Please use this identifier to cite or link to this item:
Title: Pulmonary rehabilitation in patients with a diagnosis of Chronic Obstructive Pulmonary Disease and Pulmonary Fibrosis
Authors: Sciriha, Anabel
Keywords: Lungs -- Diseases, Obstructive -- Malta
Pulmonary fibrosis -- Malta
Respiratory organs -- Diseases -- Patients -- Malta -- Rehabilitation
Quality of life -- Malta
Issue Date: 2017
Abstract: Introduction: Pulmonary Rehabilitation (PR) is now established as one of the prime modes of therapy in the management of Chronic Obstructive Pulmonary Disease, benefits of which are well documented in several guidelines. Despite this, there are still a number of areas which are equivocal. Lack of evidence regarding the appropriate length for Pulmonary Rehabilitation programmes and the benefits of such an intervention in other respiratory conditions such as pulmonary fibrosis are still major issues. Less is known about the effects of PR when delivered after an acute COPD exacerbation. This project aimed at exploring some of these questions, that is the optimum duration of PR in COPD, any benefits of PR in pulmonary fibrosis patients and attempted to look into any effects on acute COPD patients. Methodology: A quantitative, quasi-experimental, observational type of study was adopted. A total of 106 stable COPD patients, 108 pulmonary fibrosis patients and 6 acute COPD patients completed the full study. Patients were divided into two groups, an active group in which participants were enrolled into a 12-week PR programme consisting of a high intensity exercise programme and educational sessions and an inactive, control group. Baseline assessments for patients in the active groups were carried out 2 weeks before initiation of the programme. Those who formed part of the inactive group were also assessed in the same way. The 6-minute walk test, dyspnoea score using Borg Scale, spirometry testing, plethysmography, COPD Assessment Tool for COPD patients only, St. George's Respiratory Questionnaire, Hospital and Anxiety score and tests for inflammatory marker were administered at 4 weekly intervals throughout the 12 weeks. The active participants also had these tests repeated at the 28th and 52nd week, on follow-up post completion of the programme. Results: A 12-week PR programme in stable COPD patients resulted in statistically significant improvements in functional measures and health status but not in lung function measures or inflammatory markers. Mild COPD patients had improvements in functional measures as early as 4 weeks. Severe COPD patients improved in functional performance at a later point but improvements in quality of life measures happened at an earlier time point than the milder group and with more impressive changes. PR in pulmonary fibrosis patients also led to significant changes in exercise tolerance, changes which occurred at the 8th week time point. Although both the active and inactive patients in the mild to moderate severity group as per mMRC score had significant improvements, the active group had higher levels of improvement at the 12th week. Improvements in health status as measured using the St. George’s Respiratory Questionnaire were also noted for the whole cohort of patients and those with an mMRC score of 3-4. Such improvements were also noted with dyspnoea measures by the 4th week. The acute COPD patients had some promising results from such an intervention. Conclusion: Findings from this study show that 12 weeks of PR in a COPD patients resulted in clinically significant improvements in functional outcome measures which are supported with statistically significant improvements in health-related quality of life measures. In milder COPD cases, by the 4th week of PR gains in exercise tolerance had already resulted. The more severe group required more time to obtain improvements. This would facilitate the local hospital to organise shorter PR programmes on larger numbers of milder COPD patients. In the case of pulmonary fibrosis patients, a PR programme with the same components delivered to COPD patients, led to some significant but less marked improvements in exercise tolerance, dyspnoea scores and the total and impact domain of the SGRQ. Outcomes in acute COPD patients resulted in favourable trends of improvements but in view of the small sample size no concrete conclusions can be drawn. Such an intervention looks very promising in the management and care of patients with COPD and pulmonary fibrosis and further research in this field is highly recommended.
Appears in Collections:Dissertations - FacHSc - 2017
Dissertations - FacHScPhy - 2017

Files in This Item:
File Description SizeFormat 
  Restricted Access
7.68 MBAdobe PDFView/Open Request a copy

Items in OAR@UM are protected by copyright, with all rights reserved, unless otherwise indicated.