Revitalizing Pulmonary Rehabilitation (3R)

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Digital technology access among patients with chronic respiratory diseases

Publication . Jácome, Cristina; Rebelo, Patrícia; Paixão, Cátia; Oliveira, Ana; Cruz, Joana; Marques, Fábio; Marques, Alda

Background: Pulmonary rehabilitation (PR) is a well-established and evidence-based intervention to manage chronic respiratory diseases (CRD), but its benefits diminish over time. Self-management can slow down this tendency and digital technologies may have a key-role in such approaches. However, few studies have evaluated the access to digital technology among patients with CRD, which is fundamental for the implementation of technology-based self-management strategies. Aims: The objective of this study was to explore if patients with CRD have access to digital technology and if they feel confident in using it. Methods: This was an exploratory cross-sectional study. Patients with CRD were recruited from community-based PR programmes between October 2017 and September 2018. Patients were surveyed regarding access to computers, smartphones, tablets, cell phones and internet. Their confidence in using these technologies was assessed using a numerical scale from 0 (not at all confident) to 10 (completely confident). Patients were considered confident when a score higher than5 was selected. Chisquare tests were used to explore if access to digital technology was related to age, sex, marital status, education or occupation. Results: 123 patients (n=76; 62% male; 67±11 [32-87] years) were included. Chronic obstructive pulmonary disease (n=73; 59%) and asthma (n=23; 19%) were the most common diagnosis. 80% of patients reported having access to digital technology: 34% reported having a computer, 44% owned a smartphone or tablet and 36% a cell phone. 81% of patients reported themselves as confident in using these technologies (median 7, interquartile range 5-8.5). About half of them (n=64; 52%) used the internet and, from these, 84% felt confident in using it (median 8, interquartile range 5-9). Patients with access to digital technology and internet were younger (p=.029 and p<.001) and with higher levels of education (p=.010 and p<.001). No further associations were found. Conclusions: Patients with CRD have access to and feel confident in using digital technologies. These results reinforce the potential of using digital technologies as a resource for the implementation of selfmanagement strategies in this population.

2018Conference object

Open access

Minimal Clinically Important Difference for Quadriceps Muscle Strength in People with COPD Following Pulmonary Rehabilitation

Publication . Oliveira, Ana; Rebelo, Patrícia; Paixão, Cátia; Jácome, Cristina; Cruz, Joana; Martins, Vitória; Simão, Paula; Brooks, Dina; Marques, Alda

Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR. A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values. Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV1 49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT (p > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD. The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions.

2021-02-03Journal article

Open access

Effective pulmonary rehabilitation in primary health care with minimal resources

Publication . Marques, Alda; Rebelo, Patrícia; Paixão, Cátia; Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Marília, Rua; Loureiro, Helena; Freitas, Célia

Background: 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.

2018Conference object

Open access

Construct Validity of the Brief Physical Activity Assessment Tool for Clinical Use in COPD

Publication . Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Paixão, Cátia; Rebelo, Patrícia; Flora, Sofia; Januário, Filipa; Valente, Carla; Andrade, Lília; Marques, Alda

Introduction Low physical activity (PA) levels are associated with poor health‐related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice. Objectives This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD, and explored differences in age, sex and COPD grades. Methods After linguistic adaptation of the tool to Portuguese, 110 patients (66.4±9.6yrs, 72.7% male, FEV1=59.3±25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous‐ and moderate‐intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA=1952‐5724 counts‐per‐min[CPM]); vigorous PA, VPA=5725‐∞CPM; moderate‐to‐vigorous PA, MVPA=1952‐∞CPM; daily steps), through: Spearman’s correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data. Results The BPAAT was weakly to moderately correlated with accelerometry (0.394≤ρ≤0.435, p<0.05), except for VPA (p=0.440). This was also observed in age (<65/≥65yrs), COPD grades (GOLD 1‐2/3‐4), and in male patients (0.363≤ρ≤0.518, p<0.05 except for VPA). No significant correlations were found in female patients (p>0.05). The BPAAT correctly identified 73.6% patients as ‘insufficiently active’ and 26.4% as ‘sufficiently active’. Agreement was fair to moderate (0.36≤kappa≤0.43; 73.6%≤%agreement≤74.5%; 0.50≤sensitivity≤0.52; 0.84≤specificity≤0.91, 0.55≤PPV≤0.79, 0.72≤NPV≤0.82). Conclusion The BPAAT may be useful to screen patients’ PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients.

2021-01-23Journal article

Open access

Embracing digital technology in chronic respiratory care: Surveying patients access and confidence

Publication . Jácome, C.; Marques, F.; Paixão, C.; Rebelo, P.; Oliveira, A.; Cruz, J.; Freitas, C.; Rua, M.; Loureiro, H.; Peguinho, C.; Simões, A.; Santos, M.; Valente, C.; Simão, P.; Marques, A.

2019-06-01Journal article

Open access