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Effective pulmonary rehabilitation in primary health care with minimal resources

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.authorMarília, Rua
dc.contributor.authorLoureiro, Helena
dc.contributor.authorFreitas, Célia
dc.date.accessioned2019-10-04T15:18:04Z
dc.date.available2019-10-04T15:18:04Z
dc.date.issued2018
dc.description.abstractBackground: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.urihttp://hdl.handle.net/10400.8/4170
dc.language.isoporpt_PT
dc.peerreviewedyespt_PT
dc.relationPOCI-01-0145-FEDER016701pt_PT
dc.relationRevitalizing Pulmonary Rehabilitation (3R)
dc.relationPOCI-01-0145-FEDER-007628- iBiMEDpt_PT
dc.relationInstitute for Biomedicine - Aveiro
dc.relation.publisherversionhttps://www.gifcr-apf.com/eventos/pt_PT
dc.subjectPulmonary rehabilitationpt_PT
dc.subjectPrimary health carept_PT
dc.subjectMinimal resourcespt_PT
dc.titleEffective pulmonary rehabilitation in primary health care with minimal resourcespt_PT
dc.typeconference object
dspace.entity.typePublication
oaire.awardTitleRevitalizing Pulmonary Rehabilitation (3R)
oaire.awardTitleInstitute for Biomedicine - Aveiro
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/9876 - Politécnicos/SAICT-POL%2F23926%2F2016/PT
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UID%2FBIM%2F04501%2F2013/PT
oaire.citation.conferencePlaceLeiria, Portugalpt_PT
oaire.citation.endPage13pt_PT
oaire.citation.startPage12pt_PT
oaire.citation.titleBetween2Lungs – Atualização da Fisioterapia Cardiorrespiratória 2018pt_PT
oaire.fundingStream9876 - Politécnicos
oaire.fundingStream6817 - DCRRNI ID
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
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typeconferenceObjectpt_PT
relation.isAuthorOfPublication2b4618ae-9c47-4033-94ea-24c9793d73e7
relation.isAuthorOfPublication33428074-748a-4751-b2f7-9f24247715fd
relation.isAuthorOfPublication.latestForDiscovery2b4618ae-9c47-4033-94ea-24c9793d73e7
relation.isProjectOfPublication75349ce3-48e8-4fa6-8621-8df9126bfb35
relation.isProjectOfPublicatione14d6486-f3c2-4e1d-90c2-a9739583d9b4
relation.isProjectOfPublication.latestForDiscoverye14d6486-f3c2-4e1d-90c2-a9739583d9b4

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