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Research Project
Institute for Biomedicine - Aveiro
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Publications
Relationship between 1-minute sit-to-stand and respiratory muscle strength in COPD
Publication . Alves, Ana; Miranda, Sara; Machado, Ana; Paixão, Cátia; Oliveira, Ana; Rebelo, Patrícia; Cruz, Joana; Jácome, Cristina; Marques, Alda
Background: It has been suggested that patients with chronic obstructive pulmonary disease (COPD) with respiratory muscle weakness achieve poorer results in exercise capacity tests, namely in the six-minute walk test (6MWT). The 1-minute sit-to-stand test (1-min STST) is simple to perform and a reliable and valid indicator of functional exercise capacity that correlates well with the 6MWT. However, its association with respiratory muscle strength in COPD is poorly studied. Objective: To explore the relationship between the 1-min STST and maximum inspiratory (MIP) and expiratory pressures (MEP) in patients with COPD. Methods: A cross-sectional study was conducted in the center and north regions of Portugal. Outpatients with COPD were recruited from routine pulmonology appointments. The 1-min STST and MIP/MEP were collected and predicted percentages (pp) of MIP/MEP were calculated using the equation set by Neder and colleagues. Correlations between the number of repetitions in the 1-min STST and MIPpp/MEPpp were explored by sex using Spearman coefficient correlation. Results: 376 outpatients with COPD (66.3±10.2y; 76.1%♂; FEV1 61.1±23.4pp; 101.6±8.0% ♂MIPpp; 79.2±5.2% ♀MIPpp; 110.9±8.1% ♂MEPpp; 76.7±6.5% ♀MEPpp) were included in this study. When the correlation was assessed by sex, low positive correlations were found between 1-min STST and MIP/MEPpp in males (r=0.37, p<0.001) (Fig.1). There was no significant correlation between 1-min STST and of MIP/MEPpp in females (p>0.05). Conclusion: 1-min STST correlated significantly with predicted respiratory muscle strength in male patients with COPD. Patients with respiratory muscle impairment seem to have worse functional capacity than those with better MIP and MEP. Thus, respiratory muscle training may play an important role in the improvement of functional capacity in patients with COPD with respiratory muscle weakness.
Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis
Publication . 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, Paula
Pulmonary 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.
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.
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.
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.
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Funders
Funding agency
Fundação para a Ciência e a Tecnologia
Funding programme
6817 - DCRRNI ID
Funding Award Number
UID/BIM/04501/2013