A Novel Concentrated, Interdisciplinary Group Rehabilitation Program for Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Nonrandomized Clinical Intervention Study

Bente Frisk, Kiri Lovise Njøten, Bernt Aarli, Sigurd William Hystad, Sidsel Rykken, Ane Kjosås, Eirik Søfteland, Gerd Kvale, Bente Frisk, Kiri Lovise Njøten, Bernt Aarli, Sigurd William Hystad, Sidsel Rykken, Ane Kjosås, Eirik Søfteland, Gerd Kvale

Abstract

Background: Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD.

Objective: The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients.

Methods: This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV1) <80% of expected and a FEV1/forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at α=.05.

Results: The recruitment period will last from April 2022 until June 2023.

Conclusions: If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD.

Trial registration: ClinicalTrials.gov NCT05234281; https://ichgcp.net/clinical-trials-registry/NCT05234281.

International registered report identifier (irrid): PRR1-10.2196/40700.

Keywords: COPD; chronic disease; chronic illness; group therapy; health intervention; interdisciplinary; intervention study; patient outcome; pulmonary disease; pulmonary rehabilitation; rehabilitation; rehabilitation model; treatment.

Conflict of interest statement

Conflicts of Interest: None declared.

©Bente Frisk, Kiri Lovise Njøten, Bernt Aarli, Sigurd William Hystad, Sidsel Rykken, Ane Kjosås, Eirik Søfteland, Gerd Kvale. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.10.2022.

Figures

Figure 1
Figure 1
Flowchart of the study. Physical examinations at baseline and the 3-, 6-, and 12-month follow-ups include a cardiopulmonary exercise test, the Stair Climbing Test, the 60-Second Sit-to-Stand Test, and a lung function test. The cardiopulmonary exercise test will be administered only at baseline and at the 12-month follow-up. Daily online follow-up (in phase 2) includes two questions: (1) “To what extent did you allow the symptoms to decide today?” and (2) “To what extent did you make use of the principle of ‘doing something else’?” (responses range from 0-10 for both).

References

    1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 Report. Global Initiative for Chronic Obstructive Lung Disease. [2022-10-14].
    1. Chronic obstructive pulmonary disease (COPD) 2022. World Health Organization. [2022-10-14].
    1. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, Schmid V, Buist S. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006 Feb;27(2):397–412. doi: 10.1183/09031936.06.00025805. 27/2/397
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442. doi: 10.1371/journal.pmed.0030442. 06-PLME-RA-0071R2
    1. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. National Institute for Health and Care Excellence. [2022-10-14]. .
    1. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen Job, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken Maureen P M H, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM, ATS/ERS Task Force on Pulmonary Rehabilitation An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13–64. doi: 10.1164/rccm.201309-1634ST.
    1. Camp PG, Hernandez P, Bourbeau J, Kirkham A, Debigare R, Stickland MK, Goodridge D, Marciniuk DD, Road JD, Bhutani M, Dechman G. Pulmonary rehabilitation in Canada: A report from the Canadian Thoracic Society COPD Clinical Assembly. Can Respir J. 2015;22(3):147–52. doi: 10.1155/2015/369851. doi: 10.1155/2015/369851.16722
    1. Nishi SPE, Zhang W, Kuo Y, Sharma G. Pulmonary rehabilitation utilization in older adults with chronic obstructive pulmonary disease, 2003 to 2012. J Cardiopulm Rehabil Prev. 2016;36(5):375–82. doi: 10.1097/HCR.0000000000000194.
    1. Frisk B, Sundør Ingrid Elise, Dønåsen Mette Ramstad, Refvem OK, Borge CR. How is the organisational settings, content and availability of comprehensive multidisciplinary pulmonary rehabilitation for people with COPD in primary healthcare in Norway: a cross-sectional study. BMJ Open. 2022 Feb 17;12(2):e053503. doi: 10.1136/bmjopen-2021-053503. bmjopen-2021-053503
    1. Holland AE, Cox NS, Houchen-Wolloff L, Rochester CL, Garvey C, ZuWallack R, Nici L, Limberg T, Lareau SC, Yawn BP, Galwicki M, Troosters T, Steiner M, Casaburi R, Clini E, Goldstein RS, Singh SJ. Defining modern pulmonary rehabilitation. An official American Thoracic Society workshop report. Ann Am Thorac Soc. 2021 May;18(5):e12–e29. doi: 10.1513/AnnalsATS.202102-146ST.
    1. Hansen B, Hagen K, Öst Lars-Göran, Solem S, Kvale G. The Bergen 4-Day OCD treatment delivered in a group setting: 12-month follow-up. Front Psychol. 2018;9:639. doi: 10.3389/fpsyg.2018.00639. doi: 10.3389/fpsyg.2018.00639.
    1. Stubhaug B, Lier HO, Aßmus Jörg, Rongve A, Kvale G. A 4-Day mindfulness-based cognitive behavioral intervention program for CFS/ME. An open study, with 1-year follow-up. Front Psychiatry. 2018;9:720. doi: 10.3389/fpsyt.2018.00720. doi: 10.3389/fpsyt.2018.00720.
    1. Haukebø Kristin, Skaret E, Ost L, Raadal M, Berg E, Sundberg H, Kvale G. One- vs. five-session treatment of dental phobia: a randomized controlled study. J Behav Ther Exp Psychiatry. 2008 Sep;39(3):381–90. doi: 10.1016/j.jbtep.2007.09.006.S0005-7916(07)00060-2
    1. Kvale G, Hansen B, Björgvinsson Thröstur, Børtveit Tore, Hagen K, Haseth S, Kristensen UB, Launes G, Ressler KJ, Solem S, Strand A, van den Heuvel OA, Öst Lars-Göran. Successfully treating 90 patients with obsessive compulsive disorder in eight days: the Bergen 4-day treatment. BMC Psychiatry. 2018 Oct 04;18(1):323. doi: 10.1186/s12888-018-1887-4. 10.1186/s12888-018-1887-4
    1. Launes G, Hagen K, Sunde T, Öst Lars-Göran, Klovning I, Laukvik I, Himle JA, Solem S, Hystad SW, Hansen B, Kvale G. A randomized controlled trial of concentrated ERP, self-help and waiting list for obsessive- compulsive disorder: the Bergen 4-day treatment. Front Psychol. 2019;10:2500. doi: 10.3389/fpsyg.2019.02500. doi: 10.3389/fpsyg.2019.02500.
    1. Kvale G, Frisk B, Jürgensen Marte, Børtveit Tore, Ødegaard-Olsen Øystein Theodor, Wilhelmsen-Langeland A, Aarli BB, Sandnes K, Rykken S, Haugstvedt A, Hystad SW, Søfteland Eirik. Evaluation of novel concentrated interdisciplinary group rehabilitation for patients with chronic illnesses: protocol for a nonrandomized clinical intervention study. JMIR Res Protoc. 2021 Oct 07;10(10):e32216. doi: 10.2196/32216. v10i10e32216
    1. Beauchamp MK, Janaudis-Ferreira T, Goldstein RS, Brooks D. Optimal duration of pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease - a systematic review. Chron Respir Dis. 2011;8(2):129–40. doi: 10.1177/1479972311404256. 8/2/129
    1. Yohannes AM, Alexopoulos GS. Depression and anxiety in patients with COPD. Eur Respir Rev. 2014 Sep;23(133):345–9. doi: 10.1183/09059180.00007813. 23/133/345
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen W, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009 Sep;34(3):648–54. doi: 10.1183/09031936.00102509. 34/3/648
    1. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. 1979;2(3):197–207. doi: 10.1016/0149-7189(79)90094-6.0149-7189(79)90094-6
    1. Smith D, Roche E, O'Loughlin K, Brennan D, Madigan K, Lyne J, Feeney L, O'Donoghue B. Satisfaction with services following voluntary and involuntary admission. J Ment Health. 2014 Feb;23(1):38–45. doi: 10.3109/09638237.2013.841864.
    1. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006 Jun;60(6):631–7. doi: 10.1016/j.jpsychores.2005.10.020.S0022-3999(05)00491-5
    1. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, Enright PL, Hankinson JL, Ip MSM, Zheng J, Stocks J, ERS Global Lung Function Initiative Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012 Dec;40(6):1324–43. doi: 10.1183/09031936.00080312. 09031936.00080312
    1. Nguyen TD, Attkisson CC, Stegner BL. Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Eval Program Plann. 1983;6(3-4):299–313. doi: 10.1016/0149-7189(83)90010-1.0149-7189(83)90010-1
    1. Broadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health. 2015;30(11):1361–85. doi: 10.1080/08870446.2015.1070851.
    1. VanItallie TB, Yang MU, Heymsfield SB, Funk RC, Boileau RA. Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Clin Nutr. 1990 Dec;52(6):953–9. doi: 10.1093/ajcn/52.6.953.
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten C P M, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319–38. doi: 10.1183/09031936.05.00034805. 26/2/319
    1. Albouaini K, Egred M, Alahmar A, Wright DJ. Cardiopulmonary exercise testing and its application. Postgrad Med J. 2007 Nov;83(985):675–82. doi: 10.1136/hrt.2007.121558. 83/985/675
    1. Borg G. Borg's Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1998. p. viii, 104.
    1. Tveter AT, Dagfinrud H, Moseng T, Holm I. Measuring health-related physical fitness in physiotherapy practice: reliability, validity, and feasibility of clinical field tests and a patient-reported measure. J Orthop Sports Phys Ther. 2014 Mar;44(3):206–16. doi: 10.2519/jospt.2014.5042.
    1. Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, Falzon C, Garrod R, Lee C, Polkey MI, Jones PW, Man WD, Hopkinson NS. The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study. Thorax. 2011 May;66(5):425–9. doi: 10.1136/thx.2010.156372.thx.2010.156372
    1. Jones PW, Tabberer M, Chen W. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT™) scores. BMC Pulm Med. 2011 Aug 11;11:42. doi: 10.1186/1471-2466-11-42. 1471-2466-11-42
    1. Smid DE, Franssen FME, Houben-Wilke S, Vanfleteren LEGW, Janssen DJA, Wouters EFM, Spruit MA. Responsiveness and MCID estimates for CAT, CCQ, and HADS in patients with COPD undergoing pulmonary rehabilitation: a prospective analysis. J Am Med Dir Assoc. 2017 Jan;18(1):53–58. doi: 10.1016/j.jamda.2016.08.002.S1525-8610(16)30312-7
    1. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999 Jul;54(7):581–6. doi: 10.1136/thx.54.7.581.
    1. Yorke J, Moosavi SH, Shuldham C, Jones PW. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax. 2010 Jan;65(1):21–6. doi: 10.1136/thx.2009.118521. thx.2009.118521
    1. Spitzer RL, Kroenke K, Williams JBW, Löwe Bernd. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7. doi: 10.1001/archinte.166.10.1092.166/10/1092
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999 Nov 10;282(18):1737–44. doi: 10.1001/jama.282.18.1737.joc90770
    1. Pallesen S, Bjorvatn B, Nordhus IH, Sivertsen B, Hjørnevik Mari, Morin CM. A new scale for measuring insomnia: the Bergen Insomnia Scale. Percept Mot Skills. 2008 Dec;107(3):691–706. doi: 10.2466/pms.107.3.691-706.
    1. Craig CL, Marshall AL, Sjöström Michael, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381–95. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Dawson AP, Steele EJ, Hodges PW, Stewart S. Development and test-retest reliability of an extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E): a screening instrument for musculoskeletal pain. J Pain. 2009 May;10(5):517–26. doi: 10.1016/j.jpain.2008.11.008.S1526-5900(08)00903-6
    1. Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013 Aug;14(8):531–2. doi: 10.1016/j.jamda.2013.05.018.S1525-8610(13)00303-4
    1. Ross SM. Introductory Statistics. Cambridge, MA: Academic Press; 2017.
    1. Rossi G, Florini F, Romagnoli M, Bellantone T, Lucic S, Lugli D, Clini E. Length and clinical effectiveness of pulmonary rehabilitation in outpatients with chronic airway obstruction. Chest. 2005 Jan;127(1):105–9. doi: 10.1378/chest.127.1.105.S0012-3692(15)32378-3
    1. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005 Jul 01;172(1):19–38. doi: 10.1164/rccm.200408-1109SO.200408-1109SO
    1. Havnen A, Hansen B, Öst Lars-Göran, Kvale G. Concentrated ERP delivered in a group setting: a replication study. Behav Cogn Psychother. 2017 Sep;45(5):530–536. doi: 10.1017/S1352465817000091.S1352465817000091

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir