Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report.
Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report.
复制标题
DOI：
10.1513/annalsats.202302-129st
复制
发表时间：
2023-06
影响因子：
8.3
通讯作者：
中科院分区：
文献类型：
--
作者：
患有呼吸系统疾病的人群出现衰弱的风险更高，而衰弱与较差的健康状况相关。越来越多的证据表明，康复治疗在管理呼吸系统疾病患者的衰弱方面发挥着作用。然而，在针对这一人群确定衰弱的最佳方法以及提供康复治疗方面，仍存在一些挑战。本次美国胸科学会研讨会的目的是概述围绕呼吸系统疾病和衰弱患者康复的关键定义及概念，综合现有证据，并探讨如何调整康复项目以契合这一人群的需求和经历。在两场为期半天的线上研讨会上，来自不同学科、专业及国家的20位专业人士讨论了关键进展，并确定了未来研究的机会，同时还通过线上通信获取了更多意见。参与者强调了一种 “衰弱康复悖论”，即肺康复能有效减轻衰弱，但对部分衰弱个体而言，完成康复项目颇具挑战。衰弱不应成为获得康复治疗的限制因素；相反，识别出衰弱应促使进行全面评估并提供量身定制的支持，包括进一步转诊以获取更多专家意见。明确考虑症状负担和合并症的运动处方、融入更多老年病学或缓和医疗专业知识，以及 / 或者针对参与康复可能遇到的干扰进行预先规划，或许有助于提高参与度并改善康复效果。为识别和衡量呼吸系统疾病患者的衰弱情况，应根据预期用途，基于敏感性、特异性、反应性和可行性来选择评估工具。需要开展研究，以拓宽对衰弱的理解，不局限于其身体维度，并探索远程康复或居家肺康复对患有慢性呼吸系统疾病和衰弱的人群的优点及局限性。
People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a “frailty rehabilitation paradox” whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.