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， 在老龄化退伍军人群体中非常普遍。 COPD 的医疗保健费用主要归因于急性发作 慢性阻塞性肺病 (AECOPD) 恶化，定义为呼吸短促、咳嗽和/或咳痰加重 产量超出了典型的日常变化，通常需要改变药物。另外 AECOPD 与肺功能丧失、生活质量下降和死亡率增加有关 体力活动减少、肌肉功能障碍以及与健康相关的生活质量较差。肌肉损失和 反过来，功能障碍又与 COPD 患者死亡率增加相关。门诊 病情加重后立即开始的肺康复已被证明具有积极的效果 对肌肉功能、运动耐力和健康相关生活质量的影响。如此看来，共识 指南建议在接受肺康复治疗后三到四周内参加肺康复计划 COPD 急性加重。然而，在术后开始门诊肺康复的努力 急性加重期往往因缺乏医生转诊、患者获得肺部治疗的机会有限而受到阻碍 康复设施或患者积极性低。启动了基于家庭的肺远程康复计划 出院时可能会绕过这些障碍。肺部远程康复计划已被展示 具有较高的接受率和坚持率，从而提高运动能力和生活质量 处于稳定的慢性阻塞性肺病。然而，关于肺远程康复的可行性和影响的数据 因 AECOPD 住院治疗的体力活动水平、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 AECOPD 出院后启动的计划在退伍军人群体中是可行的，并且将 导致身体活动增加，肌肉功能、运动能力和健康得到更大改善 与常规护理相比，相关的生活质量。我们将通过以下具体目标来检验这一假设：（1） 确定退伍军人为期八周的家庭肺远程康复计划的可行性 AECOPD 出院后立即出现中度至重度 COPD。 (2) 确定体力活动水平以及肌肉测量变化的幅度和变异性 八周居家训练后的力量、功能锻炼表现以及与健康相关的生活质量 基于肺部远程康复计划与针对中度至重度退伍军人启动的常规护理的比较 因 AECOPD 住院后立即出现 COPD。我们将随机（1:1 分配）30 名男性和 因 AECOPD 住院的女性退伍军人接受为期 8 周、每周 3 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 通过视频会议进行1:1监督的上下肢力量训练和练习 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相比。 身体活动水平、握力和股四头肌力量、运动量相对基线的变化 肺部远程康复计划后将评估耐力和与健康相关的生活质量 与通常的护理相比。该项目的研究结果将有助于肺部远程康复领域的不断发展 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.