Lisa Jane Brighton, Catherine J. Evans, Morag Farquhar, K. Bristowe, Aleksandra Kata, Jade Higman, Margaret Ogden, C. Nolan, Deokhee Yi, Wei Gao, M. Koulopoulou, Sharmeen Hasan, Karen Ingram, Stuart F. Clarke, Kishan Parmar, Eleni Baldwin, C. Steves, William D-C Man, Matthew Maddocks
{"title":"为同时患有慢性阻塞性肺病和体弱的患者进行肺康复综合老年评估:混合方法可行性试验","authors":"Lisa Jane Brighton, Catherine J. Evans, Morag Farquhar, K. Bristowe, Aleksandra Kata, Jade Higman, Margaret Ogden, C. Nolan, Deokhee Yi, Wei Gao, M. Koulopoulou, Sharmeen Hasan, Karen Ingram, Stuart F. Clarke, Kishan Parmar, Eleni Baldwin, C. Steves, William D-C Man, Matthew Maddocks","doi":"10.1183/23120541.00774-2023","DOIUrl":null,"url":null,"abstract":"Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated.To determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation.Multicentre mixed-methods randomised controlled feasibility trial (“Breathe Plus”;ISRCTN13051922). People with COPD, aged ≥50, Clinical Frailty Scale ≥5, and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during Covid-19 restrictions. Outcomes (physical, psycho-social, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews.Recruitment stopped at 31 participants (mean age 72.4 [sd10.1], 68% MRC 4–5), due to Covid-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8–129) and prompted 46 individual care recommendations (median 3 per participant, range 0–12); 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it.Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comprehensive Geriatric Assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial\",\"authors\":\"Lisa Jane Brighton, Catherine J. Evans, Morag Farquhar, K. Bristowe, Aleksandra Kata, Jade Higman, Margaret Ogden, C. Nolan, Deokhee Yi, Wei Gao, M. 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Comprehensive Geriatric Assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial
Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated.To determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation.Multicentre mixed-methods randomised controlled feasibility trial (“Breathe Plus”;ISRCTN13051922). People with COPD, aged ≥50, Clinical Frailty Scale ≥5, and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during Covid-19 restrictions. Outcomes (physical, psycho-social, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews.Recruitment stopped at 31 participants (mean age 72.4 [sd10.1], 68% MRC 4–5), due to Covid-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8–129) and prompted 46 individual care recommendations (median 3 per participant, range 0–12); 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it.Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.
期刊介绍:
ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.