Papers by Simone Dal Corso
Cochrane Database of Systematic Reviews, 2021
BACKGROUND Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease ... more BACKGROUND Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease (COPD), but gains are not maintained over time. Maintenance pulmonary rehabilitation has been defined as ongoing supervised exercise at a lower frequency than the initial pulmonary rehabilitation programme. It is not yet known whether a maintenance programme can preserve the benefits of pulmonary rehabilitation over time. Studies of maintenance programmes following pulmonary rehabilitation are heterogeneous, especially regarding supervision frequency. Furthermore, new maintenance models (remote and home-based) are emerging. OBJECTIVES To determine whether supervised pulmonary rehabilitation maintenance programmes improve health-related quality of life (HRQoL), exercise performance, and health care utilisation in COPD patients compared with usual care. Secondly, to examine in subgroup analyses the impact of supervision frequency and model (remote or in-person) during the supervised maintenance programme. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PEDro, and two additional trial registries platforms up to 31 March 2020, without restriction by language or type of publication. We screened the reference lists of all primary studies for additional references. We also hand-searched conference abstracts and grey literature through the Cochrane Airways Trials Register and CENTRAL. SELECTION CRITERIA We included only randomised trials comparing pulmonary rehabilitation maintenance for COPD with attention control or usual care. The primary outcomes were HRQoL, exercise capacity and hospitalisation; the secondary outcomes were exacerbation rate, mortality, direct costs of care, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts, extracted data, and assessed the risk of bias. Results data that were similar enough to be pooled were meta-analysed using a random-effects model, and those that could not be pooled were reported in narrative form. Subgroup analyses were undertaken for frequency of supervision (programmes offered monthly or less frequently, versus more frequently) and those using remote supervision (e.g. telerehabilitation versus face-to-face supervision). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 21 studies (39 reports) with 1799 COPD patients. Participants ranged in age from 52 years to 88 years. Disease severity ranged from 24% to 88% of the predicted forced expiratory volume in one second. Programme duration ranged from four weeks to 36 months. In-person supervision was provided in 12 studies, and remote supervision was provided in six studies (telephone or web platform). Four studies provided a combination of in-person and remote supervision. Most studies had a high risk of performance bias due to lack of blinding of participants, and high risk of detection, attrition, and reporting bias. Low- to moderate-certainty evidence showed that supervised maintenance programmes may improve health-related quality of life at six to 12 months following pulmonary rehabilitation compared to usual care (Chronic Respiratory Questionnaire total score mean difference (MD) 0.54 points, 95% confidence interval (CI) 0.04 to 1.03, 258 participants, four studies), with a mean difference that exceeded the minimal important difference of 0.5 points for this outcome. It is possible that supervised maintenance could improve six-minute walk distance, but this is uncertain (MD 26 metres (m), 95% CI -1.04 to 52.84, 639 participants, 10 studies). There was little to no difference between the maintenance programme and the usual care group in exacerbations or all-cause hospitalizations, or the chance of death (odds ratio (OR) for mortality 0.73, 95% CI 0.36 to 1.51, 755 participants, six studies). Insufficient data were available to understand the impact of the frequency of supervision, or of remote versus in-person supervision. No adverse events were reported. AUTHORS' CONCLUSIONS This review suggests that supervised maintenance programmes for COPD patients after pulmonary rehabilitation are not associated with increased adverse events, may improve health-related quality of life, and could possibly improve exercise capacity at six to 12 months. Effects on exacerbations, hospitalisation and mortality are similar to those of usual care. However, the strength of evidence was limited because most included studies had a high risk of bias and small sample size. The optimal supervision frequency and models for supervised maintenance programmes are still unclear.
Respiratory Care, 2020
BACKGROUND: Field walking tests are commonly used in patients with chronic pulmonary diseases for... more BACKGROUND: Field walking tests are commonly used in patients with chronic pulmonary diseases for assessment of functional capacity. However, the physiological demands and magnitude of desaturation on 6-min walk test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT) have not been investigated in patients with bronchiectasis. The objective of this study was to compare the physiological responses and the magnitude of desaturation of subjects with bronchiectasis when performing the 6MWT, ISWT, and ESWT. METHODS: Thirty-two subjects underwent the 6MWT, ISWT, and ESWT on 3 different days. Pulmonary gas exchange, heart rate, and S pO 2 were measured in all tests. RESULTS: There were no differences in the peak rate of oxygen uptake, ventilation, dyspnea, and leg fatigue between the tests. Equivalent cardiac demand (ie, heart rate at peak) was observed with the 6MWT (137 6 21 beats/min) and the ESWT (142 6 21 beats/min), but this was lower in the ISWT (135 6 19 beats/min) compared to ESWT (P < .05). Most subjects achieved a vigorous exercise intensity (heart rate of 70-90% of predicted) in all tests. There was no difference in desaturation among the tests (6MWT: 26.8 6 6.6%, ISWT: 26.1 6 6.0%, and ESWT: 27.0 6 5.4%). CONCLUSIONS: The 6MWT, ISWT, and ESWT induced similar physiological responses at the peak of exercise, eliciting a vigorous exercise intensity. The magnitude of desaturation was similar across tests. This means these tests can be used interchangeably for evaluation of exercise-induced desaturation.
European Respiratory Journal, 2016
Background: The clinical utility of walking tests to evaluate the exercise capacity of patients w... more Background: The clinical utility of walking tests to evaluate the exercise capacity of patients with pulmonary arterial hypertension (PAH) is in need of further investigation.Very few studies have compared the clinical utility of field walking tests (The 6-min walk test -6MWT); Incremental Shuttle Walk Test (ISWT)) to CPET to assess exercise tolerance in patients with PAH. Objectives: To compare three field tests: 6MWT, ISWT and Endurance Shuttle Walk Test (ESWT)to CPET in patients with PAH. Methods and Results: 20 PAH patients (49.8±14.6 years old), WHO functional class II-III, mean pulmonary artery pressure (PAPm): 45 mmHg, were subjected to the three field tests and CPET. The ISWT reached maximum levels of effort and no significant differences in any variable when compared to CPET results. However,the 6MWT and ESWT achieved submaximal levels when compared to CPET results. A higher correlation was observed between ISWT walk distance (WD) and peak oxygen consumption (pVO2) of CPET than between 6MWT distance and pVO 2 (r=0.89versus0.52, respectively;p 2 and workload (r=-0.80versus-0.87, respectively). There was no significant correlation between PAPm with the WD during the 6MWT. Conclusion: The ISWT is an effective and safe alternative to CPET with the advantage of being simple and inexpensive, and capable of capturing the functional status of patients with PAH.
Brazilian Journal of Physical Therapy, 2006
Pacientes hospitalizados por pneumonia adquirida na comunidade apresentam redução da capacidade f... more Pacientes hospitalizados por pneumonia adquirida na comunidade apresentam redução da capacidade funcional, força muscular periférica e qualidade de vida./ Anderson José. 2011. 48 f.
Brazilian Journal of Physical Therapy, 2013
Background: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulatin... more Background: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP) could affect the patients' exercise tolerance and peripheral muscle strength (PMS). Objective: To evaluate the functional capacity (FC) of patients hospitalized for CAP and to correlate the FC with length of hospital stay. Method: We prospectively evaluated 45 patients (49±16 years; CAP group) and 20 healthy subjects (53±17 years; control group). They were randomized to perform, on separate days, a 6-minute walk test (6MWT), a test of PMS, and the Glittre test (GT). Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. Results: There were significant differences between the groups (CAP and controls) for the 6MWT (381.3±108 vs. 587.1±86.8 m) and GT (272.8±104.3 vs. 174±39 sec). The CAP group also presented worse health-related quality of life (HRQoL) scores, reduced strength (quadriceps and biceps), and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02) and dyspnea (r=0.36, P=0.02). Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001) and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001). Conclusions: Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay.
European Respiratory Journal, 2006
A 6-min step test (6MST) may constitute a practical method for routinely assessing effort toleran... more A 6-min step test (6MST) may constitute a practical method for routinely assessing effort tolerance and exercise-related oxyhaemoglobin desaturation (ERD) in the primary care of patients with interstitial lung disease. In total, 31 patients (19 males) with idiopathic pulmonary fibrosis (n525) and chronic hypersensitivity pneumonia were submitted, on different days, to two 6MSTs. Physiological responses were compared with those found on maximal and submaximal cycle ergometer tests at the same oxygen uptake (V9O 2). Chronic breathlessness was also determined, as measured by the baseline dyspnoea index (BDI). Responses to 6MST were highly reproducible: 1.3¡2.0 steps?min-1 , ¡5 beats?min-1 (cardiac frequency), ¡50 mL?min-1 (V9O 2), ¡7 L?min-1 (minute ventilation) and ¡2% (arterial oxygen saturation measured by pulse oximetry (Sp,O 2)). The number of steps climbed in 6 min was correlated to peak V9O 2 and the BDI. There were significant associations among the tests in relation to presence (change in Sp,O 2 between rest and exercise o4%) and severity (Sp,O 2 ,88%) of ERD. Four patients, however, presented ERD only in response to 6MST. Resting diffusing capacity of the lung for carbon monoxide and alveolar-arterial oxygen tension difference were the independent predictors of the number of steps climbed. A single-stage, self-paced 6-min step test provided reliable and reproducible estimates of exercise capacity and exercise-related oxyhaemoglobin desaturation in interstitial lung disease patients.
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Papers by Simone Dal Corso