Brighton Lisa Jane, Evans Catherine J, Farquhar Morag, Bristowe Katherine, Kata Aleksandra, Higman Jade, Ogden Margaret, Nolan Claire, Yi Deokhee, Gao Wei, Koulopoulou Maria, Hasan Sharmeen, Ingram Karen, Clarke Stuart, Parmar Kishan R, Baldwin Eleni, Steves Claire J, Man William D-C, Maddocks Matthew
King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK.
King's College London, Department of Psychology, London, UK.
ERJ Open Res. 2024 Jul 29;10(4). doi: 10.1183/23120541.00774-2023. eCollection 2024 Jul.
Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated. The aim of the present study was to determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation.
A multicentre mixed-methods randomised controlled feasibility trial ("Breathe Plus"; ISRCTN13051922) was carried out. People with COPD, aged ≥50 years, Clinical Frailty Scale ≥5 and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during COVID-19 restrictions. Outcomes (physical, psychosocial, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews.
Recruitment stopped at 31 participants (mean±sd age 72.4±10.1 years, 68% Medical Research Council Dyspnoea Scale 4-5), due to COVID-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8-129) and prompted 46 individual care recommendations (median 3 per participant, range 0-12), 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it.
Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.
许多慢性阻塞性肺疾病（COPD）患者存在身体虚弱的情况。身体虚弱会增加健康状况不佳的风险，包括无法完成肺康复治疗。因此，需要采取综合方法来在康复期间及康复后为COPD合并身体虚弱的患者提供支持。本研究的目的是确定对开始肺康复治疗的COPD合并身体虚弱患者进行综合老年评估（CGA）的随机对照试验的可行性。
开展了一项多中心混合方法随机对照可行性试验（“呼吸增强”；ISRCTN13051922）。年龄≥50岁、临床衰弱量表评分≥5且被转诊接受肺康复治疗的COPD患者按1:1随机分组，分别接受常规肺康复治疗或肺康复治疗加CGA。在新冠疫情限制期间采用了远程干预方式。在基线、90天和180天时测量结果（身体、心理社会、服务使用情况），同时收集过程数据并进行定性访谈。
由于新冠疫情相关干扰，招募在31名参与者时停止（平均年龄±标准差为72.4±10.1岁，68%的医学研究委员会呼吸困难量表评分为4 - 5级）。招募情况（46%的符合条件者被招募）和保留率（90天和180天随访时为87%）是可以接受的。CGA平均在随机分组后60.5天进行（范围为8 - 129天），并提出了46项个性化护理建议（每位参与者中位数为3项，范围为0 - 12项），其中65%在随访期间得到实施。CGA期间涉及的最常见领域是营养和心血管健康。参与者重视CGA的整体方法，但对引入CGA的最佳时间提出了疑问。
将CGA与肺康复相结合是可行的，并能识别COPD合并身体虚弱患者未得到满足的多维度需求。鉴于在时间安排和包容性方面存在的挑战，老年护理和呼吸护理的整合不应局限于康复服务。
