The impact of a home-based pulmonary telerehabilitation program on muscle function and quality of life following acute exacerbations of chronic obstructive pulmonary disease

慢性阻塞性肺疾病(COPD)是美国第三大死亡原因， 在老龄化的退伍军人中非常普遍。慢性阻塞性肺病的医疗费用在很大程度上可归因于急性 慢性阻塞性肺疾病急性加重(AECOPD)，定义为呼吸急促、咳嗽和/或痰的增加 这种生产超出了典型的日常可变性，通常需要更换药物。此外 导致肺功能丧失、生活质量下降和死亡率增加，AECOPD与 体力活动减少，肌肉功能障碍，与健康相关的生活质量变差。肌肉损失和 功能障碍反过来又与COPD患者死亡率的增加有关。门诊病人 在急性加重后立即开始的肺康复已被证明具有积极的作用 对肌肉功能、运动耐力和与健康相关的生活质量的影响。因此，共识 指南建议在术后3至4周内参加肺康复计划 慢性阻塞性肺疾病急性加重。然而，在后一年启动门诊肺康复的努力 由于缺乏医生转诊，患者接触肺脏的机会有限，往往阻碍了病情恶化时期 康复设施，或患者积极性不高。一项基于家庭的肺远程康复计划启动 在医院出院时可能会绕过这些障碍。已经展示了肺远程康复计划 高接受率和坚持率，提高运动能力和生活质量 病情稳定的慢性阻塞性肺疾病。然而，关于肺远距离康复的可行性和影响的数据如下 AECOPD住院治疗对身体活动水平、肌肉功能、运动能力和健康的影响- 缺乏相关的生活质量。我们的主要假设是基于家庭的肺远程康复 在AECOPD后出院时启动的计划在退伍军人群体中是可行的，并将 导致身体活动增加，肌肉功能、运动能力和健康状况得到更大改善- 与平时护理相比，相关的生活质量。我们将以以下具体目标来检验这一假设：(1) 确定在退伍军人中实施为期8周的家庭肺功能康复计划的可行性 中度至重度COPD在AECOPD后立即住院期间开始。(2) 确定体力活动水平和肌肉测量变化的大小和变异性 在八周的家庭生活后，力量、功能锻炼表现和与健康相关的生活质量- 基于肺远程康复计划的中重度退伍军人与常规护理的比较 在因AECOPD住院后立即发生COPD。我们将随机(1：1分配)30名男性和 女性退伍军人通过AECOPD住院接受为期八周、每周三次的家庭治疗 肺功能康复计划，包括使用自行车测功器进行下肢耐力训练 以及通过视频会议和锻炼进行1：1监督的上下肢力量训练 生理学家以及每月两次的在线支持小组，通过视频会议与常规护理。 体力活动水平、握力和股四头肌肌力、运动与基线的变化 耐力和与健康相关的生活质量将在肺远程康复计划之后进行评估 而不是平时的照顾。该项目的发现将有助于肺远程康复领域的不断发展 并将为设计和实施更大规模的随机对照试验提供关键的初步数据 评估肺快速康复对AECOPD后长期临床结果的影响。

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and is highly prevalent in the aging veteran population. Health care costs in COPD are largely attributable to acute exacerbations of COPD (AECOPD), defined as an increase in shortness of breath, cough, and/or sputum production that is beyond typical day-to-day variability and usually requires a change in medication. In addition to loss of lung function, decreased quality of life, and increased mortality, AECOPD are associated with reduced physical activity, muscle dysfunction, and poorer health-related quality of life. Muscle loss and dysfunction have, in turn, been associated with increased mortality in patients with COPD. Outpatient pulmonary rehabilitation initiated in the immediate post-exacerbation period has been shown to have a positive impact on muscle function, exercise endurance, and health-related quality of life. As such, consensus guidelines recommend the participation in a pulmonary rehabilitation program within three to four weeks of an acute exacerbation of COPD. However, efforts to initiate outpatient pulmonary rehabilitation in the post- exacerbation period are often hindered by lack of physician referral, limited patient access to pulmonary rehabilitation facilities, or low patient motivation. A home-based pulmonary telerehabilitation program initiated at hospital discharge may circumvent these barriers. Pulmonary telerehabilitation programs have been shown to have a high acceptance and adherence rate and lead to improvement in exercise capacity and quality of life in stable COPD. However, data regarding the feasibility and impact of pulmonary telerehabilitation following hospitalization for an AECOPD on physical activity levels, muscle function, exercise capacity, and health- related quality of life are lacking. Our primary hypothesis is that a home-based pulmonary telerehabilitation program initiated at hospital discharge following an AECOPD is feasible in the veteran population and will result in increased physical activity and greater improvement in muscle function, exercise capacity, and health- related quality of life compared to usual care. We will test this hypothesis with the following specific aims: (1) To determine the feasibility of an eight-week home-based pulmonary telerehabilitation program in veterans with moderate to severe COPD initiated in the immediate post-hospitalization period following an AECOPD. (2) To determine physical activity levels and the magnitude and variability in changes of measurements of muscle strength, functional exercise performance, and health-related quality of life following an eight-week home- based pulmonary telerehabilitation program versus usual care initiated in veterans with moderate to severe COPD immediately following hospitalization for an AECOPD. We will randomize (1:1 allocation) 30 male and female veterans hospitalized with an AECOPD to either an eight-week, three sessions per week, home-based pulmonary telerehabilitation program that includes lower extremity endurance exercises with a cycle ergometer and upper and lower extremity strength training with 1:1 supervision via video conferencing with an exercise physiologist as well as a twice-monthly online support group via video conferencing versus usual care. Changes from baseline in physical activity levels, handgrip and quadriceps muscle strength, exercise endurance, and health-related quality of life will be assessed following the pulmonary telerehabilitation program versus usual care. Findings from this project will contribute to the growing field of pulmonary telerehabilitation and will provide critical preliminary data for the design and implementation of a larger, randomized control trial assessing the impact of pulmonary telerehabilitation on long-term clinical outcomes following AECOPD.