Pulmonary Rehabilitation and Acute Exacerbations of COPD.

Pulmonary rehabilitation and acute exacerbations of COPD.

Filed under: Rehab Centers

Expert Rev Respir Med. 2012 Nov; 6(5): 523-31
Kon SS, Canavan JL, Man WD

Acute exacerbations are major events in the natural history of chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. Although pulmonary rehabilitation increases exercise capacity, reduces dyspnea and improves health-related quality of life, the effects on risk of future exacerbations (and by extension, healthcare utilization) are less well documented. Furthermore, there has been a growing evidence base to support provision of pulmonary rehabilitation in the acute phase of COPD, for example, shortly after hospitalization for an acute exacerbation. This article reviews the role of pulmonary rehabilitation in the prevention and treatment of acute exacerbations of COPD.
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Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease.

Filed under: Rehab Centers

Nephrol Dial Transplant. 2012 Oct; 27 Suppl 3: iii126-iii134
Greenwood SA, Lindup H, Taylor K, Koufaki P, Rush R, Macdougall IC, Mercer TH

Background Physical activity has the potential to positively impact upon aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients independent of the stage of the disease process. Physical activity is recommended in a number of national CKD guidelines, but its incorporation into routine care has been slow. The translation of research-led physical activity programmes into an established procedure appears to be a particular obstacle. This study included 263 patients, consecutively referred over a 4-year period, to a pragmatic 12-week renal rehabilitation (RR) programme delivered within a National Health Service (NHS). Methods One hundred and thirty-one patients were assessed and started the RR programme. Anxiety and depression were measured using the hospital anxiety and depression (HAD) scale. The self-reported level of fitness was measured with the Duke’s activity status index (DASI), and exercise capacity was assessed with the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 s (STS60), timed up and go (TUAG) and stair-climb descent (SCD) tests. All measures were assessed at baseline and at 12 weeks. Attendance and completion of the RR programme were recorded for all patients. Results There were significant improvements in exercise capacity and functional ability ranging from 21 to 44%, and significant improvements in anxiety (15%) and depression (29%) in the 77 patients who completed the RR programme. The self-reported level of fitness was found to be significantly associated with completion (P = 0.01), with older participants showing a trend towards being more likely to complete (P= 0.07). Fifty-four patients, out of the 131 patients who commenced the RR programme, failed to complete 12 or more of the 24 scheduled sessions. Patients requiring haemodialysis (HD) treatment constituted the largest number of dropouts/non-completers (49%) in the study. Conclusions This study demonstrates that a pragmatically constructed, NHS-delivered exercise-based RR can substantially improve both physical function and mental well-being for the wide range of CKD patients who regularly participated (55%). Compliance/adherence data indicate that this type of rehabilitation programme is particularly well received by pre-dialysis (PD) CKD and post-transplantation patients.
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LULAC protests rehab transportation cuts – LULAC representatives from as far away as San Antonio, health care professionals from across the Rio Grande Valley and state leaders including State Rep. Eddie Lucio, III gathered to protest health care cuts, Tuesday at the Regional Academic Health Center in Harlingen. They said state budget cuts to Medicaid, specifically the transportation services for indigent children that need to get to and from rehab violates civil rights. Organizers add cuts to the transportation program has left about 100000 children in the Valley without the rehab care they need. Child care advocate Mary Helen Barrera said the cuts have also negatively impacted rehab centers and therapists. “We had two year olds who were taking two hours to get to rehab, (spend) five hours in the rehabs without food or diapers, without prescribed medications – we saw our children suffer and that is inhumane treatment for a child.” Attorneys at the protest told Action 4 News that even a state judicial court issued three different injunctions preventing the state from enforcing these transportation cuts. The state has already filed an appeal. “You have a tremendous amount of children that are not receiving the services because the transportation program has become more stringent on them to be able to access those services – which is a state offered service to begin with,” one attorney said. Rep. Lucio said by preventing these children from getting the help they need now, the state is creating a bigger problem for


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