Integrated Care Team-Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
BMJ Open. 2019 Aug 8;9(8):e028507. doi: 10.1136/bmjopen-2018-028507.
This feasibility study aimed to assess the acceptability of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD) who declined pulmonary rehabilitation (PR) as a potential treatment option or precursor to PR. Objectives were to assess attitudes to IMT, PR and alternatives to PR; factors influencing adherence with IMT and acceptability of outcome measures, research tools and study protocol.
A pragmatic, mixed methods, prepost feasibility study was conducted. Recruitment took place over a 4-month period. Participants were followed up for a period of 6 months.
IMT sessions and assessments were conducted in the domiciliary setting.
Inclusion criteria: people over the age of 35, stable COPD, Medical Research Council Dyspnoea scale of 3 or above, declined PR.
history of spontaneous pneumothorax, incomplete recovery from a traumatic pneumothorax, asthma, known recently perforated eardrum, unstable angina, ventricular dysrhythmias, cerebrovascular event or myocardial infarction within the last 2 months. Participants were selected from a purposive sample. Of the 22 potential participants screened, 11 were recruited and interviewed. Ten participants commenced IMT. Seven participants completed the follow-up assessment.
Eight weeks of IMT twice a day, 5 days a week with visits once weekly by a physiotherapist. Unsupervised IMT twice a day three times a week until follow-up at 6 months.
Acceptability of IMT and the study process was explored via semi-structured interviews. Adherence with IMT was assessed by the Powerbreathe K3 device and participant diaries. Uptake of PR was identified.
IMT was found to be acceptable. Adherence was explored. Four people went on to participate in PR.
Feasibility was established. A randomised controlled trial is warranted to establish efficacy and cost-effectiveness of IMT in those who decline PR and IMT as an intervention to promote uptake of PR.
NCT01956565; Post-results.
本可行性研究旨在评估对拒绝接受肺康复（PR）的慢性阻塞性肺疾病（COPD）患者进行吸气肌训练（IMT）的可接受性，将其作为一种潜在的治疗选择或 PR 的前奏。目的是评估对 IMT、PR 和 PR 替代方案的态度；影响 IMT 依从性的因素以及对结果测量、研究工具和研究方案的可接受性。
采用实用、混合方法、前后可行性研究。招募工作持续了 4 个月。参与者随访了 6 个月。
IMT 课程和评估在家庭环境中进行。
纳入标准：年龄在 35 岁以上，COPD 稳定，呼吸困难程度 MRC 量表评分为 3 或更高，拒绝接受 PR。
自发性气胸病史、创伤性气胸未完全恢复、哮喘、最近鼓膜穿孔、不稳定型心绞痛、室性心律失常、脑血管事件或心肌梗死在过去 2 个月内。参与者是从一个有目的的样本中选择的。在筛选出的 22 名潜在参与者中，有 11 名被招募并接受了采访。10 名参与者开始进行 IMT。7 名参与者完成了随访评估。
每天两次、每周 5 天进行 8 周 IMT，每周由物理治疗师进行一次随访。在 6 个月的随访前，每天进行两次、每周三次进行非监督 IMT。
通过半结构式访谈探讨了 IMT 的可接受性和研究过程。通过 Powerbreathe K3 设备和参与者日记评估 IMT 的依从性。确定了 PR 的参与情况。
确立了可行性。需要进行随机对照试验，以确定在拒绝 PR 和 IMT 的患者中，IMT 的疗效和成本效益，以及 IMT 作为促进 PR 参与的干预措施。
NCT01956565；试验后。
