Rajiv Gandhi University of Health Sciences
|A RANDOMIZED CONTROL STUDY TO FIND THE EFFECT OF PHYSICAL THERAPY TECHNIQUES ON LUNG FUNCTION AND HEALTH RELATED QUALITY OF LIFE |
|IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
| |
|SUBMISSION OF SYNOPSIS FOR THE REGISTRATION OF THE DISSERTATION FOR MASTER OF PHYSIOTHERAPY |
|SUBMITTED TO |
|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES |
|BANGALORE, KARNATAKA |
|SUBMITTED BY |
|MOIRANGTHEM JAMES |
| |
| |
|NAVODAYA COLLEGE OF PHYSIOTHERAPY |
|P.B. NO. 26 MANTRALAYAM ROAD, RAICHUR |
|KARNATAKA |
|SEPTEMBER 2009 |
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE - II
|1. |NAME OF THE CANDIDATE AND ADDRESS: |MOIRANGTHEM JAMES |
| | |NAVODAYA COLLEGE OF PHYSIOTHERAPY, MANTRALAYAM ROAD, RAICHUR. KARNATAKA.|
|2. |NAME OF THE INSTITUTION: |NAVODAYA COLLEGE OF PHYSIOTHERAPY, MANTRALAYAM ROAD, RAICHUR. KARNATAKA.|
|3. |COURSE OF STUDY AND SUBJECT: |MASTER OF PHYSIOTHERAPY (MPT) |
| | |PHYSIOTHERAPY IN CARDIO-RESPIRATORY DISORDERS |
|4. |DATE OF ADMISSION TO COURSE: |12 NOVEMBER 2009 |
|5. |TITLE OF THE TOPIC: |
| |“A RANDOMISED CONTROL STUDY TO FIND THE EFFECT OF PHYSICAL THERAPY TECHNIQUES ON LUNG FUNCTION AND HEALTH RELATED QUALITY OF LIFE IN|
| |PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE” |
PROFORMA FOR THE REGISTRATION OF SUBJECT OF DISSERTATION
|6. |RESEARCH QUESTION: |
| |Is there any significant effect of physical therapy technique on lung function and health related quality of life in patients with |
| |chronic obstructive pulmonary disease (COPD)? |
|6.1 |BRIEF RESUME OF THE INTENEDED WORK: |
| | |
| |The American Thoracic Society (ATS) defined Chronic Obstructive Pulmonary Disease (COPD) as “a disease state characterized by the |
| |presence of airflow limitation due to chronic bronchitis or emphysema; the airflow obstruction is generally progressive, may be |
| |accompanied by airway hyper-reactivity, and may be partially reversible.”5 |
| | |
| |The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defined COPD as a disease state characterized by airflow |
| |limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal |
| |inflammatory response of the lungs to noxious particles or gases.35 |
| | |
| |Chronic Obstructive Pulmonary Disease (COPD) encompasses the Chronic bronchitis and Emphysema. Chronic bronchitis is defined in |
| |clinical terms as a cough with sputum production on most days for 3 months of a year, for 2 consecutive years.24Emphysema is |
| |defined as enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls.24 |
| | |
| |The prevalence of COPD range from 14 million to 20 million persons in the United States and is steadily increasing.9 COPD now ranks|
| |as the fourth leading cause of death. It is also a major contributor to job absenteeism and the overall cost of caring for COPD |
| |patients has been estimated as high as $40 billion annually with $1.6 billion for long-term oxygen alone.34 The largest portion of |
| |health-care cost is borne in the last year of the patient's life.9,10,38,40 |
| | |
| |Risk for COPD is related to an interaction between genetic factors and many different environmental exposures, which could also be|
| |affected by comorbid disease. Risk factors for the disease are Genetic factors,47 Tobacco smoke,25 Outdoor air pollutants,25 |
| |Occupational dust, vapours, and fumes,18 Infections,49 Indoor air pollutants,25 Asthma,23,46 Gender,11 Socioeconomic and related |
| |factors.7,44,28 |
| | |
| |A variety of pathological changes have been observed in the central airways, peripheral airways and lung parenchyma of patients |
| |with chronic obstructive pulmonary disease (COPD). The characteristic changes in the central airways include inflammatory cellular|
| |infiltration into the airway wall and mucous gland enlargement. In the peripheral airways, various morphological changes are |
| |observed, including mucous plugging, epithelial abnormalities, inflammatory cellular infiltrates, fibrosis and distortion; these |
| |changes lead to airway narrowing. Although the major sites of airflow limitation in patients with COPD are most likely the |
| |peripheral airways, lesions in both the peripheral airways and the lung parenchyma contribute to chronic airflow limitations.32 |
| | |
| |Patients with chronic obstructive pulmonary disease (COPD) exhibit characteristics of airway mucus hypersecretion, including |
| |sputum production, increased luminal mucus, goblet cell hyperplasia and submucosal gland hypertrophy. These features are not |
| |common to all patients. However, current evidence indicates that airway hypersecretion has pathophysiological and clinical |
| |significance in COPD.41 |
| | |
| |The presence of clinical symptoms such as cough, sputum, or dyspnea on exertion, or middle aged or older people who have risk |
| |factors such as a history of smoking, COPD must always be suspected. Typical physical findings in COPD usually do not appear until|
| |the disease is severe.48 |
| | Spirometry is essential for diagnosis of COPD. Airflow limitation is judged to be present when the FEV1/FVC ratio is less |
| |than 70% after administration of bronchodilators. For a definitive diagnosis, it is necessary to exclude various other diseases by|
| |means of diagnostic imaging and detailed pulmonary function examinations.48 |
| |The spirometer was invented and introduced into medicine in 1846 by John Hutchinson, a surgeon.19 Spirometer is one of the |
| |equipments used for basic Pulmonary Function Tests (PFTs). It is useful as a preliminary test of the health condition for |
| |patient's lung. Besides, it often used for finding the cause for shortness of breath, assess the effects of contaminants on lung |
| |functions, effect of medication, and progress for disease treatment.31 |
| |Six Minute Walk Test is a valuable tool to evaluate functional aerobic exercise capacity and endurance. The area tested include |
| |distance walked, number and duration of rests in 6 minutes, perceived exertion, dyspnea, oxygen saturation, heart rate, overall |
| |aerobic exercise capacity and endurance. This test is objective and has limited costs.26,42 |
| |Chronic Respiratory Questionnaire (CRQ) is used to assess Health Related Quality of Life (HRQL). The questionnaire includes 20 |
| |items in four domains: dyspnea (five items), fatigue (four items), emotional function (seven items), and mastery (four items). 16 |
| | |
| |Traditionally COPD is treated by Medication, Pulmonary Rehabilitation, Disease management, Supplemental Oxygen and Surgery.5 |
| | |
| |Pulmonary rehabilitation has been well established as a means of enhancing standard therapy in order to control and alleviate |
| |symptoms, optimize functional capacity, and reduce the medical and economic burdens of disabling lung disease. Benefits include |
| |improved exercise tolerance, symptoms, and quality of life and decreases health care expenditures; results of published trials |
| |provide a sound scientific basis for the overall intervention as well as specific components.1,2,6,21 |
| | |
| |A comprehensive rehabilitation programme for respiratory patients includes: medical therapy, reinforcement of smoking cessation, |
| |education of the patient and family, exercise reconditioning, nutritional, occupational therapies, and physical therapy |
| |techniques. 13 |
| | |
| |Respiratory Physical therapy assesses and provides treatment to enhance functional capacity, increase lung expansion, reduce |
| |dyspnea, remove excessive bronchial secretion and restore maximum movement and function throughout life.3 |
| | |
| |Physical therapy techniques includes Exercise training,8 Arm exercise,22,30 Respiratory muscle training,45 Breathing retraining |
| |techniques,10 Chest physiotherapy4,51 and Education.10,29 |
| | |
| |Therefore, almost all COPD patients may be incorporated into such programme, including one or more of these various forms of |
| |therapy on the basis of an in- or out-patient programmed or even at home.12 ,39 |
| | |
| |Although in Pulmonary Rehabilitation Physical Therapy Technique plays a major role, its effect has not been studied extensively. |
| | |
| |Thus the aim of this study is to evaluate the effect of Physical Therapy Techniques on lung function and health related quality of|
| |life in patients with moderate COPD. |
|6.2 |HYPOTHESIS: |
| |NULL HYPOTHESIS (H0): |
| |There will be no significant difference in outcomes of both experimental and control group following Physical Therapy Techniques. |
| |ALTERNATIVE HYPOTHESIS (H1): |
| |There will be a significant difference in outcomes of both experimental and control group following Physical Therapy Techniques. |
|6.3 |REVIEW OF LITERATURE: |
| | |
| |1) Paz-Diaz, Hildegarde MD et al (2007)36 conducted a randomized study on 24 patients with COPD to determine the impact of an 8-wk |
| |program of comprehensive pulmonary rehabilitation on depression, anxiety, dyspnea, and health-related quality of life in patients |
| |with chronic obstructive pulmonary disease (COPD). The PR program included disease education Physical Therapy techniques, |
| |relaxation, and exercise including 20-min arm elevation with dumbbells and 20-min leg exercise sessions three times a week for 8 |
| |wks. They found that there was a significant improvement in the severity of depression (P < 0.01), a decrease in symptoms (P < |
| |0.05), an increase in daily living activities (P < 0.05), and a decrease in the total score of the SGRQ (P < 0.01). Dyspnea measured|
| |by the MRC scale was significantly better in the PR group (P < 0.01).Hence this study shows that in patients with COPD; pulmonary |
| |rehabilitation induces important changes on depression and anxiety independent of changes in dyspnea and health-related |
| |quality-of-life. |
| | |
| |2) Laura B et al (2006)27 have studied the spirometric values of patients with COPD with the objective of finding the suitable |
| |criterion to use, to find the variability of FEV1 and FVC among absolute and percentage variations. The samples were taken from |
| |two different centers, National Emphysema Treatment Trial (NETT) and Lung Health Study (LHS). The method used for the purpose was |
| |repeated measures. The baseline values of LHS was2.64+/-60 L and 0.68+/-0.22 L for NETT. As the degree of obstruction increased |
| |(with the mean number of days between sessions 24.9+/-17% for LHS and 85.7+/-21.7% for NETT, intersession percent difference of |
| |FEV1 increased. However absolute difference between the tests remained relatively constant despite the severity of obstruction |
| |over 90% of participants had an intersession FEV1 difference less than 225 ml irrespective of severity of obstruction. So they |
| |conclude that absolute changes in FEV1 rather than percent change should be used to determine the changes in COPD status. |
| | |
| |3) Hideki Katsura et al (2004)17 conducted a study to evaluate the long-term effects of rehabilitation in elderly COPD patients. |
| |The patients were monitored for 1 year after they completed a 2-week inpatient pulmonary rehabilitation program which included |
| |Physical Therapy techniques. Fifty-nine elderly COPD patients (mean age 72.8 years) were studied. They underwent a comprehensive |
| |2-week inpatient pulmonary rehabilitation program incorporating 10 exercise sessions, each of which included aerobic exercise |
| |training of the lower extremities, peripheral muscle conditioning training of the upper and lower extremities, and stretching, |
| |along with various education sessions. The effects of pulmonary rehabilitation were evaluated at 3, 6, and 12 months after |
| |completion of the program. Exercise capacity assessed by a 6-min walking distance test (6MWD) was significantly improved. However,|
| |there was some fall-off in terms of the distance walked 12 months after pulmonary rehabilitation. |
| | |
| | |
| | |
| | |
| |4) Ghassan F et al (2003)14 conducted a randomized controlled to determine the effectiveness of rehabilitation in patients with |
| |chronic obstructive pulmonary disease (COPD). Rehabilitation group received at least 4 weeks of rehabilitation; control group |
| |received no rehabilitation; and outcome measures included exercise capacity and shortness of breath. They identified 69 trials, of|
| |which 20 trials were included in the final analysis. They conclude that COPD patients who received pulmonary rehabilitation with |
| |Physical Therapy Technique have a better exercise capacity and they experience less shortness of breath than patients who do not |
| |receive rehabilitation. COPD patients may benefit from rehabilitation programs that include at least lower-extremity training. |
| |Patients with mild/moderate COPD benefit from short- and long-term rehabilitation. |
| | |
| |5) Lacasse et al. (2002)20 evaluated the impact of rehabilitation on health-related quality of life (HRQL) and exercise capacity |
| |in patients with COPD. A total of 23 Randomized control trial met the inclusion criteria for this review. Study results |
| |demonstrated clinically and statistically significant improvements in dyspnea, fatigue and mastery. These results were reported to|
| |strongly support PR, including at least four weeks of aerobic exercise training as part of the management for individuals with|
| |COPD. When compared with other modalities of treatment for COPD (e.g., bronchodilators). Physical Therapy Technique in Pulmonary |
| |rehabilitation showed greater improvements in important areas of HRQL and functional exercise capacity. |
| | |
| |6) Normandin EA et al (2002)33 conducted a prospective, randomized, 8-week trial to compare the effectiveness of two forms of |
| |exercise training in pulmonary rehabilitation in COPD patients. Forty patients with COPD were divided into two groups. The |
| |high-intensity group trained predominately on the stationary bicycle and treadmill, with a goal of exercising at > or = 80% of |
| |maximal level determined from incremental testing for 30 min per session. The low-intensity group performed predominately |
| |classroom exercises for approximately 30 min per session. For both groups, twice-weekly sessions were held for 8 weeks. The |
| |primary outcome measure was health status, measured using the Chronic Respiratory Disease Questionnaire. Patients in the |
| |high-intensity group showed greater increases in treadmill endurance and greater reductions in exertional dyspnea, whereas those |
| |in the low-intensity group showed greater increases in arm-endurance testing. Both groups had similar improvements in overall |
| |dyspnea, functional performance, and health status. Hence they conclude that despite differences in exercise performance, both |
| |high-intensity, lower-extremity endurance training and low-intensity calisthenics led to similar short-term improvements in |
| |questionnaire-rated dyspnea, functional performance, and health status. |
| | |
| |7) R H Green et al (2001)37 conducted a randomized controlled trial on 44 patients to identify four weeks versus seven weeks of |
| |rehabilitation which included Physical Therapy Technique in chronic obstructive pulmonary disease. Rehabilitation programmes have |
| |been shown to improve both exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). |
| |Patients were randomized to either standard seven week twice weekly outpatient based programme or a comparable but shortened four |
| |week course. They were assessed at baseline and at completion by the Chronic Respiratory Questionnaire (CRQ), the Breathing |
| |Problems Questionnaire (BPQ), the incremental shuttle walking test (SWT), and the treadmill endurance test (TET). Patients who |
| |completed the seven week rehabilitation programme had greater improvements in all outcome measures than those undertaking the four|
| |week course. Hence they concluded that seven week course of pulmonary rehabilitation provides greater benefits to patients than a|
| |four week course in terms of improvements in health status. |
| | |
| |8) Sherra Solway et al (2001)43 performed a qualitative systematic overview of the measurement properties of the most commonly |
| |utilized walk tests in the cardiorespiratory domain: the 2-min walk test (2MWT), 6-min walk test (6MWT), 12-min walk test (12MWT),|
| |self-paced walk test (SPWT), and shuttle walk test (SWT). Only studies conducted on patients with cardiac and/or respiratory |
| |involvement were included. They found fifty-two studies examining measurement properties of the various walk tests, 5 studies on |
| |the 2MWT, 29 studies on the 6MWT, 13 studies on the 12MWT, 6 studies on the SPWT, and 4 studies on the SWT. Measurement properties|
| |were most strongly demonstrated for the 6MWT. Correlations of 6MWT distance and maximal oxygen consumption ranged from 0.51 to |
| |0.90. A change in distance walked of at least 54 m was found to be clinically significant for the 6MWT. They conclude that |
| |measurement properties of the 6MWT have been the most extensively researched and established. In addition, the 6MWT is easy to |
| |administer, better tolerated, and more reflective of activities of daily living than the other walk tests. Therefore, the 6MWT is |
| |currently the test of choice when using a functional walk test for clinical or research purposes. |
| | |
| |9) Gordon H Guyatt et al (1987)15 Since the relationships between pulmonary function, exercise capacity, and functional state or |
| |quality of life are generally weak, a self report questionnaire has been developed to determine the effect of treatment on quality|
| |of life in clinical trials. One hundred patients with chronic airflow limitation were asked how their quality of life was affected|
| |by their illness, and how important their symptoms and limitations were. The most frequent and important items were used to |
| |construct a questionnaire evaluating four dimensions: dyspnoea, fatigue, emotional function, and the patient's feeling of control |
| |over the disease (mastery). Reproducibility, tested by repeated administration to patients in a stable condition, was excellent: |
| |the coefficient of variation was less than 12% for all four dimensions. |
|6.4 |OBJECTIVE OF THE STUDY: |
| |To determine the impact of 8 week program of Physical Therapy Techniques on lung function and health related quality of life in|
| |patients with moderate Chronic Obstructive Pulmonary Disease (COPD). |
| |To study the effect of Physical Therapy Techniques as an adjunct to Medical Management in patients with Chronic Obstructive |
| |Pulmonary Disease (COPD). |
|7. |MATERIALS AND METHOD: |
| |Manual Treadmill |
| |Stethoscope |
| |Sphygmomanometer |
| |Stop watch |
| |Incentive Spirometry |
| |Inch tape |
| |Tilt table |
| |Computerised Spirometry |
| |Mouth piece |
| |Nose clip |
| |chair with back rest |
|7.1 |SOURCES OF DATA: |
| |For the purpose of data collection 30 subjects with the mean age of 30-50 years diagnosed as moderate COPD by the Physician and |
| |will be referred to cardiorespiratory Physiotherapy department in Navodaya Medical College Hospital And Research Centre, Raichur. |
| |Only Male population will be chosen for this study. |
|A. |RESEARCH DESIGN: |
| |The Pre-Test, Post-Test Control Group Study Design which is true experimental in nature. |
|B. |SETTING OF STUDY: |
| |Department of cardiorespiratory Physiotherapy, Navodaya Medical College Hospital and Research Center, Raichur which is 950 bedded |
| |multi speciality hospital with fully equipped cardiorespiratory unit. |
|C. |VARIABLES: |
| |Independent Variable: Physical Therapy Techniques. |
| |Dependent Variables: Lung function (FEV1, FVC, FEV1/FVC %, MVV), Functional level (6 minute walk test) and Health Related Quality |
| |Of Life (CRQ). |
|D. |SAMPLE AND SAMPLING TECHNIQUES |
| |Since the study is true experimental in nature, Randomized sampling technique is adopted to select the subjects who are all |
| |attending the cardiorespiratory physiotherapy Department. |
| |Total sample consists of 30 subjects with moderate COPD. |
| |15 Patients are in Group A will be receiving Physical Therapy Techniques. |
| |15 Patients are in Group B will not be receiving any treatment except medication. |
|E. |INCLUSION CRITERIA: |
| |Patients having moderate COPD (GOLD criteria). |
| |The age between 30-50 years male population. |
| |smoking male population |
| |Patients taking same medication prescribed by the physician |
|F. |EXCLUSION CRITERIA: |
| |Mild COPD patients (GOLD criteria) |
| |Severe COPD patients (GOLD criteria) |
| |Fracture ribs |
| |Lung cancer |
| |Tuberculosis patients |
| |Non Smokers |
| |Lower limb impairment |
| |Patients with cardiac disease |
| |Respiratory paralysis |
| |Female population |
|7.2 |METHODS OF DATA COLLECTION: |
| |Lung function of FEV1, FVC, FEV1/FVC %, MVV will be assessed by SpirowinR Spirometry before and after the treatment. |
| |Functional level of the patient will be assessed before and after the treatment by using Six Minute Walk Test. |
| |Health related quality of life will be assessed before and after the treatment by using Chronic Respiratory Questionnaire (CRQ). |
|A. |STATISTICAL TEST: |
| |The student’s‘t’ test will be used to analyze the obtained data between experimental groups and control group. |
| |Intra group analysis will be done by using Paired‘t’ test. |
|7.3 |PROCEDURE: |
| |The subjects who will be diagnosed as Moderate COPD (GOLD criteria) and referred to the Cardiorespiratory Physiotherapy |
| |Department by the Physician will be taken into this study. |
| |A brief explanation of the process shall be given to prepare the subjects after obtaining the informed consent. |
| |Group A will be receiving Physical Therapy Techniques with medication. |
| |Group B will be receiving medication alone. |
| | |
| |For Spirometry: |
| |To measure FVC: |
| |The subject will be asked to sit comfortably in a chair. |
| |Tight clothing will be loosened. |
| |Appropriate FVC technique will be demonstrated and enthusiastic coaching will be given to the subject. |
| |A mouthpiece will be inserted into the mouth of the subject with lips closed tightly. |
| |The subject will be asked to take a deep breath and to blow out the air as rapidly, forcibly and completely as possible. |
| |To measure MVV: |
| |The subjects will instruct and demonstrated the maneuver prior to testing. Subjects will tested in the sitting position wearing |
| |nose clip and instructed to do maximum inhalation and exhalation as rapidly as possible for 12 seconds. |
| |For Six Minute Walk Test: |
| |The subjects will be asked to walk as much as possible within 6 minute. |
| | |
| |For Health Related Quality Of Life: |
| |The subjects Health Related Quality Of Life will be assessed by using the Chronic Respiratory Questionnaire ( CRQ).The |
| |Questionnaire consists of 20 items which is divided into four domains: dyspnea (five items), fatigue (four items), emotional |
| |function (seven items) and mastery (four items) which will be asking to the subjects. |
| | |
| |Physical Therapy Techniques will be given to the patients in the following ways: |
| |Exercise training in the form of treadmill for 30 minutes followed by 10 minutes of rest.8 According to AACVPR intensity for |
| |exercise training will be taken as 40 – 60% of THRR. |
| |Arm exercises for 10 minute. It improves performance and tolerance to dyspnea.22,30 |
| |Respiratory muscle training in the form of Incentive Spirometry for 20 minutes followed by 5 minutes of rest.45 |
| |Breathing retraining in the form of pursed lip breathing for 8 minutes followed by 5 minutes of rest. This technique modulates and |
| |creates a new type of breathing which enhances tidal volume and lowers respiratory frequency without affecting the duty cycle |
| |fraction of inspiration to total duration of breathing cycle.4,9 |
| |Chest clearance technique in the form of Postural Drainage and Forced Expiratory Technique for 30 minutes followed by 15 minutes of|
| |rest. Forced Expiratory Technique together with Postural Drainage is more effective.4,51 |
| |Education for 5 minutes which is of objective benefit. It is necessary in order to maintain a proper compliance to treatment.9,29 |
| |In order to maintain the flexibility and extensibility Warm up and Cool down period will be given for 10 minutes in the form of |
| |calisthenics and stretching. |
| |Before and after the Rehabilitation Programme Haemodynamic Variables will be assessed to evaluate the Exercise response. |
| |Therefore, the total duration of the rehabilitation programme is 2 hours and 30 minutes per day which will be given 3 times a week |
| |for 8 weeks. |
| |The Lung Function FEV1, FVC, FEV1/FVC%, MVV, the Functional Level of the patients and the Health Related Quality Of Life will be |
| |assessed by using the SpirowinR Spirometry, Six Minute Walk Test and Chronic Respiratory Questionairre (CRQ) respectively in |
| |baseline and at the end of 8 weeks. |
| | |
|7.4 | | |
| | | |
|A. |Has the study required any investigation Or Interventions|No other investigations |
| |to be conducted on animals Or human beings? | |
| | | |
|B. |Has ethical clearance obtained |(i) Yes, ethical clearance is obtained from the institutional ethical |
| | |committee of NAVODAYA COLLEGE OF PHYSIOTHERAPY |
| | | |
| | |(ii) Informed consent will be obtained from subject before the |
| | |treatment. |
| |REFERENCE: |
| | |
| |ACCP-AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonary rehabilitation: joint ACCP/AACVPR evidence based guidelines. J |
| |Cardiopulmonary Rehabil 1997;17:371-405. |
| | |
| |ACCP-AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonary rehabilitation:Joint ACCP/AACVPR evidence based guidelines. Chest |
| |1997; 112:1363-1396. |
| | |
| |American Physical Therapy Association. "Discovering Physical Therapy. What is physical therapy". American Physical Therapy |
| |Association. Retrieved 2008-05-29. |
| | |
| |American Thoracic Society. Standards for the diagnosis and care of patients with obstructive pulmonary disease (COPD) and asthma. Am|
| |Rev Respir Dis 1987;136: 225–244. |
| | |
| |American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir |
| |Crit Care Med 1995;152(5 Pt 2):S77–S121. |
| | |
| |American Thoracic Society. Standards for the diagnosis and care of patients with chronicobstructive pulmonary disease (COPD) and |
| |asthma. Am Rev Respir Dis 1995; 152:S78-S121. |
| | |
| |Anto JM, Vermeire P, Vestbo J, et al. Epidemiology of chronic obstructive pulmonary disease. Eur Respir J 2001; 17: 982–94. |
| | |
| | |
| | |
| |Belman MJ. Exercise training in pulmonary rehabilitation. Clin Chest Med 1986; 7: 585–598. |
| | |
| |Celli BR. Pulmonary rehabilitation in patients with COPD. Am J Respir Crit Care Med 1995; 152:861-64. |
| | |
| |Celli BR, Snider GL, Heffner J, et al. Standards for the diagnosis and care of patients with COPD. Am J Respir Crit Care Med 1995; |
| |152(suppl 5):S78-121. |
| | |
| |de Torres JP, Casanova C, Hernandez C, Abreu J, Aguirre-Jaime A, Celli BR. Gender and COPD in patients attending a pulmonary clinic.|
| |Chest 2005; 128: 2012–16. |
| | |
| |Donner CF, Braghiroli A, Lusuardi M. Selection criteria for pulmonary rehabilitation. Eur Respir Rev 1991;1: 472–474. |
| | |
| |European Respiratory Society Rehabilitation and Chronic Care Scientific Group. Pulmonary rehabilitation in chronic obstructive |
| |pulmonary disease (COPD) with recommendations for its use. Eur Respir Rev 1991; 6: 1–568. |
| | |
| |Ghassan F. Salman, Michael C. Mosier, Brent W. Beasley and David R. Calkins. Rehabilitation for patients with chronic obstructive |
| |pulmonary disease. Journal of General Internal Medicine. Volume 18, Number 3 / March, 2003: 213-221. |
| | |
| |Gordon H Guyatt, Leslie B Berman, Marie Townsend, Stewart O Pugsley, Larry W Chambers. A measure of quality of life for clinical |
| |trials in chronic lung disease. Thorax 1987;42:773-778. |
| | |
| | |
| |Guell R, Casan P, Sangenis M, et al. Quality of life in patients with chronic respiratory disease: the Spanish version of the |
| |Chronic Respiratory Questionnaire (CRQ). Eur Respir J 1998; 11:55–60. |
| | |
| |Hideki Katsura, Akiko Kanemaru, Kouichi Yamada, Takashi Motegi, Ritsuko Wakabayashi and Kozui Kida. Long-term effectiveness of an |
| |inpatient pulmonary rehabilitation program for elderly COPD patients: Comparison between young-elderly and old-elderly groups. |
| |Respirology Volume 9 Issue 2, Pages 230 – 236. |
| | |
| |Hnizdo E, Sullivan PA, Bang KM, Wagner G. Association between chronic obstructive pulmonary disease and employment by industry and |
| |occupation in the US population: a study of data from the Third National Health and Nutrition Examination Survey.Am J Epidemiol |
| |2002; 156: 738–46. |
| | |
| |Hutchinson J. On the capacity of the lungs and on the respiratory function with a view of establishing a precise and easy method of |
| |detecting disease by the spirometer. Med Chir (London).1846;29:137-161. |
| | |
| |Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, et al. Pulmonary rehabilitation for chronic obstructive pulmonary |
| |disease. Cochrane Database Syst Rev. 2002;(3):CD003793. |
| | |
| |Lacasse Y, Wong E, Guyatt GH, King D, Cook DJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive |
| |pulmonary disease. Lancet 1996; 348:1115-1119. |
| | |
| |Lake FR, Henderson K, Briffa T, Openshaw J, Musk W. Upper limb and lower limb exercise training in patients with chronic airflow |
| |limitation. Chest 1990; 97: 1077–1082. |
| | |
| |Lange P, Parner J, Vestbo J, et al. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998; 339:|
| |1194–200. |
| | |
| |Longmore, J. M.; Murray Longmore; Wilkinson, Ian; Supraj R. Rajagopalan (2004). Oxford handbook of clinical medicine. Oxford |
| |[Oxfordshire]: Oxford University Press. pp. 188–9. ISBN 0-19-852558-3. |
| | |
| |Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global burden of disease and risk factors. Washington: The WorldBank, 2006. |
| | |
| |Laskin JJ, Bundy S, Marron H, et al. Using a treadmill for the 6-minute walk test: Reliability and validity. Journal of |
| |Cardiopulmonary Rehabilitation and Prevention. 2007;27:407-410. |
| | |
| |Laura B Herpel, Richard E, Kanner M. Variability of Spirometry in COPD. Am J Respir crit care MED. May 2006;173(10):1106-13. |
| | |
| |Lawlor DA, Ebrahim S, Davey SG. Association between self-reported childhood socioeconomic position and adult lung function: findings|
| |from the British Women’s Heart and Health Study. Thorax 2004; 59: 199–203. |
| | |
| |Make BJ. Collaborative self-management strategies for patients with respiratory disease. Respir Care 1994; 39: 566–579. |
| | |
| |Martinez FJ, Vogel PD, Dupont DN, Stanopoulos I, Gray A, Beamis JF. Supported arm exercise vs unsupported arm exercise in the |
| |rehabilitation of patients with severe chronic airflow obstruction. Chest 1993; 103: 1397–1402. |
| | |
| | |
| |Mason RJ, Broaddus VC, Murray JF, Nadel JA. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders;|
| |2005. |
| | |
| |NHLBI/WHO workshop report. Global initiative for chronic obstructive lung disease. National Institutes of Health, National Heart, |
| |Lung, and Blood Institute, Publication No. 2701, April, 2001. |
| | |
| |Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in |
| |pulmonary rehabilitation. Chest. 2002 Apr;121(4):1085-91. |
| | |
| |O'Donohue WJ Jr, Plummer AL. Magnitude of usage and cost of home oxygen therapy in the United States [editorial]. Chest 1995; |
| |107:301-2. |
| | |
| |Pauwels, R, et al: global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLB/WHO |
| |global initiative for chronic obstructive lung disease (GOLD) workshop summary. Am J Respir Crit Care Med 163:1256, 2001. |
| | |
| |Paz-Diaz H, Montes de Oca M, López JM, Celli BR: Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in|
| |patients with COPD. Am J Phys Med Rehabil 2007;86:30-36. |
| | |
| |R H Green, S J Singh, J Williams, M D L Morgan A randomised controlled trial of four weeks versus seven weeks of pulmonary |
| |rehabilitation in chronic obstructive pulmonary disease. Thorax 2001;56:143-145 doi:10.1136/thorax.56.2.143. |
| | |
| |Ries AL. Position paper of the American Association of Cardiovascular and Pulmonary Rehabilitation: Scientific basis of pulmonary |
| |rehabilitation. J Cardiopulm Rehabil 1990;10:418-41. |
| | |
| |Ries AL. Pulmonary rehabilitation. In: Mahler DA, ed. Lung Biology in Health and Disease: Pulmonary Disease in the Elderly Patient. |
| |New York, Marcel Dekker Inc., 1993; pp. 219–237. |
| | |
| |Ries AL. What pulmonary rehabilitation can do for your patients. J Respir Dis 1995; 16:685-704. |
| | |
| |Rogers DF. Mucus pathophysiology in COPD: differences to asthma, and pharmacotherapy. Monaldi Arch Chest Dis. 2000 Aug;55(4):324-32.|
| | |
| |Sadaria KS, Bohannon RW. The 6-minute walk test: A brief review of literature. Clinical Exercise Physiology. 2001;3:127-132. |
| | |
| |Sherra Solway, Dina Brooks, Yves Lacasse and Scott Thomas. Measurement Properties of Functional Walk A Qualitative Systematic |
| |Overview of the Tests Used in the Cardiorespiratory Domain. Chest 2001;119;256-270. |
| | |
| |Shohaimi S, Welch A, Bingham S, et al. Area deprivation predicts lung function independently of education and social class. Eur |
| |Respir J 2004; 24: 157–61. |
| | |
| |Smith K, Cook D, Guyatt GH, Madhavan J, Oxman AD. Respiratory muscle training in chronic airflow limitation: a meta-analysis. Am Rev|
| |Respir Dis 1992; 145:533–539. |
| | |
| | |
| |Soriano JB, Davis KJ, Coleman B, et al. The proportional Venn diagram of obstructive lung disease: two approximations from the |
| |United States and the United Kingdom. Chest 2003; 124: 474–81. |
| | |
| |Stoller JK, Aboussouan LS. α1-antitrypsin defi ciency. Lancet 2005; 365:2225–36. |
| | |
| |UEKI Jun (Juntendodai Iryokango). Diagnosis of COPD. Prog Med Vol.25; No.4; Page.965-968(2005). |
| | |
| |Wedzicha JA. COPD exacerbations: defi ning their cause and preventions. Lancet 2007; 370: 786–96. |
| | |
| |Wilt TJ, Niewoehner D, Kim C-B, Kane RL, Linabery A, Tacklind J, MacDonald R, Rutks I.Use of Spirometry for Case Finding, Diagnosis,|
| |and Management of Chronic ObstructivePulmonary Disease (COPD). Evidence Report/Technology Assessment No. 121 (Prepared by |
| |theMinnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQPublication No. 05-E017-2. Rockville, MD. Agency |
| |for Healthcare Research and Quality.September 2005. |
| | |
| |ZuWallack RL, Patel K, Reardon JZ, Clark BA, Normandin EA. Predictors of improvement in the 12-minute distance following a six week |
| |out-patient pulmonary rehabilitation program. Chest 1991; 99: 805–808. |
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|NAME OF THE CANDIDATE |MOIRANGTHEM JAMES |
| | |
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|SIGNATURE | |
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|REMARKS OF THE GUIDE |PROJECT IS RECOMMENDED FOR APPROVAL BY THE UNIVERSITY |
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|NAME AND DESIGNATION OF GUIDE |Mrs. HEERA VIJAYAKUMAR |
| |ASSOCIATE PROFESSOR |
| |NAVODAYA COLLEGE OF PHYSIOTHERAPY, RAICHUR. |
| | |
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|SIGNATURE | |
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|PRINCIPAL |MR.P.VIJAYAKUMAR |
| |NAVODAYA COLLEGE OF PHYSIOTHERAPY, |
| |RAICHUR. |
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|REMARKS OF THE PRINCIPAL |RECOMMENDED FOR APPROVAL |
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|SIGNATURE | |
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