Maria Tereza A. P. Morano

Preoperative Pulmonary Rehabilitation Versus Chest Physical Therapy in Patients Undergoing Lung Cancer Resection: A Pilot Randomized Controlled Trial

OBJECTIVE To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection. DESIGN Randomized single-blinded study. SETTING A teaching hospital. PARTICIPANTS Patients undergoing lung cancer resection (N=24). INTERVENTIONS Patients were randomly assigned to receive PR (strength and endurance training) versus CPT (breathing exercises for lung expansion). Both groups received educational classes. MAIN OUTCOME MEASURES Functional parameters assessed before and after 4 weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2). RESULTS Twelve patients were randomly assigned to the PR arm and 12 to the CPT arm. Three patients in the CPT arm were not submitted to lung resection because of inoperable cancer. During phase 1 evaluation, most functional parameters in the PR group improved from baseline to 1 month: forced vital capacity (FVC) (1.47L [1.27-2.33L] vs 1.71L [1.65-2.80L], respectively; P=.02); percentage of predicted FVC (FVC%; 62.5% [49%-71%] vs 76% [65%-79.7%], respectively; P<.05); 6-minute walk test (425.5±85.3m vs 475±86.5m, respectively; P<.05); maximal inspiratory pressure (90±45.9cmH(2)O vs 117.5±36.5cmH(2)O, respectively; P<.05); and maximal expiratory pressure (79.7±17.1cmH(2)O vs 92.9±21.4cmH(2)O, respectively; P<.05). During phase 2 evaluation, the PR group had a lower incidence of postoperative respiratory morbidity (P=.01), a shorter length of postoperative stay (12.2±3.6d vs 7.8±4.8d, respectively; P=.04), and required a chest tube for fewer days (7.4±2.6d vs 4.5±2.9d, respectively; P=.03) compared with the CPT arm. CONCLUSIONS These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.

Portuguese-language version of the COPD Assessment Test: validation for use in Brazil.

OBJECTIVE: To validate a Portuguese-language version of the COPD assessment test (CAT) for use in Brazil and to assess the reproducibility of this version. METHODS: This was multicenter study involving patients with stable COPD at two teaching hospitals in the city of Fortaleza, Brazil. Two independent observers (twice in one day) administered the Portuguese-language version of the CAT to 50 patients with COPD. One of those observers again administered the scale to the same patients one week later. At baseline, the patients were submitted to pulmonary function testing and the six-minute walk test (6MWT), as well as completing the previously validated Portuguese-language versions of the Saint Georges Respiratory Questionnaire (SGRQ), modified Medical Research Council (MMRC) dyspnea scale, and hospital anxiety and depression scale (HADS). RESULTS: Inter-rater and intra-rater reliability was excellent (intraclass correlation coefficient [ICC] = 0.96; 95% CI: 0.93-0.97; p < 0.001; and ICC = 0.98; 95% CI: 0.96-0.98; p < 0.001, respectively). Bland Altman plots showed good test-retest reliability. The CAT total score correlated significantly with spirometry results, 6MWT distance, SGRQ scores, MMRC dyspnea scale scores, and HADS-depression scores. CONCLUSIONS: The Portuguese-language version of the CAT is a valid, reproducible, and reliable instrument for evaluating patients with COPD in Brazil.

Chronic obstructive pulmonary disease patients’ experience with pulmonary rehabilitation: A systematic review of qualitative research

The aim of this study was to give an in-depth consideration of the chronic obstructive pulmonary disease (COPD) patients’ subjective view of the impact of pulmonary rehabilitation (PR) on their lives. A systematic review in PubMed, Embase, CINAHL and PsychInfo databases yielded 3306 articles, of which 387 were duplicates, 263 remained after screening abstract and title; of them, 4 were excluded (editorial or due to lacking of full text) remaining a total of 259 for full text reading. Among these, eight studies met the inclusion criteria and were finally included. The meta-ethnography approach synthesized an understanding of the studies, which focused on constructing interpretations and developed a ‘line-of-argument’ synthesis. The psychosocial support of PR contributes to the patients’ strength and desire for participation and the health education leads to illness-perception learning. Both psychosocial support and health education develop patients’ empowerment, while PR promotes opportunities to health transitions. The empowerment experienced by the patients in taking advantage of these opportunities leads to positive impacts over time. If they do not exploit these occasions, negative impacts arise in their life, which make the treatment assistance or follow-up more difficult. The COPD patients’ feedback revealed that PR promotes a better ‘way of life’, well-being and important behavioural changes towards health promotion.

Rede de apoio social e saúde de idosos pneumopatas crônicos

This study sought to analyze characteristics of the social support network of the elderly with chronic pneumopathies, establishing links with health maintenance/rehabilitation. The assumptions of Social Network Analysis (SNA) methodology were used, addressing the social support concept. A questionnaire and semi-structured interviews, both applied to 16 elderly people attended by a public hospital in Fortaleza-CE, were used for data collection. Quantitative data were processed using the UCINET 6.123, NetDraw 2.38 and Microsoft Excel software programs. In the qualitative analysis, the body of material was subjected to interpretations based on relevant and current theoretical references. Each informant brought an average of 10.37 individuals into the network. Among the 3 types of social support, there was a predominance of informational support given by health professionals. The importance of reciprocity in providing/receiving social support was also noted, as well as the participation of health professionals and the family functioning as social support. The conclusion reached was that the network of the elderly with pneumopathies is not cohesive, being restricted to the personal network of each individual, and that even so, the informants recognize and are satisfied with the social support it provides.

The impact of lung cancer resection surgery on fibrinogen and C-reactive protein and their relationship with patients outcomes: A prospective follow up study

BACKGROUND Major thoracic surgery is characterized by release of inflammatory markers.The objective of this study was to assess the preoperative and postoperative systemic inflammatory markers of patients undergoing lung cancer resection. METHODS This is a prospective follow up study conducted with 48 patients submitted to lung cancer resection.All patients were assessed before and 1 month after surgery through measurement of fibrinogen and C-reative protein(CRP), pulmonary function tests, 6- minute Walk Test (6 MWT), maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), anxiety and depression scale and karnofsky performance status scale. RESULTS Both fibrinogen and CRP were higher 1 month after surgery, although only the change in CRP was statistically significant (p= 0.03). The following functional parameters: 6 MWT, PImax, PEmax, FEV1(%) and FVC(%) decreased after surgery with p ≤ 0.001 for all the parameters. Anxiety and depression improved and Karnofsky decrease after surgery (p= 0.03, p= 0.01 and p= 0.02; respectively). Change in CRP score following lung resection correlated significantly with changes in fibrinogen (r= 0.40; p= 0.003), change in Karnofsky scale (r= -0.50; p< 0.001) and a borderline significant trend with the 6 MWT (r= -0.28; p= 0.05). With the exception of video-assisted thoracoscopic surgery (VATS), who had a significantly lower fibrinogen level 1 month after surgery compared with thoracotomy (p= 0.01), no significant differences in fibrinogen or CRP were noted in other subgroups of patients considered at increased risk for higher levels of inflammation compared with lower risk counterparts. CONCLUSION Lung cancer resection surgery was associated with increased level of CRP, 1 month after surgery, and correlated directly with change in fibrinogen and inversely with measurement of performance status. VATS provided lower level of fibrinogen after surgery.

Religious coping and religiosity in patients with COPD following pulmonary rehabilitation

Background Religious coping (RC) is defined as the use of behavioral and cognitive techniques in stressful life events in a multidimensional construct with positive and negative effects on outcomes, while religiosity is considered a use of individual beliefs, values, practices, and rituals related to faith. There is no evidence for the effects of pulmonary rehabilitation (PR) in RC and religiosity in patients with COPD. The aims of this study were 1) to compare RC and religiosity in patients with COPD following PR and 2) to investigate associations between changes in RC, religiosity and exercise capacity, quality of life (QoL), anxiety, depression, and dyspnea. Methods Seventy-four patients were enrolled in this study including 38 patients in the PR group and 36 patients in the control group. PR protocol was composed of a 12-week (three sessions per week, 60 min per day) outpatient comprehensive program, and the control group was composed of patients in a waiting list for admission to PR program. RC, religiosity, exercise capacity, QoL, anxiety, depression, and dyspnea were measured before and after the study protocol. Results Positive religious coping and organizational religious activities increased (p=0.01; p<0.001, respectively), while negative religious coping decreased (p=0.03) after 12 weeks in the PR group (p<0.001). Significant associations were observed between changes in RC, organizational religiosity with exercise capacity, and QoL following PR. No differences were found in the control group. Conclusion PR improves RC and organizational religiosity in patients with COPD, and these improvements are related to increases in exercise capacity and QoL.

Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer

Objetivo: Avaliar as propriedades da Escala de Identificacao e Consequencias da Fadiga (EICF) em pacientes com câncer de pulmao (CP), analisando a intensidade da fadiga e fatores associados. Metodos: Estudo transversal com pacientes com CP, atendidos em um hospital-escola no Brasil, que preencheram a EICF. Pacientes com doencas cardiacas cronicas (DCC) e controles saudaveis, pareados por idade e sexo, tambem preencheram a escala. Inicialmente, uma versao brasileira da escala foi aplicada a 50 pacientes com CP por dois entrevistadores independentes; para testar a reprodutibilidade, ela foi reaplicada aos mesmos pacientes. No momento basal, os pacientes com CP realizaram espirometria e teste de caminhada de seis minutos, bem como preencheram a Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Fatigue Severity Scale (FSS). O estado inflamatorio foi avaliado pelos niveis de proteina C reativa (PCR) no sangue. Para validar a EICF, avaliamos as correlacoes entre as pontuacoes na mesma e essas variaveis. Resultados: A amostra foi composta por 50 pacientes em cada grupo (CP, DCC e controle). No grupo CP, os coeficientes de correlacao intraclasse para confiabilidade intra e interobservador para as variaveis resumidas da EICF variaram de 0,94 a 0,76 e de 0,94 a 0,79, respectivamente. A EICF apresentou excelente consistencia interna, e as disposicoes graficas de Bland-Altman demonstraram boa confiabilidade teste-reteste. A EICF apresentou correlacoes significativas com as pontuacoes na FSS, HADS e SF-36, bem como com os niveis de PCR. As medias das pontuacoes na EICF do grupo CP diferiram significativamente das dos grupos DCC e controle. Conclusoes: A EICF e um instrumento valido e confiavel para a avaliacao de pacientes com CP, nos quais depressao, qualidade de vida e niveis de PCR parecem estar significativamente associados a fadiga.

Programas de reabilitação pulmonar em transplante de pulmão: uma revisão de literatura

Objective: To analyze, using a literature review, Pulmonary Rehabilitation (RP) Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periodicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation”) and Portuguese (“reabilitacao” AND/OR “transplante pulmonar”). The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient) and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL) and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients. Descriptors: Rehabilitation; Transplantation; Physical Therapy SpecialtyObjective: To analyze, using a literature review, Pulmonary Rehabilitation (RP) Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periodicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation”) and Portuguese (“reabilitacao” AND/OR “transplante pulmonar”). The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient) and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL) and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients.

A hidroterapia no tratamento de pacientes com doença pulmonar obstrutiva crônica - doi:10.5020/18061230.2007.p221

The Chronic Obstructive Pulmonary Disease (COPD) is a serious, disabling disease, presenting the pulmonary function test with abnormalities in the expiratory flow. Under this denomination, it comprises the chronic bronchitis and pulmonary emphysema. The hydrotherapy involves the physical therapy with aquatic exercises and has being used because it is a pleasant activity with positive results. The aim of this exploratory study was to compare the performance of the patients with COPD treated with hydrotherapy associated to pulmonary rehabilitation with those treated only with pulmonary rehabilitation, being held in the cardiopulmonary rehabilitation center of Messejana Hospital, in Fortaleza - Ceara. The sample consisted of 10 patients, independently of sex and age, randomly divided into two groups. The evaluation instrument was the upper limbs incremental test observing the following parameters: the cardiac frequency (FC), the respiratory frequency (f), the degree of dyspnea, the tiredness of the upper limbs, the maximum burden reached and the oxygen saturation (SatO2). The parameters FC (p=0.04), f (p=0.046) e SatO2 (p=0.008) presented an average improvement of 33.33% above those of the patients that were just in the pulmonary rehabilitation. The other evaluated parameters also presented positive results, but with p>0.05. In conclusion, the results obtained with the pulmonary rehabilitation associated to the hydrotherapy overcome those found just with the pulmonary rehabilitation treatment, allowing an increase in the physical conditioning and improvement in the functional activities; although, due to the reduced number of cases, new researches should be held to confirm this exploratory study.