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Lin-Yu Laio 1 , Jung- Yien Chien 2, Kuei -Min Chen 3

The Effects of Respiratory Rehabilitation Program on Six Minutes Walking Exercise Test in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Taiwan. Lin-Yu Laio 1 , Jung- Yien Chien 2, Kuei -Min Chen 3 Chest Hospital, Department of Health Executive Yuan 1,2

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Lin-Yu Laio 1 , Jung- Yien Chien 2, Kuei -Min Chen 3

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  1. The Effects of Respiratory Rehabilitation Program on Six Minutes Walking Exercise Test in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Taiwan Lin-Yu Laio1, Jung-Yien Chien2,Kuei-Min Chen3 Chest Hospital, Department of Health Executive Yuan1,2 Ph.D. Student, Kaohsiung Medical University 1 Professor, Kaohsiung Medical University 3 2012/7/31Brisbance oral

  2. Jung-Yien Chien2 • Kuei-Min Chen3 2012/7/31Brisbance oral

  3. Introduction(i) • The world's third-leading cause of death in chronic obstructive pulmonary disease 2030(WHO,2008) • In Taiwan accounted for 10 causes of death in the elderly population of 65-year-old seventh (Department of Health,2009) • A chronic disease and the main risk factors are exposure to pollution, infection, and cigarette smoking (WHO, 2008) 2012/7/31Brisbance oral

  4. Introduction(ii) • Acute exacerbation of COPD often increases mucus production, coughing, and wheezing, due to gas changes. (Irwin & Madison, 1998) • Dyspnea, fatigue, cough, anxiety, decrease exercise capacity are the most common physical symptoms. (Lee, et al., 2010). • Lead to admission or readmission ( Burge & Wedzicha, 2003) 2012/7/31Brisbance oral

  5. Introduction(iii) • Pulmonary rehabilitation exercises are a form of non-pharmacologic treatment for maintaining a stable condition and improving the life quality (Minkoff, Leff, & Hilleman, 2005) • Respiratory rehabilitation included • Patient assessment: persistent respiratory symptoms • Exercise training • upper and lower extremity training • Self-management education • Depression, anxiety psychosocial support. ( Linda, Lareau, and Zuwllack,2010). 2012/7/31Brisbance oral

  6. Purpose • To evaluate the effects of respiratory rehabilitation program on the six minutes walking distance in COPD patients with acute exacerbation. 2012/7/31Brisbance oral

  7. Study design(i) • A quasi-experimental, convenience sample. • Randomized assigned to the experimental and control group. • Stetted at a hospital in southern Taiwan • Data collected from November 2011 to April 2012. • Intervention was respiratory rehabilitation, and follow up baseline(1th admitted day) , after, 2th , 3th and 4th admitted days. 2012/7/31Brisbance oral

  8. Study design(ii) • Data collection in the four times, intervention before 1 times and after 3 times. • The medical treatment was standardized in all patients according to GOLD guidelines, included bronchodilators therapy, or intravenous methylprednisolone and antibiotic coverage (Minkoff, Leff, &Hilleman, 2005) in the two groups. 2012/7/31Brisbance oral

  9. Participants(i) • Inclusion criteria • COPD with acute exacerbation by physician diagnosis • Age＞18years (3) Conscious clear (4) Speak Chinese (5) Clinical condition stable (6) Get permit 2012/7/31Brisbance oral

  10. Participants(ii) • Exclusion criteria (1) Unable to walking (2)Hempotysis (3)Combine had pleural effusion, congestive heart failure, pneumo-thorax (4) Dyspnea induced by Heart disease (5)Spo2≦90 2012/7/31Brisbance oral

  11. Sample sizes(i) 2012/7/31Brisbance oral

  12. Ethics • This study has been approved by the participating institution’s Ethics Committee. Informed consent was obtained from each patient. 2012/7/31Brisbance oral

  13. Respiratory rehabilitation program(i) • Include chest percussion and postural drainage (Lester & Flume,2009), pursed-lip breathing( Lee et, et.al.,2010), and self-management (Clary, Janz, Dodge & Sharp, 1991). • Postural drainage and percussion was used chest precursor twice times and each times was 30 minute through nurse do it, until after admitted1st , 2nd , 3rd and4th day . • Pursed-lip breathing tool for pursed-lip breathing training at admission during day-to-day activities. 2012/7/31Brisbance oral

  14. Respiratory rehabilitation program(ii) • Self-management program workbooks • Pointed out that lung lesion on lung anatomy pictures, to correct evaluate postural drainage position, • Record and appraisal sputum amount and color while sputum a little or cough server will be initiative postural drainage. • To correct to do pursed-lip breathing and with the walking and chest physical therapy. • Teaching upper arm exercise and inhalation management for 30 min in prior of hospitalities. 2012/7/31Brisbance oral

  15. Pointed out that lung lesion on lung anatomy pictures, to correct evaluate postural drainage position 2012/7/31Brisbance oral

  16. Chest precursor 2012/7/31Brisbance oral

  17. Postural Drainage 2012/7/31Brisbance oral

  18. Pursed-lip breathingtool 2012/7/31Brisbance oral

  19. upper arm exercise 2012/7/31Brisbance oral

  20. Circle =60m 2012/7/31Brisbance oral

  21. Control group • provide and educate chest percussion, postural drainage, pursed-lip breathing and underwent standard medical treatment 2012/7/31Brisbance oral

  22. Baseline assessment and outcomes measured(ii) • Time: at the 1th admitted day . • Variables: • Demographic data: age, sex, education, marry, BMI, chronic disease • Social data：smoking status • Lung function: peak expiratory flow • Outcome: • Six minutes walking distance (6MWD) 2012/7/31Brisbance oral

  23. Statistical analysis(i) • Descriptive statistics : Test of e distribution • Percentage • Mean • Standard deviation • Chi-square test :Test of homogeneity in two groups 2012/7/31Brisbance oral

  24. Statistical analysis(ii) • Independent t-test: Compare the two groups differences in the average. • Repeated ANOVA: Exposure the two groups in the time and six minutes walking distance interaction • A P-value of less than 0.05 was considered significant. 2012/7/31Brisbance oral

  25. Results Table 1. Demographic profiles of 105 COPD with AE 2012/7/31Brisbance oral

  26. Compare with 6MWD in the pretest and post effect 2012/7/31Brisbance oral

  27. Two groups at the time and six minutes walking distance interaction Note:*p＜0.05; **p＜0.01; ***p＜0.001 2012/7/31Brisbance oral

  28. Discuss(ii)-Comparison of intervention effect • Improvement of the experimental group than the control group significant. The intervention effect same as the findings of Ghanem, et al.(2010) and Troosters, et al.(2010) • Effective health education materials and process design can effectively resolve troubled by the nurses faced with health education and execution to enhance the effectiveness of health education, The intervention programs same as the findings of Ghanem, et al.(2010). 2012/7/31Brisbance oral

  29. Discuss(i)- Intervention time the effectiveness of comparison • After the implementation of two days was significant progress, same as the Clini (2009). • The results show that provide respiratory rehabilitation need two days, can improve exercise tolerance for AECOPD patients in the hospital . 2012/7/31Brisbance oral

  30. Conclusion(i) • The experimental group on six minutes walking distance increased more than control group. • Change over time, experimental group on six minutes walking distance increased degree more than control group. 2012/7/31Brisbance oral

  31. Conclusion(ii) • Base on the results of this study, Respiratory Rehabilitation of Program improved 6 MWD in the AECOPD patients. • This study implies that the program may provide useful nursing guidance for managing patients with AECOPD. 2012/7/31Brisbance oral

  32. Acknowledgements • Thanks the staff、DR. for care patient • Thanks the fund supported for Chest Hospital, Department of Health, Executive Yuan. 2012/7/31Brisbance oral

  33. References(ii) • 1.World Health Organization(2008, May20). COPD. Retrieved July 05,2008,fromm http://www.who.int/resiratory/copd/en/ • 2.行政院衛生署：十大死亡原因統計資料.2009,from Available http://www.doh.gov.tw/statistic/data/. • 3.Henke MO, Shah SA, Rubin BK. The role of airway secretions in COPD –clinical applications. COPD 2005;2:377-390. • 4.Lee AL, Cecins N, Hill JC, et al. The effect of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: Protocol for randomized controlled trial. BMC Pulmonary Medicine 2010;10;1-7. • 5.Mutalithas K, Watkin G, Willing B, et al. Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis. Respiratory Medical 2008;102:1140-1144. • 6.Lau ACW, Yam LYC, Poon E. Hospital re-admission in patients with acute exacerbation of chronic obstructive pulmonary disease. Respiratory Medicine 2001; 95: 876-884. • 7.吳英黛.呼吸循環系統物理治療基礎實務.台北：金名圖書有限公司;2008。 • 8.Clarice YT, Nicholas FT, Felicity CB. Chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD): A systematic review. Physiotherapy 2010;96:1-13. • 9.Lester MK, Flume PA. Airway - Clearance therapy guideline and implementation. Respiratory Care 2009 ;54: 733-752. 2012/7/31Brisbance oral

  34. References(ii) • 10.Kodric M, Garuti G, Colomban M, et al. The effectiveness of a bronchial drainage technique (ELTGOL) in COPD exacerbations. Respirology 2009;14: 424-428. • 11.Kuo CC, Lin CC. Improving acute exacerbation symptoms in • COPD patients: Effectiveness of the self-regulation protocol. J of Nursing and Health Research 2009;5:182-191. • 12.Meek PM, Lareau SC, Anderson D. Memory for symptoms in COPD patients: How accurate are their report？European J of Respiratory diseases 2001;18:474-481. • 13.Ghanem M, Elaa EA, Mehany M, et al. Home-Based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients. Annals of Thoracic Medicine.2010;5:18-25. • 14.Troosters T, Probst VS, Crul1 T, et al. Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. American J of Respiratory and Critical Care Medicine.2010:181:1072-1079. • 15.Tasai LY, Yau KP, Hsu SL. Problem and their frequency, and emotional disturbances and need among nurses proving sexual health education. The J of Nursing 2005;52:41-50. • 16.Clini EM, Crisafulli E, Costi S, et al. Effect of early inpatients rehabilitation after acute exacerbation of COPD. Respiratory Medicine 2009;103,152-1531. • 17.Ho SC, Kao CH, Kao SF, et al. The efficiency of nursing protocol of • airway clearance on the patients with mucus hyper-secretion. Chang Gung Nursing 1996;7:26-40. • 18.Bellone A, Lascioli R, Raschi S, et al. Chest physical therapy in patients • with acute exacerbation of chronic bronchitis: effectiveness of three methods. Archives of Physical Medicine and Rehabilitation 2000;81:558-60. 2012/7/31Brisbance oral

  35. Thank you 2012/7/31Brisbance oral

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