Pulmonary Rehabilitation

Description

Pulmonary rehabilitation programmes are a fundamental part of the clinical management of patients with chronic respiratory diseases. This comprehensive reference book places pulmonary rehabilitation within the wider framework of respiratory disease. Now in six parts, it includes new sections on the development of PR as a discipline, global perspectives on quality control, new chapters on early PR post exacerbation and personalized rehabilitation, innovative approaches to exercise, PR in interstitial lung disease and lung transplantation, and the latest research into the application of music, dance and yoga. Key Features Global contributions compare practice around the world where differences have developed. New six Part structure covers new approaches to exercise testing, interstitial lung diseases and other diseases, and add-on interventions drawing on new technologies. Contains recommendations of the large collaborative ERS/ATS task forces on guidelines for PR as well as suggested policies for its implementation and use. Covers the important topic of balance impairment as a focus of rehabilitation for the at-risk patient and a new chapter on monitoring physical activity. The voices of patients and caregivers describe the impact of chronic respiratory disease on their lives. Cover Half Title Title Page Copyright Page Contents Foreword About the Book Preface Editors Contributors Part 1: The foundation of pulmonary rehabilitation 1. A framework for medical rehabilitation: Restoring function and improving quality of life Introduction A unifying model for rehabilitation: The International Classification of Functioning, Disability and Health The approach to rehabilitation assessment Unpacking the black box of rehabilitation: Important service delivery considerations and questions Measuring the benefits of rehabilitation Summary Conflict of interest References 2. Pulmonary rehabilitation: The development of a scientific discipline Introduction Definition and concepts History Summary References 3. Key concepts in pulmonary rehabilitation Definition and concept Exercise training Non-exercising interventions Future perspectives for PR Summary References 4. Enhancing use and delivery of pulmonary rehabilitation Introduction Knowledge and awareness of pulmonary rehabilitation Access, uptake and adherence to pulmonary rehabilitation Use of pulmonary rehabilitation services compared to other effective therapies in COPD Ensuring quality of PR programmes Conclusion Summary References 5. Pathophysiological basis, evaluation and rationale of exercise training Introduction Pathophysiological basis of exercise training Rationale of exercise testing Exploring factors explaining exercise limitation Rationale of exercise training Benefits of exercise training Summary References 6. Education: Realizing the potential for learning in pulmonary rehabilitation Overview History of education in pulmonary rehabilitation Examining outcomes from education Educational design for pulmonary rehabilitation Factors that influence learning Digital pulmonary rehabilitation education Summary References 7. Self-management Introduction Definition of self-management interventions Self-management interventions in COPD Gap between the current best evidence, guidelines and practice Model of care that includes pulmonary rehabilitation enhanced with self-management Summary and clinical implications References 8. Dual therapy: Pharmacologic management in pulmonary rehabilitation Introduction Bronchodilators Supplemental oxygen and heliox Anabolic agents Nutritional supplements Other pharmacologic agents Summary References Part 2: Evaluation and management 9. Respiratory muscle function in rehabilitation Introduction Indications Respiratory muscle assessment, theoretical considerations Place of assessment of respiratory muscle function in some typical rehabilitation scenarios Summary References 10. Peripheral muscles Introduction Epidemiology and natural history Causes Structural and biological changes Evaluation of limb muscle mass Evaluation of limb muscle strength Evaluation of muscle endurance Effects of interventions on limb muscle function in COPD Summary References 11. Anxiety and depression in patients with chronic respiratory disease Introduction Depression Anxiety Barriers to depression and anxiety management in COPD Treatment approaches for depression and anxiety in patients with COPD Clinical tips Summary References 12. Dyspnoea Introduction What is dyspnoea? Impact of dyspnoea in patients who have respiratory disease Descriptors of dyspnoea Measurements of dyspnoea for pulmonary rehabilitation Effects of pulmonary rehabilitation on relieving dyspnoea Responders versus non-responders Mechanisms for relief of dyspnoea with pulmonary rehabilitation Summary References 13. Nutritional management in pulmonary rehabilitation Introduction Nutritional risk Nutritional risk for development and progression of COPD Nutritional risk for decreased physical performance Nutritional risk for cardiovascular disease Pharmaconutrients Nutrition as part of integrated disease management Summary References 14. Balance impairment Introduction Balance and its assessment Balance deficits in chronic lung disease Balance assessment in pulmonary rehabilitation Approaches to balance training as part of pulmonary rehabilitation Conclusion summary References 15. Monitoring of physical activity Physical activity: A clinically relevant (new) measure in pulmonary rehabilitation Measurement of physical activity Interpretation of PA in the context of pulmonary rehabilitation Sedentary behaviour, a closely related concept Summary References 16. Monitoring health status Why measure health status? Measuring and monitoring health status St. George’s Respiratory Questionnaire Chronic Respiratory Questionnaire COPD Assessment Test Clinical COPD Questionnaire Pulmonary rehabilitation and health status in COPD: Randomized, controlled trials Comparison of pulmonary rehabilitation and pharmacologic therapy on health status in COPD Pulmonary rehabilitation following exacerbations of COPD Pulmonary rehabilitation and health status in respiratory patients with diseases other than COPD Summary References Part 3: How, Who and Where? 17. Establishing a pulmonary rehabilitation programme Introduction The process Outcome data Conclusion Summary References 18. Quality assurance and control in pulmonary rehabilitation Introduction Quality control and assurance in PR Quality standards Pulmonary rehabilitation audit Pulmonary rehabilitation certification and accreditation schemes Pulmonary rehabilitation accreditation, certification and supporting processes in the US and UK The dissemination of audit data and the development of quality improvement in PR Broader impacts and future direction Quality improvement resources References 19. The ideal candidate Introduction Guidance criteria for inclusion in pulmonary rehabilitation Responders and non-responders to PR Contraindications to pulmonary rehabilitation Adapting the pulmonary rehabilitation programme to different candidates Final remarks Summary References 20. Rehabilitation team Definition Composition of the interdisciplinary PR team Interdisciplinary pulmonary rehabilitation programme Advantages Barriers Summary References 21. Modalities of exercise training Introduction Exercise assessment tests Modalities of exercise types Exercise prescription Supervision during training Safety and recording during training Oxygen supplementation Summary References 22. Physiotherapy and airway clearance Introduction Impairment of mucus elimination and clinical indications for airway clearance physiotherapy techniques Control of mucus and airway clearance techniques Mechanical respiratory muscle aids for secretion management Summary References 23. Smoking cessation Introduction Smoking cessation: An overview Smoking cessation in pulmonary rehabilitation Summary References 24. Early rehabilitation following exacerbation of COPD Introduction Consequences of acute exacerbations Early pulmonary rehabilitation in the exacerbation setting – the evidence base Challenges in delivering early rehabilitation following exacerbation Implementation of early rehabilitation after an exacerbation Further research Summary References 25. Personalized rehabilitation Introduction Definitions Personalized rehabilitation Personalized comprehensive management Awareness Present evidence Future Summary References 26. Pulmonary rehabilitation and primary care Introduction Epidemiology of the problem Barriers to adaptation Outcomes Outlook Summary References 27. Home rehabilitation What is the rationale for home-based rehabilitation? Patient factors and perceptions Alternative forms of rehabilitation Supervision of participants Access to staff The evidence Studies in the literature Technology Post exacerbation home-based studies Maintenance programmes Non-COPD populations Conclusion Summary References 28. Telerehabilitation Definition, rationale and opportunities for telerehabilitation Telerehabilitation: Signals and models used Telerehabilitation in COPD Telerehabilitation in chronic respiratory insufficiency patients Risk/disadvantages Economic considerations (cost-effectiveness data) Future directions and conclusions Summary References 29. Living with chronic lung disease: The experiences and needs of patients and caregivers Introduction Living with a chronic lung disease from the perspective of patients and caregivers Pulmonary rehabilitation to support the family through the chronic lung disease journey Real-world testimonials of patients and caregivers Conclusion Summary Acknowledgements References Part 4: New Approaches to Exercise Training 30. Partitioned aerobic exercise training of ventilatory-limited patients with chronic respiratory disease Overview Background Application Summary References 31. Whole-body vibration training Introduction WBVT platforms techniques Summary References 32. Neuromuscular electrical stimulation Introduction Principles of NMES Clinical effects of NMES Role in rehabilitation toolkit Summary References 33. A role for water-based rehabilitation Introduction Aquatic therapy Water-based exercise for people with COPD Conditions affecting the lower limbs and aquatic therapy Special considerations for exercise in the aquatic environment Special considerations for people with COPD for exercise in the aquatic environment Summary References 34. Sedentarism and light-intensity physical activity (in COPD) Introduction What do we know about sedentary time in people with COPD? What are the health consequences of sedentary behaviour in the general population and those with COPD? What is the physiological basis for sedentary behaviour being harmful? Considerations when applying an intervention to reduce sedentary time in COPD A behavioural science approach to sedentarism in COPD Summary and conclusions References Part 5: Diseases Other than COPD 35. The multi-morbidity patient Multi-morbidity in patients with COPD The multi-morbid COPD patient: A model in rehabilitation How multi-morbidity might impact outcomes of pulmonary rehabilitation The effects of tailored pulmonary rehabilitation in multi-morbid patients Conclusion Summary References 36. Is there any role for pulmonary rehabilitation in asthma? Introduction Patients Types of intervention Summary References 37. Neuromuscular disorders Introduction Pathophysiology What are respiratory muscle aids? Patient evaluation The intervention objectives Long-term management Glossopharyngeal breathing (GPB) Oximetry monitoring and feedback protocol Long-term outcomes Extubation of unweanable patients Decannulation of unweanable patients Summary References 38. Interstitial lung diseases Introduction Comprehensive symptom management Pulmonary rehabilitation Conclusion Summary References 39. Management of suppurative lung diseases Background Healthcare utilization in non-cystic fibrosis bronchiectasis The implications of chronic sputum Physiological consequences of bronchiectasis Benefits of airway clearance techniques Pulmonary rehabilitation in non-CF bronchiectasis Physical activity in cystic fibrosis Effect of cystic fibrosis on skeletal muscle dysfunction Airway clearance techniques in cystic fibrosis Summary Financial support Conflicts of interest References 40. Rehabilitation in the intensive care unit Introduction Consequences of acute illness Management of muscle weakness Management of airway secretions Prevention of cognitive impairment Technical considerations Conclusion Summary References 41. Chronic respiratory failure – pathophysiology Introduction and definition Overview Causes of chronic hypercapnic respiratory failure Chronic respiratory failure - diagnosis Summary References Further Reading 42. Lung transplantation Introduction Rehabilitation before transplantation Immediate post-transplant rehabilitation Outpatient rehabilitation phase (hospital discharge up to 12 months post-transplant) Long-term post-transplant phase (greater than 12 months post-transplant) Conclusions and research needs Summary References 43. Lung volume reduction - old and new approaches Introduction Rationale for reducing lung volume reduction Lung volume reduction surgery Nonsurgical approaches to lung volume reduction Summary References Part 6: Add-on interventions 44. Supplemental oxygen and heliox Introduction Dynamic hyperinflation of the lung during exercise Supplemental oxygen breathing Low-density gas mixture breathing Relevance to rehabilitation programmes Summary References 45. Noninvasive ventilation during exercise training Introduction Exercise training for patients with chronic respiratory failure Physiological effects of NIV on exercise Noninvasive ventilation and exercise training Technicalities Future research Alternative strategies Summary References 46. COPD patients requiring chronic nocturnal noninvasive ventilation Introduction Mechanisms of action Chronic noninvasive ventilation in stable COPD Chronic noninvasive ventilation after acute respiratory failure Issues to be solved Summary References 47. More tools in the toolbox Introduction Music listening during PR Singing Tai Chi Yoga Active video games Dance in COPD Conclusion Summary References 48. Palliative care and end of life Introduction Palliative care Dyspnoea Fatigue Cough Pain Integration of palliative care with pulmonary rehabilitation Decision making A place to die Conclusion Summary References 49. Economical evaluation Introduction COPD Interstitial lung disease and pulmonary fibrosis Bronchiectasis Summary References 50. Pulmonary rehabilitation in the integrated care of the chronic respiratory patient Introduction Integrated care and the chronic care model Similar, but not identical, concepts Telemedicine Pulmonary rehabilitation Pulmonary rehabilitation and integrated care Summary References 51. Pulmonary rehabilitation in post-acute patients with COVID-19 Introduction General recommendations Principles of rehabilitation Lessons from ARDS and other pandemics Prevention of spread of infection The intervention Future directions Conclusion References Index