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Pulmonary rehabilitation in primary health care: an effective intervention even with minimal resources

2018Other Open access
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dc.contributor.authorMarques, Alda
dc.contributor.authorRebelo, Patrícia
dc.contributor.authorPaixão, Cátia
dc.contributor.authorCruz, Joana
dc.contributor.authorJácome, Cristina
dc.contributor.authorOliveira, Ana
dc.contributor.authorRua, Marília
dc.contributor.authorLoureiro, Helena
dc.contributor.authorFreitas, Célia
dc.date.accessioned2019-10-04T14:16:28Z
dc.date.available2019-10-04T14:16:28Z
dc.date.issued2018
dc.description.abstractPulmonary 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.pt_PT
dc.description.versionN/Apt_PT
dc.identifier.urihttp://hdl.handle.net/10400.8/4167
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.relation3R - Revitalizing Pulmonary Rehabilitationpt_PT
dc.subjectPumonary rehabilitationpt_PT
dc.subjectPrimary health carept_PT
dc.subjectMinimal resourcespt_PT
dc.titlePulmonary rehabilitation in primary health care: an effective intervention even with minimal resourcespt_PT
dc.typeother
dspace.entity.typePublication
oaire.citation.conferencePlaceCentro de Congressos EPIC Sana, Praia da Falésia (Portugal)pt_PT
oaire.citation.titleXXXIV Congresso da Sociedade Portuguesa de Pneumologia, X Congresso Luso-Brasileiro de Pneumologiapt_PT
person.familyNameMarques
person.familyNameCruz
person.givenNameAlda
person.givenNameJoana
person.identifier.ciencia-idDE15-EFBA-4856
person.identifier.ciencia-idE213-7D20-5C3C
person.identifier.orcid0000-0003-4980-6200
person.identifier.orcid0000-0002-4911-4469
person.identifier.ridK-7030-2013
person.identifier.scopus-author-id36715922000
rcaap.rightsopenAccesspt_PT
rcaap.typeotherpt_PT
relation.isAuthorOfPublication2b4618ae-9c47-4033-94ea-24c9793d73e7
relation.isAuthorOfPublication33428074-748a-4751-b2f7-9f24247715fd
relation.isAuthorOfPublication.latestForDiscovery33428074-748a-4751-b2f7-9f24247715fd

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