Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Enhancing Partnership with Patients and Community (Projects initiated to engage patients / carers / community to improve efficiency / quality of care)
Authors (including presenting author) :
Wu WY(1), Kwan CK(1), Chan HL(1), Kwok WS(1), Cheung PC(1)
Affiliation :
(1) Department of Physiotherapy, Tin Shui Wai Hospital
Introduction :
Chronic obstructive pulmonary diseases (COPD) is a chronic respiratory disease associated with high levels of morbidity and mortality. The COPD patients are presented with decreased exercise capacity and quality of life due to dyspnea.
Inspiratory muscle training (IMT) could be a possible choice of treatment for the COPD patients. Respiratory muscles weakness and poor exercise training compliance are commonly found in COPD patients. Evidences showed that IMT is able to increase the inspiratory muscle strength and endurance, as well as the exercise capacity and quality of life. The sense of dyspnea can be also reduced. Therefore, IMT could be one of the treatments with positive effects on COPD patients.
IMT is not a commonly applied intervention for our COPD patients. Moreover, exercise compliance of COPD patients is usually low. This pilot aims to investigate the effectiveness of IMT with regular telephone follow up for improving the severity of COPD symptoms and exercise tolerance.
Objectives :
1. To share the experience on IMT in COPD patients.
2. To assess the feasibility of IMT in COPD patients of Tin Shui Wai Hospital (TSH).
3. To review outcome and change in patient’s performance after IMT with tele-follow-up.
Methodology :
Patients who admitted to TSH with the diagnosis of acute exacerbation of COPD were selected for analysis during the period of 1 Feb 2023 – 31 Oct, 2023. The inclusion criteria include: [1] stable COPD patients with GOLD 2-3; and [2] MFAC ≥ cat 6.
Patients with the following conditions were excluded: [1] history of pneumothorax; [2] large bullae found in chest X-ray; [3] known perforated ear drum; [4] unstable cardiac condition; and [5] recent cerebrovascular event or myocardial infarction. IMT would be prescribed during the hospital stay. The progression of IMT would be monitored by monthly telephone follow-up.
Outcome measures including: [1] adherence (%, from patient’s diary); [2] COPD Assessment Test (CAT: 0-40, 40 showed the worst symptoms); [3] modified Medical Research Council Dyspnea Scale (mMRC: grade 0-4, 4 showed the worst symptoms); [4] and the walking tolerance on level ground (ET: minute) would be assessed before discharge and 2-month post-discharge via telephone follow-up.
Result & Outcome :
Nine patients were selected for the study. Among them, 7 patients successfully completed all the follow-up and was not admitted during the period. Two patients dropped-out from the study. One was admitted and declined further follow-up due to deteriorated condition, and the other defaulted the tele-follow up. No adverse event was reported.
For the patients who completed the follow-up, their maximal inspiratory pressure (MIP) ranged from 6-68 cmH2O. The mean exercise adherence rate dropped from 63.6% to 51.6% after 2 months. Before the IMT, the mean CAT score was 21.3(+6.94). After the IMT, the mean CAT score was 16.6(+9.04), which represent improved symptoms, though statistically insignificant (p=0.184). However, the median mMRC grades remained the same before and after the IMT (p=0.584). The scale may not be sensitive enough to detect the change. The exercise tolerance on level ground (ET) was generally better (p=0.140). The averaged ET roughly doubled from 7.3(+5.56) to 15.3(+9.21).
Although there were no significant differences in CAT score, mMRC and ET, patients who had completed the 2-month program demonstrated improved ET and CAT scores. This pilot showed that IMT with regular telephone follow up might bring benefits in symptoms and ET of COPD patients. Further study with bigger sample size may be indicated for exploring the effects of IMT in COPD patients.
