Browsing by Author "Loureiro, Helena"
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- Effective pulmonary rehabilitation in primary health care with minimal resourcesPublication . Marques, Alda; Rebelo, Patrícia; Paixão, Cátia; Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Marília, Rua; Loureiro, Helena; Freitas, CéliaBackground: Pulmonary rehabilitation (PR) is a cornerstone intervention for the management of chronic respiratory diseases (CRD). However, it is underutilised and highly inaccessible to patients as most PR programmes are directed to patients with advanced disease and/or held on a hospital basis. Recognising the urgent need to increase access to this intervention, the Portuguese National Health Service has determined that until the end of 2017, all Agrupamentos de Centros de Saúde should provide access to PR. Aims: To assess the effects of PR conducted in primary health care centres (PHCC), with minimal resources. Methods: A quasi-experimental pre-post study was conducted. Eligible patients with CRD were identified and refereed by family doctors. Patients enrolled in a 12-week PR programme implemented with minimal resources (pulse oximeters, blood pressure monitors, modified Borg scales, chairs, stairs, corridors, free weights built with bottles with sand, resistance bands and cushions), composed of exercise training twice a week, and education and psychosocial support once every other week. Outcome measures used to assess effectiveness of the programme were collected pre/post PR. Dyspnoea during activities was collected with the modified medical research council–dyspnoea scale (mMRC); peripheral muscle strength in the upper limbs with a handgrip, in the lower limbs - quadriceps muscle strength (QMS), with the handheld dynamometry and respiratory muscle strength with maximal inspiratory and expiratory pressures (MIP/MEP); functionality with 1-minute sit-to-stand (1-min STS), exercise tolerance with the six-minute walk test (6MWT), functional balance with the Brief-BESTest and healthrelated quality of life with the Saint George’s Respiratory Questionnaire (SGRQ). Pre/post differences and effect sizes (ES) were calculated. For the measures with an established minimal clinical important difference (MCID), an analysis of the number of patients improving above that value was conducted. Results: Eighteen patients (68.6±1.9 years old; 11(61.1%) female; FEV1pp=70.2±4.9), with chronic obstructive pulmonary disease (n=6), asthma (n=8), Asthma-COPD Overlap Syndrome (n=3) and pulmonary fibrosis (n=1) participated. After PR, significant improvements were observed in all measures (Table 1). Concerning the MCID, 10(55.6%) improved above the established 1 point in the mMRC, 14(77.8%) patients above the 3 repetitions in the 1min-STS; 15(83.3%) patients above the 25m in the 6MWT, 7(38.9%) patients above the 4.9 points in the Brief BESTest and 11(61.1%) patients above the 4 points in SGRQ. Conclusions: Even with minimal resources, PR is feasible and possible to implement in PHCC, providing similar benefits to those well-established for PR programmes carried out in hospital outpatient settings.
- Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysisPublication . Marques, Alda; Jácome, Cristina; Rebelo, Patrícia; Paixão, Cátia; Oliveira, Ana; Cruz, Joana; Freitas, Célia; Rua, Marília; Loureiro, Helena; Peguinho, Cristina; Marques, Fábio; Simões, Adriana; Santos, Madalena; Martins, Paula; André, Alexandra; De Francesco, Sílvia; Martins, Vitória; Brooks, Dina; Simão, PaulaPulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.
- Pulmonary rehabilitation in primary health care: an effective intervention even with minimal resourcesPublication . Marques, Alda; Rebelo, Patrícia; Paixão, Cátia; Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Rua, Marília; Loureiro, Helena; Freitas, CéliaPulmonary rehabilitation (PR) is a cornerstone intervention for the management of chronic respiratory diseases however it is underutilised and highly inaccessible to patients. In Portugal, most PR programmes are outpatient, hospital-based and directed to patients with advanced disease leading to less than 1% of patients having access to it. Recognising the urgent need to increase access to this fundamental intervention, the Portuguese National Health Service has determined that until the end of 2017, all Agrupamentos de Centros de Saúde should provide access to PR (Law n. 6300/2016). This study assessed the effects of PR conducted in primary health care centres (PHCC), with minimal resources. A quasi-experimental pre-post study was conducted. Eligible patients with chronic respiratory diseases were identified by family doctors and refereed to PR. Sociodemographic, anthropometric and clinical data were collected with a questionnaire and lung function with spirometry. The following measures were collected: dyspnoea during activities with the modified medical research council–dyspnoea scale (mMRC); peripheral muscle strength in the upper limbs with the handgrip, in the lower limbs - quadriceps muscle strength (QMS), with the handheld dynamometry and respiratory muscle strength with maximal inspiratory and expiratory pressures (MIP/MEP); functionality with 1-minute sit-to-stand (1-min STS), exercise tolerance with the six-minute walk test (6MWT), functional balance with the Brief-BESTest and quality of life with the Saint George’s Respiratory Questionnaire (SGRQ). All data were collected pre/post a 12-week PR programme implemented with minimal resources (pulse oximeters, blood pressure monitors, modified Borg scales, chairs, stairs, corridors, free weights built with bottles with sand, therabands and cushions), composed of exercise training twice a week and education and psychosocial support once every other week. Pre/post differences and effect sizes (ES) were calculated. For the measures with an established minimal clinical important difference (MCID), an analysis of the number of patients improving above that value was conducted. Eighteen patients participated (68.6±1.9 years old; 11(61.1%) female; BMI=29.5±4.8kg/m2; FEV1pp=70.2±4.9; FVCpp=88.4±24.3), 6(33.3%) with chronic obstructive pulmonary disease (FEV1pp=61.7±16; FVCpp=89±30; GOLD II-5, GOLD III-1, 1A, 4B, 1D), 8(44.4%) with asthma (FEV1pp=79.1±12; FVCpp=92±20.1), 3(16.7%) with Asthma-COPD Overlap Syndrome (FEV1pp=67.7±42.3; FVCpp=88.7±28.8) and 1(5.6%) with pulmonary fibrosis (FEV1pp=58; FVCpp=56). After PR, significant improvements were observed in all measures (Table 1). Concerning the MCID, 10(55.6%) improved above the established 1 point in the mMRC, 14(77.8%) patients above the 3 repetitions in the 1min-STS; 15(83.3%) patients above the 25m in the 6MWT, 7(38.9%) patients above the 4,9 points in the Brief BESTest and 11(61.1%) patients above the 4 points in SGRQ. Even with minimal resources, PR is feasible and possible to implement in PHCC, providing similar benefits to those well-established for PR programmes carried out in hospital outpatient settings.
- Relationship between family function and exercise capacity and inspiratory muscle strength in COPDPublication . Paixão, Cátia Filipa Pinto da; Rebelo, Patrícia; Oliveira, Ana; Jácome, Cristina; Cruz, Joana; Freitas, Célia; Loureiro, Helena; Rua, Marília; Ferreira, Pedro; Marques, AldaChronic obstructive pulmonary disease (COPD) is a multidimensional disease known to affect not only patients but also family functioning. Family functioning affects several dimensions of patients’ psychological and social performance, however the association with patient’s physical outcomes remains unknown. This study explored associations between family function and exercise capacity and inspiratory muscle strength in COPD. 20 patients with COPD (85% male; 67.5±10y; 54.3±29.4FEV1%predicted) were included. Sociodemographic, anthropometric and lung function data were collected to characterise the sample. 2 six-minute walk tests (6MWT) and up to 5 maximum inspiratory pressure (MIP) manoeuvres were performed. The best performances were analysed. Family function was assessed with the family adaptability and cohesion evaluation scale (FACES-IV). Correlations were explored with the Spearman’s correlation coefficient. Moderate and positive correlations were found between family satisfaction and 6MWT (r=0.55; p=0.02) and between family cohesion and MIP values (r=0.59; p=0.01). Strong and positive correlations (r=0.61; p=0.01) were found between family satisfaction and MIP values. No further correlations were found (Fig.1). Family function correlated significantly with patients’ exercise capacity and inspiratory muscle strength. Further research on family functioning is needed to enhance knowledge on COPD management.