Effects of a Walking Aid in COPD Patients Receiving Oxygen Therapy

1. Effects of a Walking Aid in COPD Patients Receiving Oxygen Therapy Study objectives: To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister. Design: Randomized crossover trial. Setting: Physiopathology laboratory of three rehabilitation centers. Patients and interventions: We studied 60 stable COPD patients (mean age, 70.6 +/-7.9 years; FEV1, 44.8 14.3% of predicted [ SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient’s shoulder (No-Aid modality). Measurements and results: The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance ( 43 m, p < 0.001), peak effort dyspnea ( 2.0 points, p < 0.001), leg fatigue ( 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline. Conclusions: This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity. Abstract Crisafulli E, Costi S, De BlasioF, et al.Effects of a Walking Aid in COPD Patients Receiving Oxygen Therapy. American College of Chest Physicians. September2007; 131:1068-1074. doi: 10.1378/chest.06-2108. Background Patients: • Inclusion Criteria: Patients had to receive LTOT for at least six months; be in stable condition; walk without assistance and perform the 6MWT. • Exclusion Criteria: Any condition that limited exercise tolerance, i.e. cardiovascular, advanced osteoarthritis. • Diagnosis of COPD was made by the Global Initiative for Chronic Obstructive Lung Disease Stage and definition. Materials and Methods Distance walked and symptoms were significantly improved when patients pulled the oxygen using the aid in patients who initially walked <300m. No significant difference in patients who could initially walk >300m. Results Article 1 and Evidence Gupta R, Brooks D, et al. Effect of Rollator Use on Health-Related Quality of Life in Individuals with COPD. American College of Chest Physicians. October 2006. 130(4):1089-1095. doi: 10.1378/chest.130.4.1089. The purpose of this study (a RCT) was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. Subjects walked further with the use of an aid, when compared to walking independently. This study supports the main article in that walking with an aid improves walking distance in patients with COPD. This study further investigated that although patients walked further with the use of aid, many of them did not use their aid. Article 2 and Evidence Probst V, Troosters T, et al. Mechanisms of Improvement in Exercise Capacity Using a Rollator in Patients with COPD. American College of Chest Physicians. May 2004. 126: 1102-1107. doi: 10.1378/chest.126.4.1102. This study (a RCT) analyzed the effects of the use of a rollator on walking distance and physiologic variables: pulmonary gas exchange, heart rate, minute ventilation, oxygen saturation, and symptoms during the 6MWT in patients with COPD. The results showed when a rollator is used, there is a significant increase in distance walked, oxygen uptake, tidal volume, minute ventilation, and Borg scale for dypsnea decreased. Summary In COPD patients who walked <300m, a rollator is beneficial to increase walking distance and walking speed, and decrease the feeling of dypsnea and fatigue. The rollator gives patients a sense of security. Although a rollator is beneficial, many patients do not use them. Purpose Patients with COPD have reduction in their functional exercise capacity as the disease progresses. Walking with a rollator that supports both of the upper arms has been proven to be effective in improving physical performance and decreasing dypsnea in patients with COPD. The 6 Minute Walk Test (6MWT) is a measure widely used in clinical practice to determine exercise tolerance in patients with COPD. To compare walking distance, symptoms, and main physiologic parameters during walking with the oxygen canister carried on the shoulder, or pulled using a small, wheeled cart in COPD patients receiving long term oxygen therapy (LTOT). 6MWT: • Standardized instructions and a practice walk were given to each patient. • Tests were conducted indoors on a 40m x 3m track. Outcomes: • Primary: exercise tolerance, effort dypsnea, and leg fatigue. • Secondary: mean arterial oxygen saturation and heart rate values at rest and during walking. Walking with a wheeled cart improved distance walked, symptoms, and cardiopulmonary parameters. The minimal change for 6MWT is +54m but that was based on COPD patients who could initially walk >350m, and 37 of the patients who participated in this study ambulated <300m. This study provided only a rollator; other studies usually also implement therapeutic activities to gain improved 6MWT. By the addition of a rollator, we can address dypsnea, fatigue, and walking distance, which is directly related to living longer. Adding a rollator is an easy way to make our patients more stable and feel safe and secure when they are ambulating. A rollatoralso increases walking speed, which correlates with older adults crossing the street in a more timely manner. The addition of an aid could prolong their independence. Megan Clayton, Student Physical Therapy mclayton01@bellarmine.edu The use of a rollator may be helpful in COPD patients needing oxygen, particularly in those with a lower residual exercise capacity. Study Design: • Randomized Crossover Design • Patients performed two 6MWT at the same time on two consecutive days the first week of hospital admission. • First, the patient pulled a full oxygen canister (3.5kg) using a wheeled cart (aid). Then the control test was conducted by the same oxygen tank on the patient’s shoulder (no aid). • Baseline data was collected at rest through arterial blood to obtain PaO2, PaCO2, and pH by an automated analyzer. Discussion Clinical Significance Conclusion