Publications by authors named "Alda Marques"

104 Publications

Measuring intensity during free-living physical activities in people with chronic obstructive pulmonary disease: a systematic literature review.

Ann Phys Rehabil Med 2021 Nov 21:101607. Epub 2021 Nov 21.

Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal. Electronic address:

Background: Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD).

Objective: This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures.

Methods: PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100.

Results: We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0-10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO vs metabolic equivalent of task [MET]; %HR vs Fatigue Borg; MET vs walking speed) to 100% (%HR vs dyspnoea Borg; fatigue and exertion Borg vs walking speed). %VO elicited the highest intensity. Hence, Borg scores, %HR and MET may underestimate PA-related intensity.

Conclusions: Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.
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http://dx.doi.org/10.1016/j.rehab.2021.101607DOI Listing
November 2021

Quadriceps weakness associated with mortality in individuals with chronic obstructive pulmonary disease.

Ann Phys Rehabil Med 2021 Nov 18;65(5):101587. Epub 2021 Nov 18.

Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil; Stricto Sensu Graduate Program in Rehabilitation Sciences, University Pitágoras Unopar (UNOPAR), Londrina, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.rehab.2021.101587DOI Listing
November 2021

Responsiveness and Minimal Clinically Important Difference of the Brief-BESTest in People With COPD After Pulmonary Rehabilitation.

Phys Ther 2021 Nov;101(11)

Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.

Objective: he Brief-Balance Evaluation Systems Test (Brief-BESTest) is a comprehensive, reliable, and valid balance test that provides valuable information to guide balance training in people with chronic obstructive pulmonary disease (COPD). Its clinical interpretability is, however, currently limited, because cutoff points to identify clinically relevant changes in people with COPD after pulmonary rehabilitation are still lacking. This study aimed to establish the responsiveness and minimal clinically important difference (MCID) for the Brief-BESTest in people with COPD after pulmonary rehabilitation (PR).

Methods: A secondary analysis of data from 2 previous studies was conducted. The modified British Medical Research Council (mMRC) dyspnea scale, the 6-Minute Walk Test (6-MWT), and the Brief-BESTest (0-24 points) were collected in people with COPD pre/post a 12-week PR program including balance training. The MCID was computed using anchor- and distribution-based methods. Changes in the 6-MWT and the mMRC were assessed and used as anchors. The pooled MCID was computed using the arithmetic weighted mean (2/3 anchor- and 1/3 distribution-based methods).

Results: Seventy-one people with COPD (69 years [SD = 8]; 76% male; FEV1 = 49.8%predicted [SD = 18%]) were included. There was a significant improvement in the Brief-BESTest after PR (mean difference = 3 points [SD = 3]). Significant correlations were found between the Brief-BESTest and the mMRC (r = -.31) and the 6-MWT (r = .37). The pooled MCID was 3.3 points.

Conclusion: An improvement of at least 3 points in the Brief-BESTest in people with COPD will enhance the interpretability of PR effects on balance performance of this population and guide tailored interventions.

Impact: The Brief-BESTest outcome measure is comprehensive, easily administered, and simple to interpret in clinical practice. This study represents a significant contribution toward the clinical interpretation of changes in balance in people with COPD following PR.
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http://dx.doi.org/10.1093/ptj/pzab209DOI Listing
November 2021

Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: A systematic review.

Ann Phys Rehabil Med 2021 Nov 15;65(3):101564. Epub 2021 Nov 15.

Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal. Electronic address:

Background: The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures.

Objectives: This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD).

Methods: The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel.

Results: We included 267 studies (43153 individuals with COPD). A broad range of domains (n = 22), outcomes (n = 163) and measures (n = 217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n = 218) assessed with the 6-min walk test (n = 140), health-related quality of life (n = 204) assessed with the Saint George's respiratory questionnaire (n = 99), and symptoms (n = 158) assessed with the modified Medical Research Council dyspnoea scale (n = 56). The least reported outcomes were comorbidities, adverse events and knowledge.

Conclusions: This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders.

Prospero Id: CRD42017079935.
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http://dx.doi.org/10.1016/j.rehab.2021.101564DOI Listing
November 2021

Interventions to Support Informal Caregivers of People with Chronic Obstructive Pulmonary Disease: A Systematic Literature Review.

Respiration 2021 14;100(12):1230-1242. Epub 2021 Jul 14.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.

Background: Chronic obstructive pulmonary disease (COPD) imposes tremendous challenges for both patients and informal caregivers. Caregivers are key players in the management of COPD. Recently, COVID-19 further increased reliance on informal caregivers who urgently need specific support. This systematic literature review aimed to systematically describe the content and explore the effects of interventions to support informal caregivers of people with COPD.

Methods: A mixed-methods systematic review was conducted. PubMed, Scopus, Web of Science, and EBSCO were searched. Studies implementing interventions supporting informal caregivers of people with COPD were included. Data were extracted and analysed in outcome domains and categories using framework analysis.

Results: Twenty (14 quantitative, 4 mixed-methods, and 2 qualitative) studies were included. Informal caregivers were mainly female (86%). Caregiving context was poorly/never described. Interventions included patient-caregiver dyads and never caregivers only. Informal caregivers were invited to participate if available. Interventions were delivered across all COPD phases (acute/stable/advanced) and settings (inpatient/outpatient/home), with a wide range of total length, frequency, and duration of sessions. All included education about the disease and its management. Discharge/action plans (n = 12); adherence to therapy and healthy lifestyles (n = 9); and family concerns and psychosocial issues (n = 7) were also commonly addressed. Only 9 (45%) studies reported caregiver-related outcomes, and overall positive effects were observed in 7/9 outcome domains, using a high variety of qualitative and qualitative methods. Often categories were addressed but not assessed.

Conclusion: Interventions have a narrow scope (i.e., education) and have not been specifically designed to support informal caregivers. Current evidence showed positive effects, but high methodological heterogeneity exists. Future studies need to explore caregiver-tailored, taking into consideration gender differences; multicomponent; and flexibly administered interventions to effectively support COPD caregivers.
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http://dx.doi.org/10.1159/000517032DOI Listing
July 2021

Lifestyle-Integrated Functional Exercise for People With Dementia: A Pilot Study.

J Aging Phys Act 2021 Feb 13;29(5):771-780. Epub 2021 Feb 13.

The objective of this study was to explore the feasibility and preliminary effectiveness of the Lifestyle-Integrated Functional Exercise for People with Dementia (LiFE4D) on health-related physical fitness, cognitive function, physical activity, and respiratory and upper limb functions. A randomized controlled pilot study was conducted (control group: usual care; experimental group: usual care and LiFE4D). The feasibility of LiFE4D was determined considering recruitment, protocol acceptability, adherence, and safety. Measures of health-related physical fitness, cognitive function, physical activity, and respiratory and upper limb functions were assessed at the baseline and 3 months. Twelve participants (8 [66.7%] female, 82 [72.2-84] years) were included, six per group. Recruitment was challenging. LiFE4D was acceptable with excellent adherence and no major adverse events. Cardiorespiratory endurance (effect size = 1.64, 95% confidence interval [CI; 0.33, 2.95]) and balance (effect size = 1.46, 95% CI [0.19, 2.73]) improved after LiFE4D. LiFE4D seems to be feasible and safe, and it shows potential to significantly improve the health-related physical fitness of people with dementia.
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http://dx.doi.org/10.1123/japa.2020-0349DOI Listing
February 2021

Minimal Clinically Important Difference for Quadriceps Muscle Strength in People with COPD following Pulmonary Rehabilitation.

COPD 2021 02 3;18(1):35-44. Epub 2021 Feb 3.

Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.

Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR.A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values.Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV 49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT ( > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD.The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions.
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http://dx.doi.org/10.1080/15412555.2021.1874897DOI Listing
February 2021

Rehabilitative practice in Europe: Roles and competencies of physiotherapists. Are we learning something new from COVID-19 pandemic?

Pulmonology 2021 Jul-Aug;27(4):283-285. Epub 2021 Jan 23.

Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.

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http://dx.doi.org/10.1016/j.pulmoe.2020.12.014DOI Listing
July 2021

Construct validity of the brief physical activity assessment tool for clinical use in COPD.

Clin Respir J 2021 May 15;15(5):530-539. Epub 2021 Feb 15.

Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.

Introduction: Low physical activity (PA) levels are associated with poor health-related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice.

Objectives: This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD and explored differences in age, sex and COPD grades.

Methods: After linguistic adaptation of the tool to Portuguese, 110 patients (66.4 ± 9.6yrs, 72.7% male, FEV = 59.3 ± 25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous- and moderate-intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA = 1952-5724 counts-per-min [CPM]); vigorous PA, VPA = 5725-∞CPM; moderate-to-vigorous PA, MVPA = 1952-∞CPM; daily steps), through: Spearman's correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data.

Results: The BPAAT identified 73.6% patients as "insufficiently active" and 26.4% as "sufficiently active". The BPAAT was weakly to moderately correlated with accelerometry (0.394 ≤ ρ ≤ 0.435, P < 0.05), except for VPA (P = 0.440). This was also observed in age (<65/≥65yrs), COPD grades (GOLD 1-2/3-4) and in male patients (0.363 ≤ ρ ≤ 0.518, P < 0.05 except for VPA). No significant correlations were found in female patients (P > 0.05). Agreement was fair to moderate (0.36 ≤ κ ≤ 0.43; 73.6% ≤ %agreement ≤ 74.5%; 0.50 ≤ sensitivity ≤ 0.52; 0.84 ≤ specificity ≤ 0.91, 0.55 ≤ PPV ≤ 0.79, 0.72 ≤ NPV ≤ 0.82).

Conclusion: The BPAAT may be useful to screen patients' PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients.
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http://dx.doi.org/10.1111/crj.13333DOI Listing
May 2021

Automatic Classification of Adventitious Respiratory Sounds: A (Un)Solved Problem?

Sensors (Basel) 2020 Dec 24;21(1). Epub 2020 Dec 24.

University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, 3030-290 Coimbra, Portugal.

(1) Background: Patients with respiratory conditions typically exhibit adventitious respiratory sounds (ARS), such as wheezes and crackles. ARS events have variable duration. In this work we studied the influence of event duration on automatic ARS classification, namely, how the creation of the class (negative class) affected the classifiers' performance. (2) Methods: We conducted a set of experiments where we varied the durations of the other events on three tasks: crackle vs. wheeze vs. other (); crackle vs. other (); and wheeze vs. other (). Four classifiers (linear discriminant analysis, support vector machines, boosted trees, and convolutional neural networks) were evaluated on those tasks using an open access respiratory sound database. (3) Results: While on the task with fixed durations, the best classifier achieved an accuracy of 96.9%, the same classifier reached an accuracy of 81.8% on the more realistic task with variable durations. (4) Conclusion: These results demonstrate the importance of experimental design on the assessment of the performance of automatic ARS classification algorithms. Furthermore, they also indicate, unlike what is stated in the literature, that the automatic classification of ARS is not a solved problem, as the algorithms' performance decreases substantially under complex evaluation scenarios.
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http://dx.doi.org/10.3390/s21010057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795327PMC
December 2020

Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury.

Phys Ther 2021 02;101(2)

Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Agras do Crasto, Building 30, 3810-193, Aveiro, Portugal.

Objective: The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation.

Methods: Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean.

Results: Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL.

Conclusion: Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI.

Impact: Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.
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http://dx.doi.org/10.1093/ptj/pzaa210DOI Listing
February 2021

Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach.

Expert Rev Respir Med 2021 01 10;15(1):131-142. Epub 2020 Dec 10.

REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University , Diepenbeek, Belgium.

: Chronic obstructive pulmonary disease (COPD) is a complex and heterogenous disease that is associated with a range of respiratory and non-respiratory symptoms, which highly contribute to the daily burden of the disease. Symptoms burden remains high despite optimal bronchodilator therapy, but pulmonary rehabilitation (PR) is an effective intervention to improve patients' symptoms. A comprehensive interdisciplinary approach within the framework of a PR program is warranted to tackle these complex symptoms and their consequences. : This narrative review describes how symptoms of dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances, and cognitive decline arise in COPD and can contribute to several non-pulmonary manifestations of the disease. It also describes evidence of the effectiveness of interdisciplinary PR programs to counteract these symptoms. A literature search was performed on PubMed and Scopus between June and July 2020. : Respiratory and non-respiratory symptoms are highly prevalent, often not comprehensively assessed, and result in several extra-pulmonary manifestations of the disease (physical, emotional and social). Interdisciplinary PR programs can improve these negative manifestations through different pathways, contributing for an effective symptoms' management. A thorough assessment of symptoms (beyond dyspnea) should be routinely performed and may support the identification of treatable traits, allowing the tailoring of PR interventions and assessment of their real-life impact.
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http://dx.doi.org/10.1080/17476348.2021.1854737DOI Listing
January 2021

Design of pulmonary rehabilitation programmes during acute exacerbations of COPD: a systematic review and network meta-analysis.

Eur Respir Rev 2020 Dec 18;29(158). Epub 2020 Nov 18.

Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal

This systematic review aimed to systematise the different designs used to deliver pulmonary rehabilitation during acute exacerbations of COPD (AECOPD) and explore which ones are the most effective. PubMed, Scopus, Web of Science, EBSCO and Cochrane were searched. Randomised controlled trials comparing pulmonary rehabilitation or at least one of its components with usual care or comparing different components of pulmonary rehabilitation were included. Network meta-analysis was conducted in MetaXL 5.3 using a generalised pairwise modelling framework. Pooled effects compared each treatment to usual care. 42 studies were included. Most studies were conducted in an inpatient setting (57%) and started the intervention 24-48 h after hospital admission (24%). Exercise training (71%), education and psychosocial support (57%) and breathing techniques (55%) were the most used components. Studies combining exercise with breathing techniques presented the larger effects on exercise capacity (weighted mean difference (WMD) -41.06, 95% CI -131.70-49.58) and health-related quality of life (WMD 16.07, 95% CI 10.29-21.84), and breathing techniques presented the larger effects on dyspnoea (WMD 1.90, 95% CI 0.53-3.27) and length of hospitalisation (effect size =0.15, 95% CI -0.28-0.57). A few minor adverse events were found.Pulmonary rehabilitation is a safe intervention during AECOPD. Exercise, breathing techniques, and education and psychosocial support seem to be the core components for implementing pulmonary rehabilitation during AECOPD. Studies may now focus on comparisons of optimal timings to start the intervention, total duration of the intervention, duration and frequency of sessions, and intensity for exercise prescription.
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http://dx.doi.org/10.1183/16000617.0039-2020DOI Listing
December 2020

Environmental Awareness for Patients with COPD Undergoing Pulmonary Rehabilitation: Is It of Added Value?

Int J Environ Res Public Health 2020 10 29;17(21). Epub 2020 Oct 29.

Lab 3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal.

Chronic obstructive pulmonary disease (COPD) is impacted by exposure to environmental contaminants. Improving health literacy on this topic might help to optimize health outcomes. We aimed to design and deliver a health-education session about the impact of environmental contaminants on respiratory symptoms and explore participants' perceptions on such session. Patients with COPD were recruited from a pulmonary rehabilitation (PR) program. Two focus groups were first conducted to explore knowledge amongst the group. Then, the session was designed and delivered, and three focus groups were conducted to obtain feedback from participants. Data were analyzed thematically by two independent researchers. Thirty-one patients (71 ± 8 years old, FEV = 47.6 ± 16.8% predicted; 74.2% male) were included. Prior to the session, participants recognized the importance of this topic and described avoidance strategies to deal with symptom triggering due to air pollution. After the session, participants had their knowledge validated, kept some avoidance strategies, but also adapted some "unavoidable" activities of daily living. Patients with COPD value education on this topic, and PR offers a friendly environment to discuss prevention and management strategies. Contents of the session are provided to help deliver these sessions. Future studies could investigate the effectiveness of this intervention on self-management and exacerbations of COPD.
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http://dx.doi.org/10.3390/ijerph17217968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663233PMC
October 2020

Relationship between Distress Related to Caregiver Burden and Physical Activity in Informal Caregivers of Patients with COPD.

COPD 2020 10 5;17(5):562-567. Epub 2020 Aug 5.

Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal.

Chronic obstructive pulmonary disease (COPD) can lead to increased dependence on the informal caregiver and, consequently, to distress associated with caregiving burden. In the general population, higher levels of physical activity (PA) are related to lower distress levels; however, this relationship has been scarcely studied in COPD. This study aimed to explore the relationship between distress and PA in informal caregivers of patients with COPD, and the influence of caregivers' (age, sex) and patients' (age, sex, lung function) characteristics and caregiving duration on this relationship.A cross-sectional study was conducted with 50 caregivers (62.7 ± 9.8 years, 88% female; 78% caring for a spouse/partner; 38% caring >40 h/week; patients' FEV=45.2 ± 21.3% predicted). Data collection comprised questions related to the caregiving context, distress related to caregiving burden assessed with the Informal Caregiver Burden Assessment Questionnaire (QASCI; total score, 7 subscales), and self-reported PA with the Habitual Physical Activity Questionnaire (HPAQ). Spearman's correlation coefficient and linear regressions were used.Significant, negative and moderate correlations were found between the QASCI (28.5 ± 19.8) and the HPAQ (5.2 ± 1.3) (ρ=-0.46;  = 0.01); and between the HPAQ and some QASCI subscales (emotional burden ρ=-0.47; implications for personal life ρ=-0.52; financial burden ρ=-0.44; perception of efficacy and control mechanisms ρ=-0.42;  < 0.01). Two linear regression models were tested to predict QASCI total score including as predictors: 1) HPAQ alone ( = 0.001; r=0.23); 2) HPAQ and caregiving h/week ( < 0.001; r=0.34).Higher self-reported PA levels are related to decreased levels of distress associated with caregiver burden in COPD caregivers. Duration of caregiving may negatively influence this relationship.
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http://dx.doi.org/10.1080/15412555.2020.1799964DOI Listing
October 2020

Respiratory Function and Upper Extremity Functional Activity Performance in People With Dementia: A Shout for Attention.

J Aging Phys Act 2020 07 28;29(1):89-98. Epub 2020 Jul 28.

The aim of this study was to explore respiratory function and upper extremity functional activity in people with dementia (PWD) and the associations between these variables and cognitive function (n = 22 institutionalized PWD, 28 community-dwelling PWD, and 26 healthy older people). All measures were significantly lower in PWD who live in an institution, such as a nursing home or long-term care facility or who attend adult daycare than PWD who live in a community dwelling . The values from these two groups were significantly lower than those from healthy older people. Moderate to high negative correlations between upper extremity functional activity and respiratory function (-.73 < rs < -.49) and cognitive function (rs = -.83), and between cognitive function and respiratory function (-.74 < rs < -.58) were identified (p < .001). When adjusted for cognitive function (-.38 < rs < -.29; p < .05), the association between upper limb functional activity and respiratory function decreased. The decline demonstrates the importance of physical activity and cognitive and respiratory function in PWD.
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http://dx.doi.org/10.1123/japa.2020-0005DOI Listing
July 2020

Physical activity for people living with dementia: carer outcomes and side effects from the perspectives of professionals and family carers.

Aging Clin Exp Res 2021 May 3;33(5):1267-1274. Epub 2020 Jul 3.

Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA) and Institute for Research in Biomedicine (iBiMED), University of Aveiro, Agras do Crasto, Campus Universitário de Santiago, Building 30, 3810-193, Aveiro, Portugal.

Background: Adherence to physical activity is challenging for people living with dementia, and largely dependent on carers' involvement. Carers are likely to support physical activity based on their perceived balance between benefits and potential side effects of such intervention for both patients and themselves. Professionals also have a role in terms of optimising such interventions not only for people with dementia but also their carers.

Aims: The present study aimed to identify the priorities of carers and professionals regarding (1) outcomes of physical activity for people living with dementia on carers and (2) side effects on patients and carers.

Methods: This was a two-round prioritisation exercise. In round one, participants were asked to rank, from most to least important, 2 lists of outcomes generated in a previous systematic review and qualitative study: (i) 10 outcomes on carers; (ii) 17 side effects on patients and carers. In round two, participants were asked to consider their own ranking in round one against the overall group ranking and re-rank both lists.

Results: 36 carers and 39 professionals completed both rounds. The carer outcomes ranked as highest priority were "carer feeling positive and satisfied", "carer improving wellbeing" and "making lives of carers easier". The most undesirable side effects were "becoming agitated and confused", "falling over" and "feeling discomfort and pain".

Discussion And Conclusions: Carers and professionals value the potential reduction in carer burden that may occur as a consequence of the person with dementia engaging in physical activity. Behavioural and psychological symptoms, falls and pain are the most undesirable side effects of physical activity. Future research should aim to address, and consistently report on these outcomes.
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http://dx.doi.org/10.1007/s40520-020-01636-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081678PMC
May 2021

Minimal Clinically Important Differences for Patient-Reported Outcome Measures of Fatigue in Patients With COPD Following Pulmonary Rehabilitation.

Chest 2020 08 14;158(2):550-561. Epub 2020 Mar 14.

Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; iBiMED-Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal. Electronic address:

Background: Fatigue is a burdensome and prevailing symptom in patients with COPD. Pulmonary rehabilitation (PR) improves fatigue; however, interpreting when such improvement is clinically relevant is challenging. Minimal clinically important differences (MCIDs) for instruments assessing fatigue are warranted to better tailor PR and guide clinical decisions.

Research Question: This study estimated MCIDs for the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-FS), the modified FACIT-FS, and the Checklist Individual Strength-Fatigue Subscale in patients with COPD following PR.

Study Design And Methods: Data from patients with COPD who completed a 12-week community-based PR program were used to compute the MCIDs. The pooled MCID was estimated by calculating the arithmetic weighted mean, resulting from the combination of anchor-based (weight, two-thirds) and distribution-based (weight, one-third) methods. Anchors were patients' and physiotherapists' Global Rating of Change Scale, COPD Assessment Test, St. George's Respiratory Questionnaire (SGRQ), and exacerbations. To estimate MCIDs, we used mean change, receiver-operating characteristic curves, and linear regression analysis for anchor-based approaches, and 0.5 × SD, SE of measurement, 1.96 × SE of measurement, and minimal detectable change for distribution-based approaches.

Results: Fifty-three patients with COPD (79% male, 68.4 ± 7.6 years of age, and FEV 48.7 ± 17.4% predicted) were included in the analysis. Exacerbations and the SGRQ-impact and the SGRQ-total scores fulfilled the requirements to be used as anchors. Pooled MCIDs were 4.7 for FACIT-FS, 3.8 for the modified FACIT-FS, and 9.3 for the Checklist Individual Strength-Fatigue Subscale.

Intrpretation: The MCIDs proposed in this study can be used by different stakeholders to interpret PR effectiveness.

Clinical Trial Registration: ClinicalTrials.gov; No.: NCT03799666; URL: www.clinicaltrials.gov.
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http://dx.doi.org/10.1016/j.chest.2020.02.045DOI Listing
August 2020

Minimal Clinically Important Differences for Patient-Reported Outcome Measures of Cough and Sputum in Patients with COPD.

Int J Chron Obstruct Pulmon Dis 2020 29;15:201-212. Epub 2020 Jan 29.

Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.

Background: Cough and sputum are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of minimal clinically important differences (MCIDs).

Purpose: This study established MCIDs for the Leicester cough questionnaire (LCQ) and the cough and sputum assessment questionnaire (CASA-Q), in patients with COPD after PR.

Patients And Methods: An observational prospective study was conducted in patients with COPD who participated in a 12-weeks community-based PR program. Anchor- (mean change, receiver operating characteristic curves and linear regression analysis) and distribution-based methods [0.5*standard deviation; standard error of measurement (SEM); 1.96*SEM; minimal detectable change and effect size] were used to compute the MCIDs. The anchors used were: i) patients and physiotherapists global rating of change scale, ii) COPD assessment test, iii) St. George's respiratory questionnaire and iv) occurrence of an exacerbation during PR. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 for anchor- and 1/3 for distribution-based methods).

Results: Forty-nine patients with COPD (81.6% male, 69.8±7.4years, FEV50.4±19.4) were used in the analysis. The pooled MCIDs were 1.3 for LCQ and for CASA-Q domains were: 10.6 - cough symptoms; 10.1 - cough impact; 9.5 - sputum symptoms and 7.8 - sputum impact.

Conclusion: The MCIDs found in this study are potential estimates to interpret PR effects on cough and sputum, and may contribute to guide interventions.
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http://dx.doi.org/10.2147/COPD.S219480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996113PMC
February 2021

A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections.

Respir Med 2020 02 1;162:105861. Epub 2020 Jan 1.

School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal. Electronic address:

Introduction: Physiotherapy may play a role in the recovery of signs, symptoms and function of patients with lower respiratory tract infections (LRTI) but its effectiveness is still controversial.

Objectives: To assess the effects of respiratory physiotherapy compared with standard pharmacological care on symptoms and function in outpatients with LRTI.

Design: Single-blind, randomised controlled trial.

Setting: Outpatients were recruited from the casualties of a central hospital.

Participants: Outpatients with LRTI were recruited and randomly allocated to the control (pharmacological) or experimental (pharmacological and respiratory physiotherapy) group.

Intervention: The intervention consisted of conventional pharmacological treatment and conventional pharmacological treatment plus respiratory physiotherapy. Respiratory physiotherapy included breathing and airway clearance techniques, exercise training and education during 3-weeks, 3 times per week.

Main Outcome Measure: Primary outcome measures - occupation rate of wheezes Wh%; Secondary outcome measures - number of crackles, peripheral oxygen saturation (SpO2) modified Borg scale (mBorg), modified Medical Research Council scale (mMRC), 6-min walk test (6MWT), forced expiratory volume in 1 s and forced vital capacity, and volume and density of the lung and bronchial tree volume.

Results: Ninety-seven patients (53 controls and 44 experimental) completed the intervention. After the intervention, both groups improved significantly in all variables (0.0001 < p < 0.04; 0.001<ƞ<0.092), with the exception of the mBorg. The magnitude of improvement of the experimental group exceeded the control group in the number of crackles, SpO2 levels, mMRC and 6MWT (0.002 < p < 0.032; 0.002<ƞ<0.092).

Conclusion: Adding respiratory physiotherapy to the pharmacological treatment of outpatients with LRTI results in greater recovery of symptoms and function parameters.

Trial Registration: NCT02053870.
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http://dx.doi.org/10.1016/j.rmed.2019.105861DOI Listing
February 2020

Home-Based Physical Activity Programs for People With Dementia: Systematic Review and Meta-Analysis.

Gerontologist 2020 11;60(8):600-608

Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA),, Portugal.

Background And Objectives: Physical activity has the potential to improve health outcomes in people with dementia, namely when living at home. However, the knowledge about home-based physical activity for this population is scarce. Thus, we aim to identify and synthesize the effects of home-based physical activity for people with dementia.

Research Design And Methods: A systematic review was conducted. Quality of studies was assessed using the Delphi List. Effect sizes (ES) were calculated with MetaXL 2.0. A meta-analysis was conducted for the Mini-Mental Status Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia, Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS-ADL), Functional Reach test, Timed Up and Go (TUG) test, Short Physical Performance Battery, Dementia Quality of Life, NPI Caregivers subscale and Zarit Burden Interview (ZBI).

Results: Sixteen randomized controlled trials were included. Most were of high quality and published after 2015. A large heterogeneity of interventions was found. Meta-analysis showed significant results in MMSE (ES = 0.71, 95% CI 0.43, 0.99), NPI (ES = -0.37, 95% CI -0.57, -0.17), ADCS-ADL (ES = 0.80, 95% CI 0.53, 1.07), Functional Reach test (ES = 2.24, 95% CI 1.80, 2.68), TUG test (ES = -2.40, 95% CI -2.84, -1.96), NPI Caregivers subscale (ES = -0.63, 95% CI -0.94, -0.32), and ZBI (ES = -0.45, 95% CI -0.77, -0.13). Few minor adverse events and high adherence to intervention were found.

Discussion And Implications: Home-based physical activity seems safe and effective in delaying cognitive function decline and improving changes in behavioral and psychological symptoms of dementia, activities of daily living, health-related physical fitness, and carer's burden in people with dementia living at home.
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http://dx.doi.org/10.1093/geront/gnz176DOI Listing
November 2020

Effects of a community-based pulmonary rehabilitation programme during acute exacerbations of chronic obstructive pulmonary disease - A quasi-experimental pilot study. Authors' reply.

Pulmonology 2020 Mar - Apr;26(2):112-113. Epub 2019 Oct 8.

Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal. Electronic address:

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http://dx.doi.org/10.1016/j.pulmoe.2019.09.001DOI Listing
March 2020

Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review.

J Clin Med 2019 Sep 13;8(9). Epub 2019 Sep 13.

REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure ( = 13) and a small statistically significant effect ( = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.
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http://dx.doi.org/10.3390/jcm8091458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780679PMC
September 2019

Outcomes of physical activity for people living with dementia: qualitative study to inform a Core Outcome Set.

Physiotherapy 2020 09 2;108:129-139. Epub 2019 Jun 2.

School of Health Professions University of Plymouth, Plymouth, United Kingdom. Electronic address:

Background: The need for a Core Outcome Set to evaluate physical activity interventions for people living with dementia, across stages of disease and intervention settings has been established. This qualitative study precedes the consensus phase of developing this Core Outcome Set and aims to: (i) compare the outcomes identified by patients, carers and professionals to those previously reported in the literature; (ii) and understand why certain outcomes are considered important.

Design And Methods: In-depth semi-structured interviews were conducted with people living with dementia, family carers and professionals (n=29). The outcomes identified in the interviews were mapped to a list of outcomes reported in a recent literature review. An in-depth thematic analysis was conducted to understand the importance of physical activity in dementia care.

Results: A comprehensive, inductively derived list of 77 outcomes, common across stages of dementia and intervention setting, was put together for the consensus phase of this Core Outcome Set: ten of these were new outcomes generated by this qualitative study. Five themes explained why stakeholders perceived physical activity outcomes as important for people living with dementia: "being well and staying well", "having a role towards others", "maintaining identity", "being connected to the present" and "delivering good quality care".

Conclusion: Ten new outcomes of physical activity, not previously reported in recent literature, were identified. Physical activity is considered important to people living with dementia due to its positive impact on multiple health outcomes for both patients and carers.
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http://dx.doi.org/10.1016/j.physio.2019.05.003DOI Listing
September 2020

A Core Outcome Set to Evaluate Physical Activity Interventions for People Living With Dementia.

Gerontologist 2020 05;60(4):682-692

School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.

Background And Objectives: A core outcome set (COS) to evaluate physical activity (PA) interventions for people living with dementia is needed, as the development of guidelines is currently limited by important heterogeneity in this field of research. Development of COS often includes Delphi surveys, but people living with dementia are often excluded. This study aimed to reach consensus on this COS using a modified Delphi survey to enable the participation of people living with dementia.

Research Design And Methods: Two stakeholders groups took part in a Delphi survey (Group 1: people living with dementia and family caregivers; Group 2: professionals from different backgrounds, including physiotherapists, occupational therapists, and researchers). Caregivers and professionals completed the survey remotely. Participants living with dementia took part face-to-face, using a card sorting strategy. The consensus process was finalized with a consensus meeting.

Results: Ninety-five participants of both groups completed the modified Delphi. Of those, 11 attended the consensus meeting. The card sorting strategy was successful at including people living with dementia. Seven outcomes reached consensus: preventing falls; doing what you can do; staying healthy and fit; walking better, being able to stand up and climb stairs; feeling brighter; enjoying the moment; and, feeling useful and having a purpose.

Discussion And Implications: Robust and innovative methodological strategies were used to reach a consensus on a COS (what to measure) to evaluate PA for people living with dementia. Future work will focus on the selection of the most appropriate tools to measure these outcomes (how to measure).
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http://dx.doi.org/10.1093/geront/gnz100DOI Listing
May 2020

The Kinematic Chain of Arm Elevation Is Impaired in Patients with Chronic Obstructive Pulmonary Disease.

COPD 2019 08 5;16(3-4):240-245. Epub 2019 Jul 5.

Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA) , Aveiro , Portugal.

Patients with chronic obstructive pulmonary disease (COPD) often complain about difficulties in performing activities with their arms above shoulders height. These difficulties have been associated with increased cardiorespiratory demand and altered lung mechanics; however, musculoskeletal-related mechanisms may also contribute to constrain the mechanics of the upper body quadrant, increasing the effort to perform the activities. This exploratory research aimed to assess potential changes in the kinematic chain of arm elevation in patients with COPD. A secondary analysis from a cross-sectional exploratory case-control and prediction study was conducted in 15 patients with COPD (2 females) and 15 controls (8 females) matched for age and body mass index. The sagittal alignment and active range of motion (ROM) of the head, thoracic spine and shoulder complex were measured, using a computer software, in digital lateral photographs obtained in three different testing positions: arms at rest, arms at 90° of shoulder flexion and full arm elevation. From rest to full arm elevation, both groups moved from a more flexed to a less flexed or more upright thoracic spine position (∼7°,  < 0.001, 0.419 < <0.767). However, the COPD group showed significantly less shoulder flexion (∼12°,  = 0.007,  = 1.05) and thoracic spine extension (∼6°,  = 0.015, = 0.139) ROM than the control group in the full arm elevation position. These findings suggest that this population may show changes in the kinematic chain of arm elevation that possibly contribute to arm movement-related complains and limited performance in their daily living.
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http://dx.doi.org/10.1080/15412555.2019.1632281DOI Listing
August 2019

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis.

BMC Public Health 2019 May 31;19(1):676. Epub 2019 May 31.

Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.

Background: Pulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.

Methods: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy - fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted.

Discussion: This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases.

Trial Registration: The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ).
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http://dx.doi.org/10.1186/s12889-019-7045-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544941PMC
May 2019

An open access database for the evaluation of respiratory sound classification algorithms.

Physiol Meas 2019 03 22;40(3):035001. Epub 2019 Mar 22.

Department of Informatics Engineering, Centre for Informatics and Systems (CISUC), University of Coimbra, Coimbra, Portugal. Author to whom any correspondence should be addressed.

Objective: Over the last few decades, there has been significant interest in the automatic analysis of respiratory sounds. However, currently there are no publicly available large databases with which new algorithms can be evaluated and compared. Further developments in the field are dependent on the creation of such databases.

Approach: This paper describes a public respiratory sound database, which was compiled for an international competition, the first scientific challenge of the IFMBE's International Conference on Biomedical and Health Informatics. The database includes 920 recordings acquired from 126 participants and two sets of annotations. One set contains 6898 annotated respiratory cycles, some including crackles, wheezes, or a combination of both, and some with no adventitious respiratory sounds. In the other set, precise locations of 10 775 events of crackles and wheezes were annotated.

Main Results: The best system that participated in the challenge achieved an average score of 52.5% with the respiratory cycle annotations and an average score of 91.2% with the event annotations.

Significance: The creation and public release of this database will be useful to the research community and could bring attention to the respiratory sound classification problem.
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http://dx.doi.org/10.1088/1361-6579/ab03eaDOI Listing
March 2019

Feasibility of computerized adventitious respiratory sounds to assess the effects of airway clearance techniques in patients with bronchiectasis.

Physiother Theory Pract 2020 Nov 23;36(11):1245-1255. Epub 2019 Jan 23.

Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto - Campus Universitário de Santiago , Aveiro, Portugal.

To examine the feasibility of adventitious respiratory sound (ARS) as an outcome measure to assess the effects of airway clearance techniques (ACTs) in outpatients with bronchiectasis. ARS were registered pre/post four ACTs sessions. Clinical outcomes included: number of crackles (coarse and fine), number of wheezes (monophonic and polyphonic), wheezes occupation rate (%) and sputum quantity. Feasibility outcomes of ARS included: reasons for exclusion, suitability, safety, equipment and time required, magnitude of change after intervention and sample size estimation. Seven patients (49.7 ± 20.5 years; FEV 69.3 ± 15.8% predicted) were included. Recordings from four patients were excluded due to excessive environment noise. All ARS measurements were completed without any adverse events. An electronic stethoscope was acquired and the time spent to complete each assessment was 6 ± 3.5 min. The largest changes were observed for number of expiratory coarse crackles [effect size (95%CI) ES = 0.40 (0.01-0.79)], which correlated moderately with sputum quantity (r = 0.56), and inspiratory monophonic wheezes [ES = 0.61 (0.22-1.00)]. The estimated sample size for a full crossover trial was 46. ARS is feasible to assess the effects of ACTs in patients with bronchiectasis. Expiratory coarse crackles seem to be the most appropriate ARS parameter, but this finding needs to be confirmed in an adequately powered trial.
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http://dx.doi.org/10.1080/09593985.2019.1566945DOI Listing
November 2020

Triangulated perspectives on outcomes of pulmonary rehabilitation in patients with COPD: a qualitative study to inform a core outcome set.

Clin Rehabil 2019 Apr 28;33(4):805-814. Epub 2018 Dec 28.

Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.

Introduction:: Pulmonary rehabilitation implies a comprehensive assessment. Although several outcomes are commonly measured, those are selected mainly by health professionals and researchers, with the voice of patients and informal caregivers being minimally captured. Qualitative studies are fundamental to enhance our knowledge on perspectives of different stakeholders involved in pulmonary rehabilitation.

Objective:: This study aimed to explore the views of different stakeholders on outcomes of pulmonary rehabilitation, contributing to one of the stages of a core outcome set for pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).

Methods:: Semi-structured interviews were conducted with 12 patients with COPD, 11 informal carers and 10 health professionals. Data were analysed with content analysis, followed by thematic analysis to gain deeper understanding of the different perspectives.

Results:: A total of 44 outcomes were identified, being the most reported 'improving functional performance' (67%) and 'reducing and taking control over dyspnoea' (64%). Five relevant themes across stakeholders were generated: having a healthy mind in a healthy body; I can('t) do it; feeling fulfilled; knowing more, doing better and avoiding doctors and expenses. Although perspectives were mostly consensual, some outcomes were only valued by health professionals (e.g. pulmonary function) or by patients and informal carers (e.g. quality of sleep).

Conclusion:: Views of the different stakeholders on outcomes of pulmonary rehabilitation were similar although, some specificities existed. Comprehensive assessments are needed to reflect what is valued by the different stakeholders in pulmonary rehabilitation. This study contributed to a future core outcome set in this field.
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http://dx.doi.org/10.1177/0269215518821405DOI Listing
April 2019
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