary rehabilitation program. Two 6MWs were performed at baseline, 4 weeks, and 8 weeks, one walking unaided and the other walking with the assistance of a rollator. The test order was randomly chosen at baseline, and the same test order was used at each time point. The primary outcome measures were distance walked in 6 minutes (meters), perceived dyspnea using a modified Borg scale, and number of rests taken. Subjects achieved higher 6MW distances during assisted compared with unassisted walking at baseline (292 +/- 67 vs 263 +/- 67 m), 4 weeks (296 +/- 62 vs 275 +/- 63m), and 8 weeks (283 +/- 65 vs 259 +/- 68 m) (P = .013), with no time effect (P = .5). In addition, use of a rollator resulted in a significant improvement in dyspnea (P = .004) at baseline, 4 weeks, and 8 weeks, with no time effect (P = .7). The use of a rollator also reduced the number of rests taken during the 6MW (P < .001), with no time effect (P = .9). Rollator use resulted in improvements in performance in the 6MW, which were consistent over time among individuals with moderate to severe chronic obstructive pulmonary disease who walk less than 375 m during an unaided 6MW.
Functional outcome difference using a rollator walker versus a two-wheeled rolling walker
• Cornely
The effect of walking aids on walking distance, breathlessness and oxygenation in patients with severe chronic obstructive pulmonary disease
• Dalton