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Effects of and barriers to hospital-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

  • Kim, Sang Hun (Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital) ;
  • Jeong, Jong Hwa (Department of Physical Therapy, Rehabilitation Medicine, Pusan National University Hospital) ;
  • Lee, Byeong Ju (Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital) ;
  • Shin, Myung-Jun (Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Shin, Yong Beom (Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • 투고 : 2020.04.17
  • 심사 : 2020.05.04
  • 발행 : 2020.06.30

초록

Objective: The purpose of this study was to assess the effect of hospital-based pulmonary rehabilitation (PR) on exercise capacity and quality of life as well as barriers to participation in persons with chronic obstructive pulmonary disease (COPD) in South Korea. Design: One-group pretest-posttest design. Methods: A total of 14 patients were enrolled in this study in an 8-week PR program with two 60-minute sessions per week. The program included: flexibility exercises, breathing techniques, strengthening exercises, and aerobic exercises. The outcomes were defined as changes in the variables before and after the PR program. A change in the 6-minute walk distance (6MWD) was defined as the primary outcome, and changes in pulmonary function test, respiratory and grip strength, and the St. George's Respiratory Questionnaire (SGRQ) about quality-of-life results were secondary outcomes. A dropout was defined as missing >3 of the 16 sessions. Results: Patients who completed the program showed a significant improvement of 43.57±39.43 m in the 6MWD (p<0.05), but no significant differences were noted for the other function tests. The SGRQ showed a significant improvement in the activity and total score (p<0.05). The total dropout rate was 53.3%. Newly developed symptoms, exacerbation of COPD, transport problems, and lack of motivation were major barriers to PR. Conclusions: Our study showed that an 8-week hospital-based PR program improved exercise capacity and quality of life but had a high dropout rate in individuals with COPD. Since comprehensive PR has only recently been established in South Korea, patient motivation and education are critical.

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참고문헌

  1. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64. https://doi.org/10.1164/rccm.201309-1634st
  2. Hill K, Vogiatzis I, Burtin C. The importance of components of pulmonary rehabilitation, other than exercise training, in COPD. Eur Respir Rev 2013;22:405-13. https://doi.org/10.1183/09059180.00002913
  3. Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, Kim SH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology 2011;16:659-65. https://doi.org/10.1111/j.1440-1843.2011.01951.x
  4. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017;195:557-82. https://doi.org/10.1164/rccm.201701-0218PP
  5. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest 2007;131(5 Suppl):4S-42S. https://doi.org/10.1378/chest.06-2418
  6. The Korean Academy of Tuberculosis and Respiratory Diseases. Consensus document on pulmonary rehabilitation in Korea 2015. Seoul: The Korean Academy of Tuberculosis and Respiratory Diseases; 2015.
  7. Riario-Sforza GG, Incorvaia C, Paterniti F, Pessina L, Caligiuri R, Pravettoni C, et al. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: a number needed to treat study. Int J Chron Obstruct Pulmon Dis 2009;4:315-9.
  8. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. 7th ed. Philadelphia (PA): F.A. Davis; 2018.
  9. Casciari RJ, Fairshter RD, Harrison A, Morrison JT, Blackburn C, Wilson AF. Effects of breathing retraining in patients with chronic obstructive pulmonary disease. Chest 1981;79:393-8. https://doi.org/10.1378/chest.79.4.393
  10. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al; ATS/ERS Pulmonary Rehabilitation Writing Committee. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006;173:1390-413. https://doi.org/10.1164/rccm.200508-1211ST
  11. Dohoney P, Chromiak JA, Lemire D, Abadie BR, Kovacs C. Prediction of one repetition maximum (1-RM) strength from a 4-6 RM and a 7-10 RM submaximal strength test in healthy young adult males. J Exerc Physiol 2002;5:54-9.
  12. Gea J, Pascual S, Casadevall C, Orozco-Levi M, Barreiro E. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings. J Thorac Dis 2015;7:E418-38.
  13. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. 9th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2013.
  14. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7. https://doi.org/10.1164/ajrccm.166.1.at1102
  15. Becklake M, Crapo R, Buist S. American Thoracic Society Statement. Lung function testing: selection of reference values and interpretive strategies. Am Rev Respir Dis 1991;144:1202-18. https://doi.org/10.1164/ajrccm/144.5.1202
  16. Lagerstrom C, Nordgren B. On the reliability and usefulness of methods for grip strength measurement. Scand J Rehabil Med 1998;30:113-9. https://doi.org/10.1080/003655098444228
  17. Kim SH, Shin MJ, Shin YB, Kim KU. Sarcopenia associated with chronic obstructive pulmonary disease. J Bone Metab 2019;26:65-74. https://doi.org/10.11005/jbm.2019.26.2.65
  18. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Leidy NK. Development and first validation of the COPD Assessment Test. Eur Respir J 2009;34:648-54. https://doi.org/10.1183/09031936.00102509
  19. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis 1992;145:1321-7. https://doi.org/10.1164/ajrccm/145.6.1321
  20. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005-12. https://doi.org/10.1056/NEJMoa021322
  21. Make B. How can we assess outcomes of clinical trials: the MCID approach. COPD 2007;4:191-4. https://doi.org/10.1080/15412550701471231
  22. Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997;155:1278-82. https://doi.org/10.1164/ajrccm.155.4.9105067
  23. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;(4):CD003793.
  24. Byun MK, Cho EN, Chang J, Ahn CM, Kim HJ. Sarcopenia correlates with systemic inflammation in COPD. Int J Chron Obstruct Pulmon Dis 2017;12:669-75. https://doi.org/10.2147/COPD.S130790
  25. Jones SE, Maddocks M, Kon SS, Canavan JL, Nolan CM, Clark AL, et al. Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax 2015;70:213-8. https://doi.org/10.1136/thoraxjnl-2014-206440
  26. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014;15:95-101. https://doi.org/10.1016/j.jamda.2013.11.025
  27. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16-31. https://doi.org/10.1093/ageing/afy169
  28. Nici L, Lareau S, ZuWallack R. Pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease. Am Fam Physician 2010;82:655-60.
  29. Jones PW. St. George's respiratory questionnaire: MCID. COPD 2005;2:75-9. https://doi.org/10.1081/COPD-200050513
  30. Lacasse Y, Martin S, Lasserson TJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. A Cochrane systematic review. Eura Medicophys 2007;43:475-85.
  31. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016;12:CD005305.
  32. Cote CG, Celli BR. Pulmonary rehabilitation and the BODE index in COPD. Eur Respir J 2005;26:630-6. https://doi.org/10.1183/09031936.05.00045505
  33. Johnston KN, Young M, Grimmer KA, Antic R, Frith PA. Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study. Prim Care Respir J 2013;22:319-24. https://doi.org/10.4104/pcrj.2013.00062
  34. Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis 2011;8:89-99. https://doi.org/10.1177/1479972310393756
  35. Fischer MJ, Scharloo M, Abbink JJ, van't Hul AJ, van Ranst D, Rudolphus A, et al. Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respir Med 2009;103:1564-71. https://doi.org/10.1016/j.rmed.2008.11.020
  36. Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J 2006;27:788-94. https://doi.org/10.1183/09031936.06.00130605
  37. Hayton C, Clark A, Olive S, Browne P, Galey P, Knights E, et al. Barriers to pulmonary rehabilitation: characteristics that predict patient attendance and adherence. Respir Med 2013;107:401-7. https://doi.org/10.1016/j.rmed.2012.11.016