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

慢性阻塞性肺病（COPD）是美国第三大死亡原因， 在老年退伍军人中非常普遍。COPD的医疗保健费用主要归因于急性 COPD急性加重（AECOPD），定义为呼吸短促、咳嗽和/或咳痰增加 生产超出了典型的日常变化，通常需要改变药物。此外 肺功能丧失、生活质量下降和死亡率增加，AECOPD与 身体活动减少、肌肉功能障碍和与健康相关的生活质量较差。肌肉损失和 功能障碍反过来与COPD患者死亡率的增加有关。门诊 在急性加重期后立即开始的肺康复已被证明具有积极的 对肌肉功能、运动耐力和健康相关生活质量的影响。因此，共识 指南建议在肺康复计划的三到四周内参与， COPD急性加重。然而，努力启动门诊肺康复后， 急性加重期往往由于缺乏医生转诊，患者获得肺部 康复设施，或低患者的积极性。一项以家庭为基础的肺远程康复计划启动 在出院时可以绕过这些障碍。肺远程康复计划已经显示， 接受率和坚持率高，并导致运动能力和生活质量的改善 COPD稳定期然而，关于肺远程康复的可行性和影响的数据， 因AECOPD住院治疗，包括身体活动水平、肌肉功能、运动能力和健康状况- 缺乏相关的生活质量。我们的主要假设是家庭肺远程康复 在AECOPD后出院时启动的项目在退伍军人人群中是可行的， 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- 与常规护理相比的相关生活质量。我们将通过以下具体目标来检验这一假设：（1） 确定在退伍军人中进行为期八周的家庭肺远程康复计划的可行性 在AECOPD后住院后即刻开始的中度至重度COPD患者。（二） 确定身体活动水平以及肌肉测量值变化的幅度和可变性 力量、功能性运动表现和健康相关的生活质量， 基于远程肺康复计划与常规护理开始在退伍军人中的中度至重度 因AECOPD住院后立即发生COPD。我们将随机分配（1：1分配）30名男性和 患有AECOPD住院的女性退伍军人接受为期八周，每周三次的家庭治疗， 肺部远程康复计划，包括使用自行车测力计进行下肢耐力练习 和上肢和下肢力量训练与1：1监督通过视频会议与演习 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、握力和四头肌肌力、运动较基线的变化 耐力和健康相关的生活质量将在肺远程康复计划后进行评估 与常规护理相比。该项目的研究结果将有助于肺远程康复领域的发展 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 评估肺远程康复对AECOPD后长期临床结局的影响。

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.