Raquel Gabriel

Day-to-day living with severe chronic obstructive pulmonary disease: Towards a family-based approach to the illness impacts

Objective: This study explores the perspectives of both patients and family members regarding the impact of chronic obstructive pulmonary disease (COPD) in their family life. Design: An exploratory qualitative study was conducted with patients and their family members in the chronic phase of COPD. Individual interviews were performed to explore participants’ perspectives and submitted to thematic analysis. Results: Six major themes emerged from patients’ perspective: (1) impact of COPD symptoms on personal and family daily life; (2) (over)protective family support; (3) difficulties in couple communication; (4) sense of identity loss; (5) fear of COPD progression; and (6) coping resources. Five main themes emerged from the family members’ perspective: (1) restrictions in family’s social life; (2) emotional distress related to COPD exacerbations; (3) tension in couple relationship; (4) financial strain of COPD; and (5) coping resources. Conclusions: The overall findings illustrate the complex interaction between the experience of living with COPD and communication patterns, emotional states, social support and social roles within the family. The results highlight the need to develop family-based interventions to facilitate a functional adjustment to COPD. However, these interventions in COPD remain undeveloped and empirical evidence is needed.

Caring for relatives with chronic obstructive pulmonary disease: how does the disease severity impact on family carers?

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for families. However, information on the impacts of caring for relatives with COPD on carers’ psychological health is limited. This study aimed to analyse the subjective burden of family carers of people with early and advanced COPD and its predictor variables. Methods: A cross-sectional study was conducted. A structured questionnaire was used to collect socio-demographics and care-giving characteristics. Self-rated physical and mental health were measured by two items from the International Classification of Functioning, Disability and Health checklist. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Subjective burden was assessed with the Carers’ Assessment of Difficulties Index (CADI). Descriptive and inferential analyses were performed. Results: A total of 167 family carers participated: 113 were caring for people with early and 54 with advanced COPD. Both groups presented anxiety/depression symptoms. Those caring for people with advanced COPD reported higher subjective burden, more depression symptoms and poorer self-rated mental health than those caring for early COPD. Advanced COPD (coefficient 6.7), depression (coefficient 6.3), anxiety (coefficient 5.6), care-giving hours per week (coefficient 3.2) and self-rated mental health (coefficient 2.8) were significant predictors of carers’ subjective burden. Conclusion: The findings suggest that the gradual course of COPD imposes an increasing physical and emotional burden on carers, with negative impacts on their psychological health. The study highlights the relevance of early interventions in the context of COPD to prevent carers’ burden.

Effects of a pulmonary rehabilitation program with balance training on patients with COPD.

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) have balance impairments. However, pulmonary rehabilitation (PR) is associated with only minor improvements in functional balance. Therefore, there is a need to explore the role of balance training within PR. This study aimed at assessing the effects of a PR program, with a specific component of balance training, on functional balance of patients with COPD. METHODS: Outpatients with COPD (N = 22, age = 68.0 ± 11.8 years; forced expiratory volume in 1 second = 72.2 ± 22.3% predicted) participated in a 12-week PR program including exercise training and psychosocial support and education. Exercise training sessions comprised endurance, strength, and a specific component of balance training. The Timed Up and Go (TUG) test was used to assess functional balance before and after the PR. Health-related quality of life (St Georges Respiratory Questionnaire), quadriceps muscle strength (10 repetition maximum), and exercise tolerance (6-minute walk test) were also assessed. RESULTS: Patients demonstrated significant improvements in TUG scores after PR (mean change −1.7 ± 1.4 seconds; P = .001; effect size = 1.249). Before PR, 9 (41%) participants and after PR only 1 (4.5%) participant had a TUG performance worse than the average performance of age-matched healthy peers (P = .008). The St Georges Respiratory Questionnaire symptoms score (P = .012), quadriceps muscle strength (P = .001), and exercise tolerance (P = .001) were also improved. CONCLUSIONS: Pulmonary rehabilitation with a specific component of balance training had a large effect on functional balance in patients with COPD. Findings highlight the value of including balance training in PR programs. Further research is needed to determine the optimal intervention to improve balance and its specific components among patients with COPD.

Global Functioning of COPD Patients With and Without Functional Balance Impairment: An Exploratory Analysis Based on the ICF Framework

Abstract Balance impairment is a common manifestation in older people with COPD and may contribute to overall functional decline; however, the relationship between balance and global functioning has not been studied. This study aimed to explore the global functioning of COPD patients with and without functional balance impairment. Functional balance was assessed with the Timed Up-and-Go (TUG) test and global functioning with the Comprehensive ICF Core Set for Obstructive Pulmonary Diseases. Participants (n = 134) were divided in 2 groups according to their performance in TUG (with and without balance impairment) and the ICF Core Set results were compared between groups. Fifty-four (40.3%) participants had functional balance impairment. The groups presented a similar extent of problems in several categories of the ICF components. However, participants with balance impairment were more severely affected (p < 0.05) in energy, pain, respiratory system, weight maintenance, exercise tolerance, neuromusculoskeletal and movement-related functions, and structure of head and neck. They also presented a significantly worse performance in handling psychological demands and activities related to mobility, self-care, domestic, community and social life, and a more negative perception of Environmental factors related to products and technology of buildings for private use and social support services (p < 0.05). Patients with functional balance impairment have more functional problems and are more severely restricted in daily life than patients without compromised balance. Understanding the relationship between balance control and global functioning will contribute to guide interventions aimed at maintaining functioning and minimizing disability.

Chronic obstructive pulmonary disease and functioning: implications for rehabilitation based on the ICF framework

Abstract Purpose: This study aimed to describe the functioning of patients with Chronic Obstructive Pulmonary Disease (COPD) according to the International Classification of Functioning, Disability and Health (ICF) framework to inform future rehabilitation interventions. Method: A cross-sectional study with a convenience sample of outpatients with COPD was conducted. Data were collected using the Comprehensive ICF Core Set for Obstructive Pulmonary Diseases. Descriptive and inferential statistics were applied. Results: In total, 119 participants (71.43% male) with a mean age of 68.71 ± 11.61 years old were included. The frequency and extent of the majority of the impairments assessed were similar among participants at different COPD grades. The most relevant (frequency >70%) Body functions and structures impairments were related to exercise tolerance functions, sensations associated with cardiovascular and respiratory functions and respiratory system structure. Mobility and domestic life restrictions were the most frequently reported in the activities and participation component. Products for personal consumption, immediate family, health professionals and their attitudes were most frequently understood as facilitators whilst climate and air quality were perceived as barriers. Conclusions: Recommendations were drawn from this study in order to improve comprehensive rehabilitation interventions for patients with COPD based on ICF framework. Implications for Rehabilitation Functioning of patients with Chronic Obstructive Pulmonary Disease can be comprehensively assessed in a worldwide common language – the International Classification of Functioning, Disability and Health. Rehabilitation interventions for patients with Chronic Obstructive Pulmonary Disease should be designed according to the International Classification of Functioning, Disability and Health framework, i.e. assessing and monitoring Body functions, Body structures, Activities and participation and Environmental factors.

Comprehensive ICF Core Set for Obstructive Pulmonary Diseases: validation of the Activities and Participation component through the patient’s perspective

Abstract Purpose: This study aimed to validate the Activities and Participation component of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Obstructive Pulmonary Diseases (OPD) from the patient’s perspective. Methods: A cross-sectional qualitative study was conducted with a convenience sample of outpatients with Chronic Obstructive Pulmonary Disease (COPD). Individual interviews were performed and analysed according to the meaning condensation procedure. Results: Fifty-one participants (70.6% male) with a mean age of 69.5 ± 10.8 years old were included. Twenty-one of the 24 categories contained in the Activities and Participation component of the Comprehensive ICF Core Set for OPD were identified by the participants. Additionally, seven second-level categories that are not covered by the Core Set were reported: complex interpersonal interactions, informal social relationships, family relationships, conversation, maintaining a body position, eating and preparing meals. Conclusions: The activities and participation component of the ICF Core Set for OPD was largely supported by the patient’s perspective. The categories included in the ICF Core Set that were not confirmed by the participants and the additional categories that were raised need to be further investigated in order to develop an instrument according to the patient’s perspective. This will promote a more patient-centred assessments and rehabilitation interventions. Implications for Rehabilitation The Activities and Participation component of the Comprehensive ICF Core Set for OPD is largely supported by the perspective of patients with COPD and therefore could be used in the assessment of patients’ individual and social life. The information collected through the Activities and Participation component of the Comprehensive ICF Core Set for OPD could be used to plan and assess rehabilitation interventions for patients with COPD.

Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the patient's perspective

This study aimed to validate the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for obstructive pulmonary diseases (OPDs) from the perspective of patients with chronic obstructive pulmonary disease. A cross-sectional qualitative study was carried out with outpatients with chronic obstructive pulmonary disease using focus groups with an ICF-based approach. Qualitative data were analysed using the meaning condensation procedure by two researchers with expertise in the ICF. Thirty-two participants (37.5% women; 63.8±11.3 years old) were included in six focus groups. A total of 61 (86%) ICF categories of the Comprehensive ICF Core Set for OPD were confirmed. Thirty-nine additional second-level categories not included in the Core Set were identified: 15 from the body functions component, four from the body structures, nine from the activities and participation and 11 from the environmental factors. The majority of the categories included in the Comprehensive ICF Core Set for OPD were confirmed from the patients’ perspective. However, additional categories, not included in the Core Set, were also reported. The categories included in the Core Set were not confirmed and the additional categories need to be investigated further to develop an instrument tailored to patients’ needs. This will promote patient-centred assessments and rehabilitation interventions.