29 results on '"Maria Sedeno"'
Search Results
2. Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD
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Kim L. Lavoie, Maria Sedeno, Alan Hamilton, Pei-Zhi Li, Dorothy De Sousa, Thierry Troosters, François Maltais, and Jean Bourbeau
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Medicine - Abstract
This study explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial. A 12-week, four-group, randomised, partially double-blind, placebo-controlled, parallel-group trial of SMBM in addition to tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, tiotropium/olodaterol 5/5 µg plus ExT, or placebo was conducted in 304 patients. Outcomes included anxiety (Hospital Anxiety and Depression Scale (HADS)-A), depression (HADS-D and Patient-Health Questionnaire (PHQ)-9) and cognitive function (Montreal Cognitive Assessment (MoCA)). All outcomes showed statistically and clinically significant improvements after 12 weeks independent of treatment group. However, greater improvements in HADS-A and MoCA were seen in patients who exhibited greater increases in physical activity and exercise capacity, respectively, whereas greater improvements in HADS-D and PHQ-9 were seen in patients who exhibited increases in either physical activity or exercise capacity. The results indicate that SMBM with/without bronchodilators or ExT was associated with improved psychological and cognitive functioning. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD.
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- 2019
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3. Behaviour-change intervention in a multicentre, randomised, placebo-controlled COPD study: methodological considerations and implementation
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Jean Bourbeau, Maria Sedeno, François Maltais, Kim L Lavoie, Thierry Troosters, Damijan Erzen, Nancy Leidy, Dorothy De Sousa, and Alan Hamilton
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Medicine - Abstract
Introduction Chronic obstructive pulmonary disease is generally progressive and associated with reduced physical activity. Both pharmacological therapy and exercise training can improve exercise capacity; however, these are often not sufficient to change the amount of daily physical activity a patient undertakes. Behaviour-change self-management programmes are designed to address this, including setting motivational goals and providing social support. We present and discuss the necessary methodological considerations when integrating behaviour-change interventions into a multicentre study.Methods and analysis PHYSACTO is a 12-week phase IIIb study assessing the effects on exercise capacity and physical activity of once-daily tiotropium+olodaterol 5/5 µg with exercise training, tiotropium+olodaterol 5/5 µg without exercise training, tiotropium 5 µg or placebo, with all pharmacological interventions administered via the Respimat inhaler. Patients in all intervention arms receive a behaviour-change self-management programme to provide an optimal environment for translating improvements in exercise capacity into increases in daily physical activity. To maximise the likelihood of success, special attention is given in the programme to: (1) the Site Case Manager, with careful monitoring of programme delivery; (2) the patient, incorporating patient-evaluation/programme-evaluation measures to guide the Site Case Manager in the self-management intervention; and (3) quality assurance, to help identify and correct any problems or shortcomings in programme delivery and ensure the effectiveness of any corrective steps. This paper documents the comprehensive methods used to optimise and standardise the behaviour-change self-management programme used in the study to facilitate dialogue on the inclusion of this type of programme in multicentre studies.Ethics and dissemination The study has been approved by the relevant Institutional Review Boards, Independent Ethics Committee and Competent Authority according to national and international regulations. The results of this study will be disseminated through relevant, peer-reviewed journals and international conference presentations.Trial registration number NCT02085161.
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- 2016
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4. Evaluation of an Enhanced Pulmonary Rehabilitation Program: A Randomized Controlled Trial
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Maria Sedeno, Jean Bourbeau, Joshua Wald, Tina Jourdain, Tania Janaudis-Ferreira, Michael K. Stickland, Anne-Marie Selzler, and Roger S. Goldstein
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Pulmonary and Respiratory Medicine ,COPD ,medicine.medical_specialty ,Healthcare use ,Exercise Tolerance ,business.industry ,medicine.medical_treatment ,Physical activity ,Pulmonary disease ,medicine.disease ,Health outcomes ,Self Efficacy ,law.invention ,Pulmonary Disease, Chronic Obstructive ,Randomized controlled trial ,law ,Quality of Life ,medicine ,Humans ,Pulmonary rehabilitation ,business ,Intensive care medicine ,Exercise - Abstract
Rationale: Pulmonary rehabilitation (PR) is the most effective strategy to improve health outcomes in people with chronic obstructive pulmonary disease (COPD), although it has had limited success i...
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- 2021
5. Canadian consensus recommendations for a research agenda in pulmonary rehabilitation post-acute exacerbation of COPD: A meeting report
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Gregory Moullec, Maria Sedeno, H M Vasiliadis, Tania Janaudis-Ferreira, Donna Goodridge, S Levitz, Lauren Tracey, Samantha L. Harrison, Sara Ahmed, Joshua Wald, Michael K. Stickland, Jean Bourbeau, J Spahija, F Campbell, Roger S. Goldstein, Gail Dechman, and Pat G. Camp
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COPD ,Exacerbation ,business.industry ,medicine.medical_treatment ,education ,Pulmonary disease ,Critical Care and Intensive Care Medicine ,medicine.disease ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Pulmonary rehabilitation ,030212 general & internal medicine ,Intensive care medicine ,business - Abstract
RATIONALE: A recent Cochrane review concluded that Pulmonary Rehabilitation (PR) post-acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is safe, reduces hospital admissions and ...
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- 2020
6. Multicentre comparison of self-management in patients with COPD
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Tomoko Kutsuzawa, Ritsuko Wakabayashi, Takashi Motegi, Maria Sedeno, Jean Bourbeau, Tetsuya Urano, and Kozui Kida
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COPD ,Self-management ,business.industry ,Psychological intervention ,Information needs ,medicine.disease ,Pulmonary function testing ,Original Research Articles ,Physical therapy ,medicine ,Outpatient clinic ,Medicine ,Disease management (health) ,business ,Patient education - Abstract
In patients with COPD, self-management plays an important role in disease management. Recently, self-management programmes have expanded patient education practices to include a variety of disease management techniques. We hypothesised that COPD patients have insufficient and/or different self-management needs according to institution. We compared information needs of patients between specialised clinics in Canada (SCC) and Japan and a hospital outpatient clinic in Japan (HCJ), all employing different self-management interventions. This cross-sectional study evaluated patients’ information needs for disease management using the Lung Information Needs Questionnaire (LINQ). Furthermore, we assessed pulmonary function tests, modified Medical Research Council (mMRC) dyspnoea scale and frequencies of hospitalisations and emergency visits. The total number of patients was 183. Those attending SCC were younger (p=0.047), with lower forced expiratory volume in 1 s % predicted (p, This study compared patients’ information needs from three institutions, highlighting real-world differences in information needs and the importance of assessing individual needs for self-management in COPD https://bit.ly/3jlPbse
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- 2021
7. Mechanisms associated with increased physical activity in patients undergoing self-management behaviour modification in the randomised PHYSACTO trial
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Maria Sedeno, Alan Hamilton, François Maltais, Dorothy De Sousa, Thierry Troosters, Kim L. Lavoie, Damijan Erzen, Jean Bourbeau, and Pei Zhi Li
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COPD ,Self-management ,business.industry ,Visual analogue scale ,Behaviour modification ,Olodaterol ,lcsh:R ,Increased physical activity ,lcsh:Medicine ,Original Articles ,Placebo ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Physical therapy ,Medicine ,In patient ,sense organs ,business - Abstract
Introduction In this analysis of the PHYSACTO® study, we assessed the efficacy of a self-management behaviour modification (SMBM) programme to improve physical activity (PA) levels, and the extent to which effects were mediated by readiness to change, motivation and confidence. Methods PHYSACTO® was a randomised, partially double-blind, parallel-group, 12-week trial to evaluate the effects of treatment on exercise capacity and PA. COPD patients received placebo, tiotropium 5 µg or tiotropium/olodaterol 5/5 µg, with or without exercise training, all with an SMBM intervention (the Living Well with COPD programme). Changes were assessed in readiness to change (stage of change visual analogue scale [VAS]), motivation (Treatment Self-Regulation Questionnaire [TSRQ]) and confidence (Perceived Competence Scale [PCS]) to engage in PA. Results PA was increased in all patients with complete PA data at Week 12 (n=262; +6038 steps·week−1, p, Self-management improves motivation and confidence to engage in physical activity in COPD patients in PHYSACTO https://bit.ly/2MKoPSy
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- 2021
8. Implementation and Sustainability of an Enhanced Pulmonary Rehabilitation Program in a Single Centre
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Joshua Wald, Tania Janaudis-Ferreira, Michael K. Stickland, Catherine M. Tansey, Thais Paes, Anne-Marie Selzler, Maria Sedeno, Jean Bourbeau, and Kim van der Braak
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Single centre ,medicine.medical_treatment ,Sustainability ,medicine ,Pulmonary rehabilitation ,Operations management ,Business - Abstract
Background: Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). The availability of PR in Canada is low. To facilitate implementation, a standardized and enhanced PR Program has been developed with a self-management education intervention that has been validated and shown to be effective. The objectives of our study were to assess the implementation of this program into a single site; determine the sustainability 18 months after implementation; and to identify the satisfaction with, facilitators of and barriers to implementation and sustainability of the program as perceived by patients with COPD and HCPs. Methods: We conducted a prospective pre-post study which consisted of two phases: 1) the implementation phase (first six months after implementation) and 2) the sustainability phase (18 months after implementation). Guided by the RE-AIM framework, outcomes including: Reach (number of patients enrolled and demographics), Effectiveness (Change in patient outcomes), Adoption (HCPs’ characteristics), Implementation (Program fidelity) and Maintenance (Patient outcomes at 3-month follow-up). Results: Reach: Twenty-six patients were included for both phases (two different samples). Effectiveness: Clinically important improvements in patient outcomes were found for functional exercise capacity, knowledge, functional status and self-efficacy in both phases of the study. Adoption: All HCPs involved in PR (N=8) agreed to participate and used the program in both phases of the study. Implementation: Fidelity for the group education sessions ranged from 76-95% in the implementation phase and from 82-88% in the sustainability phase. Maintenance (implementation phase): Clinical important improvements at 3-month follow-up were found in knowledge, self-efficacy for exercise and walking. Patients and HCPs were highly satisfied with the program. Lack of time was reported as the most common barrier and having longstanding procedures as the most common facilitator by HCPs to implementation and sustainability of the program. Conclusions: The enhanced PR program was accepted by the patients and HCPs and could be reliably implemented and maintained at a single expert center. The program provided clinical benefits for patients in terms of functional capacity, knowledge and self-efficacy for walking. These findings will guide planning for wide scale dissemination and implementation of the program.
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- 2020
9. Canadian consensus recommendations for a research agenda in pulmonary rehabilitation post-acute exacerbation of COPD
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Gail Dechman, Gregory Moullec, Lauren Tracey, Jadranka Spahija, Sara Ahmed, Samantha L. Harrison, Maria Sedeno, Pat G. Camp, Michael K. Stickland, Jean Bourbeau, Francine Campbell, Joshua Wald, Donna Goodridge, Tania Janaudis-Ferreira, Helen-Maria Vasiliadis, Roger S. Goldstein, and Suzanne Levitz
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medicine.medical_specialty ,COPD ,Exacerbation ,business.industry ,medicine.medical_treatment ,medicine ,Pulmonary rehabilitation ,Intensive care medicine ,business ,medicine.disease - Published
- 2020
10. Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD
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Maria Sedeno, Thierry Troosters, Kim L. Lavoie, Pei-Zhi Li, Dorothy De Sousa, Alan Hamilton, Jean Bourbeau, and François Maltais
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Psychological intervention ,lcsh:Medicine ,Hospital Anxiety and Depression Scale ,Placebo ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,COPD ,030212 general & internal medicine ,business.industry ,Olodaterol ,lcsh:R ,Montreal Cognitive Assessment ,Cognition ,Original Articles ,medicine.disease ,3. Good health ,030228 respiratory system ,chemistry ,Physical therapy ,Anxiety ,medicine.symptom ,business - Abstract
This study explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial. A 12-week, four-group, randomised, partially double-blind, placebo-controlled, parallel-group trial of SMBM in addition to tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, tiotropium/olodaterol 5/5 µg plus ExT, or placebo was conducted in 304 patients. Outcomes included anxiety (Hospital Anxiety and Depression Scale (HADS)-A), depression (HADS-D and Patient-Health Questionnaire (PHQ)-9) and cognitive function (Montreal Cognitive Assessment (MoCA)). All outcomes showed statistically and clinically significant improvements after 12 weeks independent of treatment group. However, greater improvements in HADS-A and MoCA were seen in patients who exhibited greater increases in physical activity and exercise capacity, respectively, whereas greater improvements in HADS-D and PHQ-9 were seen in patients who exhibited increases in either physical activity or exercise capacity. The results indicate that SMBM with/without bronchodilators or ExT was associated with improved psychological and cognitive functioning. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD., Behavioural modification adjunct to bronchodilator therapy and exercise training to increase exercise capacity and physical activity can also be beneficial for improving anxiety, cognitive function and depression in patients with COPD http://bit.ly/33ZufNM
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- 2019
11. Telehealth pulmonary rehabilitation: A review of the literature and an example of a nationwide initiative to improve the accessibility of pulmonary rehabilitation
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Michael K. Stickland, Maria Sedeno, Joshua Wald, Tania Janaudis-Ferreira, Jean Bourbeau, Anne-Marie Selzler, Jourdain T, and Roger S. Goldstein
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Pulmonary and Respiratory Medicine ,Canada ,Functional exercise ,telehealth ,medicine.medical_treatment ,Reviews ,Telehealth ,Health Services Accessibility ,chronic obstructive pulmonary disease ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Quality of life (healthcare) ,medicine ,chronic disease management ,Humans ,Pulmonary rehabilitation ,030212 general & internal medicine ,Telerehabilitation ,Rehabilitation ,business.industry ,Program quality ,medicine.disease ,Telemedicine ,accessibility ,030228 respiratory system ,Healthcare utilization ,Medical emergency ,business - Abstract
Several different applications of telehealth technologies have been used in the care of respiratory patients, including telemonitoring, teleconsultations, tele-education, and telehealth-pulmonary rehabilitation (PR). Telehealth technology provides an opportunity to assist in the management of chronic respiratory diseases and improve access to PR programs. While there is inconclusive evidence as to the effectiveness of telemonitoring to reduce healthcare utilization and detection of exacerbations, teleconsultations have been shown to be an effective means to assess patients' disease prior to the initiation of PR, and telehealth PR has been shown to be as effective as institution-based PR at improving functional exercise capacity and health-related quality of life. To improve PR access across Canada and ensure a high standard of program quality, a team of clinicians and researchers has developed and begun to implement a national standardized PR program that can be delivered across different settings of practice, including remote satellite sites via telehealth PR. The program has adapted the "Living Well with COPD" self-management program and includes standardized reference guides and resources for patients and practitioners. A progressive and iterative process will evaluate the success of program implementation and outcomes. This initiative will address nationwide accessibility challenges and provide PR content as well as evaluations that are in accordance with clinical standards and established self-management practices.
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- 2017
12. Effects of bronchodilator therapy and exercise training, added to a self-management behaviour-modification programme, on physical activity in COPD
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Maria Sedeno, Damijan Erzen, D De Sousa, Thierry Troosters, François Maltais, Lawrence Korducki, Kim L. Lavoie, Wim Janssens, Nancy Kline Leidy, Jean Bourbeau, and Alan Hamilton
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COPD ,Self-management ,Behaviour modification ,medicine.drug_class ,business.industry ,Physical activity ,Physiology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Bronchodilator ,Physical therapy ,medicine ,030212 general & internal medicine ,business - Published
- 2017
13. Innovating the treatment of COPD exacerbations: a phone tele-system to increase Action Plan adherence
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Maria Sedeno, Raquel Farias, Danielle Beaucage, Rita Abimaroun, Jean Bourbeau, Mira Abou Rjeili, Isabelle Drouin, Isabelle Ouellet, Alexandre Joubert, Pei Zhi Li, and Meena Patel
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COPD ,Phone ,business.industry ,Action plan ,medicine ,Medical emergency ,medicine.disease ,business - Published
- 2018
14. Effect of Bronchodilation, Exercise Training, and Behavior Modification on Symptoms and Physical Activity in Chronic Obstructive Pulmonary Disease
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Kim L. Lavoie, Damijan Erzen, Jean Bourbeau, François Maltais, Lawrence Korducki, Alan Hamilton, Thierry Troosters, Maria Sedeno, Wim Janssens, Nancy Kline Leidy, Judith Garcia-Aymerich, and Dorothy De Sousa
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Physical activity ,Pulmonary disease ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Double-Blind Method ,Behavior Therapy ,Bronchodilation ,Accelerometry ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Tiotropium Bromide ,Exercise ,Aged ,COPD ,Walking test ,business.industry ,Tiotropium-olodaterol ,Exercise capacity ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Benzoxazines ,Bronchodilator Agents ,Drug Combinations ,Treatment Outcome ,030228 respiratory system ,Physical therapy ,Female ,business ,human activities - Abstract
Bronchodilation and exercise training (ExT) improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD); however, behavior modification is required to impact daily physical activity (PA).To assess whether tiotropium/olodaterol, with or without ExT, would improve exercise endurance time (EET) and PA compared with placebo in patients participating in a self-management behavior-modification (SMBM) program.This was a 12-week, randomized, partially double-blind, placebo-controlled, parallel-group trial in patients with COPD (PHYSACTO; NCT02085161). All patients were enrolled into SMBM and randomized 1:1:1:1 to once-daily placebo, tiotropium 5 μg, tiotropium/olodaterol 5/5 μg, or tiotropium/olodaterol 5/5 μg plus 8 weeks ExT. EET, measured by endurance shuttle walk test after 8 weeks, was the primary endpoint. Additional endpoints assessed downstream effects on PA (measured via accelerometry), and activity-related dyspnea and difficulty (using validated patient-reported questionnaires).SMBM plus tiotropium/olodaterol, with or without ExT, significantly improved EET at Week 8 versus SMBM plus placebo (treatment ratio vs. placebo: with ExT, 1.46; 95% confidence interval, 1.20-1.78; P = 0.0002; without ExT, 1.29; 95% confidence interval, 1.06-1.57; P = 0.0109). No significant increases in steps per day from baseline were observed over SMBM plus placebo at Week 12 (increase of 1,098) when other therapies were added. Adding tiotropium/olodaterol, with or without ExT, to SMBM reduced activity-related dyspnea versus placebo, whereas adding tiotropium/olodaterol plus ExT reduced activity-related difficulty.Tiotropium/olodaterol, with or without ExT, improved EET in patients with COPD taking part in an SMBM program. Combination bronchodilation, with or without ExT, did not provide additional increases in objective PA compared with SMBM alone but did reduce PA-related dyspnea and difficulty. Clinical trial registered with www.clinicaltrials.gov (NCT02085161).
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- 2018
15. Comprehensive Self-Management Strategies
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Maria Sedeno, Kim L. Lavoie, and Jean Bourbeau
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Behavior Control ,Pulmonary and Respiratory Medicine ,Self-management ,Quality Assurance, Health Care ,business.industry ,Health Behavior ,Behavior change ,Psychological intervention ,Critical Care and Intensive Care Medicine ,law.invention ,Self Care ,Pulmonary Disease, Chronic Obstructive ,Quality of life (healthcare) ,Randomized controlled trial ,Nursing ,law ,Intervention (counseling) ,Generalization (learning) ,Outcome Assessment, Health Care ,Health care ,Quality of Life ,Humans ,Medicine ,business ,Case Management - Abstract
In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance.
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- 2015
16. Impact of meeting behavioral targets in a self-management behaviour-modification program designed to improve physical activity in COPD patients
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Maria Sedeno, Alan Hamilton, Kim L. Lavoie, Damijan Erzen, Dorothy De Sousa, François Maltais, Thierry Troosters, Pei-Zh Li, Jean Bourbeau, and Nancy Kline Leidy
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medicine.medical_specialty ,COPD ,Self-management ,business.industry ,Copd patients ,Behaviour modification ,Olodaterol ,Physical activity ,medicine.disease ,Walking time ,chemistry.chemical_compound ,chemistry ,Activity limitation ,Physical therapy ,Medicine ,business - Abstract
Introduction: Critical to changing health behaviors and improving outcomes in COPD patients (pts) is increasing motivation and confidence to engage in those behaviors. Aim: Assess whether a self-management behaviour-modification programme (SMBM) aimed at increasing pt motivation and confidence to engage in daily physical activity (PA) is associated with increases in daily step count among COPD pts in the PHYSACTO ® Trial. Methods: A 12-wk, randomised, partially double-blind, placebo-controlled, parallel-group trial (NCT02085161) of bronchodilators ± exercise training (ExT) (tiotropium [T] 5 µg; T+olodaterol [O] 5/5 µg; T+O 5/5 µg +ExT), all with SMBM, was conducted in COPD pts. Associations between changes in motivation (Treatment Self-Regulation Questionnaire: TSRQ) and confidence (Perceived Competence Scale: PCS) and changes in PA levels (step count, walking time via accelerometer) and health status (SGRQ) from baseline to post-intervention were assessed using multiple regression, adjusting for age, sex, BMI, smoking, FEV 1 , treatment group, baseline endurance time. Results: 304 COPD pts (M age 64.8) were enrolled; 262 pts had complete PA data at 12 wks (M %FEV 1 : 49±13; baseline steps/day: 5423). Every 1-point increase on the TSRQ or PCS was associated with +297 and 202 steps, respectively and increased walking time (+2.9 & +2.1 min); every 1-point increase on the PCS was also associated with less activity limitation (SGRQ activity score: -1.77), p’s Conclusion: A SMBM program designed and able to change mediator variables such as motivation and confidence (to engage in PA) is associated with changes in actual behaviour (i.e., PA).
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- 2017
17. Effects of bronchodilator therapy and exercise with self-management behaviour-modification on psychological and cognitive outcomes in COPD
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Thierry Troosters, Alan Hamilton, Pei-Zhi Li, Maria Sedeno, Jean Bourbeau, Dorothy De Sousa, and Kim L. Lavoie
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medicine.medical_specialty ,COPD ,medicine.drug_class ,business.industry ,Olodaterol ,Montreal Cognitive Assessment ,Cognition ,Hospital Anxiety and Depression Scale ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Bronchodilator ,Physical therapy ,medicine ,Anxiety ,medicine.symptom ,business ,Depression (differential diagnoses) - Abstract
Introduction: PHYSACTO ® has demonstrated improvements in daily physical activity (PA) and PA-related symptoms in COPD patients (pts) receiving bronchodilators (BDs) ± exercise training (ExT) added to a self-management behaviour-modification programme (SMBM). Aim: To explore the impact of BDs ± ExT and SMBM on psychological and cognitive function. Methods: A 12-week (wk), randomised, partially double-blind, placebo-controlled, parallel-group trial (NCT02085161) of BDs ± ExT (tiotropium [T] 5 µg; T + olodaterol [O] 5/5 µg; T+O 5/5 µg + ExT), all with SMBM, was conducted in 304 COPD pts. Psychological outcomes included changes in levels of depression and anxiety (Hospital Anxiety and Depression Scale, HADS; Patient Health Questionnaire-9, PHQ-9) and cognitive function (Montreal Cognitive Assessment, MoCA) adjusting for age, sex, BMI, smoking, FEV 1 , and treatment group. Results: Anxiety (HADS-A -1.1), depression (HADS-D -.7, PHQ-9 -1.3) and cognitive function (MoCA +1.8) showed statistically (p Conclusions: In moderate-severe COPD, BD ± ExT with SMBM are associated with improvements in psychological and cognitive symptoms; greater improvements in depression and anxiety are associated with greater increases in PA variables. Interventions that increase daily PA may improve both physical and psychological/cognitive function in COPD pts.
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- 2017
18. Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence
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Isabelle Drouin, Meena Patel, Maria Sedeno, Isabelle Ouellet, Alexandre Joubert, Raquel Farias, Rita Abimaroun, Jean Bourbeau, Mira Abou Rjeili, and Danielle Beaucage
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Male ,Pulmonary and Respiratory Medicine ,self-management ,medicine.medical_specialty ,Exacerbation ,telehealth ,Chronic Obstructive Pulmonary Disease ,Psychological intervention ,Pilot Projects ,Telehealth ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,exacerbations ,Phone ,Health care ,medicine ,Humans ,COPD ,030212 general & internal medicine ,Aged ,Self-management ,business.industry ,Middle Aged ,Symptom Flare Up ,medicine.disease ,Telemedicine ,action plan adherence ,Telephone ,3. Good health ,Hospitalization ,Treatment Outcome ,030228 respiratory system ,Action plan ,Emergency medicine ,Quality of Life ,Feasibility Studies ,Patient Compliance ,Female ,business ,Case Management ,Follow-Up Studies - Abstract
IntroductionSelf-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic.MethodsInitially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients’ behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases.ResultsThirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, pDiscussionCOPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations.Trial registration numberNCT02275078.
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- 2019
19. Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis
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Heleen Westland, Nicholas Zwar, Jaap C.A. Trappenburg, Nini H. Jonkman, Rolf H.H. Groenwold, Maria Sedeno, Arno W. Hoes, Job van der Palen, Erik Bischoff, Thierry Troosters, Suzanne M. Lloyd, Frode Gallefoss, Michael J. Epton, Judith Garcia-Aymerich, Tanja Effing, Christine Bucknall, Marieke J. Schuurmans, Huong Q. Nguyen, Kathryn L. Rice, Jean Bourbeau, Evelyn M. Monninkhof, Stephanie Taylor, David B. Coultas, Neuromechanics, Research Institute MOVE, and Faculty of Behavioural, Management and Social Sciences
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Male ,Pediatrics ,Time Factors ,METIS-317983 ,Individual patient data meta-analysis ,Psychological intervention ,law.invention ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Quality of life ,Randomized controlled trial ,Risk Factors ,law ,Forced Expiratory Volume ,Odds Ratio ,030212 general & internal medicine ,Lung ,Original Research ,Randomized Controlled Trials as Topic ,Evidence-Based Medicine ,Chronic obstructive pulmonary disease ,Health Policy ,Hazard ratio ,General Medicine ,Middle Aged ,Hospitalization ,Treatment Outcome ,Meta-analysis ,Disease Progression ,Subgroup analysis ,Female ,Public Health ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,International Journal of Chronic Obstructive Pulmonary Disease ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,medicine ,Self-management ,Journal Article ,Humans ,Aged ,business.industry ,Patient Selection ,Environmental and Occupational Health ,Public Health, Environmental and Occupational Health ,Recovery of Function ,Confidence interval ,Self Care ,IR-101352 ,030228 respiratory system ,Strictly standardized mean difference ,Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] ,Quality of Life ,business ,Meta-Analysis - Abstract
Nini H Jonkman,1 Heleen Westland,1 Jaap CA Trappenburg,1 Rolf HH Groenwold,2 Erik WMA Bischoff,3 Jean Bourbeau,4 Christine E Bucknall,5 David Coultas,6 Tanja W Effing,7 MichaelJ Epton,8 Frode Gallefoss,9 Judith Garcia-Aymerich,10–12 Suzanne M Lloyd,13 Evelyn M Monninkhof,2 Huong Q Nguyen,14 Job van der Palen,15,16 Kathryn L Rice,17 Maria Sedeno,4 Stephanie JC Taylor,18 Thierry Troosters,19 Nicholas A Zwar,20 Arno W Hoes,2 Marieke J Schuurmans1 1Department of Rehabilitation, Nursing Science and Sports, 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; 4Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, QC, Canada; 5Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK; 6Veterans Administration Portland Health Care System and Oregon Health & Science University, Portland, OR, USA; 7Department of Respiratory Medicine, Repatriation General Hospital, Adelaide, SA, Australia; 8Canterbury District Health Board, Respiratory Services, Christchurch Hospital, Christchurch, New Zealand; 9Department of Pulmonary Medicine, Sorlandet Hospital, Kristiansand, Norway; 10Centre for Research in Environmental Epidemiology CREAL, 11Pompeu Fabra University, 12CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain; 13Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK; 14Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; 15Department of Research Methodology, Measurement and Data Analysis, University of Twente, 16Department of Clinical Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands; 17Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis Veterans Affairs Health Care Service and University of Minnesota, Minneapolis, MN, USA; 18Centre for Primary Care and Public Health, Queen Mary University of London, London, UK; 19Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium; 20School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most.Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models.Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes.Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended. Keywords: chronic obstructive pulmonary disease, individual patient data meta-analysis, self-management, subgroup analysis
- Published
- 2016
20. Early COPD Exacerbation Treatment with Combination of ICS and LABA for Patients Presenting with Mild-to-Moderate Worsening of Dyspnea
- Author
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Pei Zhi Li, Jean Bourbeau, Katrina Metz, Maria Sedeno, and Lancelot Pinto
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.drug_class ,Proof of Concept Study ,Severity of Illness Index ,Fluticasone propionate ,Medication Adherence ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Clinical Protocols ,Prednisone ,Internal medicine ,Early Medical Intervention ,Administration, Inhalation ,medicine ,Humans ,030212 general & internal medicine ,Medical prescription ,Adrenergic beta-2 Receptor Agonists ,Glucocorticoids ,Aged ,COPD ,business.industry ,Middle Aged ,medicine.disease ,Fluticasone-Salmeterol Drug Combination ,Anti-Bacterial Agents ,Dyspnea ,030228 respiratory system ,B2 receptor ,Copd exacerbation ,Physical therapy ,Disease Progression ,Corticosteroid ,Feasibility Studies ,Female ,Salmeterol ,business ,medicine.drug - Abstract
This is a proof of concept study that aims to establish feasibility and safety of a new strategy that includes an action plan for early treatment of acute exacerbations of COPD (AECOPD) with doubling dose of a combination of a long-acting beta2 agonist and an inhaled corticosteroid, and to explore its potential for avoiding the requirement of prednisone and its safety. Thirty-seven COPD outpatients with previous exacerbations were enrolled and followed-up for 12 months. The written action plan included a standing prescription to be used in the event of an AECOPD: Antibiotic, for 5 days (for purulent exacerbations) and doubling a combination of Salmeterol and Fluticasone Propionate for 10 days. The primary outcome was "treatment success" defined as "no need of prednisone within 30 days of the onset." Twenty-seven patients experienced an AECOPD and doubled their combination dose. Among the 27 patients, there were 21 patients (78%) who did not require prednisone, and none of those had cardiovascular events, pneumonia, ER and hospital admissions. We have assessed that an early treatment of AECOPD with doubling the dose of a combination of Salmeterol and Fluticasone Propionate appears to be safe, well-tolerated and adhered to, and results in no requirement of systemic corticosteroid in a large proportion of patients presenting with mild-to-moderate worsening of dyspnea. This trial has the potential to change the approach of treatment of AECOPD and reduce the use of oral corticosteroids.
- Published
- 2016
21. Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis
- Author
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Huong Q. Nguyen, Erik Bischoff, Suzanne M. Lloyd, Jaap C.A. Trappenburg, Stephanie Taylor, Nini H. Jonkman, Michael J. Epton, Rolf H.H. Groenwold, Nicholas Zwar, David B. Coultas, Tanja Effing, Judith Garcia-Aymerich, Christine Bucknall, Jean Bourbeau, Evelyn M. Monninkhof, Marieke J. Schuurmans, Arno W. Hoes, Kathryn L. Rice, Heleen Westland, Frode Gallefoss, Jacobus Adrianus Maria van der Palen, Maria Sedeno, Thierry Troosters, and Faculty of Behavioural, Management and Social Sciences
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Psychological intervention ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Forced Expiratory Volume ,Internal medicine ,medicine ,Journal Article ,Humans ,030212 general & internal medicine ,Intervention Duration ,Aged ,Proportional Hazards Models ,Randomized Controlled Trials as Topic ,COPD ,Evidence-Based Medicine ,Proportional hazards model ,business.industry ,Self-Management ,Hazard ratio ,Middle Aged ,medicine.disease ,Hospitalization ,030228 respiratory system ,Meta-analysis ,Relative risk ,Multivariate Analysis ,IR-101434 ,Quality of Life ,Physical therapy ,Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] ,Patient Compliance ,Female ,METIS-318025 ,business - Abstract
It is unknown whether heterogeneity in effects of self-management interventions in patients with chronic obstructive pulmonary disease (COPD) can be explained by differences in programme characteristics. This study aimed to identify which characteristics of COPD self-management interventions are most effective.Systematic search in electronic databases identified randomised trials on self-management interventions conducted between 1985 and 2013. Individual patient data were requested for meta-analysis by generalised mixed effects models.14 randomised trials were included (67% of eligible), representing 3282 patients (75% of eligible). Univariable analyses showed favourable effects on some outcomes for more planned contacts and longer duration of interventions, interventions with peer contact, without log keeping, without problem solving, and without support allocation. After adjusting for other programme characteristics in multivariable analyses, only the effects of duration on all-cause hospitalisation remained. Each month increase in intervention duration reduced risk of all-cause hospitalisation (time to event hazard ratios 0.98, 95% CI 0.97–0.99; risk ratio (RR) after 6 months follow-up 0.96, 95% CI 0.92–0.99; RR after 12 months follow-up 0.98, 95% CI 0.96–1.00).Our results showed that longer duration of self-management interventions conferred a reduction in all-cause hospitalisations in COPD patients. Other characteristics are not consistently associated with differential effects of self-management interventions across clinically relevant outcomes.
- Published
- 2016
22. Impact of meeting behavioral targets in a self-management behaviour-modification program designed to improve physical activity in COPD patients
- Author
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Damijan Erzen, Maria Sedeno, D De Sousa, Thierry Troosters, Jean Bourbeau, Kim L. Lavoie, François Maltais, Nancy Kline Leidy, B Schmidt, Pei-Zhi Li, and Alan Hamilton
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Self-management ,business.industry ,Behaviour modification ,Copd patients ,Physical activity ,Physical therapy ,Medicine ,business - Published
- 2018
23. LATE-BREAKING ABSTRACT: Who benefits most from COPD self-management interventions? An individual patient data meta-analysis
- Author
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Erik Bischoff, Nini H. Jonkman, Maria Sedeno, Frode Gallefoss, Job van der Palen, Judith Garcia-Aymerich, Rolf H.H. Groenwold, Michael J. Epton, Suzanne M. Lloyd, Arno W. Hoes, Tanja Effing, Nicholas Zwar, Jean Bourbeau, Evelyn M. Monninkhof, Heleen Westland, David B. Coultas, Thierry Troosters, Christine Bucknall, Stephanie Taylor, Kathryn L. Rice, Marieke J. Schuurmans, Huong Q. Nguyen, and Jaap C.A. Trappenburg
- Subjects
Pediatrics ,medicine.medical_specialty ,COPD ,Self-management ,business.industry ,Hazard ratio ,Psychological intervention ,Subgroup analysis ,medicine.disease ,Quality of life ,Meta-analysis ,Internal medicine ,medicine ,Stage (cooking) ,business - Abstract
Background: Self-management interventions are considered effective in COPD patients, but trials have shown inconsistent results and it is unknown which patients benefit most. Aims: To summarise the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomised trials on self-management interventions between 1985 and 2013 were identified through a systematic literature search. The original data of selected studies were analysed using generalised mixed effects models. Results: Fourteen trials representing 3282 patients were included. Self-management improved health-related quality of life (standardised mean difference 0.08, 95%CI 0.00-0.16), COPD-related hospitalisation (hazard ratio 0.79, 95%CI 0.66-0.94) and all-cause hospitalisation (hazard ratio 0.80, 95%CI 0.69-0.90), but had no effect on mortality. Pre-specified subgroup analysis showed significant interactions for certain outcomes: interventions were more effective in males (6-month COPD-related hospitalisation: P=0.006), patients with severe lung function (6-month all-cause hospitalisation: P=0.016), moderate self-efficacy (12-month COPD-related hospitalisation: P=0.036), and high body mass index (6-month-COPD-related hospitalisation: P=0.028; and 6-month mortality: P=0.026). Conclusion: Self-management improved health-related quality of life, COPD-related and all-cause hospitalisation in COPD patients. Our findings support implementation of self-management strategies in practice and suggest subgroups with greater benefit. However, the inconsistent subgroup effects across outcomes do not endorse targeting to subgroups at this stage of our understanding.
- Published
- 2015
24. Early COPD Diagnosis in Family Medicine Practice: How to Implement Spirometry?
- Author
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Maria Sedeno, Katrina Metz, Jean Bourbeau, and Nathalie Saad
- Subjects
Spirometry ,COPD ,medicine.medical_specialty ,Article Subject ,medicine.diagnostic_test ,business.industry ,Advanced stage ,MEDLINE ,Alternative medicine ,Primary care ,Airflow obstruction ,medicine.disease ,Test (assessment) ,respiratory tract diseases ,Family medicine ,medicine ,business ,Research Article - Abstract
Introduction. COPD is often diagnosed at an advanced stage because symptoms go unrecognized. Furthermore, spirometry is often not done. Methods. Study was conducted in diverse family medicine practice settings. Patients were targeted if respiratory symptoms were present. Patients had a spirometry to confirm the presence of airflow obstruction and COPD diagnosis. An evaluation of the process was done to better understand facilitating/limiting factors to the implementation of a primary care based spirometry program. Results. 12 of 19 primary care offices participated. 196 of 246 (80%) patients targeted based on the presence of smoking and respiratory symptoms did not have COPD; 18 (7%) and 32 (13%) had COPD, respectively, GOLD I and ≥II. There was no difference in the type and number of respiratory symptoms between non-COPD and COPD patients. Most of the clinics did not have access to a trained healthcare professional to accomplish spirometry. They agreed that giving access to a trained healthcare professional was the easiest and most reliable way of doing spirometry. Conclusion. Spirometry, a simple test, is recommended in guidelines to make the diagnosis of COPD. The lack of allocated time and training of healthcare professionals makes its implementation challenging in family medicine practices.
- Published
- 2014
25. Strategy For Early Treatment Of Exacerbations In COPD: Standing Prescriptions Of Advair With A Written Action Plan In The Event Of An Exacerbation
- Author
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Alexandre Joubert, Jean Bourbeau, Isabelle Drouin, Nathalie Saad, Isabelle Ouellet, Katrina Metz, and Maria Sedeno
- Subjects
COPD ,Exacerbation ,business.industry ,Event (relativity) ,Action plan ,medicine ,Medical emergency ,Medical prescription ,medicine.disease ,business - Published
- 2012
26. Effects of written action plan adherence on COPD exacerbation recovery
- Author
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Erik Bischoff, Tjard Schermer, Dina H Hamd, Maria Sedeno, Sarah Bernard, Andrea Benedetti, François Maltais, and Jean Bourbeau
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Canada ,medicine.medical_specialty ,Time Factors ,Exacerbation ,Drug Prescriptions ,Drug Administration Schedule ,Patient Care Planning ,law.invention ,Pulmonary Disease, Chronic Obstructive ,Pharmacotherapy ,Patient Education as Topic ,Randomized controlled trial ,law ,medicine ,Humans ,Prospective Studies ,Medical prescription ,Intensive care medicine ,Prospective cohort study ,Glucocorticoids ,Aged ,COPD ,business.industry ,Effective primary care and public health [NCEBP 7] ,Middle Aged ,medicine.disease ,Comorbidity ,Effective primary care and public health Poverty-related infectious diseases [NCEBP 7] ,Anti-Bacterial Agents ,Self Care ,Action plan ,Patient Compliance ,Prednisone ,Drug Therapy, Combination ,Female ,Pathogenesis and modulation of inflammation Implementation Science [N4i 1] ,business ,Delivery of Health Care - Abstract
Item does not contain fulltext BACKGROUND: The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence. METHODS: This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan. RESULTS: From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (-5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV(1) as percentage predicted. CONCLUSIONS: This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.
- Published
- 2011
27. A self-management education program including an action plan for acute COPD exacerbations
- Author
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Diane Nault, Dina H Hamd, Maria Sedeno, and Jean Bourbeau
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Exacerbation ,law.invention ,Pulmonary Disease, Chronic Obstructive ,Randomized controlled trial ,Patient Education as Topic ,Prednisone ,law ,Recurrence ,Health care ,medicine ,Humans ,Medical prescription ,Intensive care medicine ,Glucocorticoids ,Aged ,Retrospective Studies ,COPD ,business.industry ,Retrospective cohort study ,medicine.disease ,Anti-Bacterial Agents ,Self Care ,Treatment Outcome ,Action plan ,Emergency medicine ,Disease Progression ,Female ,business ,medicine.drug ,Follow-Up Studies ,Program Evaluation - Abstract
Exacerbations are an important cause of morbidity and mortality in COPD. We assessed treatment initiation and health care use at exacerbation in patients receiving a self-management education program including an action plan. COPD patients were randomly assigned to usual care or to a comprehensive self-management program "Living Well with COPD" including a written action plan and case manager support, and were followed-up for 12 months. Patients in the usual care were managed by their respective practitioners. Patients in the self-management program received, as part of a written action plan, a prescription of antibiotics and prednisone for self-initiation in case of aggravation of 2 or more symptoms (dyspnea, sputum volume, sputum purulence) for at least 24 hours, and they had the support of a case-manager for reinforcement and monthly telephone follow-ups. At 12 months, 166 patients presented with at least one exacerbation. Exacerbations (606) were confirmed by aggravation of at least one symptom; 403 (67.6%) presented 2 or more. Antibiotics were used in 61.6% of exacerbations and prednisone in 47.9%. In exacerbations presenting aggravation of 2 or more symptoms, antibiotics and prednisone were used together more often in the action plan than in the usual care group (54.4% vs. 34.8%, p < 0.001). In the action plan, compared to the usual care group, 17.2% vs. 36.3% exacerbations resulted in a hospitalization (p < 0.001). Self-management with the successful use of an action plan for acute exacerbation of COPD holds promise for reducing health care use.
- Published
- 2009
28. A Written Action Plan for Early Treatment of COPD Exacerbations: An Important Component to the Reduction of Hospitalizations
- Author
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Maria Sedeno, Diane Nault, Jean Bourbeau, and Dina H. Hamd
- Subjects
medicine.medical_specialty ,COPD ,Exacerbation ,business.industry ,medicine.drug_class ,Antibiotics ,General Medicine ,medicine.disease ,law.invention ,Randomized controlled trial ,Prednisone ,law ,Intervention (counseling) ,Action plan ,Internal medicine ,Medicine ,Medical prescription ,business ,Intensive care medicine ,medicine.drug - Abstract
Background: This study explored the role of a written action plan in reducing hospitalizations as a component of a COPD self-management program in a recent multi-centre RCT. Methods: Patients were randomly allocated into 2 groups: intervention or usual care. The intervention group had access to a self-management education program Living Well with COPD, the support of a case manager, and a written action plan with a self-administered prescription of antibiotics and prednisone. Patients were instructed to start both antibiotics and prednisone in case of exacerbation with a change in 2 or more symptoms (increased dyspnea, increased sputum volume and/or purulent sputum) for at least 24 hr. Results: One hundred and sixty six patients with COPD presented with one exacerbation or more in the 12-month study period. Exacerbations (608) were confirmed by a change in at least one symptom; 429 (70.6%) by a change in 2 or more. Antibiotics were used in 61.3% of the exacerbations and prednisone in 47.7%. The combination of antibiotics and prednisone was used more often by the intervention group in exacerbations presenting changes in 2 or more symptoms (52.97% vs. 34.8%, P < 0.001). This difference was driven by a higher use of prednisone in the intervention group (55.7% vs. 44.3%, P < 0.001) consistent with dyspnea deterioration. In the intervention group, exacerbations treated with antibiotics and prednisone had less risk of requiring an hospitalization than those occurring in the control group (16.5% vs. 35.1%, P < 0.001). Conclusions: Improved access to treat exacerbations provided by the written action plan plays an important role in reducing hospitalization risk.
- Published
- 2007
29. New Strategy of Intervention Using a Written Action Plan in COPD: Early Treatment of Exacerbation Reduces Symptom Recovery Time
- Author
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Jean Bourbeau, Maria Sedeno, S Bernard, Erik Bischoff, François Maltais, Tjard Schermer, Andrea Benedetti, and DH Hamd
- Subjects
medicine.medical_specialty ,COPD ,Exacerbation ,business.industry ,Action plan ,Intervention (counseling) ,Physical therapy ,medicine ,business ,medicine.disease
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