呼吸疾病与虚弱人群的康复:美国胸科学会官方工作坊报告
Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report.
出版信息
Ann Am Thorac Soc. 2023 Jun;20(6):767-780. doi: 10.1513/AnnalsATS.202302-129ST.
People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a "frailty rehabilitation paradox" whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.
患有呼吸系统疾病的人发生衰弱的风险增加,衰弱与更差的健康结局相关。越来越多的证据表明康复在管理呼吸系统疾病患者的衰弱中发挥作用。然而,对于识别衰弱和为这一人群提供康复治疗的最佳方法,仍存在一些挑战。本次美国胸科学会研讨会的目的是概述针对呼吸系统疾病和衰弱患者的康复的关键定义和概念,综合现有证据,并探讨如何调整方案以适应这一人群的需求和体验。在为期两天的虚拟研讨会中,来自不同学科、专业和国家的 20 名专业人员讨论了关键的发展,并确定了未来研究的机会,同时通过在线交流获得了更多的意见。与会者强调了“衰弱康复悖论”,即肺康复可以有效地减少衰弱,但对于一些衰弱患者来说,完成康复计划具有挑战性。衰弱不应限制康复的机会;相反,应通过明确的评估和个性化支持来识别衰弱,包括为进一步的专家意见提供转诊。明确考虑症状负担和合并症的运动处方、整合更多老年或姑息治疗专业知识,以及/或预先计划参与的中断,可能会支持参与和结果。为了在患有呼吸系统疾病的人群中识别和测量衰弱,应根据其预期目的选择工具的敏感性、特异性、响应性和可行性。需要开展研究来扩展对衰弱的身体维度之外的理解,并探索远程康复或家庭为基础的慢性呼吸系统疾病和衰弱患者的肺康复的优点和局限性。
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