Man William D-C, Chowdhury Faiza, Taylor Rod S, Evans Rachael A, Doherty Patrick, Singh Sally J, Booth Sara, Thomason Davey, Andrews Debbie, Lee Cassie, Hanna Jackie, Morgan Michael D, Bell Derek, Cowie Martin R
NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, UK
NIHR CLAHRC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Chron Respir Dis. 2016 Aug;13(3):229-39. doi: 10.1177/1479972316642363. Epub 2016 Apr 12.
The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the 'most important' component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers.
该研究旨在就为慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）患者开发呼吸康复服务的关键优先事项达成共识。74名受邀利益相关者参加了为期1天的会议，以审查COPD和CHF中基于运动的康复的证据基础。此外，47人就一系列针对这两类患者需求的呼吸康复声明发表了意见。共有75%的利益相关者支持基于症状而非疾病的呼吸康复，89%的人认为此类服务对医疗保健专员具有吸引力。共有87%的人认为CHF患者可以采用COPD训练原则进行锻炼，反之亦然。共有81%的人认为社区运动训练对重度CHF或COPD患者是安全的，但只有23%的人认为人工提供的康复是监督运动训练的有效替代方案。尽管人们强烈共识运动训练是CHF和COPD人群康复的核心组成部分，但只有36%的人认为这是“最重要”的组成部分，这凸显了对呼吸急促进行心理和其他非运动干预的必要性。COPD和CHF患者在多病共存的背景下面临类似的呼吸急促和残疾问题。现有的肺部和心脏康复服务应寻求协同效应，以提供足够的灵活性来接纳所有COPD和CHF患者。新服务的开发可以考虑采用以患者为中心而非基于疾病的方法。运动训练是核心组成部分，但康复应包括其他干预措施，以解决患者的呼吸困难、心理和教育需求以及护理人员的需求。
