https://doi.org/10.4081/monaldi.2021.1984

Home-based unsupervised pulmonary rehabilitation program improves the respiratory disability in systemic sclerosis patients with dyspnea: an observational prospective study

Vol. 92 No. 3 (2022)
Submitted: June 21, 2021
Accepted: December 17, 2021
Published: December 28, 2021
Pulmonary rehabilitation, Systemic Sclerosis, dyspnea
Abstract Views: 1093
PDF: 456
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Authors

Silvia Faverzani
silvia.faverzani@unipr.it
https://orcid.org/0000-0001-7989-4956
Rehabilitation Medicine Service, Rehabilitation Geriatrics Department, University Hospital of Parma, Italy.
Filippo Nocera
https://orcid.org/0000-0001-6859-6961
Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Italy.
Ernesto Crisafulli
https://orcid.org/0000-0001-7298-7084
Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Italy.
Maurizio Marvisi
https://orcid.org/0000-0002-7349-2734
Internal Medicine Unit, Figlie di San Camillo Hospital, Cremona, Italy.
Andrea Becciolini
Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Italy.
Federica Mosetti
Rehabilitation Medicine Service, Rehabilitation Geriatrics Department, University Hospital of Parma, Italy.
Eleonora Di Donato
Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Italy.
Flavio Mozzani
Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Italy.
Daniele Santilli
Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Italy.
Giuseppe Scopelliti
https://orcid.org/0000-0002-7393-3931
Cystic Fibrosis Unit, Azienda Ospedaliero Universitaria di Ancona, Italy.
Alarico Ariani
https://orcid.org/0000-0003-1428-6102
Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Italy.

Dyspnea is a common symptom in systemic sclerosis (SSc) that considerably decreases patients’ quality of life (QoL). Pulmonary rehabilitation (PR) mitigates dyspnea impact on daily activities. The aim of this study is to evaluate the effect on respiratory disability of home-based PR in SSc patients with dyspnea. In this observational prospective monocentric study, we screened all dyspneic SSc consecutive patients attending the Rheumatological day hospital in the University hospital of Parma from January 2019 and June 2019. The aim of our study was to understand if a PR unsupervised home-based program could improve respiratory disability in this specific population. Dyspnea was evaluated with the self-administered questionnaires modified Medical Research Council (mMRC) and Saint George's Respiratory Questionnaire (SGRQ). Patients also filled in Short Form 36 (SF36) and the Modified-Health Assessment Questionnaire for SSc (HAQ-MOD). Health Professionals assessed and trained the patients and collected data before PR and at the end of the program. PR consisted in 5 weekly unsupervised sessions for 8 weeks. Wilcoxon test for paired data evaluated the changes after PR. p<0.05 was considered statistically significant. 46 SSc patients were included (43 female). Only 31 (29 female) performed PR as planned (Adherent Group-AG) while the others gave up within the first week (Non-Adherent Group-NAG). All SGRQ domains (symptoms: from 30 to 18; p=0.0055; activity: from 47 to 35, p=0.23; impact from 29 to 25, p=0.044) and SGRQ total score (from 35 to 29; p=0.022) improved in AG. SGRQ scores did not change in NAG as well as SF36 and HAQ-MOD in both groups. The home-based PR program dramatically decreased the effect, frequency and severity of respiratory symptoms. Conversely, it slightly changed the activities causing breathlessness and dyspnea-related social functioning disturbances. PR appears to be a useful tool in treatment strategies aiming to achieve a QoL improvement in SSc patients.

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Scopus
Google Scholar
Europe PMC
Solomon JJ, Olson AL, Fischer A, et al. Scleroderma lung disease. Eur Respir Rev 2013;22:6-19. DOI: https://doi.org/10.1183/09059180.00005512
Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/ European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-e64. DOI: https://doi.org/10.1164/rccm.201308-1509ST
Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788-824. DOI: https://doi.org/10.1164/rccm.2009-040GL
Ferrer M, Villasante C, Alonso J, et al. Interpretation of quality of life scores from the St George’s Respiratory Questionnaire. Eur Respir J 2002;19:405-13. DOI: https://doi.org/10.1183/09031936.02.00213202
Jones PW. St. George’s Respiratory Questionnaire: MCID. COPD 2005;2:75-9. DOI: https://doi.org/10.1081/COPD-200050513
Pope J. Measures of systemic sclerosis (scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), physician- and patient-rated global assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler's Index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud's Condition Score (RCS). Arthritis Care Res (Hoboken) 2011;63:S98-111. DOI: https://doi.org/10.1002/acr.20598
Johnson SR, Hawker GA, Davis AM. The health assessment questionnaire disability index and scleroderma health assessment questionnaire in scleroderma trials: an evaluation of their measurement properties. Arthritis Rheum 2005;53:256-62. DOI: https://doi.org/10.1002/art.21084
McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36®): III. tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Care 1994;32:40-66. DOI: https://doi.org/10.1097/00005650-199401000-00004
Holland AE. Exercise limitation in interstitial lung disease – mechanisms, significance and therapeutic options. Chron Respir Dis 2010;7:101-11. DOI: https://doi.org/10.1177/1479972309354689
Rochester CL, Vogiatzis I, Holland AE, et al. An Official American Thoracic Society/European Respiratory Society Policy Statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med 2015;192:1373–86. DOI: https://doi.org/10.1164/rccm.201510-1966ST
Spruit MA, Pitta F, Garvey C, et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J 2014;43:1326-37. DOI: https://doi.org/10.1183/09031936.00145613
Ryerson CJ, Berkeley J, Carrieri-Kohlman VL, et al. Depression and functional status are strongly associated with dyspnea in interstitial lung disease. Chest 2011;139:609–16. DOI: https://doi.org/10.1378/chest.10-0608
Akhtar AA, Ali MA, Smith RP. Depression in patients with idiopathic pulmonary fibrosis. Chron Respir Dis 2013;10:127-33. DOI: https://doi.org/10.1177/1479972313493098
Ferrara G, Luppi F, Birring SS, et al. Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions. Eur Respir Rev 2018;27:170076. DOI: https://doi.org/10.1183/16000617.0076-2017
McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015;(2):CD003793. DOI: https://doi.org/10.1002/14651858.CD003793.pub3
Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax 2017;72:57-65. DOI: https://doi.org/10.1136/thoraxjnl-2016-208514
Lumetti F, Barone L, Alfieri C, et al. Quality of life and functional disability in patients with interstitial lung disease related to Systemic Sclerosis. Acta Biomed 2015;86:142-8.

How to Cite

Faverzani, Silvia, Filippo Nocera, Ernesto Crisafulli, Maurizio Marvisi, Andrea Becciolini, Federica Mosetti, Eleonora Di Donato, Flavio Mozzani, Daniele Santilli, Giuseppe Scopelliti, and Alarico Ariani. 2021. “Home-Based Unsupervised Pulmonary Rehabilitation Program Improves the Respiratory Disability in Systemic Sclerosis Patients With Dyspnea: An Observational Prospective Study”. Monaldi Archives for Chest Disease 92 (3). https://doi.org/10.4081/monaldi.2021.1984.
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