Compared Articles: Rehabilitation Aspect - Essay Example

? Comparison between Two Articles Focusing on Short- and Long-term Effects of Outpatient Rehabilitation in COPD Patients Introduction This paper presents in depth comparison and contrast between two scientific research articles focusing on outpatient pulmonary rehabilitation of COPD patients. The first article is by Troosters, Gosselink and Decramer and it is titled “Short- and Long-term Effects of Outpatient Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Trial.” The second article is written by Verrill, Barton, Beasly and Lippard and bears the title “The Effects of Short-term and Long-term Pulmonary Rehabilitation on Functional Capacity, Perceived Dyspnea, and Quality of Life.” Both articles focus on effects of outpatient PR programs on COPD patients in the short and long-term periods. The second article’s title is, however, specific in regard to the aspects being examined such as impact of PR on COPD patients’ functional capacity and life quality, while the first is a general and randomized trial. These and other similarities and differences are the principal focus of this paper, especially in consideration of the articles’ purpose, methods, subjects, results and conclusions. Purpose Troosters, Gosselink & Decramer, (2000) recognize the fact that short term effects of PR on patients with severe COPD are better known than long term impacts. Therefore the authors’ principal purpose is to find out the effects of a 6-month outpatient PR program on patients with severe COPD. When indicating the purpose, the authors do not explicitly state the specific outcomes to be measured. Contrastingly, Verrill, Barton, Beasley & Lippard, (2005) article seeks to find out if respiration difficulties or Dyspnea, physical performance and general quality of life improves following short and long term outpatient PR. Other than the aspects under scrutiny, Verrill’s et al. article also compares the mentioned effects between males and females. This shows that even though both articles focus on one subject, that written by Verrill’s et al. depicts higher specificity both in the title and purpose statement than Troosters’ et al. Target population During the research by Troosters et al. (2000) one hundred COPD patients were selected from a group of individuals referred to the outpatient clinic at the Catholic University Hospital in Leuven, Belgium, between the years 1995 and 1997. Patients’ eligibility was evaluated on the basis of age and forced expiratory volume (FEV). Individuals were therefore deemed eligible for inclusion if they were less than 75 years old and had a FEV1 lower than 65% of predetermined value. Additionally, the chosen participants were determined to have a stable clinical condition and without infection or COPD aggravation in the preceding 4 weeks. All patients with severe health problems like myocardial infarction, heart failure, cancer, neuro-vascular ailments, or orthopedic problems were excluded from the study. In Verrill et al.’s (2005) research, subjects comprised of 309 females and 281 males falling within the age bracket of 20 and 93 years. This shows that the study, unlike that conducted by Troosters’ et al., had more participants and a higher age limit. The subjects came from North Carolina hospitals with PR programs, particularly in urban areas like Greensboro and Charlotte. For randomization purposes, the partisans were obtained from 7 outpatient PR programs and they all had obstructive, restrictive or other forms of lung disease. Unlike in Troosters et al.’s study this one did not evaluate the severity of COPD in patients; neither did the authors exclude patients with a history of other ailments. For instance, two patients had previously received transplants for both lungs, and others had undergone surgery to reduce lung volume. Methodology The one hundred COPD patients selected for participation in the research by Troosters et al. (2000) randomly got assigned to either of two groups, one with fifty partisans undergoing a training program that involved walking, strength training and cycling, and the other, with an equal number of participants getting ordinary COPD medical care. Thirty-four participants in the group undergoing training were examined during the PR program’s conclusion, that is, after 6 months and 26 individuals from the same group underwent evaluation after 18 months of re-examination. The other group receiving usual medical care made up the study’s control group, and 28 of these patients underwent evaluation after 6 months, while the remaining participants were evaluated after 18 months. The researchers measured the participants’ 6-minute walking (6-MW) distance, maximal exercise capacity, pulmonary function, respiratory and peripheral strength of muscles, and general life quality (based on a scale of 20 to 140 points). The researchers also estimated the outpatient program’s cost-effectiveness. Verrill et al.’s (2005) research article indicates that the subjects participated in either the 12 week or 24 week outpatient rehabilitation program. This shows that unlike in the other article there was no control group to offer a comparison basis and there was also no strategic randomization of participants into different groups. However, the two studies are similar on the basis of the fact that they offered training comprising of treadmill walking, cycling and exercise based on aerobic therapy. Additionally, most programs within the study conducted by Verrill and co-authors also included resistive exercise or strength training, which involved utilization of hand weights, weight machines, and elastic bands. Unlike Troosters’ research, however, programs in Verrill’s et al. study combined incorporated psychosocial and nutritional assessment, as well as, counseling. The outpatient research programs also offered education modules concerning; restrictive and obstructive lung ailments, pulmonary hygiene, retraining on breathing rhythm, dietary changes, prescription of medications for pulmonary ailments, relaxation or stress management tactics, benefits on exercise, advice on avoiding tobacco smoking, prevention of musculoskeletal injuries, and overall intervention strategies for pulmonary diseases. Centers participating in the research complied on the provision of utilizing a similar combination of outcome measures and adhering to similar instructions for subjects enrolled in the seven programs. Just like in Troosters et al., study the outcome measures included 6-minute walking (6-MW) distance, maximal exercise capacity, pulmonary function, respiratory and peripheral strength of muscles (as determined by shortness of breath assessed using the SOBQ), and general life quality. Results According to research findings by Troosters et al. (2000), the group undergoing training showed improvement after 6 months or 24 weeks in consideration of the 6-MW distance. The latter was determined to be 52m and while utilizing a confidence interval of 95% the improvement was from 15 to 89m. The authors also indicate that maximal work load improved from 6 to 19 joules per second (19 W) or an average of 12 W, also at a confidence interval of 95%. The maximal oxygen uptake was determined to be 0.26 liters/min, the quadriceps force was 18 Nm, inhalation muscle force at 11 cmH2O, and finally QOL was 14 points as per the scale utilized. All these disparities persisted, depicting statistical significance at the P value of 0.05, with the exception of the inhalation muscle strength. However, the differences between QOL and 6-MW distance between the control and training groups went beyond the nominal clinically-significant difference. In Verrill et al.’s (2005) article, the average summary scores on the SF-36 and the quality of life index (QLI) increased following 12 weeks of pulmonary rehabilitation, both showing statistical significance at a P value of 0.05. These improvements showed maintained significance until the end of the 6-month or 24-week PR participation. Scores on the SOBQ showed positive change after three months (p < 0.001) among participants in the short-term program, but only showed improvement after 24 weeks among participants of the long-term program. The 6-minute walking test performance depicted improvement after 12 weeks and once again from the 12th to 24th week (p _ 0.002) among long-term partisans. In the research conducted by Troosters et al. (2000) the outcome measures for the two groups involved were compared by utilizing unpaired t tests. Treatment effects for both the treatment group and the control group were evaluated using repeated measures variance analysis. Further, unpaired t tests were utilized to examine treatment effects after 6 months, that is, when the training duration ended and during re-examination after 18 months. The statistical significance of the results was set at a P value of 0.05. Verrill et al. (2005) also conducted statistical analysis for all the parameters outlined earlier. Just like in Troosters et al.’s study, repeated measures variance analysis was used to evaluate differences for each parameter. Nonetheless it is imperative to note that, in Verrill et al. (2005), the disparities were analyzed on the basis of gender. Further, the study did not utilize unpaired t tests in the statistical analysis. Instead this study utilized two variance analysis tests for every parameter, that is, one comparing patients that completed the 12 week program and one comparing those that completed 12 and 24 weeks while accounting for treatment, time and other interaction effects. The most outstanding similarity between the two studies, other than utilization of repeated procedures breakdown of variance, is that they both considered results to be statistically significant at the P value of 0.05. Conclusions According to the findings by Troosters et al. (2000), the authors conclude that outpatient training among participants that finished the 6-month PR program, brought about clinically significant changes. The same clinically relevant variations in; 6-MW distance, the maximum exercise performance, physical/ respiratory strength of muscles, and overall life quality were also observed. Therefore, the authors conclude that a 6-month PR program with intensive outpatient training can significantly improve COPD patients’ physical strength and quality of life. Just like Troosters et al., Verrill et al. (2005), note that physical performance of COPD patients as determined by the 6-minute walking test, showed continued improvement up to 24 weeks months of PR participation. Quality of life, as shown by measures like reduction of Dyspnea and shortness of breath showed improvement after participating in PR for 12 weeks, a trend that continued over the remaining part of the 24-week program. The authors recommend that COPD patients should participate in supervised outpatient PR for 6 months, in order to gain and sustain optimal health benefits. Limitations Troosters et al.’s study’s principal limitation was the failure to increase outcome measures for higher specificity. In contrast, Verrill’s chief limitations included failure to include a control group for comparison purposes, and not randomizing the study. The number of evaluations for both studies was limited, since participants were examined at the beginning and end of the research. Recommendations Based on the research and the results shown, it is proper to engage in informal programs with the supervised patients in order to evaluate the actual positive effects of long-term PR. Additionally, it is imperative to evaluate how long the positive effects of long term outpatient PR would last. This would determine if attenuation of COPD symptoms is long lasting enough to justify the patients' extra efforts. Further, it is imperative to determine the prudence of long term PR for COPD patients with severe symptoms and determine if such patients would require extra supervision. It would also be crucial to carry out further research on physical, behavioral, psychological and social attributes of specific segments of COPD patients especially the ones that have undergone respiratory organs surgery. Conclusion Despite the minor differences between the two studies under scrutiny, the authors in both cases come up with the same conclusion. The scholars all suggest that supervised outpatient training, for COPD patients in PR programs continually improves their physical performance especially over a 6-month or 24-week duration. The high similarity index of results from the two studies emphasizes their credibility and applicability in the field of PR and COPD treatment in general. References Troosters, T., Gosselink, R., & Decramer, M. (2000). Short- and Long-term Effects of Outpatient Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Trial. The American Journal of Medicine, 109, 207-212. Verrill, D., Barton, C. Beasley, W., & Lippard, M. (2005). The Effects of Short-term and Long term Pulmonary Rehabilitation on Functional Capacity, Perceived Dyspnea, and Quality of Life. CHEST Journal, 128(2): 673-683. Read More