Brazilian Journal of Respiratory, Cardiovascular and Critical Care Physiotherapy
https://bjr-assobrafir.org/article/5de1655f0e88256e684ce1d5
Brazilian Journal of Respiratory, Cardiovascular and Critical Care Physiotherapy
Artigo Original

Desfechos e instrumentos de avaliação em programas de reabilitação pulmonar para pacientes com DPOC: revisão de literatura baseada na CIF

Outcomes and assessment tools in pulmonary rehabilitation programs for patients with COPD: literature review based on the ICF

Filipe Tadeu Sant’Anna Athayde, Raquel Rodrigues Britto, Verônica Franco Parreira

ASSOBRAFIR Ciênc., vol.1, n1, p.9-22, 2010
PDF
Downloads: 14
Views: 1396

Resumo

Introdução: Os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) podem apresentar manifestações sistêmicas signifi cativas, como a disfunção muscular periférica, além de dispnéia, capacidade de exercício reduzida e morbidades associadas. Considerando a Classifi cação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e as repercussões globais da DPOC, é importante que a avaliação dos programas de reabilitação pulmonar direcionados a esses pacientes seja ampla. Objetivo: sistematizar o conhecimento acerca dos principais desfechos e instrumentos de avaliação utilizados em programas de reabilitação pulmonar para pacientes com DPOC, de acordo com o modelo da CIF, discriminando os domínios de “estrutura e função do corpo” e “atividade e participação”. Metodologia: Foi realizada uma revisão de literatura nas bases de dados MedLine, LILACS e SciELO, com os descritores: pulmonary rehabilitation, chronic obstructive pulmonary disease, COPD, dyspnoea, exercise capacity, exercise tolerance, muscle strength, health-related quality of life, physical activity, motion sensor, respiratory muscle training, maximum respiratory pressures; e seus respectivos descritores em português. Estudos adicionais foram identifi cados por meio de pesquisa manual de referências obtidas nos artigos. Resultados e Discussão: A partir do modelo teórico da CIF, foi possível discriminar os diversos desfechos e instrumentos de avaliação empregados nos estudos relativos aos efeitos dos programas de reabilitação pulmonar em seus domínios de “estrutura e função do corpo” e “atividade e participação”. Conclusões: Os desfechos e instrumentos de avaliação empregados são variados. Tradicionalmente, consistiam de aspectos exclusivamente direcionados para o domínio de “estrutura e função do corpo” do modelo de funcionalidade e incapacidade da CIF. Entretanto, mais recentemente, o domínio “atividade e participação” vem sendo abordado, o que ainda não acontece de maneira relevante com os fatores ambientais. 

Palavras-chave

Fisioterapia respiratória, Doença Pulmonar Obstrutiva Crônica, Reabilitação pulmonar, Classificação Internacional de Funcionalidade.

Abstract

Introduction: Patients with Chronic Obstructive Pulmonary Disease (COPD) may have signifi cant systemic manifestations, such as peripheral muscle dysfunction, beyond dyspnea, reduced exercise capacity and associated morbidity. Considering the International Classifi cation of Functioning, Disability and Health (ICF) and the overall impact of COPD, it is important that the evaluation of pulmonary rehabilitation programs for these patients is widely used. Objective: To systematize knowledge about the main outcomes and assessment tools used in pulmonary rehabilitation programs for patients with COPD, according to the ICF model, identifying components of “structure and function of the body” and “activity and participation.” Methods: We performed a literature review on the databases Medline, LILACS and SciELO, using the key words: pulmonary rehabilitation, chronic obstructive pulmonary disease, COPD, dyspnoea, exercise capacity, exercise tolerance, muscle strength, health-related quality of life, physical activity, motion sensor, respiratory muscle training, maximum respiratory pressures; and their respective descriptors in Portuguese. Additional studies were identifi ed through manual search of references obtained in papers. Results and Discussion: From the theoretical model of ICF, it was possible to discriminate the various outcomes and assessment tools employed in studies related to the eff ects of pulmonary rehabilitation programs in components of “structure and function of the body” and “activity and participation.” Conclusions: Th e outcomes and assessment tools employed are varied. Traditionally, consisted exclusively of aspects targeted to the component “structure and function of the body” of ICF’s model of functioning and disability. However, more recently, the component of “activity and participation” has been approached, what does not still happen so relevant with the environmental factors.

Keywords

Chest physiotherapy, Chronic Obstructive Pulmonary Disease, Pulmonary rehabilitation, International Classifi cation of Functioning

Referências

1. Global Initiative for Chronic Obstructive Pulmonary Disease. Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [update 2009; cited 2009 Apr 12). Available from: http://www.goldcopd com/Guidelineitem asp?l1=2&l2=1&intId=2180.

2. Sociedade Brasileira de Pneumologia e Tisiologia. II Consenso Brasileiro sobre Doença Pulmonar Obstrutiva Crônica. J Bras Pneumol. 2004 Nov;30(Supl 5):S1-S42.

3. Velloso M, Jardim JR. Funcionalidade do paciente com Doença Pulmonar Obstrutiva Crônica e Técnicas de Conservação de Energia. J Bras Pneumol. 2006 Nov-Dez;32(6):580-6.

4. Wouters EF, Creutzberg EC, Schols AM. Systemic eff ects in COPD. Chest 2002 May;121(5 Suppl):127S-30S.

5. Sin DD, Man SF. Skeletal muscle weakness, reduced exercise tolerance, and COPD: is systemic infl ammation the missing link? Th orax. 2006 Jan;61(1):1-3.

6. Sin DD, Man SF. Systemic infl ammation and mortality in chronic obstructive pulmonary disease. Can J Physiol Pharmacol. 2007 Jan;85(1):141-7.

7. Dourado VZ, Tanni SE, Vale SA, Faganello MM, Sanchez FF, Godoy I. Manifestações sistêmicas na doença pulmonar obstrutiva crônica. J Bras Pneumol. 2006 Mar-Abr;32(2):161-71.

8. Agusti AG, Noguera A, Sauleda J, Sala E, Pons J, Busquets X. Systemic eff ects of chronic obstructive pulmonary disease. Eur Respir J. 2003 Feb;21(2):347-60.

9. Lacasse Y, Martin S, Lasserson TJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. A Cochrane systematic review. Eura Medicophys. 2007 Dec;43(4):475-85.

10. Langer D, Probst VS, Pitta F, Burtin C, Hendriks E, Schans CPVD, et al. Clinical Practice Guideline for physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD) - Portuguese version. Rev Bras Fisioter. 2009 May-Jun;13(3):183-204.

11. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007 May;131(5 Suppl):4S-42S.

12. Steele BG, Belza B, Cain K, Coppersmith J, Howard J, Lakshminarayan S, et al. Th e impact of chronic obstructive pulmonary disease exacerbation on pulmonary rehabilitation participation and functional outcomes. J Cardiopulm Rehabil Prev. 2010 Jan;30(1):53-60.

13. Th eander K, Jakobsson P, Jorgensen N, Unosson M. Eff ects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Clin Rehabil. 2009 Feb;23(2):125-36.

14. Troosters T, Gosselink R, Janssens W, Decramer M. Exercise training and pulmonary rehabilitation: new insights and remaining challenges. Eur Respir Rev. 2010 Mar;19(115):24-9.

15. Nici L, Donner C, Wouters E, ZuWallack R, Ambrosino N, Bourbeau J, et al. American Th oracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006 Jun 15;173(12):1390-413.

16. Stucki A, Stoll T, Cieza A, Weigl M, Giardini A, Wever D, et al. ICF Core Sets for obstructive pulmonary diseases. J Rehabil Med. 2004 Jul;(44 Suppl):114-20.

17. Organização Mundial de Saúde, Organização Pan-Americana de Saúde. CIF: Classifi cação Internacional de Funcionalidade, Incapacidade e Saúde. São Paulo: EDUSP; 2003.

18. Di Nubila HBV, Buchalla CM. O papel das Classifi cações da OMS - CID e CIF nas defi nições de defi ciência e incapacidade. Rev Bras Epidemiol. 2008 Jun;11(2):324-35.

19. Farias N, Buchalla CM. A Classifi cação Internacional de Funcionalidade, Incapacidade e Saúde da Organização Mundial da Saúde: Conceitos, Usos e Perspectivas. Rev Bras Epidemiol. 2005 Jun;8(2):187-93.

20. Sampaio RF, Mancini MC, Gonçalves GGP, Bittencourt NFN, Miranda AD, Fonseca ST. Aplicação da Classifi cação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) na Prática Clínica do Fisioterapeuta. Rev Bras Fisioter. 2005 Maio-Ago;9(2):129-36.

21. Stucki G, Ewert T, Cieza A. Value and application of the ICF in rehabilitation medicine. Disabil Rehabil. 2002 Nov;24(17):932-8.

22. Ustun TB, Chatterji S, Bickenbach J, Kostanjsek N, Schneider M. Th e International Classifi cation of Functioning, Disability and Health: a new tool for understanding disability and health. Disabil Rehabil. 2003 Jun 3;25(11-12):565-71.

23. Steiner WA, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G. Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Phys Th er. 2002 Nov;82(11):1098-107.

24. Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al. Long-term eff ects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000 Apr;117(4):976-83.

25. Riario-Sforza GG, Incorvaia C, Paterniti F, Pessina L, Caligiuri R, Pravettoni C, et al. Eff ects of pulmonary rehabilitation on exercise capacity in patients with COPD: a number needed to treat study. Int J Chron Obstruct Pulmon Dis. 2009;4:315-9.

26. Dallas MI, McCusker C, Haggerty MC, Rochester CL, ZuWallack R, Northeast Pulmonary Rehabilitation Consortium. Using pedometers to monitor walking activity in outcome assessment for pulmonary rehabilitation. Chron Respir Dis. 2009;6(4):217-24.

27. Evans RA, Singh SJ, Collier R, Williams JE, Morgan MD. Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respir Med. 2009 Jul;103(7):1070-5.

28. Godoy RF, Teixeira PJ, Becker JB, Michelli M, Godoy DV. Long-term repercussions of a pulmonary rehabilitation program on the indices of anxiety, depression, quality of life and physical performance in patients with COPD. J Bras Pneumol. 2009 Feb;35(2):129-36.

29. Green RH, Singh SJ, Williams J, Morgan MD. A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Th orax. 2001 Feb;56(2):143-5.

30. Guell MR, de LP, Galdiz JB, Montemayor T, Rodriguez Gonzalez-Moro JM, Gorostiza A, et al. [Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial]. Arch Bronconeumol. 2008 Oct;44(10):512-8.

31. Pitta F, Troosters T, Probst VS, Langer D, Decramer M, Gosselink R. Are patients with COPD more active aft er pulmonary rehabilitation? Chest. 2008 Aug;134(2):273-80.

32. Riario-Sforza GG, Incorvaia C, Paterniti F, Dugnani N, Fumagalli M. Diff erent outcomes of pulmonary rehabilitation in patients with COPD with or without exacerbations. Monaldi Arch Chest Dis. 2005 Sep;63(3):129-32.

33. Sewell L, Singh SJ, Williams JE, Collier R, Morgan MD. Can individualized rehabilitation improve functional independence in elderly patients with COPD? Chest. 2005 Sep;128(3):1194-200.

34. Skumlien S, Skogedal EA, Bjortuft O, Ryg MS. Four weeks’ intensive rehabilitation generates signifi cant health eff ects in COPD patients. Chron Respir Dis. 2007;4(1):5-13.

35. Stav D, Raz M, Shpirer I. Th ree years of pulmonary rehabilitation: inhibit the decline in airfl ow obstruction, improves exercise endurance time, and body-mass index, in chronic obstructive pulmonary disease. BMC Pulm Med. 2009 May 30;9:26.

36. Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, et al. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil. 2008 Mar;89(3):404-12.

37. Troosters T, Gosselink R, Decramer M. Short- and long-term eff ects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med. 2000 Aug 15;109(3):207-12.

38. Wewel AR, Gellermann I, Schwertfeger I, Morfeld M, Magnussen H, Jörres RA. Intervention by phone calls raises domiciliary activity and exercise capacity in patients with severe COPD. Respir Med. 2008 Jan;102(1):20-6.

39. Zwick RH, Burghuber OC, Dovjak N, Hartl S, Kossler W, Lichtenschopf A, et al. Th e eff ect of one year outpatient pulmonary rehabilitation on patients with COPD. Wien Klin Wochenschr. 2009;121(5-6):189-95.

40. Standardization of Spirometry, 1994 Update. American Th oracic Society. Am J Respir Crit Care Med. 1995 Sep;152(3):1107-36.

41. Pereira CAC. Diretrizes para testes de função pulmonar. J Pneumol. 2002;28:S1-S241.

42. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319-38.

43. Ruiz de Ona Lacasta JM, Puente ML, Rodriguez Hermosa JL, Tatay ME, Cubillo Marcos JM. A comparison of several measurement scales for assessing dyspnea in their daily activities in patients with chronic obstructive lung disease. Arch Bronconeumol. 2000 Jan;36(1):25-8.

44. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Th orax. 1992 Dec;47(12):1019-24.

45. Silva KR, Marrara KT, Marino DM, Di Lorenzo VAP, Jamami M. Fraqueza muscular esquelética e intolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica. Rev Bras Fisioter. 2008 Maio-Jun;12(3):169-75.

46. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7.

47. Revill SM, Morgan MD, Singh SJ, Williams J, Hardman AE. Th e endurance shuttle walk: a new fi eld test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Th orax. 1999 Mar;54(3):213-22.

48. Geddes EL, Reid WD, Crowe J, O’Brien K, Brooks D. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: a systematic review. Respir Med. 2005 Nov;99(11):1440-58.

49. Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J. 2006 Jun;27(6):1119-28.

50. Lotters F, van TB, Kwakkel G, Gosselink R. Eff ects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J. 2002 Sep;20(3):570-6.

51. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Specifi c expiratory muscle training in COPD. Chest. 2003 Aug;124(2):468-73.

52. Chhabra SK, Gupta AK, Khuma MZ. Evaluation of three scales of dyspnea in chronic obstructive pulmonary disease. Ann Th orac Med. 2009 Jul;4(3):128-32.

53. Kovelis D, Segretti NO, Probst VS, Lareau SC, Brunetto AF, Pitta F. Validação do Modifi ed Pulmonary Functional Status and Dyspnea Questionnaire e da escala do Medical Research Council para o uso em pacientes com doença pulmonar obstrutiva crônica no Brasil. J Bras Pneumol. 2008 Dez;34(12):1008-18.

54. Ozalevli S, Ucan ES. Th e comparison of diff erent dyspnoea scales in patients with COPD. J Eval Clin Pract. 2006 Oct;12(5):532-8.

55. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006 May;27(5):1040-55.

56. Steele BG, Belza B, Cain K, Warms C, Coppersmith J, Howard J. Bodies in motion: Monitoring daily activity and exercise with motion sensors in people with chronic pulmonary disease. J Rehabil Res Dev. 2003 Sep-Oct;40(5 (Suppl. 2)):45-58.

57. Moore R, Berlowitz D, Denehy L, Jackson B, McDonald CF. Comparison of pedometer and activity diary for measurement of physical activity in chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2009 Jan;29(1):57-61.

58. Dedding C, Cardol M, Eyssen IC, Dekker J, Beelen A. Validity of the Canadian Occupational Performance Measure: a client-centred outcome measurement. Clin Rehabil. 2004 Sep;18(6):660-7.

59. Bryant D, Schunemann H, Brozek J, Jaeschke R, Guyatt G. Patient reported outcomes: general principles of development and interpretability. Pol Arch Med Wewn. 2007 Apr;117(4):5-11.

60. Huff ord MR, Shiff man S. Assessment methods for Patient-Reported Outcomes. Dis Manage Health Outcomes. 2003;11(2):77-86.

61. Camelier A, Rosa FW, Salim C, Nascimento OA, Cardoso F, Jardim JR. Using the Saint George’s Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil. J Bras Pneumol. 2006 Mar;32(2):114-22.

62. De Sousa TC, Jardim JR, Jones P. Validação do Questionário do Hospital Saint George na Doença Respiratória (SGRQ) em pacientes portadores de doença pulmonar obstrutiva crônica no Brasil. J Pneumol. 2000 Maio-Jun;26(3):119-28.

63. Moreira GL, Pitta F, Ramos D, Nascimento CS, Barzon D, Kovelis D, et al. Portuguese-language version of the Chronic Respiratory Questionnaire: a validity and reproducibility study. J Bras Pneumol. 2009 Aug;35(8):737-44.

64. Stucki A, Stucki G, Cieza A, Schuurmans MM, Kostanjsek N, Ruof J. Content comparison of health-related quality of life instruments for COPD. Respir Med. 2007 Jun;101(6):1113-22.

65. Celli BR, Cote CG, Marin JM, Casanova C, Montes de OM, Mendez RA, et al. Th e body-mass index, airfl ow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004 Mar 4;350(10):1005-12.

5de1655f0e88256e684ce1d5 1571231544 Articles
Links & Downloads
BJR ©2024 Todos os direitos reservados.

BJR

Share this page
Page Sections