Home Care NetWork
Home Care Literature Review: January– June 2006
Pulmonary Rehabilitation:
Boxall AM, Barclay L, Sayers A, et al. Managing chronic obstructive pulmonary disease in the community.: a randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients. J Cardiopulm Rehabil 2005; 25:378-385
This Australian randomized clinical trial compared an individualized home-based pulmonary rehabilitation for housebound COPD patients with usual care in 60 patients with COPD who are housebound and aged greater than 60 years. There were 23 patients in each group available for analysis at the end of the 12-week program. Compared with the control group, intervention patients demonstrated a significant improvement in 6-minute walk test (p = 0.023), Borg score of perceived breathlessness (p = 0.024), St. George's respiratory questionnaire total score (p = 0.020), and impact sub score (p = 0.024). At 6 months, the intervention group had a significantly shorter average length of stay at readmission to hospital with exacerbation (p = 0.035). While this study does not compare in the home to ambulatory pulmonary rehab, it does demonstrate a significant impact for an organized in-home pulmonary rehabilitation program and housebound patients.
Murphy N, Bell C, Costello RW. Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation. Respir Med 2005; 99:1297-1302. Epub 2005 Mar 31
This Irish randomized controlled trial evaluated the effectiveness of a twice-weekly supervised home exercise program following hospitalization for exacerbation of COPD in 31 patients, (exercise group: n=16, FEV1 0.94+/-0.34 L and control group: n=15, FEV11.08+/-0.33 L). At 6 weeks, the exercise group exhibited improved shuttle walk test (198 m+/-95-304+/-136 m) and increased 3-min step test capacity (119+/-40-163+/-26s) (both p<0.001). Knee extensor muscle strength and quality of life scores also increased. Neither exercise capacity nor muscle strength was altered in the control group. Follow-up at 3 months showed that three of the control group and none of the exercise group had experienced subsequent exacerbations (p=0.06). A good result for a relatively simple in- home intervention.
Duiverman ML, Bladder G, Meinesz AF, et al. Home mechanical ventilatory support in patients with restrictive ventilatory disorders: a 48-year experience. Respir Med 2006; 100:56-65. Epub 2005 Jun 6
This case series reviews one hospital’s experience managing 114 patients with restrictive ventilatory disorders with various forms of home mechanical ventilation (negative pressure ventilation ([NPV], tracheal intermittent positive pressure ventilation [TIPPV], and nasal intermittent positive pressure ventilation [NIPPV, volume or pressure-controlled ventilatory mode], over a 50-year period. Patients were subdivided in an idiopathic kyphoscoliosis group (IK, n=64), a post-poliomyelitis syndrome group (PP, n=30), or a miscellaneous group (M, n=20). The patients in the PP group had higher survival rates compared to the IK patients (p<0.05), while the M patients had the lowest survival rates (p<0.01). Both NPV (p<0.01) and TIPPV (p<0.05) led to a decrease in PaCO2 after 9 months compared with baseline. This decrease in PaCO2 was still present after 5 years of NPV (p<0.001) and TIPPV (p<0.05). NIPPV led to an improvement in pulmonary function (p<0.05) and arterial blood gases (p<0.001) after 9 months compared with baseline. After 5 years of NIPPV, the arterial blood gases were still significantly improved compared with baseline (p<0.01). Both volume-controlled and pressure-controlled ventilation improved pulmonary function and arterial blood gases. This is an impressive outcome in this difficult-to-manage group.
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