Chronic obstructive pulmonary disease (COPD) is also known as chronic obstructive lung disease (COLD). It mainly consists of chronic bronchitis and emphysema. As the airways become narrower, due to the damage COPD causes, it is harder for oxygen to get in and out of the lungs. Pulmonary rehabilitation has become part of the care in patients with COPD, who still have symptoms and have reduced participation in everyday situations, even after medical treatment.
Most patients with COPD are long-term cigarette smokers. Patients will usually go and see a doctor because of two main symptoms they have, which are breathlessness and a cough. Sometimes they might also be wheezing or produce phlegm. They will usually get a lot of respiratory infections, especially in cold weather or when they are in a cold environment. Pulmonary rehabilitation can greatly help people who have COPD, but it will not improve their lung function.
Patients with COPD were advised to avoid the dyspnea that physical activity brings, in the 20th century. (Mahler DA, Faryniarz RN, Tomlinson D, 1992). The multi-disciplinary team used to treat patients today, was created by Petty in the 1960s. There were some doubts as to whether exercise improved muscle function in COPD, in the 1980s and in the 1990s studies showed that a programme that was well-designed could cause beneficial physiological adaptations.
Pulmonary rehabilitation is a multidisciplinary intervention, and patients with COPD, receive an assessment before entering a rehabilitation program. It consists of both physiological and psychosocial assessments and also nutritional status and physical activity participation needs to be assessed.
There are four main areas for pulmonary rehabilitation and they are to reduce symptoms, decrease disability, increase participation in physical and social activities and improve the overall quality of life (QOL). These main goals are achieved through patient and family education, exercise training, a psychosocial and behavioural intervention, and outcome assessments. (Haave E, Hyland M. 2008).
The purpose of this topic is to research the effects pulmonary rehabilitation has on chronic obstructive pulmonary disease, and if it is worth patients participating in it. Secondary sources will be used for the literature review and research on the short and long-term benefits will be looked at.
The advantages of looking at this topic is that there is a range of good evidence about the benefits that pulmonary rehabilitation can produce. The main disadvantage is that most of the literature is old, spanning over 10 years ago, although it is still valid and evidence-based. There are also conflicting views in literature, on whether pulmonary rehabilitation actually works and if there is some form of psychological factor at play.
There are no ethical issues with the pulmonary rehabilitation, as it is the patient’s choice as to whether they want to participate in the programme or not. Doctors will advise them to do it, but they are not under any obligation to attend. The sources that will be used to find the data will be academic journals and books. Middlesex University web resources will also be used to aid in the research.
This topic needs to be studied and researched further as there are no definitive and set guidelines as to what works, and in what types of patients who participate in pulmonary rehabilitation, and different people have different views on it. My own opinions will also be used in the research and arguments for and against will be given.
Literature Review- 2550
Ries AL et al 1995 conducted a study where the main objective was “To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease”. They conducted a randomized clinical trial using 119 outpatients with COPD that was stable, while patients received a standard medical regimen.
The patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. There were twelve 4-hour sessions of pulmonary rehabilitation, which included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Reinforcement sessions were held monthly, for a 1 year. There were four 2-hour sessions the education group had to attend, which included videotapes, lectures, and discussions but not any individual instruction or exercise training.
The patient’s symptoms of perceived breathlessness and muscle fatigue with exercise were measured. Also their general quality of well-being, pulmonary function, depression, and hospitalizations associated with pulmonary diseases were measured. Their findings were that compared with only education, comprehensive pulmonary rehabilitation produced a considerably greater increase in maximal exercise tolerance.
The conclusion was that comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease.
The reliability issues with the research, is that it did not state whether each patient attended every session. This could make the research unreliable because if one person did not attend one session, they would not get the same effects from the sessions as all the other patients. Also it didn’t state whether each patient also attended every reinforcement session. Some patients might have thought it was tedious or a waste of time to keep going back every month for a year. This would also make the research unreliable.
The validity issues with the research is that if some patients were doing slightly different things within each session, rather than everyone doing the same thing, it is not a fair test, therefore the results would be invalid to a certain point. These factors could be controlled if the patients were given an option of when to attend, between a given time frame. This would ensure the patient would turn up at the same time and to each session; therefore the results would be reliable and valid. Also if the reinforcement sessions were held for a shorter period of time, for example six months, this wouldn’t seem as daunting to a patient as one year, and they would be more likely to attend each month.
In another study, Ries AL 2003 looked at “Maintenance after Pulmonary Rehabilitation in Chronic Lung Disease”. An evaluation of a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates was conducted.
A 12-month maintenance programme, with weekly telephone calls and monthly supervised sessions was randomly assigned to the subjects for 24 months. Both the groups were equivalent in terms of their baseline measurements and showed similar improvements after rehabilitation, except for a difference between sexes.
The subjects’ exercise tolerance, where they had to do maximum treadmill workload and 6-minute walk distance and general health results were better maintained in the experimental group, together with a reduction in hospital days during the 12-month programme.
There were no major group differences at 24 months, and the patients returned to levels close to but above pre-rehabilitation measures. The conclusion was that the maintenance program and monthly supervised sessions produced only small improvements in the maintenance of benefits after pulmonary rehabilitation. (Ries AL, Kaplan R M, Myers R, Prewitt L M, 2003).
Describe the claims made by different authors on the topic
How are these claims explained: key concepts used by various authors and whether these are clearly defined and coherently inter-related
The nature of evidence itself -qualitative, quantitative or a combination of both: do these findings stand to reason (validity) and to what extent these can be generalised (reliability)
Theories used to explain findings and how compatible these are with one another
Ethical and moral implications of various claims
The relevance to current policies on the topic
To summarise, through the literature review you need to demonstrate your understanding and knowledge of such aspects as:
competing theoretical perspectives/approaches to your topic area;
discussion of any ethical issues which arose from undertaking the reported research;
relevant empirical research;
the policy context;
the institutional and organisational context.
The review should do more than summarise the arguments and findings of key articles. It should synthesise, analyse and contrast them in a manner which supports the development of your own argument.
You need to demonstrate throughout your dissertation your understanding and knowledge of such aspects as:
How you selected your data sources (local library, internet, professional library etc.), which search terms were used and what may be the resulting bias
The claims made by different authors on the topic
How are these claims explained: key concepts used by various authors and whether these concepts are clearly defined and coherently inter-related
How was the research designed and does the design lead to a certain bias?
The nature of evidence itself -qualitative, quantitative or a combination of both: does the choice of method lead to a certain bias?
What is known about the way the chosen methods were applied – does this suggest a certain bias? (reliability)
How were the research findings interpreted and do the interpretations stand to reason? ( validity)
How do the findings relate to other evidence relevant to the claim your are examining?
Theories used to explain findings and how compatible these are with one another
Contradictions, conflicts and ambiguities that arise as a result of your analysis.
Ethical and moral implications of various claims
The relevance to current policies
This Chapter should present the discussion and analysis of the research you have undertaken, or the findings from the exploration of the secondary sources you carried out. You should use examples eg Quotations, numerical or other data to support the points made. This needs to be done in a reflective and critical manner. In particular you need to ensure that:
you avoid over long descriptive passages – try to integrate your findings in an analytical framework which is informed by the way you conceptualised the research topic at the outset.
the interpretation you place on your findings is sound and supported by evidence from the study (secondary data in the case of a literature review)
the analysis of results directly addresses your research questions and does not end up answering different questions. (These should be outlined in a section on future research)
In your conclusions you need to ensure you do the following:
summarise clearly the main findings of your research in relation to your principal research questions. These conclusions should be supported by the evidence and argument developed and not merely asserted;
avoid the conclusions being a mere summary of what has gone before. You should try to progress your ideas in this section in light of your overall research questions;
relate back to the ideas of others in your literature review – how do your findings compare?
explore implications for policy and, where appropriate, make recommendations for future policy.
Outline questions for future research arising from your study.
The dissertation should be set out in `book form’: with title page; abstract, acknowledgments; contents page (e.g. chapter headings with page numbers); list of figures/tables; list of abbreviations which are used frequently; main body of the dissertation (with new chapters always beginning on a new page and clear levels of headings); bibliography; appendices.
A title page should contain, in the following order:
title of the Dissertation
the author’s full name;
the note ‘that this study is submitted in part fulfilment of the requirements of the degree of ……………….’:
at the bottom of the page the name of Middlesex University and the year in which the dissertation was examined.
All diagrams and tables should carry a title and the sources used in compiling them must be acknowledged.
To avoid breaches of academic integrity or charges of plagiarism, all quotations should be fully acknowledged and should be indicated by quotation marks in the text. Sources for illustrations and appendices should also be acknowledged e. g ‘modified from / based on / redrawn from’.
A random selection of Dissertations will be explored using plagiarism detection software and you may be requested to submit an electronic copy of your work.
Referencing should follow the School of Health and Social Science Guidelines which are available from the Learning Resource Centre.
clear and concise use of language
good grammar and spelling
proper citation and referencing system
high quality and properly labelled illustrations
full bibliography appendices
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