On the assessment of medical rehabilitation effectiveness in patients with chronic obstructive pulmonary disease in the resort setting

Close metadata

OBJECTIVE

To perform a comparative analysis of methods for assessing the medical rehabilitation outcomes in COPD patients in the resort setting.

MATERIAL AND METHODS

The study involved 71 patients with stage I-II COPD, with bronchitis (66.2%) and mixed (COPD + asthma, 33.8%) phenotypes in the clinical remission phase. The mean age of the patients was 57.0±9.8 years, and the mean duration of disease was 7.8±5.1 years. Within 14 days, all patients received an identical set of rehabilitation measures with natural and preformed physical therapeutic resort factors. Before and after the medical rehabilitation course, clinical, laboratory, functional tests and questionnaires were performed on each patient. The effectiveness of course-based complex rehabilitation was assessed using one of three methods: CAT (COPD [chronic obstructive pulmonary disease] Assessment Test), the International Classification of Functioning, Disability and Health (ICF), the COPD control and control stability criteria system.

RESULTS

Comparison of the three methods of assessment of COPD patients’ rehabilitation outcomes in resort settings showed that the CAT score is the easiest to use, the least time-consuming, highly valid, and informative. According to the CAT score, the resort medical rehabilitation effectiveness was 96.4%, with «improvement» and «significant improvement» recorded in 82.1% of cases. The use of ICF provides reliable information about the rehabilitation complex effect on the main pathogenetic links of the disease, which allows proper adjusting of rehabilitation procedures to improve effectiveness in the resort setting. Specified grades of ICF domains make it possible to translate qualitative and quantitative attributes inherent to a particular subject into points. The points trend during the medical rehabilitation indicates its effectiveness in terms of recovery of specific functions impaired by the disease. At the same time, the ICF does not allow to rank the medical rehabilitation outcomes in the resort setting in terms of the currently accepted concepts of «significant improvement,» «improvement,» «slight improvement,» «no change,» «deterioration,» which limits its application in resorts. We believe that assessment of rehabilitation outcomes based on COPD control and control stability is not applicable to resort setting due to possible discrepancy between the impression formed in a short time (14 days) about these characteristics of the pathological process and the actual status, as well as due to lack of knowledge about the effect of achieved/not achieved disease control on the choice of rehabilitation technology.

CONCLUSION

A simple and highly informative CAT score can be recommended to assess the effectiveness of resort medical rehabilitation in patients with chronic obstructive pulmonary disease.

Keywords:

medical rehabilitation

resort

chronic obstructive pulmonary disease

effectiveness assessment

Authors:

Zaripova T.N.

Tomsk Research Institute of Balneology and Physiotherapy of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency;
Altai Research Institute of Resort Medicine and Health Tourism of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency

Dorozhinskaya E.V.

Altai Research Institute of Resort Medicine and Health Tourism of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency

Titskaya E.V.

Tomsk Research Institute of Balneology and Physiotherapy of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency

Reshetova G.G.

Federal Research Clinical Centre of Balneology and Physiotherapy of the Federal Medical and Biological Agency

SPIN RSCI: 1125-1729
ORCID: 0000-0003-2653-3166

Received:

02.06.2021

Accepted:

24.06.2021

List of references:

Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine. 2013;187(4):347-365. https://doi.org/10.1164/rccm.201204-0596PP
Ajsanov ZR, Avdeev SN, Arhipov VV, Belevskij AS, Leshchenko IV, Ovcharenko SI, Shmelev EI, Chuchalin AG. National clinical guidelines on diagnosis and treatment of chronic obstructive pulmonary disease: a clinical decision: making algorithm. Pul’monologiya. 2017;27(1):13-20. (In Russ.). https://doi.org/10.18093/0869-0189-2017-27-1-13-20
Roche N, Huchson G. Epidemiology of chronic obstructive pulmonary disease. La Revue du Praticien. 2004;54(13):1408-1413.
Chuchalin AG, Khaltaev N, Antonov NS, Galkin DV, Manakov LG, Antonini P, Murphy M, Solodovnikov AG, Bousquet J, Pereira MH, Demko IV. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. International Journal of Chronic Obstructive Pulmonary Disease. 2014;9:963-974. https://doi.org/10.2147/COPD.S67283
Kachestvo zhizni u bol’nyh bronhial’noj astmoj i obstruktivnoj bolezn’yu legkih. Pod red. Chuchalina A.G. M.: Atmosfera; 2004. (In Russ.).
Koncevaya AV, Mukaneva DK, Balanova YuA, Hudyakov MB, Drapkina OM. Economic burden of respiratory diseases and chronic obstructive pulmonary disease in Russian Federation, 2016. Pul’monologiya. 2019;29(2):159-166. (In Russ.). https://doi.org/10.18093/0869-0189-2019-29-2-159-166
Mezhdunarodnaya klassifikaciya funkcionirovaniya, ogranichenij zhiznedeyatel’nosti i zdorov’ya. Vsemirnaya organizaciya zdravoohraneniya. Zheneva: VOZ; 2001. (In Russ.).
Fizicheskaya i reabilitacionnaya medicina: nacional’noe rukovodstvo. Pod red. Ponomarenko G.N. M.: GEOTAR-Media; 2016. (In Russ.).
Shoshmin AV, Ponomarenko GN. MKF v reabilitacii. SPb.: OOO «CIACAN», OOO «R-KOPI»; 2018. (In Russ.).
Orlova GG, Luk’yanova IE, Dagaeva AA, Denisenkov AI, Zlobin AN, Nikitskij DN, Rogozhnikov VA. Role and value of the International Classification of Functioning, Activity and Health (MKF) restrictions in the organization of the due preventive help to the population. Fundamentalnye issledovaniya. 2011;3:358-361. (In Russ.).
Sergeeva VV, Vladimirova ON., Nurgazizova AK. Practical use of the International Classification of Functioning, Disability and Health of patients with cardiovascular pathology. Mediko-sotsialnaya ekspertiza i reabilitatsia. 2014;17(3):11-16. (In Russ.).
Ponomarenko GN, Shamshin AV, Besstrashnova YaK, Cherkashina I V. Planning and assessment of effectiveness of rehabilitation of patients with osteoarthritis: use of the basic set of the International Classification of Functioning, Disability and Health. Voprosy kurortologii, fisioterapii i lechebnoy fizkultury. 2017;94(1):4-8. (In Russ.). https://doi.org/10.17116/kurort20179414-8
Celli BR, Barnes RJ. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. The European Respiratory Journal. 2007;29(6):1224-1238. https://doi.org/10.1183/09031936.00109906
Jones PW, Tabberer M, Chen WH. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT) scores. BMC Pulmonary Medicine. 2011;11:42. https://doi.org/10.1186/1471-2466-11-42
Varol Y, Ozacar R, Balci G, Usta L, Taymaz Z. Assessing the effectiveness of the COPD Assessment Test (CAT) to evaluate COPD severity and exacerbation rates. COPD. 2014;11(2):221-225. https://doi.org/10.3109/15412555.2013.836169
Stanford RH, Tabberer M, Kosinski M, Johnson PT, White J, Carlyle M, Tillery NA. Assessment of the COPD Assessment Test Within U.S. Primary Care. Chronic Obstructive Pulmonary Diseases. 2020;7(1):26-37. https://doi.org/10.15326/jcopdf.7.1.2019.0135
Dudchenko LSh, Mizin VI, Belyaeva SN, Maslikova GG, Kozhemyachenko EN, Kolesnik DS, Dmitrevskij AA. Assessment of the effectiveness of a sanatorium-resort medical rehabilitation of patients with bronchial asthma using the basic set of the International Classification of Functioning, Disability and Health. Fisioterapia, balneologia i reabilitatsia. 2018;17(3):133-140. (In Russ.). https://doi.org/10.18821/1681-3456-2018-17-3-133-140
Ivashchenko AS, Dudchenko LSh, Kaladze NN, Mizin VI. Phenotypes of bronchial asthma at sanatory-resort stage and personalized programs of medical rehabilitation. Voprosy kurortologii, fisioterapii i lechebnoy fizkultury. 2020;97(1):13-24. (In Russ.). https://doi.org/10.17116/kurort20209701113
Soler-Cataluna JJ, Alcazar-Novarrete B, Miravilles M. The concept of control of COPD in clinical practice. International Journal of Chronic Obstructive Pulmonary Disease. 2014;9:1397-1405. https://doi.org/10.2147/COPD.S71370
Miravil’es M, Al’kasar B, Soler-Katalun’ya HH. The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice. Pul’monologiya. 2020;30(2):142-150. (In Russ.). https://doi.org/10.18093/0869-0189-2020-30-2-142-150
Miravitlles M, Marín A, Monsó E, Vilà S, de la Roza C, Hervás R, Esquinas C, García M, Millares L, Morera J, Torres A. Colour of sputum is a marker for bacterial colonisation in chronic obstructive pulmonary disease. Respiratory Research. 2010;11(1):58. https://doi.org/10.1186/1465-9921-11-58

Close metadata