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Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting.

ABSTRACT: OBJECTIVES:This feasibility study aimed to assess the acceptability of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD) who declined pulmonary rehabilitation (PR) as a potential treatment option or precursor to PR. Objectives were to assess attitudes to IMT, PR and alternatives to PR; factors influencing adherence with IMT and acceptability of outcome measures, research tools and study protocol. DESIGN:A pragmatic, mixed methods, prepost feasibility study was conducted. Recruitment took place over a 4-month period. Participants were followed up for a period of 6?months. SETTINGS:IMT sessions and assessments were conducted in the domiciliary setting. PARTICIPANTS:Inclusion criteria: people over the age of 35, stable COPD, Medical Research Council Dyspnoea scale of 3 or above, declined PR. EXCLUSION CRITERIA:history of spontaneous pneumothorax, incomplete recovery from a traumatic pneumothorax, asthma, known recently perforated eardrum, unstable angina, ventricular dysrhythmias, cerebrovascular event or myocardial infarction within the last 2?months. Participants were selected from a purposive sample. Of the 22 potential participants screened, 11 were recruited and interviewed. Ten participants commenced IMT. Seven participants completed the follow-up assessment. INTERVENTION:Eight weeks of IMT twice a day, 5?days a week with visits once weekly by a physiotherapist. Unsupervised IMT twice a day three times a week until follow-up at 6?months. OUTCOMES:Acceptability of IMT and the study process was explored via semi-structured interviews. Adherence with IMT was assessed by the Powerbreathe K3 device and participant diaries. Uptake of PR was identified. RESULTS:IMT was found to be acceptable. Adherence was explored. Four people went on to participate in PR. CONCLUSIONS:Feasibility was established. A randomised controlled trial is warranted to establish efficacy and cost-effectiveness of IMT in those who decline PR and IMT as an intervention to promote uptake of PR. TRIAL REGISTRATION NUMBER:NCT01956565; Post-results.

SUBMITTER: O'Connor C

PROVIDER: S-EPMC6701573 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting.

O'Connor Cath C Lawson Rod R Waterhouse Judith J Mills Gary H GH

BMJ open 20190808 8

<h4>Objectives</h4>This feasibility study aimed to assess the acceptability of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD) who declined pulmonary rehabilitation (PR) as a potential treatment option or precursor to PR. Objectives were to assess attitudes to IMT, PR and alternatives to PR; factors influencing adherence with IMT and acceptability of outcome measures, research tools and study protocol.<h4>Design</h4>A pragmatic, mixed methods, prepos ...[more]

PMID: 31399454

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Project description:Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = -435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, -8.5 L/min, BF10 = 25), respiratory rate (RR, -3.3 breaths/min, BF10 = 2), heart rate (HR, -13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, -183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, -3.8 L/min, BF10 = 1.1) and compared to CG in VE (-8.3 L/min, BF10 = 3.6), VCO2 (-215.9 L/min, BF10 = 3.0), EqCO2 (-3.7 L/min, BF10 = 1.1) and HR (-12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (-4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

Project description:ObjectivesThis study aimed to review the safety of a reusable sealing instrument, BiClamp(®), as an alternative to the mechanical stapler for interlobar fissure division in pulmonary lobectomy.MethodsA retrospective review was conducted of 95 patients who underwent pulmonary lobectomy performed by a single surgeon between November 2005 and March 2010. The patients were divided into two groups according to the period before and after introduction of the BiClamp(®): 29 patients who underwent fissure division with staples only (staple group) and 66 patients who underwent the same procedure mainly with the instrument (BiClamp(®) group).ResultsThere were 60 (63.2%) male and 35 (36.8%) female patients, with a mean ± SD age of 67.5 ± 10.8 years. Comparison of the characteristics of the two groups revealed that the BiClamp(®) group included significantly more cases of lobectomy by video-assisted thoracic surgery and far fewer completely lobulated lungs; 6 of 66 patients (9.1%) compared with 9 of 29 (31.0%) of the staple group. Except for 18 patients who underwent division using staples owing to thick parenchyma of the interlobar fissure, we attempted to divide the fissure of 42 patients in the BiClamp(®) group. Solo use of the BiClamp(®) was possible for 25 of 60 patients (41.7%) with an incomplete fissure. Eight patients (13.3%) needed one staple cartridge in combination with BiClamp(®), five (8.3%) needed two cartridges and four (6.7%) patients needed three (combined use). In most cases, except for right upper or middle lobectomy, the division of the interlobar fissure could be performed by sole use of the BiClamp(®). Incidence rates of prolonged air leakage and pneumonia were not significantly different between the two groups (respectively, 6.9 and 3.4% in the staple group vs 10.6 and 9.1% in the BiClamp(®) group).ConclusionsThe study results demonstrate that the division of the interlobar fissure in pulmonary lobectomy with BiClamp(®) is safe and feasible in most cases. While the results point out the limitation that division of the right upper or middle lobe may still be a challenge, they show the potential benefit of staple reduction. Less use of staples results in reduced medical costs and carbon dioxide emission, contributing to 'ecosurgery', which ultimately conserves the global environment.

Project description:BACKGROUND:Standardised evidenced-based materials and mechanisms to facilitate the delivery of the education component of pulmonary rehabilitation are not widely available. The aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in pulmonary rehabilitation; and, 2) to conduct a process evaluation of the adapted programme. METHODS:The adaptations to the LWWCOPD programme were informed by focus groups, current practice, relevant research and guideline documents. Pulmonary rehabilitation sites used the adapted programme, the LWWCOPD programme for pulmonary rehabilitation, to deliver the education component of pulmonary rehabilitation. A process evaluation was conducted: elements included reach (patients' attendance rates), dose delivered (amount of programme delivered), dose received (health professional and patient satisfaction) and fidelity (impact on patients' knowledge, understanding and self-efficacy on the Understanding COPD questionnaire). Descriptive statistics (mean, SD) were used to summarise demographics and key data from the feedback questionnaires. Qualitative feedback on the programme was collated and categorised. Changes in the Understanding COPD questionnaire were examined using paired t-tests. RESULTS:The LWWCOPD programme for pulmonary rehabilitation was delivered in eleven hospital- and community-based programmes (n=25 health professionals, n=57 patients with COPD). It consisted of six weekly 30-45 minute sessions. The process evaluation showed positive results: 62.3% of patients attended ? 4 education sessions (reach); mean (SD) 90 (10)% of the session content were delivered (dose delivered); the majority of sessions were rated as excellent or good by health professionals and patients. Patients' satisfaction was high: mean (SD) Section B of the Understanding COPD questionnaire: 91.67 (9.55)% (dose received). Knowledge, understanding and self-efficacy improved significantly: mean change (95% CI): Section A of the Understanding COPD questionnaire: 26.75 (21.74 to 31.76)%, BCKQ 10.64 (6.92 to 14.37)% (fidelity). CONCLUSION:This rigorous process evaluation has demonstrated that the LWWCOPD programme for pulmonary rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based pulmonary rehabilitation. This programme is now available worldwide (http://www.livingwellwithcopd.com/living-well-and-pulmonary-rehabilitation.html). TRIAL REGISTRATION:This study was registered with clinicaltrials.gov (reference number: NCT01226836).

Dataset Information

Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting.

Publications

Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting.

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