Advance Care Planning Education in Pulmonary Rehabilitation: A Qualitative Study Exploring Participant Perspectives.

Advance care planning education in pulmonary rehabilitation: A qualitative study exploring participant perspectives.

Palliat Med. 2013 Mar 5;
Burge AT, Lee A, Nicholes M, Purcell S, Miller B, Norris N, McArdle S, Sandilands S, Holland AE

Background:Advance care planning is considered to have an important role in the management of people with chronic lung disease; however, uptake in clinical practice remains limited. Participant acceptance of the inclusion of an advance care planning information session in pulmonary rehabilitation and maintenance programmes could support a practical solution.Aim:To evaluate the introduction of a structured group advance care planning information session from the perspective of participants in pulmonary rehabilitation and maintenance programmes.Design:Prospective qualitative study with semi-structured interview transcripts analysed using iterative thematic analysis.Setting/participants:Participants in pulmonary rehabilitation and maintenance programmes at a tertiary metropolitan hospital and two affiliated community sites.Results:Sixty-seven participants with a range of chronic lung diseases were interviewed with ages ranging from 39 to 88 years, forced expiratory volume in 1 s (FEV1) ranging from 18% to 130% predicted and 6-min walk distance ranging from 105 to 619 m. Sixteen participants (24%) had previously heard of advance care planning. Major themes were that participants valued the advance care planning information and thought pulmonary rehabilitation was an appropriate setting. The group education format was well accepted and perceived to have advantages over individual sessions. Participants were happy to receive the information from a non-medical facilitator. Non-attendees had usually missed the session for reasons unrelated to content. A small number of participants felt advance care planning was not appropriate for them, but all recognised its value for other participants.Conclusions:Participants in our pulmonary rehabilitation and maintenance programmes value the opportunity to participate in a structured, group-based advance care planning session. Consideration should be given to broader inclusion of advance care planning education into existing pulmonary rehabilitation and maintenance programmes for people with chronic respiratory disease. HubMed – rehab


Effectiveness of Home- and Community-based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship.

Arch Phys Med Rehabil. 2013 Feb 22;
Altman IM, Swick S, Malec JF

OBJECTIVES: (1) To assess the effectiveness of home-and community-based brain rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA), and (2) to evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. DESIGN: Retrospective analysis of program evaluation data for treatment completers and non-completers. Setting: HCBR conducted in 7 geographically distinct U.S. cities. PARTICIPANTS: 738 individuals with CVA who completed the prescribed course of rehabilitation (CCT) compared to 150 who were precipitously discharged prior to program completion (PD). Intervention: HCBR delivered by certified professional staff on an individualized basis. MAIN OUTCOME MEASURES: Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. RESULTS: Using analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared to PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, p<.001) with a moderate effect size (partial ?2=.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, p<.001; partial ?2=.08), Adjustment (F=99.67, p<.001; partial ?2=.10), and Participation (F=69.15, p<.001; partial ?2=.07). CONCLUSIONS: The CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indices than the PD group who were discharged prior to completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome. HubMed – rehab


Extrinsic Bronchial Obstruction Caused by Scoliosis: A Case Report.

Spine (Phila Pa 1976). 2013 Mar 4;
de Torres García I, de Cabo Moreno P, Godoy Ramírez AM

Study Design. A case report. It’s a retrospective longitudinal descriptive design.Objective. To emphasize the importance of monitoring the breathing capacity in patients with moderate-severe scoliosis, even in adulthood.Summary of Background Data. Diseases that disturb the structure of the chest wall affect the function of the respiratory pump. Restrictive respiratory pattern is caused by severe scoliosis. However, scoliosis may provoke obstructive changes due to compression of the airways. It can be a direct compression because of imprinting of vertebral bodies, or an indirect one, due to rotation forces.Methods. We have collected data from the patient’s clinical history, as well as done a review about similar published cases.Results. Case presentation: a caucasian female, with frequent respiratory infections during her childhood. She was diagnosed with 55º right T5-T11 scoliosis. At age of 26 an increase of her pulmonary symptoms appeared with difficulty to expel mucus and medium efforts dyspnoea. A CAT scan showed T8 vertebral body pushing against the right intermediate bronchus. A bronchoscopy found a decrease in the bronchial area, with near contact between the walls. Lung function test: 41% FVC, 43% FEV1, and 91 FEV1/FVC1. The patient underwent surgical correction using rods and pedicle screws, she had improvement of symptoms, image tests and pulmonary function (70% FVC, 71% FEV1, and 101 FEV1/FVC).Review: few similar cases have been published.Conclusion. Increased frequency and severity of respiratory infections, difficulty in expelling mucus and dyspnoea are warning signs of compromised airways. Spirometry tests and image tests such as CAT scan and bronchoscopy are essential for diagnosis. Surgical approach may be the treatment of choice. HubMed – rehab