Minimizing the evidence-practice gap - a prospective cohort study incorporating balance training into pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease

Samantha L Harrison, Marla K Beauchamp, Kathryn Sibley, Tamara Araujo, Julia Romano, Roger S Goldstein, Dina Brooks, Samantha L Harrison, Marla K Beauchamp, Kathryn Sibley, Tamara Araujo, Julia Romano, Roger S Goldstein, Dina Brooks

Abstract

Background: We have recently demonstrated the efficacy of balance training in addition to Pulmonary Rehabilitation (PR) at improving measures of balance associated with an increased risk of falls in individuals with Chronic Obstructive Pulmonary Disease (COPD). Few knowledge translation (KT) projects have been conducted in rehabilitation settings. The goal of this study was to translate lessons learnt from efficacy studies of balance training into a sustainable clinical service.

Methods: Health care professionals (HCPs) responsible for delivering PR were given an hour of instruction on the principles and practical application of balance training and the researchers offered advice regarding; prescription, progression and practical demonstrations during the first week. Balance training was incorporated three times a week into conventional PR programs. Following the program, HCPs participated in a focus group exploring their experiences of delivering balance training alongside PR. Service users completed satisfaction surveys as well as standardized measures of balance control. At six month follow-up, the sustainability of balance training was explored.

Results: HCPs considered the training to be effective at improving balance and the support provided by the researchers was viewed as helpful. HCPs identified a number of strategies to facilitate balance training within PR, including; training twice a week, incorporating an interval training program for everyone enrolled in PR, providing visual aids to training and promoting independence by; providing a set program, considering the environment and initiating a home-based exercise program early. Nineteen service users completed the balance training [ten male mean (SD) age 73 (6) y]. Sixteen patients (84%) enjoyed balance training and reported that it helped them with everyday activities and 18 (95%) indicated their wish to continue with it. Scores on balance measures improved following PR that included balance training (all p < 0.05). At six month follow-up balance training is being routinely assessed and delivered as part of standardised PR.

Conclusions: Implementing balance training into PR programs, with support and training for HCPs, is feasible, effective and sustainable.

Trail registration: Clinical Trials ID: NCT02080442 (05/03/2014).

Figures

Fig 1.
Fig 1.
Recruitment flow diagram

References

    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–555. doi: 10.1164/rccm.200703-456SO.
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Measuring the Global Burden of Disease and Risk Factors, 1990–2001. Washington DC: World Bank; 2006.
    1. American Thoracic Society/ European Respiratory Society Skeletal muscle dysfunction in chronic obstructive pulmonary disease. A statement of the American Thoracic Society and European Respiratory Society. Am J Respir Crit Care Med. 1999;159(4 Pt 2):S1–40.
    1. Maltais F, Leblanc P, Whittom F, Simard C, Marquis K, Belanger M, et al. Oxidative enzyme activities of the vastus lateralis muscle and the functional status in patients with COPD. Thorax. 2000;55(10):848–853. doi: 10.1136/thorax.55.10.848.
    1. O'Loughlin JL, Boivin JF, Robitaille Y, Suissa S. Falls among the elderly: distinguishing indoor and outdoor risk factors in Canada. J Epidemiol Community Health. 1994;48(5):488–489. doi: 10.1136/jech.48.5.488.
    1. Roig M, Eng JJ, Macintyre DL, Road JD, FitzGerald JM, Burns J, et al. Falls in people with chronic obstructive pulmonary disease: an observational cohort study. Respir Med. 2011;105(3):461–469. doi: 10.1016/j.rmed.2010.08.015.
    1. American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49:664–672. doi: 10.1046/j.1532-5415.2001.49115.x.
    1. Beauchamp MK, Hill K, Goldstein RS, Janaudis-Ferreira T, Brooks D. Impairments in balance discriminate fallers from non-fallers in COPD. Respir Med. 2009;103(12):1885–1891. doi: 10.1016/j.rmed.2009.06.008.
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–1707. doi: 10.1056/NEJM198812293192604.
    1. Butcher SJ, Meshke JM, Sheppard MS. Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2004;24(4):274–280. doi: 10.1097/00008483-200407000-00013.
    1. Chang AT, Seale H, Walsh J, Brauer SG. Static balance is affected following an exercise task in chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2008;28(2):142–145. doi: 10.1097/.
    1. Eisner MD, Blanc PD, Yelin EH, Sidney S, Katz PP, Ackerson L, et al. COPD as a systemic disease: impact on physical functional limitations. Am J Med. 2008;121(9):789–796. doi: 10.1016/j.amjmed.2008.04.030.
    1. Roig M, Eng JJ, Macintyre DL, Road JD, Reid WD. Postural Control Is Impaired in People with COPD: An Observational Study. Physiother Can. 2011;63(4):423–431. doi: 10.3138/ptc.2010-32.
    1. Smith MD, Chang AT, Seale HE, Walsh JR, Hodges PW. Balance is impaired in people with chronic obstructive pulmonary disease. Gait Posture. 2010;31(4):456–460. doi: 10.1016/j.gaitpost.2010.01.022.
    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management and prevention of COPD. 2011.
    1. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390–1413. doi: 10.1164/rccm.200508-1211ST.
    1. Brooks D, Sottana R, Bell B, Hanna M, Laframboise L, Selvanayagarajah S, et al. Characterization of pulmonary rehabilitation programs in Canada in 2005. Can Respir J. 2007;14(2):87–92.
    1. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007;131(5 Suppl):4S–42S. doi: 10.1378/chest.06-2418.
    1. Desveaux L, Janaudis-Ferreira T, Goldstein R, Brooks D. An International Comparison of Pulmonary Rehabilitation: A Systematic Review. COPD. 2014;12(2):144–53. doi: 10.3109/15412555.2014.922066.
    1. Evan RA, Dolmage TE, Mangovski-Alzamora S, Romano J, O'Brein L, Brook D et al. One-Legged Cycling For Chronic Obstructive Pulmonary Disease (COPD): Knowledge Translation To Pulmonary Rehabilitation [Abstract]. American Thoracic Society; 2013;187:A2574.
    1. Janaudis-Ferreira T, Hill K, Goldstein RS, Robles-Ribeiro P, Beauchamp MK, Dolmage TE, et al. Resistance arm training in patients with COPD: A Randomized Controlled Trial. Chest. 2011;139(1):151–158. doi: 10.1378/chest.10-1292.
    1. Beauchamp MK, Sibley KM, Lakhani B, Romano J, Mathur S, Goldstein RS, et al. Impairments in systems underlying control of balance in COPD. Chest. 2012;141(6):1496–1503. doi: 10.1378/chest.11-1708.
    1. Beauchamp MK, O'Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010;91(9):1460–1465. doi: 10.1016/j.apmr.2010.06.021.
    1. Beauchamp MK, Janaudis-Ferreira T, Parreira V, Romano JM, Woon L, Goldstein RS, et al. A randomized controlled trial of balance training during pulmonary rehabilitation for individuals with COPD. Chest. 2014;144(6):1803–1810. doi: 10.1378/chest.13-1093.
    1. Scott SD, Albrecht L, O'Leary K, Ball GD, Hartling L, Hofmeyer A, et al. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci. 2012;7:70. doi: 10.1186/1748-5908-7-70.
    1. Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S. Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review. J Rehabil Med. 2009;41(13):1024–1032. doi: 10.2340/16501977-0451.
    1. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982;284(6329):1607–1608. doi: 10.1136/bmj.284.6329.1607.
    1. Williams JE, Singh SJ, Sewell L, Morgan MD. Health status measurement: sensitivity of the self-reported Chronic Respiratory Questionnaire (CRQ-SR) in pulmonary rehabilitation. Thorax. 2003;58(6):515–518. doi: 10.1136/thorax.58.6.515.
    1. Padgett PK, Jacobs JV, Kasser SL. Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct. Phys Ther. 2012;92(9):1197–1207. doi: 10.2522/ptj.20120056.
    1. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83(Suppl 2):S7–11.
    1. Finch E, Brooks D, Stratford P, Mayo N. Physical Rehabilitation Outcome Measures: A guide to Enhanced Clinical-Decision-Making. 2. Hamilton: Canadian Physiotherapy; 2002.
    1. Donoghue D, Stokes EK, How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 2009;41(5):343–346. doi: 10.2340/16501977-0337.
    1. Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484–498. doi: 10.2522/ptj.20080071.
    1. Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1998;53(4):M287–M294. doi: 10.1093/gerona/53A.4.M287.
    1. Ajzen I. The Therory of Planned Behaviour. Organ Behav Hum Decis Process. 1991;50:179–211.
    1. Kluger AN, DeNisi A. The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin. 1996;119(2):254–284. doi: 10.1037/0033-2909.119.2.254.

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