Authors (including presenting author) :
HUI HM(1), YUNK KL(2), WONG CF(3), CHAN PF(3), CHAU CH(3), YAN SW(3), CHAN YH(3), CHAN HF(1), YAU SF(1), CHAN CF(2)
Affiliation :
(1) Department of Occupational Therapy, Grantham Hospital (2) Department of Physiotherapy, Grantham Hospital (3) Tuberculosis and Chest Unit, Grantham Hospital
Introduction :
Patients with different pulmonary conditions such as Chronic Obstructive Pulmonary Disease (COPD), Idiopathic Pulmonary Fibrosis (IPF), Bronchiectasis, Interstitial Lung Disease (ILD) can progress to advanced lung diseases and result in pronounced impact on daily living. They usually experience high degree of respiratory limitation, reduced exercise tolerance, dyspnea, fatigue and poor quality of life in long-run. Lung transplantation is a worldwide accepted therapeutic option for patients with advanced lung diseases in improving survival and quality of life. In view of limited organ donors, candidates selected for lung transplantation must be expected to have a good long-term outcomes. Therefore, Pulmonary Rehabilitation (PR) plays an important role in the pre-operation stage. It aims to improve candidates’ physical and psychological condition, promote self-management on diseases, optimize functional capacity and enhance quality of life through the individualized therapy. Although different studies from Europe and US have already shown the benefits of PR in the pre-operation stage, study from Asia region and focus on In-patient PR is limited.
Objectives :
To evaluate the effects of In-patient PR in patients with debilitated advanced lung diseases in the following areas: (1) functioning level; (2) dyspnea level; and (3) quality of life.
Methodology :
This was a retrospective study on a group of patients with debilitated advanced lung diseases and who were potential candidates for lung transplantation from July 2019 to December 2019. Patients recruited for in-patient PR were given a 4-week training program provided by physiotherapists and occupational therapists. Physiotherapy (PT) training included supervised resistance and aerobic exercises, airway clearance, cardiopulmonary and peripheral muscle training, enhanced home-based or outdoor exercises. Occupational Therapy (OT) training included breathing and activity pacing in ADL and IADLs, dyspnea management, stress management, energy conservation and relaxation techniques. A total of 20 PT sessions and 20 OT sessions were provided on daily basis during their in-patient stay. Six-Minute Walk Test (6MWT), Barthel Index Dyspnea (BI-D), Modified Medical Research Council Dyspnea Scale (mMRC) and Chronic Respiratory Questionnaire (CRQ) were used as outcome measures for functional capacity, dyspnea level and quality of life before and after the program.
Result & Outcome :
A total of 14 patients (M/F: 10/4; Age 54.07 ± 9.13 years) were recruited and all of them have completed the program. Their diagnoses varied from ILD (35.7%), Bronchiectasis (21.4%), COPD (14.3%), Lung Graft Versus Host Disease (GVHD) (14.3%) and some miscellaneous, including Pneumoconiosis and Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) (14.3%). Among the 14 recruited patients, 71% of them required supplementary oxygen at rest. Wilcoxon signed rank test revealed that there was significant improvement in 6MWT (Median: 295.00m to 338.00m, IQR:174.00m to 225.00m, p=0.039), mMRC (Median: 3.00 to 2.50, IQR: 2.00 to 3.00, p=0.025), BI-D (Median: 35.00 to 27.50, IQR: 25.00 to 24.00, p=0.050), dyspnea domain (Median: 3.60 to 4.70, IQR: 1.50 to 2.30, p=0.033), fatigue domain (Median: 4.38 to 4.65, IQR: 1.88 to 2.25, p=0.049) and mastery domain (Median: 4.63 to 5.00, IQR: 1.75 to 1.44, p=0.014) in CRQ after the program. Empirical differences were also found in emotion domain (Median: 5.07 to 5.43, IQR: 1.81 to 2.22, p=0.084) of CRQ although they could not reach statistical significance. A short-term in-patient PR shows a positive impact on functional capacity, dyspnea level and quality of life in certain domains for patients with debilitated advanced lung disease.
