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Pulmonary Rehabilitation And Exercise Training In Chronic Obstructive Pulmonary Disease

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Enhancing Pulmonary Rehabilitation In COPD With Virtual Reality

Photo Credit: Freepik

The following is a summary of "Virtual reality for COPD exacerbation: A randomized controlled trial," published in the August 2024 issue of Pulmonology by Kizmaz et al.

Pulmonary rehabilitation (PR) is a well-established intervention for chronic obstructive pulmonary disease (COPD), yet managing chronic conditions like COPD, which necessitate ongoing treatment and are prone to exacerbations, often requires innovative motivational strategies. This study evaluated the impact of incorporating virtual reality (VR) into PR on symptoms, daily functioning, functional capacity, and psychological well-being in patients experiencing COPD exacerbations. 

About 50 patients hospitalized for COPD exacerbation were randomly assigned to two treatment groups. One group (n=25) engaged in traditional PR, which included daily pedaling exercises until discharge. The other group (n=25) participated in a similar PR regimen but with the addition of cycling simulation in a forest environment via VR (VR + PR). Both groups were assessed pre-and post-treatment using the 1-minute Sit-to-Stand test (STST), modified Medical Research Council (mMRC) scale, COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activities of Daily Living (LCADL). Post-treatment, the STST improved in both groups, with the VR + PR group demonstrating a significantly more significant increase (p = 0.037). 

Both groups reported reductions in dyspnea levels and CAT scores, with the VR + PR group showing more pronounced improvements (p = 0.062 and p = 0.003, respectively). HADS scores also decreased in both groups, but the VR + PR group experienced a more significant reduction in depression and total scores (p < 0.05). Improvements in LCADL scores, excluding household activities, were observed in both groups, with more substantial gains in the VR + PR group (p < 0.05). These findings suggest that integrating virtual reality into pulmonary rehabilitation offers notable benefits for patients with COPD exacerbations, enhancing physical and psychological outcomes while demonstrating safety and efficacy.

Source: sciencedirect.Com/science/article/abs/pii/S0954611124001707


COPD Pulmonary Rehabilitation Rates Following Hospitalization Are Extremely Low

Following hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), pulmonary rehabilitation (PR) initiation rates are extremely low, according to study findings published in the Annals of the American Thoracic Society.

Investigators in Michigan assessed PR utilization following AECOPD hospitalization, with the goal of characterizing hospital-level variation in their state and identifying characteristics of high-performing hospitals.

The investigators conducted a retrospective study of patients with COPD hospitalization from January 2018 through December 2021. The study used claims data from the Michigan Value Collaborative (MVC), a Blue Cross Blue Shield of Michigan-funded quality initiative that includes over 100 acute care hospitals, as well as hospital data from the American Hospital Association annual survey to. Initiation of PR within 1 month of discharge was the primary outcome.

Overall, 99 hospitals and 36,389 patients were included in analysis. The majority of patients were White, women, older than 65 years of age, and Medicare fee-for-service insured.

"

Hospital-based strategies to improve PR utilization after discharge, adapted from those being successfully used with cardiac rehabilitation, should be further explored.

The investigators found that within 30 days following discharge, the rate of PR initiation across hospitals was less than 0.8%.

PR initiation by hospital ranged from 0.4% to 2.0%, adjusted. The investigators noted that compared with the set reference groups, being older than 85 years of age, in the 5th Distressed Community Index quintile (calculated from 7 components), and being a woman independently decreased the odds of PR initiation. Hospital level accounted for some variation in initiation rate, with 7% of variation attributable to the hospital after adjustments for hospital characteristics and patient case mix. The median relative odds between 2 randomly chosen hospitals was 1.6 for PR initiation.

Study limitations include the exclusion of Medicaid claims, owing to the generally younger age of Medicaid recipients. Also, the claims data did not include referral information, and given that, as study authors noted, fewer than 20%

of eligible patients are referred to PR, it is unclear whether the low utilization found in this study is due more to low enrollment participation vs low referral rates.

"PR initiation after hospitalization for acute COPD exacerbation is extremely low, with an overall initiation rate of <1% and adjusted initiation rates by hospital ranging from 0-4%," the investigators concluded. "Interventions targeted at patients alone are not

sufficient to improve utilization. Hospital-based strategies to improve PR utilization after discharge, adapted from those being successfully used with cardiac rehabilitation, should be further explored," the study authors noted.

Several study authors have received support, funding, or fees from government and industry sources. Please see reference for a complete list of disclosures.

This article originally appeared on Pulmonology Advisor





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