Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Feasibility of Pulmonary Rehabilitation in Patients with Interstitial Lung Diseases Including Patients with Combined Pulmonary Fibrosis and Emphysema(2023-08-14) Alsomali, Hana; Ward, ChrisIntroduction: Interstitial lung diseases (ILD) are characterized by interstitial inflammation or fibrosis, leading to impaired gas exchange, shortness of breath, decreased exercise tolerance, and reduced quality of life. Combined pulmonary fibrosis and emphysema (CPFE) is the co-existing presence of pulmonary fibrosis and emphysema. Data describing the experience of tailored pulmonary rehabilitation program (PRP) in people with ILD is rare and in particular in patients with CPFE are lacking. This PhD aimed to determine the characteristics and prognosis of patients with CPFE in a United Kingdom cohort, and to assess the feasibility of inspiratory muscle training (IMT) as part of a PRP for patients with ILD including patients with CPFE. Methods: A five-year retrospective single centre study was conducted at the regional ILD clinic. Then a feasibility study with a randomized controlled trial design was conducted Patients were randomized into intervention group IMT + PRP and a control group PRP only. The IMT was performed using POWERBreathe® twice daily. The PRP consisted of one session a week for 6-8 weeks. Results: Retrospective study showed that 203 patients with CPFE were diagnosed. Mean age and Body Mass Index (BMI) for patients with CPFE were 72 years (SD = 8.7), and 28.1 kg/m² (SD = 4.4) respectively. Median survival time for patients with idiopathic pulmonary fibrosis (IPF) subtype CPFE n= 93 was 3.2 years (2.1-4.2).. Kaplan Meier analysis showed statistically significant differences between Gender at birth-Age-Physiology (GAP) stages with a p-value of 0.012 in patients with IPF subtype CPFE. PRP had an attendance and completion rates of mean of 87% and 64% respectively. No side effects were reported during the study. The maximum inspiratory pressure (MIP) improved in all participants. Conclusion: Patients with CPFE were relatively old, majority male, with a history of smoking, and had poor prognosis. The GAP index and staging system demonstrated prognostic capability in patients with IPF subtype CPFE. At least half the patients with CPFE were not referred to PRP, indicating low referral rates. A tailored PRP program was feasible and well received in patients with CPFE, indicating that this was a viable and beneficial treatment option for patients with CPFE where therapeutic options are limited.5 0Item Restricted The Effeciveness of Combining both Exercise Training and Inspiratory Muscle Training in the Treatment of Patients with Heart Failure to Improve their Quality of Life: A Systematic Review(2023-03-20) Jaber, Amal; Tame, Jo-DeeBackground: Heart failure is a multi-organ dysfunction that affects multiple systems, including the cardiovascular, and respiratory systems, potentially becoming a major contributor to oedema, dyspnoea and exercise intolerance. Dyspnoea and exercise intolerance are associated with a poor prognosis, worsened by raising physical activity levels during regular everyday activities. Consequently, poor quality of life is reported in heart failure patients as they are less healthy or able to engage in daily activities. Exercise training alone has enhanced the quality of life for heart failure patients as has inspiratory muscle training alone. Combining exercise with inspiratory muscle training may offer additional benefits in terms of patients’ quality of life. This review aims to determine the benefits in quality of life when combining exercise and inspiratory muscle training for therapy with heart failure patients. Objectives: To determine if there is evidence that exercise and inspiratory muscle training combined enhance people with heart failure's quality of life. To identify any evidence that indicates that using exercise and inspiratory muscle training combined is more beneficial for treating people with heart failure than using either one alone, in terms of enhancing quality of life. To determine the course of future research in this field. Methods: To meet the aim and objectives, a systematic review was conducted. Randomised control trials were selected for this review. Several sources were used between September first and November 18, 2022, including EMBASE, CINAHL, Web of Science, Scopus, Trip PRO, ASSIA and Dimensions.ai. Each randomised control trial’s methodological quality was evaluated by two independent reviewers. Data was synthesised using a narrative synthesis because of heterogeneity of the data. Results: There were found to be five randomised control trials of moderate to high quality with a total of 402 participants. The combination of exercise and inspiratory muscle training was shown to be statistically significant regarding quality of life outcomes pre-post intervention in all five trials (P < 0.05). There were statistically significant findings regarding quality of life outcomes pre-post inspiratory muscle training alone but not for exercise alone. Conclusion: The use of exercise training and inspiratory muscle training together to improve quality of life in people with heart failure is consistently supported by the present data, according to this systematic review. This combination may improve the quality of life in heart failure patients more than exercise alone, but to an extent that is similar to inspiratory muscle training alone. Further research is required to investigate the effects of specific types of exercise and inspiratory muscle training on quality of life outcomes in patients with heart failure, in addition to comparing the results of the combination intervention with exercise or inspiratory muscle training alone. Keywords: Inspiratory muscle training, exercise, quality of life, heart failure.26 0