Physiotherapy - Research Publications
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ItemHome-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis(WILEY, 2020-02)BACKGROUND AND OBJECTIVE: This study aimed to compare the cost-effectiveness and cost-utility of home and centre-based pulmonary rehabilitation for adults with stable chronic obstructive pulmonary disease (COPD). METHODS: Prospective economic analyses were undertaken from a health system perspective alongside a randomized controlled equivalence trial in which participants referred to pulmonary rehabilitation undertook a standard 8-week outpatient centre-based or a new home-based programme. Participants underwent clinical assessment prior to programme commencement, immediately following completion and 12 months following programme completion. They provided data for utility (quality-adjusted life years (QALY) determined using SF6D (utility scores for health states) calculated from 36-Item Short Form Health Survey version 2) and effectiveness (change in distance walked on 6-min walk test (Δ6MWD) following pulmonary rehabilitation ). Individual-level cost data for the 12 months following programme completion was sourced from healthcare administration and government databases. RESULTS: Between-group mean difference point estimates for cost (-$4497 (95% CI: -$12 250 to $3257), utility (0.025 (-0.038 to 0.086) QALY) and effectiveness (14 m (-11 to 39) Δ6MWD) favoured the home-based group. Cost-utility analyses demonstrated 63% of estimates falling in the dominant southeast quadrant and the probability that the new home-based model was cost-effective at a $0 threshold for willingness to pay was 78%. Results were robust to a range of sensitivity analyses. Programme completion was associated with significantly lower healthcare costs in the following 12 months. CONCLUSION: Home-based pulmonary rehabilitation provides a cost-effective alternative model for people with COPD who cannot access traditional centre-based programmes.
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ItemAcceptability and validity of a home exercise diary used in home-based pulmonary rehabilitation: A secondary analysis of a randomised controlled trial(WILEY, 2018-06)INTRODUCTION: Evaluating adherence to home-based pulmonary rehabilitation (PR) could be challenging due to lack of direct supervision and the complex nature of the rehabilitation model. To measure adherence to home-based PR in the HomeBase trial, participants were encouraged to work towards a goal of at least 30 min of whole-body exercise on most days of the week and report their participation using a home exercise diary. OBJECTIVE: This project aimed to evaluate the acceptability and validity of the home exercise diary. METHODS: Diary return and completion rates assessed acceptability of the home exercise diary. Home participants underwent physical activity (PA) monitoring using the Sensewear armband during the final week of an 8-week PR. The correlation between self-documented and objective daily exercise minutes was calculated. Objective exercise minutes were defined as bouts of ≥10 min spent in ≥ moderate PA. Differences in self-documented weekly exercise minutes between sufficiently active (≥7000 daily steps) and inactive participants were computed. RESULTS: Diaries were returned by 92% of programme completers. Of those who returned diaries, 72% have completed exercise documentation. Fifteen programme completers underwent PA monitoring [mean age 69 (9) (SD) years, FEV1 55 (19) %predicted]. A moderate correlation was observed between self-documented and objective mean daily exercise minutes (r = .59, P = .02). Active participants [n = 6, 10 253 (1521) daily steps] documented more exercise (111 min) during week eight compared with inactive participants [n = 9, 2705 (1772) daily steps, P = .002]. CONCLUSION: The self-documented home exercise diary is an acceptable and valid method to reflect exercise participation during home-based PR.
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ItemNo Preview Available'Willingness to Pay': The Value Attributed to Program Location by Pulmonary Rehabilitation Participants(American Thoracic Society, 2020-01-01)
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ItemThe Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial(DOVE MEDICAL PRESS LTD, 2020)BACKGROUND: Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months. METHODS: This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA). RESULTS: A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV1) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEV1%predicted (0.98, 95% CI 0.96 to 0.99). CONCLUSION: Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management.
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ItemComparison of self-report and administrative data sources to capture health care resource use in people with chronic obstructive pulmonary disease following pulmonary rehabilitation(BMC, 2020-11-23)BACKGROUND: The optimal method to collect accurate healthcare utilisation data in people with chronic obstructive pulmonary disease (COPD) is not well established. The aim of this study was to determine feasibility and compare self-report and administrative data sources to capture health care resource use in people with COPD for 12 months following pulmonary rehabilitation. METHODS: This is a secondary analysis of a randomised controlled equivalence trial comparing centre-based and home-based pulmonary rehabilitation. Healthcare utilisation data were collected for 12 months following pulmonary rehabilitation from self-report (monthly telephone questionnaires and diaries) and administrative sources (Medicare Benefits Schedule, medical records). Feasibility was assessed by the proportion of self-reports completed and accuracy was established using month-by-month and per participant comparison of self-reports with administrative data. RESULTS: Data were available for 145/163 eligible study participants (89%, mean age 69 (SD 9) years, mean forced expiratory volume in 1 s 51 (SD 19) % predicted; n = 83 male). For 1725 months where data collection was possible, 1160 (67%) telephone questionnaires and 331 (19%) diaries were completed. Accuracy of recall varied according to type of health care encounter and self-report method, being higher for telephone questionnaire report of emergency department presentation (Kappa 0.656, p < 0.001; specificity 99%, sensitivity 59%) and hospital admission (Kappa 0.669, p < 0.001; specificity 97%, sensitivity 68%) and lower for general practitioner (Kappa 0.400, p < 0.001; specificity 62%, sensitivity 78%) and medical specialist appointments (Kappa 0.458, p < 0.001; specificity 88%, sensitivity 58%). A wide variety of non-medical encounters were reported (allied health and nursing) which were not captured in administrative data. CONCLUSION: For self-reported methods of healthcare utilisation in people with COPD following pulmonary rehabilitation, monthly telephone questionnaires were more frequently completed and more accurate than diaries. Compared to administrative records, self-reports of emergency department presentations and inpatient admissions were more accurate than for general practitioner and medical specialist appointments. TRIAL REGISTRATION: NCT01423227 at clinicaltrials.gov.
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ItemNo Preview AvailableFactors predicting progression of exercise training loads in people with interstitial lung disease(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2019-10-01)In ILD, adherence to the training sessions in pulmonary rehabilitation predicts progression of exercise training loads; declining lung function is an independent predictor of failure to progress training loads http://bit.ly/2Z4x9Nw.
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ItemCardiorespiratory responses to 6-minute walk test in interstitial lung disease: not always a submaximal test(BMC, 2014-08-11)BACKGROUND: The 6-minute walk test (6 MWT) is used to measure exercise capacity and assess prognosis in interstitial lung disease (ILD). Although the 6 MWT is usually considered to be a test of submaximal exercise capacity in ILD, the physiological load imposed by this test is not well described and 6 MWT outcomes are poorly understood. This study aimed to compare cardiorespiratory responses to 6 MWT and cardiopulmonary exercise test (CPET) in people with ILD. METHODS: 47 participants with ILD (27 idiopathic pulmonary fibrosis (IPF), mean age 71 (SD 12) years, diffusing capacity for carbon monoxide (TLCO) 49(15) %predicted) undertook CPET and 6 MWT on the same day in random order. Oxygen uptake (VO(2)), ventilation (VE) and carbon dioxide production (VCO2) were assessed during each test using a portable metabolic cart. RESULTS: The VO(2)peak during the 6 MWT was lower than during CPET (1.17(0.27) vs 1.30(0.37) L.min-1, p = 0.001), representing an average of 94% (range 62-135%) of CPET VO(2)peak. Achieving a higher percentage of CPET VO(2)peak on 6 MWT was associated with lower TLCO %predicted (r = -0.43, p = 0.003) and more desaturation during walking (r = -0.46, p = 0.01). The VEpeak and VCO(2)peak were significantly lower during 6 MWT than CPET (p < 0.05). However, participants desaturated more during the 6 MWT (86(6)% vs 89(4)%, p < 0.001). The degree of desaturation was not affected by the percent of peak VO2 achieved during the 6 MWT. Responses were similar in the subgroup with IPF. CONCLUSIONS: On average, the 6 MWT elicits a high but submaximal oxygen uptake in people with ILD. However the physiological load varies between individuals, with higher peak VO2 in those with more severe disease that may match or exceed that achieved on CPET. The 6 MWT is not always a test of submaximal exercise capacity in people with ILD.