When you think of treating a disease or health issue, odds are your mind jumps to medications and lifestyle changes. But there’s also biofeedback.

Biofeedback is a method of gathering information about physiological functions in the body, so you can learn how to harness those changes to improve health and performance, according to the Association for Applied Psychophysiology and Biofeedback. It’s used by doctors, physical therapists, psychologists, and other healthcare professionals to manage and treat various health issues, such as urinary incontinence, anxiety, and chronic pain.

“Basically, biofeedback is any feedback that the patient receives about their body in the moment to help them figure out what their body is doing, so they can improve coordination and awareness,” says Nora Arnold, DPT, a physical therapist with the Johns Hopkins Rehabilitation Network who specializes in pelvic health.

There are many ways to receive biofeedback. A practitioner may attach sensors to your scalp to monitor brain activity, your abdomen or chest to monitor your breathing patterns or heart rate, or any number of other places on your body, per the Mayo Clinic.

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Newswise — Westwood, NJ - (September 26, 2022) – Pascack Valley Medical Group today announced that cardiologist Mindy Markowitz, M.D. has joined the practice.

Dr. Markowitz has extensive inpatient and outpatient cardiac care experience, treating a variety of conditions. She strives to build strong patient-physician relationships to help guide patients in preventing heart disease and obtaining a better quality of life. Her special interests include echocardiography, coronary artery disease, valvular heart disease, prevention and cardiomyopathies. 

“I chose to practice cardiology because the specialty allows me to have a significant positive impact on patient lives through the prevention and treatment of a variety of diseases,” said Dr. Markowitz. “The broad innovations in cardiac care truly help patients to achieve a better quality of life, and I enjoy being a part of the journey to a longer, healthier life.”

Dr. Markowitz received her medical degree from Boston University School of Medicine and completed her internal medicine residency and cardiology fellowship at Lenox Hill Hospital in New York City. She is board certified by the American Board of Internal Medicine in internal medicine and cardiovascular disease, and maintains certification by the National Board of Echocardiography, Board of Cardiovascular Computed Tomography, and Board of Nuclear Cardiology.

“We are pleased to welcome Dr. Markowitz to Pascack Valley Medical Group,” said Emily Holliman, chief executive officer at Pascack Valley Medical Center. “Her patient-focused approach is key to personalizing care and ensuring a positive experience for those we serve. It is important that we expand our physician network with those who have a well-rounded approach to medicine and aim to care for patients by personalizing their options.”

Dr. Markowitz sees patients at 452 Old Hook Road in Emerson, NJ. New patients are welcome and may visit www.pascackmedicalgroup.com to make an appointment or call 201-666-3900. Virtual care and in-person visits are available.

About Hackensack Meridian Pascack Valley Medical Group

Pascack Valley Medical Group provides patients with exceptional care with the support of Pascack Valley Medical Center, part of the Hackensack Meridian Health network. With more than 80 providers already in our ranks, Pascack Valley Medical Group continues to grow, adding new providers practicing in a wide range of specialties from primary care, surgery and beyond.  We believe that an established relationship with your care providers improves health and quality of life.  Convenient locations can be found across the Pascack Valley Region of Bergen County. For more information visit www.pascackvalleymedicalgroup.com.

About Hackensack Meridian Pascack Valley Medical Center Pascack Valley Medical Center is a 128-bed, full-service, acute-care community hospital, located in Westwood, NJ providing the same nationally recognized quality care for which Hackensack Meridian Health is known. The hospital features, a brand-new Emergency Department, state-of-the-art maternity center, a women’s imaging center, cardiac and pulmonary rehabilitation, center for joint replacement, wound care center, and an intensive/critical care unit.

Pascack Valley Medical Center is also the only hospital in Bergen County with all private rooms at no additional cost to the patient. This inpatient hospital acts as an anchor to many outpatient services such as radiology, women’s health, and same day surgery. Find the kind of care you’ve been looking for at Pascack Valley Medical Center. For more, please visit www.PascackMedicalCenter.com 

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Obesity constitutes an important threat to national and global public health in terms of its prevalence and rising incidence, quality of life, life expectancy, and economic burden [1,2]. In severe obesity, bariatric surgery is the most effective therapeutic option to achieve long-term weight loss and improve the associated comorbidities [3]. This has made Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding the most popular and commonly performed bariatric surgeries [4]. However, a small proportion of patients have also been reported to not reach their optimum goal for weight loss two years after the procedure and very few can fail or regain the weight. While anatomical factors can play a part, behavioural and psychosocial optimizations are regarded as equally important. This includes eating patterns, depression, nutritional factors, and exercise [5,6].

Virtual reality (VR) development and applications have gained wide recognition in medical services by providing solutions to improve patients’ outcomes. This is through patients’ education, improving mental health, and post-operative care, including pain management, physical therapy, and rehabilitation [7,8]. VR is a computer-generated simulation of a real or imagined environment. It can be immersive or non-immersive according to its ability to involve the users [9]. The former has been the focus of many medical applications due to its ability to give the user control of the reproduced environment. Immersive virtual reality (IVR) is usually delivered in a variety of ways and the most popular being head-mounted displays or simply a headset [8].

We aim to provide insight on some of these immersive applications and how they can be included to enhance the patient pathway to optimize outcomes both in the pre- and post-operative period for patients undergoing bariatric surgery.

Methods

A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) research criteria was conducted from January 2015 to December 2021. PubMed was searched using the following keywords: virtual reality, patient education, anxiety and pain, physical rehabilitation, behavioural support, obesity, eating disorders, body image, and substance cessation.

Thirty-four studies were identified and included in the final manuscript (Figure 1) supporting VR technology across applications that can be applied to bariatric patients’ surgical pathways. The applications were subcategorized into eight different areas of interest, which can help to shape the concept of the virtual ecosystem of bariatric patients (Figure 2).

Results

VR applications have been described in the eight domains mentioned below, which can be applied in relation to patients undergoing bariatric surgery.

Virtual Reality Patient Education (VR PE)

VR education has been introduced to make the information more meaningful and patient-centred by enabling its users to be fully immersed in an interactive simulated and self-controllable visual and auditory experience [10]. In a study by Pandrangi et al. [11], VR was found to be a useful informative tool in educating patients about their aneurysmal disease through interactive reconstructed three-dimensional (3D) images of their aortic anatomy. The majority of the patients in this study agreed that VR 3D anatomy helped to improve their understanding and therefore felt more engaged in their healthcare decisions [11].

VR PE has also played a role in improving the stress levels of patients undergoing radiotherapy (RT) by improving clarity and levels of education about their treatment. A randomized study on 60 patients with chest malignancy showed that patients who received VR PE showed significant improvement in comprehension and reduction in stress and anxiety levels when compared to standard education [12]. Another study on 43 patients utilized VR PE by creating 3D images of patients in RT sessions and what to expect during the treatment. After the VR PE, 95% of patients agreed that they had a clear understanding of how they would feel when lying on the treatment table. Also, patients’ understanding of the location and the size of their cancer had significantly improved from around 50% to 95% with an increase in the orientation of side effects of the treatment by 30% post-VR PE [13].

In bariatric surgery, there is no currently reported data on the applications of VR education. However, the potential impact of VR PE can be numerous across the weight management pathway. Preoperatively, bariatric patients could potentially utilize VR to be virtually educated about different surgical options versus conservative treatment through enhanced 3D interactive images. This could be seen to help in better understanding of their options including surgery and thereby enhancing informed consent and overall education.

Post-operatively, VR-enhanced education could provide an option for daily or weekly updates on lifestyle changes, which could help in improving compliance. Importantly, this can be done from the comfort of the patient’s home with the added advantage of reducing costs and time for travelling to attend appointments.

Anxiety Related to Surgery

A significant amount of anxiety related to surgery is due to the fear and uncertainty of the outcomes. Its psychological and physical effects are associated with longer recovery, an increase in the need for analgesia, anaesthetic requirement, and unfavourable behavioural and emotional outcomes [14]. Conventional methods of mitigation of preoperative anxiety are pharmacological and non-pharmacological strategies [15].

Recently, with promising results in the management of anxiety and other psychiatric disorders, VR has been successfully applied to reduce anxiety related to surgery in different surgical settings [16]. Chan et al. [17] tested the effect of VR relaxing meditation and breathing exercises on 108 women undergoing hysteroscopy. This showed that anxiety scores were significantly reduced after the 10 minutes of VR content, which helped in reducing pain and stress related to surgery. Also, around 85% of patients reported the VR experience as good or excellent [17].

In minimally invasive abdominal surgery, Haisley et al. [18] used VR meditation as a perioperative tool with favourable results in reducing pain, anxiety, and nausea and around 75% of patients stated that they would use the VR again [18]. Similarly, VR meditation showed favourable results in reducing pain and anxiety in burns and complex pain [19,20].

The rationale for using VR to improve anxiety preoperatively is by immersing patients in a fully simulated relaxing environment with the objective of placing them in a more empowered state to deal with the triggers of their anxiety [21]. This could be applied to the bariatric population before surgery. It is to be seen from future studies whether these expected results can be validated in bariatric patients. There is therefore the potential for obtaining better evidence for patient satisfaction and reducing stress related to bariatric surgery.

Pain Management

Successful pain management is a key element of the post-operative course as it shortens recovery and reduces risks of cardiovascular and pulmonary complications. In bariatric surgery, pain management is essential to enhance recovery and prompt early mobilization, which helps to decrease venous thromboembolism, prevent other events, and reduce hospitalization [22]. Therefore, a multimodal approach through regional and systematic analgesia is considered the most effective method as it minimizes opiate use, which can induce obstructive sleep apnoea, which is more liable due to the co-morbidities of obesity [23].

Applications of VR in pain management in other surgical patients have been reported to have numerous benefits. This includes a reduction in pain scores after cardiac, knee, abdominal, and spinal surgery with overall patients reporting the use of VR as a pleasant experience and stating that they would use it again on further occasions [18,24,25]. VR pain management follows a similar concept to VR and anxiety meditation by immersing patients in a simulated relaxing environment, which can help to divert the patient's feelings from their pain. This could be playing a major role in bariatric patients' management of pain and anxiety related to surgery with proper application integration in their peri-operative pathway.

Optimizing Pulmonary Function for Surgery

Respiratory function in morbidly obese patients follows a restrictive pattern with up to 77% suffering from obstructive sleep apnoea [26]. This increases the risk of impaired post-operative oxygenation and other respiratory complications in the form of atelectasis. Optimization of pulmonary function for surgery includes smoking cessation, breathing exercises, including inspiratory muscle training, incentive spirometry, and optimization of chronic disease, for example, asthma and chronic obstructive pulmonary disease (CPOD) [27].

With the increase of applications of VR in different rehabilitation programmes, VR has been aiding in pulmonary exercises in both healthy individuals and COPD patients [28,29]. VR pulmonary rehabilitation is designed to enable home-based exercises in the form of a 3D avatar instructor in an immersive relaxing environment to guide patients through breathing exercises based on traditional rehabilitation programmes [30]. In COPD patients, VR-based respiratory rehabilitation has shown to have similar outcomes when compared to a conventional programme with the additional benefit of performing the exercises from home. Moreover, VR showed enrichment of experience by also decreasing the levels of anxiety during exercise and therefore optimizing cardiorespiratory function [31].

Physical Fitness Applications

Pre- and post-operative physical activity (PA) is regarded as an important element in enhancing recovery after surgery as it improves physical state, responses to stress from surgery, and improvement of cardiovascular function, thereby reducing complications [32].

In the bariatric population, a structured exercise regime is considered a feasible and effective adjunct therapy that benefits cardiometabolic parameters when compared to those with bariatric surgery alone [33]. Exercise before surgery has shown to be beneficial in reducing body weight, improving blood pressure, general fitness, quality of life satisfaction, and decreasing fasting plasma insulin and blood lipid. Exercise after bariatric surgery has been shown to preserve dynamic muscle strength and contribute to maintaining weight loss after calorie restriction [34].

Although PA promotion is recognized as an important component of weight loss programmes, there are no current evidence-based or standardized bariatric surgery-specific PA guidelines [35]. Reported exercise regimes ranged from walking, aquatic, resistance, and supervised exercises. Also, adherence to exercise before and after surgery plays a big role in physical rehabilitation. As in the bariatric population, many can face barriers in the form of low confidence levels in their abilities and not feeling comfortable going to the gym due to real and perceived discrimination. Therefore, many come up with the belief of not having time to participate in sports [36].

VR rehabilitation has gained much recognition from dedicated platforms like treadmills, diving, cycling simulators, and medically oriented VR rehabilitation. These studies have demonstrated increased participation of users utilizing VR exercise programmes [37]. VR rehabilitation and exercise have shown to be effective in healthy individuals and different medical rehabilitations. It was reported to be equivalent and sometimes more superior to standard physiotherapy in cerebral palsy, spinal injury, and stroke [38]. In healthy individuals, VR exercise was demonstrated to increase adherence and enjoyment with positive physiological effects during exercise [39]. It was also reported that obese children performed better on treadmills while using VR than traditional walking, as VR allowed more distraction and less discomfort [40].

VR exercises during rehabilitation can therefore potentially play a major role in pre- and post-operative PA improvement in bariatric patients. Given the feasibility and the safety of these home-based devices, it can decrease the load on healthcare services, as most of the standard pre-operative programmes are resource intensive.

Virtual Reality and Enhanced Cognitive Behavioural Therapy

Eating and depressive disorders significantly affect the bariatric population with a prevalence of 24% and 17%, respectively. Both can lead to less post-operative weight loss, weight regains, impaired general psychology, and quality of life [41]. Cognitive behavioural therapy (CBT) is recommended for patients undergoing weight loss surgery (WLS). It has been shown to improve self-monitoring and control eating behaviours with significant improvement in depression and anxiety and therefore better results [42].

Over the last decades, VR-enhanced cognitive therapy (VRCBT) has been embraced for being a novel way to deliver CBT. The technique creates an interactive 3D environment to simulate successful goal achievement. This helps patients to overcome memories of previous real-life experiences through emotionally guided virtual exposure [43]. VRCBT has shown favourable results in anxiety, phobias, social anxiety disorders, and depression [21]. Moreover, randomized trials have shown VRCBT to be superior to conventional CBT in managing eating disorders and binge eating [44,45]. This helped in weight reduction therapy and adding adherence to programmes [46].

There is a paucity of evidence of the use of VR in the overweight and morbidly obese population. Phelan et al. [47] tested the use of a VR environment on 15 overweight adults for four weeks with the main hypothesis to evaluate the effect of the simulated scenes on behavioural skills related to eating habits. Although they showed no difference in weight loss among participants, VR intervention was more preferred by patients over traditional weight loss programmes [47]. Manzoni et al. [45] tested the efficacy of an enhanced VRCBT module aimed to unlock the negative memory of the body and modify its behavioural and emotional behaviour. A total of 163 female morbidly obese inpatients were randomly assigned to three CBT-based treatments: a standard behavioural inpatient programme (SBP), SBP plus standard CBT, and SBP plus VR-enhanced CBT. The study showed that patients in the VR group had a greater probability of maintaining or improving weight loss at one-year follow-up than SBP patients and, to a lesser extent, CBT patients. On the contrary, participants who received only a behavioural programme regained on average most of the weight they had lost [45].

VRCBT can therefore be a valuable tool in managing behavioural disorders related to obesity in patients undergoing WLS. This can help in maintaining weight loss and improving well-being and quality of life.

Virtual Reality and Body Image (VRBI)

Body image disorders (BIDs) are linked to various psychological and physical sequelae of impaired functions, for instance, depression, anxiety, eating disorders, and poor quality of life [48]. Among the bariatric population, body image dissatisfaction is associated with binge eating, depression, and lower self-esteem, with one in five bariatric patients identifying appearance as their main motive for surgery [49]. Improvement in body image perception after successful surgery has been linked to a decrease in compulsive eating syndromes, reduction in body mass index (BMI), and improvement in self-esteem and intimate relationships [50].

A contrary aspect of body image after surgery includes the issue of excess skin with massive weight reduction. This has been linked to poor body satisfaction, dermatitis and skin fold irritations, and impairment in daily activities and exercise. In turn, this leads 85% of bariatric patients to seek body-contouring surgery (BCS) to elevate this problem [51].

The application of VR has been used to improve BID. This is by creating a 3D simulation of their bodies in the form of avatars through an immersive environment that reproduces situations related to their body image concerns. Through multisensory simulations, it produces an empowered feeling of ownership of one’s body, which consequently promotes a healthier body image and behaviour [52]. A recent systematic review of six studies utilizing avatars and VR in weight loss programmes showed that avatar-based interventions were effective in both short- and mid-term weight loss. Also, the technology helped to improve exercise adherence in the long term [53]. VR was also used to assess the BID of 78 women with different BMIs by exposing the participants to different versions of avatars: slimmer, same weight, and overweight. The study showed that women with higher BMI reported more BID on their replicated avatar and showed satisfaction with their slimmer version. This finding indicated that VR may serve as a novel tool for measuring BID [54].

Potentially, VR avatars can also play a role in body image perception in bariatric patients. It can be integrated to improve BIDs by recreating slimmer avatars, which could promote adherence to weight loss and exercise programmes.

Smoking and Alcohol

While the increase in BMI is a risk factor for adverse outcomes related to surgical procedures, smoking's hazardous effects range from increased risks of pulmonary complications, wound infection, venous thromboembolism, and slower recovery. Similarly, alcohol consumption before surgery can lead to increased unfavourable outcomes [55]. Smoking and other substance abuse are recommended to be stopped four to six weeks pre-operatively [56]. VR has been tested as a potential solution to stop smoking and alcohol usage by inducing an advanced cue exposure therapy (CET), which was superior to static images or videos used in conventical settings [57]. Also, VR exposure therapy (VRET) has been reported to be more effective if combined with conventional cognitive behaviour therapy in relation to stopping smoking [58].

Although its applications are still under development and validation, VRET in smoking and alcohol cessation could play an important role in optimizing patients undergoing bariatric surgery as a part of a virtual reality surgical care package (VRSCP).

Discussion

Patients who are candidates for WLS usually undergo variable preparatory phase and post-operative optimization to improve both short- and long-term results. Standard care models usually involve education and follow-up through multidisciplinary teams with reflection on the patient's progress through educational sessions and follow-up plans.

While VR applications are being investigated in many surgical and medical specialities, their application to patients undergoing WLS is limited and not yet explored. The favourable applications of VR in patient education, anxiety and pain management, preoperative optimization, and behavioural and physiological treatment can be packaged as a surgical care bundle making bariatric patients' journey more satisfactory with the potential for improved outcomes.

Despite its promising applications, VR is still an emerging technology and has its own initial drawbacks to gaining traction in the healthcare system. There are several reasons for this. Firstly, the obvious cost of the systems and the absence of adequate clinical validation could play a major role in limiting widespread adoption. Further delays in adoption would likely be seen within the education of both healthcare providers and their patients, particularly on the application and utilization of the systems. The technology is still seen to be clumsy to wear and will need educational support to use [59].

With the increased investments and advancement in VR technology, education of healthcare professionals and further studies demonstrating evidence of improved outcomes, VR will play a major role in surgical patients and more specifically bariatric patients. This could be even refined as a personalized surgical care package. This will contribute to a fully virtual ecosystem in health care.



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If you have been experiencing random nosebleed incidents since you were a kid or always feel like you are fighting for inhaling breath, there is a possibility that you are suffering from a deviated nasal septum. We are here with yoga techniques that can help you deal with a deviated nasal septum.

Yoga has a profound effect on the mind and body. Apart from being a holistic practice, it also helps alleviate the symptoms associated with many conditions such as deviated nasal septum.

What is a deviated nasal septum?

As shocking as may sound, deviated nasal septum is a fairly common problem with more than 10 million cases per year found in India. Deviated nasal septum causes the thin wall inside the nose separating the nostrils to get displaced to one side. This causes the nose to get blocked from one side and interferes with breathing properly.

“While the normal course of treatment for this condition is a surgery, there are other things one can do such as practicing yoga and breathing exercises. Yoga may not fix a deviated septum but can help in opening the blocked nasal passage. It can also provide relief from symptoms such as nasal congestion, sinusitis, runny nose, snoring, etc.,” says Arunima Singhdeo, who is a Master Yoga and Meditation teacher at Shvasa.

deviated nasal septum symptom
Frequent nosebleeds is a sign of deviated nasal septum. Image Courtesy: Shutterstock

Neti for treating deviated nasal septum

Hatha yoga has 6 cleansing techniques that help relieve toxins from the body and prepare for pranayama. One such Shatkarma is Neti. The yoga expert explains, “There are two types of Neti: Jala and Sutra. Neti has a profound impact on the body and mind. It removes mucus and pollution from the nasal passages and sinuses, allowing air to flow without obstruction. It also stimulates the various nerve endings in the nose, improving the sense of smell and the overall health of the individual.”

Yoga for deviated nasal septum
Pranayama will help unblock your nasal passage! Image courtesy: Shutterstock

Singhdeo explains how to perform these Netis:

1. Jala Neti: A Neti Pot should be used for this practice. It is done by allowing warm, saline water to pass through the nose. The practitioner has to allow the water to seamlessly pass through. Jala Neti can be practiced for a week if you are suffering from sinusitis, colds, insensitivity to smell, nosebleed, headache, eye strain or eye infections. Practice this when you feel the condition is about to set in but it is best to practice only once in a fortnight.

jala neti for deviated nasal septum
Jala neti might be the solution to your deviated nasal septum problem. Image courtesy: Shutterstock

2. Sutra Neti: Sutra means ‘thread’ and this practice requires the person to pass a length of thread through the nose and gently push it so that it passes down into the throat. When it reaches the back of the throat, it should be pulled out through the mouth. One must slowly and gently pull the thread backwards and forwards 30-50 times. This is a tricky thing to do and must be done with a yoga expert only.

Breathing exercises or Pranayama for treating deviated nasal septum

Since the Netis are not that easy to practice for a beginner, Singhdeo suggests that “as an adaptation one can also practice breath exercises and maintain a certain non-mucus diet. Making breathing practices a habit and sticking to it regularly can also help manage all kinds of concerns in a holistic and sustained manner.” So, practicing exercises like anulom vilom and kapalbhati everyday will turn out to be helpful.

 

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What does "Pulmonary Fibrosis" mean?  
The word “pulmonary” means lung and the word “fibrosis” means scar tissue— similar to scars that form on the skin from an old injury or surgery. So, in its simplest sense, pulmonary fibrosis (PF) means scarring in the lungs.

Pulmonary fibrosis is a lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, people can become progressively more short of breath.

The scarring associated with pulmonary fibrosis can be caused by a multitude of factors. But in most cases, doctors can't pinpoint what's causing the problem. When a cause can't be found, the condition is termed idiopathic pulmonary fibrosis.

The lung damage caused by pulmonary fibrosis can't be repaired, but medications and therapies can help ease symptoms and improve quality of life. For some patients, a lung transplant might be appropriate.

Symptoms of Pulmonary Fibrosis:  
The most common symptoms of pulmonary fibrosis are dry, persistent cough and shortness of breath. Symptoms may be mild or even absent early in the disease process. As the lungs develop more scar tissue, symptoms worsen. Shortness of breath initially occurs with exercise, but as the disease progresses patients may become breathless while taking part in everyday activities, such as showering, getting dressed, speaking on the phone, or even eating.

Due to a lack of oxygen in the blood, some people with pulmonary fibrosis may also have “clubbing” of the fingertips. Clubbing is a thickening of the flesh under the fingernails, causing the nails to curve downward. It is not specific to pulmonary fibrosis or idiopathic pulmonary fibrosis and occurs in other diseases of the lungs, heart, and liver, and can also be present at birth.

How Do Doctors Recognize and Diagnose Pulmonary Fibrosis? 
There are three consequences of pulmonary fibrosis. Doctors use these consequences to recognize that someone has PF:

1. Stiff Lungs. Scar tissue and inflammation make your lungs stiff. Stiff lungs are hard to stretch, so your breathing muscles have to work extra hard just to pull air in with each breath. Your brain senses this extra work, and it lets you know there’s a problem by triggering a feeling of breathlessness (or “shortness” of breath) while exerting yourself.

Also, stiff lungs hold less air (they shrink a bit). Doctors take advantage of this “shrinking” to diagnose and track the disease using breathing tests (called Pulmonary Function Tests) that measure how much air your lungs can hold. The more scar tissue your lungs have, the less air they will hold.

2. Low blood oxygen. Scar tissue blocks the movement of oxygen from the inside of your air sacs into your bloodstream. For many people living with pulmonary fibrosis, oxygen levels are only reduced a little bit while resting, but their oxygen levels drop quite a bit during activity. The brain can sense these low oxygen levels, triggering breathlessness.

Doctors will check your oxygen levels to see if they drop after walking, which could be a clue that PF might be present. Doctors also often prescribe oxygen to be used through a nasal cannula or a facemask during activity and sleep for those with PF. As pulmonary fibrosis progresses, oxygen may be needed 24 hours a day and flow rates may increase.

3. “Crackles" lung sounds. Your doctor may have told you that “crackles” were heard in your lungs. Crackles (also called “rales”) sound like Velcro being pulled apart.

They are heard in many lung diseases because any type of problem affecting the air sacs (such as PF, pneumonia, or a buildup of fluid in the lungs from heart failure) can cause crackles. Some people with pulmonary fibrosis don’t have crackles, but most do.

Can pulmonary fibrosis be reversed? 
Unfortunately, lung damage due to pulmonary fibrosis is permanent (not reversible). Getting diagnosed and starting treatment as early as possible may help your lungs work better, longer.

How is pulmonary fibrosis treated? 
Most pulmonary fibrosis treatments focus on easing symptoms and improving your quality of life.

Your provider may recommend one or more treatments: 
• Medication: Two medications — pirfenidone (Esbriet®) and nintedanib (OFEV®) —may slow down lung scarring. These medications can help preserve lung function.

• Oxygen therapy: Giving your body extra oxygen helps you breathe more easily. It may also increase your energy and strength.

• Pulmonary rehabilitation: Staying active in this special exercise program may improve how much (or how easily) you can do everyday tasks or activities.

• Lung transplant: A lung transplant replaces one or both diseased lungs with a healthy lung (or lungs) from a donor. It offers the potential to improve your health and quality of life. A lung transplant is major surgery, and not everyone is a candidate. Ask your provider if you may be eligible for a lung transplant.

Can pulmonary fibrosis be cured? 
No cure for pulmonary fibrosis exists today. But researchers around the world are working to change that.



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CHI Memorial announces the certification of its cardiac rehabilitation program by the American Association of Cardiovascular and Pulmonary Rehabilitation.  This certification is recognition of CHI Memorial’s commitment to improving the patients’ quality of life by enhancing standards of care.

Cardiac rehabilitation programs are designed to help people with cardiovascular problems, like heart attacks and coronary artery bypass graft surgery, recover faster and live healthier.  The program includes exercise, education, counseling, and support for patients and their families.

“The AACVPR certification is a testament to our team's commitment and efforts in providing high-quality patient care and services,” shared Matt Thomas, manager, cardiopulmonary rehab. “Achieving this milestone was no easy task, but our patients deserve the highest level of care we can provide." 

To earn accreditation, CHI Memorial’s cardiac rehabilitation program participated in an application process that required extensive documentation of the program’s practices. AACVPR Program Certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other related professional societies.  Each program’s application is reviewed by the AACVPR Program Certification Committee, and certification is awarded by the AACVPR Board of Directors.

In 2018, AACVPR moved to an outcomes-based process with performance measurements that represent more meaningful outcomes. Therefore, AACVPR-certified programs are leaders in the cardiovascular and pulmonary rehabilitation field because they offer the most advanced practices available and have proven track records of high-quality patient care. AACVPR Program Certification is valid for three years.

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Why rehabilitation post lung transplant is critical to ensure optimum success of procedure

Human lungs. Image courtesy Pearson Scott Foresman/Wikimedia Commons

Lung transplant is an established treatment for patients with end-stage lung disease. It is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor.

Several modifiable pre- and post-transplant factors contribute to a wide range of physiological and psychological changes which need to be addressed and effectively managed.

It is well established that rehabilitation plays a major role in the pre and post-operative management of patients. It involves working in partnership with the patient, their family and caregivers and a comprehensive multidimensional medical team- towards a common goal of maximising the potential and independence of the patient and to promote a holistic health. It is the process of helping an individual achieve the highest level of function, independence, and to enhance their overall quality of life.

Global review of literature depicts that with the involvement of a multidisciplinary team of experts contributes greatly to the well-being of the patient.

The rehabilitation team typically includes physical therapist, exercise physiologist, psychologist and nutritionist.

The transplant trajectory is complex and intensive, and patients usually experience this period as extremely stressful. Along with the functional impairment – the patients also undergo significant degree of emotional distress. With the prevalence rates of anxiety and depression being high in transplant candidates and recipients, there is a strong need for psychological rehabilitation along with physical rehabilitation for their overall holistic wellbeing. Pre- and Post-transplant psychological support is an important, but overlooked, element in optimising transplant outcomes, particularly in lung transplant recipients who have some of the highest rates of complications and distress following transplantation.

In order to evaluate exercise capacity and function in lung transplant candidates and recipients, a combination of aerobic testing, muscle function, mobility testing and assessment of physical activity is utilised. Along with this- a comprehensive psycho-social assessment is carried out where patient’s understanding regarding the medical illness, process of transplant, willingness/desire for treatment, compliance and care of lifestyle factors, along with the patient’s present emotional and mental state, past psychiatric history is elicited. Based on the test results, a comprehensive rehabilitation programme is planned.

Rehabilitation can be divided into two broad categories:

1. Pre-operative Rehabilitation or Prehabilitation
2. Post-operative rehabilitation

Prehabilitation

Participating in a supervised pulmonary rehabilitation programme is recommended to assist with prevention of further deterioration and improvement in symptoms, understanding of the condition and enhancing the quality of life. The goal is to promote a better functional recovery post-transplant. Most of the patients awaiting transplant are recommended to be subjected to prehabilitation as indicated.

The prehabilitation is feasible and improves the quality of life by:

• Effective chest clearance and lung expansion techniques
• Maintaining or improving physical activity levels
• Maintaining or improving cardiorespiratory fitness
• Preparing the patient for the transplant surgery
• Psychological interventions to enhance coping

Post-operative rehabilitation

Inpatient rehabilitation

Early post-operative rehabilitation

Post-operative rehabilitation starts immediately after surgery once the patients is stabilised, where the initial focus is on maintenance of bodily systems, as well as to assist the patient with the weaning of ventilator/supplemental oxygen and facilitate early mobility.

It typically begins in ICU and then continues in wards with the goal to improve:

• pulmonary hygiene and lung capacity
• General mobility
• Functional capacity
• Muscle strength and endurance
• Emotional coping
• Facilitate discharge from the hospital

Rehabilitation in wards can be further escalated to frequent walking, cycling, strengthening and stair climbing.

Outpatient rehabilitation

An outpatient rehabilitation programme may begin as soon as possible after hospital discharge. A tailor-made exercise programme is prescribed keeping in mind individual patient goals. The outpatient rehabilitation programme facilitates regaining the muscle mass and strength lost during prolonged illness and the disuse associated with prolonged illness along with adequate emotional coping to regain a sense of normalcy in their day to day lives.

The comprehensive programme typically includes:

• Aerobic exercises
• Resistance training
• Flexibility exercises
• Breathing retraining
• Psycho-social counselling
• Nutritional intervention which makes it an efficacious rehabilitation programme

Remotely monitored (tele-health) home based exercise, or pedometer based walking interventions might serve as alternatives to supervised outpatient rehabilitation interventions in the long-term post-transplant phase.
Both inpatient and outpatient rehabilitation have proven to be beneficial for patients before and after lung transplant by improving exercise capacity, promote adaptive coping and overall quality of life.

With recent research showing reduced risk of cumulative mortality in patients of lung transplant- which was attributable to Pre and Post-Transplant rehabilitation, and with other studies depicting greater survival rates among patients even after five years- Rehabilitation should be seen as an essential service offered across all levels of the health care system. We encourage patients to enrol in rehabilitation programme pre-operatively and continue the journey post operatively for an optimal gold standard of care.

The author is Consultant – Rehabilitation and Sports Medicine, Sir HN Reliance Foundation Hospital. Views are personal.

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Patients with acute unstable chest wall injuries who were receiving mechanical ventilation experienced modest benefits with operative treatment, a randomized trial suggested.

In a modified intention-to-treat analysis involving 207 patients, those who underwent surgery to stabilize rib fractures had more ventilator-free days (VFDs) versus those who did not undergo surgery during the first 28 days after injury (22.7 vs 20.6 days), but this difference did not reach significance (mean difference 2.1 days, 95% CI -0.3 to 4.5, P=0.09), reported Niloofar Dehghan, MD, of the CORE Institute in Phoenix, Arizona, and colleagues.

However, a prespecified subgroup analysis of patients on mechanical ventilation at the time of randomization favored the operative group (mean difference 2.8 VFDs, 95% CI 0.1-5.5), they noted in JAMA Surgery.

"The potential advantage was primarily observed in the subgroup of patients at the time of randomization," Dehghan and team wrote. "We found no benefit to operative treatment in patients who were not ventilated."

Overall, lower mortality rates were seen in the operative group (0% vs 6%, P=0.01), while other secondary endpoints such as rates of complications (pneumonia, sepsis, tracheostomy) and length of hospital stay (median 16 vs 16.5 days) were similar.

Differences between the subgroups of patients ventilated and non-ventilated at the time of randomization were also similar for complications. A higher trend for mortality was seen in the subgroup who were ventilated at the time of randomization (P=0.06).

After highlighting the "methodological flaws" in the study in an accompanying editorial, Anthony G. Charles, MD, MPH, and colleagues of the University of North Carolina at Chapel Hill, concluded that "this trial demonstrates no role for routine surgical fixation of non-ventilated patients."

"However, it does not adjudicate the need for routine operative management of mechanically ventilated patients with unstable chest wall injuries," they noted. "A larger prospective randomized study with standardization of critical care management will be needed."

Unstable chest wall injuries, including flail chest, are often caused by blunt force trauma, which increases the risk for morbidity and mortality, Dehghan's group noted. Many complications can arise from these types of injuries, such as severe pulmonary restriction, chest wall instability, or even loss of lung volume, resulting in more patients requiring prolonged ventilation.

Nonoperative management strategies -- consisting of intubation, chest tube drainage, and intermittent positive-pressure ventilation, among others -- are the most common treatments for severe chest wall injuries, but these have not always led to the most optimal outcomes. While many prior studies have found improved outcomes with operative treatment for carefully selected patients, data are mixed on whether operative or nonoperative treatment is superior.

For this study, Dehghan and colleagues enrolled 207 patients ages 16 to 85 with acute unstable chest wall injuries and randomized them 1:1 to operative treatment with plate and screws (n=108) or nonoperative treatment (n=99) across 15 sites in the U.S. and Canada from October 2011 to October 2019. The nonoperative group received the standard of care, including pain management, chest tube drainage, chest physiotherapy/pulmonary toilet, or ventilation, if needed.

Baseline characteristics were similar between groups. Mean age was 53, and three-fourths were men. Most had injuries caused by motor vehicle collisions (30-37%), falls (17-26%), or motorcycle collisions (13-15%). Mean number of rib fractures was 10.

Common conditions included pneumothorax (89%), hemothorax (76%), and pulmonary contusion (54%). The most common types of plates used during surgery were pelvic reconstruction plates (53%) and pre-contoured locking rib plates (43%). Notably, 43% of patients received mechanical ventilation.

Six patients died while hospitalized, all in the nonoperative group. Four operative patients required repeat surgery.

Dehghan and team noted that their trial was "underpowered to detect statistical significance in outcomes that were potentially clinically significant" due to the small sample size. Variations in care may also have occurred across centers.

  • author['full_name']

    Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

This study was supported by the AO Foundation, Canadian Institutes of Health Research, and Physician Services.

Dehghan reported relationships with Acumed, AO International, Bioventus, Canadian Institutes of Health Research, ITS, Physician Services, Springer, Stryker, and Wolters Kluwer.

Co-authors reported relationships with Acumed, AO Foundation, AO International, Bioventus, Canadian Institutes of Health Research, DePuy Synthes, Elsevier, ITS, Medtronic, Orthopaedic Trauma Association, Physician Services, Stryker, Smith&Nephew, Springer, Synthes, Swemac, and Wolters Kluwer.

Charles and co-authors reported no conflicts of interest.

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Rehabilitation is care that can help you get back, keep or improve abilities that you need for daily life. These abilities may be physical, mental and/or cognitive (thinking and learning). You may have lost them because of a disease or injury, or as a side effect from a medical treatment. Rehabilitation can improve your daily life and functioning.

Rehabilitation is for people who have lost abilities that they need for daily life. Some of the most common causes include: injuries and trauma, including burns, fractures (broken bones), traumatic brain injury, and spinal cord injuries; stroke; severe infections; major surgery; side effects from medical treatments, such as from cancer treatments; certain birth defects and genetic disorders; developmental disabilities; and chronic pain, including back and neck pain.

The overall goal of rehabilitation is to help you get your abilities back and regain independence. But the specific goals are different for each person. They depend on what caused the problem, whether the cause is ongoing or temporary, which abilities you lost and how severe the problem is.

For example, a person who has had a stroke may need rehabilitation to be able to dress or bathe without help; an active person who has had a heart attack may go through cardiac rehabilitation to try to return to exercising; and someone with a lung disease may get pulmonary rehabilitation to be able to breathe better and improve their quality of life.

When you get rehabilitation, you often have a team of different health care providers helping you. They will work with you to figure out your needs, goals and treatment plan. The types of treatments that may be in a treatment plan include:

■ Assistive devices, which are tools, equipment and products that help people with disabilities move and function.

■ Cognitive rehabilitation therapy to help you relearn or improve skills such as thinking, learning, memory, planning and decision making.

■ Mental health counseling.

■ Music or art therapy to help you express your feelings, improve your thinking and develop social connections.

■ Nutritional counseling.

■ Occupational therapy to help you with your daily activities.

■ Physical therapy to help your strength, mobility and fitness.

■ Recreational therapy to improve your emotional well-being through arts and crafts, games, relaxation training and animal-assisted therapy.

■ Speech-language therapy to help with speaking, understanding, reading, writing and swallowing.

■ Treatment for pain.

■ Vocational rehabilitation to help you build skills for going to school or working at a job.

Depending on your needs, you may have rehabilitation in a provider’s offices, a hospital, a clinic or an inpatient rehabilitation center. In some cases, a provider may come to your home. If you get care in your home, you will need to have family members or friends who can come and help with your rehabilitation.

The aim of rehabilitation is to restore good health and function to those who have been affected by potentially disabling disease or traumatic injury. A rehabilitation team consists of certified physical, occupational and speech therapists. Although each therapy has a different focus, there is a unified goal of helping each person achieve their highest level of independence.

Physical therapy focuses on walking, balance, strength and gross motor tasks. Occupational therapy focuses on everyday activities such as dressing, bathing and fine motor skills. Speech therapy focuses on improving a person’s ability to communicate as well as addressing swallowing and feeding issues.

Certified therapists help patients find strength and rediscover independence during a challenging time. According to a recent report, 2.41 billion individuals worldwide live with conditions that would benefit from rehabilitation services, with approximately one in three individuals requiring rehabilitation services throughout the course of their illness or injury.

Rehabilitation is the care needed when a person is experiencing or is likely to experience limitations in everyday functioning due to aging or a health condition, including chronic diseases or disorders, injuries or trauma. It is an essential health service to optimize everyday functioning and ensure the highest possible standard of health and well-being.

Courtesy of MedlinePlus from the National Library of Medicine
To Your Health is provided by the staff of Boulder City Hospital. For more information, call 702-293-4111, ext. 576, or visit bchcares.org.

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Patient-Reported Outcome Measurement Information System (PROMIS) are likely the predominant method for assessing patient orthopedic surgery outcomes. Yet, they too often miss the mark. A team from Duke University decided to test whether additional domains like sleep disturbance, dyspnea or anxiety measures would improve the accuracy of PROMs. Their study, titled, “Sleep disturbance, dyspnea, and anxiety following total joint arthroplasty: an observational study,” was published in the August 19, 2022, edition of the Journal of Orthopaedic Surgery and Research.

Co-author Steven Z. George, P.T., Ph.D., Laszlo Ormandy Distinguished Professor in Orthopaedic Surgery and vice chair of research in that department at Duke University, explained to OTW why he and his team decided to tackle this subject systematically.

“We had completed a systematic review in 2020 that indicated outcomes for sleep disturbances, anxiety, and dyspnea are rarely reported following common orthopedic surgeries like total joint arthroplasty (TJA). So, we thought the time was right to report on these outcomes since they are of importance to the patient, and also impact overall quality of life.”

The team collected PROMIS scores for sleep disturbance, anxiety, and dyspnea data from 2,638 patients and compared that data to TJA location (hip, knee, and shoulder) and postoperative chronic pain status (chronic pain absent, mild chronic pain, bothersome chronic pain, high impact chronic pain).

“In my view,” said Dr. George to OTW, “the most important results are:

  • that levels of sleep disturbance, anxiety, and dyspnea are clinically very similar across total hip, knee, and shoulder arthroplasty;
  • while these levels do not correspond with location of surgery, they do correspond with the amount of pain experienced after surgery, with those having chronic postoperative pain having noticeably poorer outcomes for sleep, anxiety, and dyspnea; and
  • dyspnea is not typically measured following orthopedic surgery but was associated with poorer physical function and higher pain interference for all three surgical locations.”

Getting a Clearer Picture of Patient Experience

“This study was not designed to directly alter practice but there are some caveats worth noting that could influence practice patterns,” said Dr. George to OTW.

“First, this study could be used to inform future selection of outcome measures collected from patients. Typically, outcome assessment focuses on pain interference and/or physical function but this study suggests that broadening outcome selection to consider other factors—like sleep disturbance and/or dyspnea—could provide a better understanding of the patient experience following total joint arthroplasty.”

“Second, this study could be used to design postoperative rehabilitation programs to focus on sleep hygiene and/or addressing reasons for shortness of breath, especially in patients that have chronic pain following surgery.”



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Formal physical therapy (PT) after total joint arthroplasty (TJA) is commonly recommended and is often thought to be indispensable to favorable patient outcomes [1,2]. In contrast to the modern era, these surgeries were performed on older, less active patients with more severe diseases and deformities [3]. These earlier surgeries were more extensive, and weight bearing was often limited postoperatively [4,5]. Modern total hip arthroplasty (THA), however, is characterized by a younger, more active patient population along with dramatic advances in pain control and rapid recovery [4,5]. Despite the changing landscape, formal PT has maintained its status amongst providers and patients as an integral component to improving outcomes [2,6].

Several studies over the past few years have demonstrated that formal PT, whether inpatient or outpatient, may not have any benefit over home-based unsupervised exercise programs [7-9]. While this has led to a shift away from formal PT utilization by some, there are no guidelines to assist in determining which patients may benefit [7]. Reducing the routine use of formal PT to only those patients for whom it is warranted may offer several benefits. The responsibility of copays and transportation is often placed on the patient and, for many, can be a significant burden [10,11]. Additionally, with the increased interest in alternative healthcare models, the focus has shifted to finding methods to reduce episode-of-care costs [12,13]. The costs associated with formal PT after discharge are not trivial, comprising up to 8% of total costs for TJA episodes of care [9].

The goal of this review was to assess the existing literature comparing outcomes of primary THA patients undergoing formal supervised PT to those with unsupervised home exercise programs through a systematic review and meta-analysis of randomized controlled trials (RCTs). To avoid intervention bias towards supervised home programs, we chose to only include studies that explicitly described unsupervised home exercise regimens. The primary aim was to assess changes in lower extremity strength (LES), aerobic capacity, and patient-reported physical outcome and quality of life (QoL) scores at zero to six months and six months to one year.

This systematic review and meta-analysis were conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and were registered in the PROSPERO International Prospective Register of Systematic Reviews (PROSPERO Identifier CRD42021228071).

Inclusion criteria

This review considered all English-language RCTs that compared objective measures and patient-reported outcomes (PROs) from patients with formal postoperative PT or supervised exercise programs to those with unsupervised home exercise interventions (defined as an explicitly stated form of home exercise program to be performed without direct supervision of a health professional). This also included written exercise instructions, video programs demonstrating exercises, or phone applications containing directions for exercises). The time period of interventions was limited to the period between discharge from hospitalization and six months postoperatively. Studies involving comparisons between only supervised cohorts, unsupervised cohorts, or without clear delineation of what each exercise intervention consists of were excluded, as were those involving preoperative exercise programs as the primary intervention.

Search strategy and study screening

With the assistance of an informationist, an electronic search was conducted of all published literature from database inception to December 14, 2020 from the following databases: PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov. MeSH and Emtree terms were used alongside free text to enhance search sensitivity. Studies were screened based on titles and abstracts initially, with relevant studies subjected to full-text review. All screening was performed independently by two authors (YPC and HH). All disagreements were resolved through discussion, with input from the senior author (CAD) on an as-needed basis.

Quality appraisal

The Cochrane Risk of Bias Tool 2.0 was utilized to assess the five domains of potential bias: randomization process, deviations from intended intervention, missing outcome data, outcome measurement, and selection of reported results. The result for each domain was assigned risk scores of "low," "some concern," or "high." A risk of bias assessment was made for each outcome measurement. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system was utilized to appraise the quality of evidence included in this meta-analysis to ensure the reliability of its results.

Data extraction and statistical analysis

Data extraction was performed manually by three reviewers (YPC, HH, and ZW). Extracted descriptive variables included journal, year, and country of publication, number of cases, age, gender, body mass index, inclusion criteria, follow-up, type of intervention, time from discharge to intervention initiation, and intervention length. The outcomes of interest in this study changed from baseline data in LES (measured with a timed up-and-go test (TUG), sit-to-stand test, or hip abduction strength as measured by a dynamometer), aerobic capacity, and patient-reported physical function and QoL. Each outcome measure was divided into short-term recovery (<6 months from surgery; if multiple time points were observed <6 months from surgery, the closest one to the three-month postoperative point was chosen) and long-term recovery (≥6 months from surgery; if multiple time points were observed ≥6 months from surgery, the closest one to the one-year postoperative point was chosen) windows. Changes from baseline values were collected in the form of a mean and standard deviation (SD). When not available for change from baseline scores, they were imputed using previously established methods from the Cochrane Handbook for Systematic Reviews of Interventions [14]. For studies involving more than one outcome measure for each of the above categories, only one outcome measure was included. Outcome measures were pooled for meta-analysis if there were at least three studies with reported results. All the outcomes in this study consisted of continuous variables. Effect sizes were assessed using random effect models to calculate standardized mean differences (SMD) and 95% confidence intervals (CI). Heterogeneity was tested using the I2 statistic. All meta-analysis calculations and subsequent forest plots were generated using Review Manager Software Version 5.4.1 (Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2020).

Characteristics of included studies

A total of 4,358 citations were identified (Figure 1). After removing 1,766 duplicate citations, a total of 2,592 studies were assessed for eligibility based on title and abstract. Fifty-seven studies were eligible for full-text review. Ultimately, seven studies (n=398 cases) were included in this review.

A descriptive summary of the included studies can be found in Tables 1-2. All studies were performed within the last ten years, except for one conducted in 2008 [15]. Three of the seven studies began their intervention programs upon discharge; two in the first week after surgery, one six weeks after, and one program at 12 weeks postoperatively. The mean program length was 8.0 ± 2.8 weeks. Six studies reported outcomes in the short-term period, and five reported outcomes in the long-term period.

References Country N Mean Age (years) % Female Mean BMI (kg/m2) Inclusion/exclusion
Austin et al. [7] USA 108 62 44 29 Inclusion: age 18-80 years, primary unilateral THA for OA. Exclusion: inflammatory or post-traumatic arthritis, history of septic arthritis, revision or conversion THA, patients requiring discharge to skilled facility.
Beaupre et al. [8] Canada 21 53 52 NR Inclusion: age <65 years, primary unilateral THA with lateral approach. Exclusion: history of developmental dysplasia of the hip.
Coulter et al. [16] Australia 95 64a 58 NR Inclusion: age > 18 years, primary elective THA, patient lives locally. Exclusion: metastatic disease, pathologic fractures, infection, acute trauma, revision THA, inability to provide informed consent, UCLA scale < 2 preoperatively, unable to bear weight postoperatively, requiring inpatient rehabilitation postoperatively.
Galea et al. [15] Australia 23 68 30 29 Inclusion: primary THA for OA, ability to walk 45 minutes independently with mobility aid, independence in sit to stand transfer, adequately comprehends written/verbal instructions. Exclusion: uncontrolled systemic disease, pre-existing neurologic/other orthopedic condition affecting walking, more than four weeks physiotherapy postoperatively, revision surgery or significant postoperative complications
Mikkelsen et al. [17] Denmark 62 65 42 29 Inclusion: primary unilateral THA for OA, preoperative HOOS ADL < 67, age > 18 years, live within 30 km from hospital, willing to participate. Exclusion: BMI > 35, pre-planned supervised rehabilitation, pre-planned contralateral THA within six months, inability to speak or read Danish, mental or physical conditions impeding intervention
Monaghan et al. [18] Ireland 63 68 32 27 Inclusion: primary THA for OA, age > 50 years, able to read/understand English, willing to participate. Exclusion: medical instability, underlying terminal disease, suspicion of infection following THA
Okoro et al. [19] United Kingdom 26 64 58 NR Inclusion: unilateral THA for OA via posterior approach with 26/28/32 mm femoral head, joint affected is only arthritic joint, no evidence of inflammatory arthropathy. Exclusion: dementia, neurological impairment, cancer or other muscle wasting illness, unstable chronic or terminal illness, any co-morbid disease that contraindicates resistance training
Total   398 64 46b 29c  
References Cohorts Time from discharge to start Program length (weeks) Outcomes assessed Follow-Up Findings
Austin et al. [7] C: 10 weeks unsupervised home exercise based on manual. I: 2 weeks in-home PT followed by 8 weeks outpatient PT 2-3x per week. Upon discharge 10 HHS, WOMAC, SF-36 Physical and Mental 1 month, 6-12 months No significant difference in any of measured outcomes
Beaupre et al. [8] C: home exercise instructions for 4-6 weeks. I: outpatient rehabilitation 2x per week for 3 months. 6 weeks postoperatively 12 WOMAC, SF-36, 6MWT, gait analysis 4 months, 12 months No significant difference in any of measured outcomes
Coulter et al. [16] C: continue exercises from hospital at home, gradually increasing number of repetitions. I: supervised program 1x per week involving circuit exercises for 4 weeks. Upon discharge 4 WOMAC, SF-36, TUG, UCLA activity index 5 weeks, 12 weeks, 26 weeks No significant difference in any of measured outcomes
Galea et al. [15] C: illustrated guide of prescribed home exercises. I: 45 minute sessions 2x per week in supervised rehabilitation center-based program. First week after surgery 8 TUG, stair climb performance, 6MWT, WOMAC 8 weeks C: with faster TUG. No significant difference in other measures.
Mikkelsen et al. [17] C: home-based exercises done 7x per week. I: home-based exercises done 5x per week with additional supervised resistance training sessions 2x per week. First week after surgery 10 Leg extension power, isometric hip muscle strength, STS, stair climb, 20 minute walking speed, HOOS 6 monthsb I: with larger increase in maximal walking speed and stair climb performance. No significant difference in other measures
Monaghan et al. [18] C: postoperative home exercise booklet, advised to walk daily with crutches until review at 6 weeks. I: 35 minute class 2x per week for 6 weeks, no additional home exercises. 12 weeks postoperatively 6 WOMAC, VAS, 6MWT, SF-12, hip abduction strength 18 weeks I: with better improvement in 6MWT, WOMAC function, and SF-12 Physical. No significant differences in WOMAC pain or stiffness, SF-12 mental health score, VAS, or hip abduction strength
Okoro et al. [19] C: unsupervised home exercises. I: weekly PT sessions for 6 weeks. Upon discharge 6 Maximum voluntary contraction of operated leg quad, STS, TUG, stair climb, 6MWT, lean mass of operative leg (DEXA) 6 weeks, 6 months, 9-12 months No significant difference in any of measured outcomes
Total     8a      

Data synthesis and meta-analysis

Summaries for all outcome assessments are summarized in Table 3. No meta-analysis was conducted for long-term aerobic capacity as there were fewer than three studies with available data.

Outcome Risk of bias Directness of evidence Heterogeneity Precision Publication bias Overall quality
LE strength short term No downgrade No downgrade. No evidence of indirectness. I2 = 66%, moderate heterogeneity. Downgraded one level Rated down one level. Moderate imprecision. No assessment of publication bias conducted. Low
LE strength long term Downgraded by one level. Limitation primarily in selection of reported result. No downgrade. No evidence of indirectness. I2 = 22%, low heterogeneity Rated down one level. Moderate imprecision. No assessment of publication bias conducted. Low
Aerobic capacity short term No downgrade No downgrade. No evidence of indirectness. I2 = 12%, low heterogeneity Rated down two levels. Significant imprecision. Very wide confidence interval. Well underneath suggested sample size. No assessment of publication bias conducted. Low
Self-reported physical outcome short term Downgraded by one level. Limitation primarily in measurement of outcome. No downgrade. No evidence of indirectness. No downgrade. I2 = 0%, low heterogeneity Rated down one level. Moderate imprecision. No assessment of publication bias conducted. Low
Self-reported physical outcome long term Downgraded by one level. Limitation primarily in measurement of outcome. No downgrade. No evidence of indirectness. I2 = 0%, low heterogeneity Rated down one level. Moderate imprecision. No assessment of publication bias conducted. Low
Self-reported QoL short term Downgraded by one level. Limitation primarily in measurement of outcome. No downgrade. No evidence of indirectness. I2 = 0%, low heterogeneity Rated down one level. Moderate imprecision. No assessment of publication bias conducted. Low
Self-reported QoL long term Downgraded by one level. Limitation primarily in measurement of outcome. No downgrade. No evidence of indirectness. I2 = 0%, low heterogeneity Rated down one level. Moderate imprecision. No assessment of publication bias conducted. Low

Short-Term Outcomes

Of the six studies included in the short-term outcome analysis, five found both interventions to be equivocal. One study found a statistically significant difference in physical function scores favoring the supervised cohort but was unable to determine if this difference was clinically significant. Based on five studies and a low level of certainty, no differences in short-term LES were found (SMD −0.04 [−0.50, 0.41]; I2=66%; p=0.85) (Figure 2). There was no significant difference in short-term aerobic capacity based on three studies and a low level of certainty (SMD −0.50 [−36.88, 35.89]; I2=12%; p=0.98) (Figure 3). Compared with unsupervised home exercise, the supervised exercise regimen was associated with improved self-reported physical function outcome scores based on six studies and a low level of certainty (SMD 0.23 [95% CI, 0.02-0.44]; I2=0%; p=0.04) (Figure 4). According to Cohen's work [20,21], an SMD of 0.23 is considered a small effect size. No differences were found between the two cohorts with regard to short-term QoL scores based on six studies and a low level of certainty (SMD 0.15 [−0.07, 0.36]; I2=0%; p=0.18) (Figure 5).

Long-Term Outcomes

No long-term outcome differences were identified between the unsupervised and supervised cohorts in this study. There was no significant difference observed with regards to long-term LES, based on four studies and a low level of certainty (SMD −0.19 [−0.52, 0.13]; I2=22%; p=0.24) (Figure 6). Similarly, no differences were observed with regards to long-term patient-reported physical outcome scores, based on four studies and a low level of certainty (SMD 0.11 [−0.13, 0.36]; I2=0%; p=0.37) (Figure 7), or long-term QoL scores based on four studies and a low level of certainty (SMD 0.19 [−0.06, 0.43]; I2=0%; p=0.14) (Figure 8).

Risk of bias

The results of the quality appraisal are summarized in risk of bias summary plots in the appendices (Appendix Figures 9-15). The self-reported scores all had a high risk of bias, primarily due to bias in outcome measurement (Table 3). All outcomes were rated as low-quality evidence (Table 4). The primary reasons for the downgrade in quality were the risk of bias and imprecision. Publication bias was not assessed as there were fewer than 10 studies involved in each outcome.

Outcome Supervised participants (n) Unsupervised participants (n) SMD/MD (95% CI) Risk of bias Certainty of evidence
LE strength short term 142 (5) 121 (5) −0.04 (−0.50, 0.41)a Some concerns Low ⨁⨁◯◯
LE strength long term 112 (4) 95 (4) −0.19 (−0.52, 0.13)a High Low ⨁⨁◯◯
Aerobic capacity short term 54 (3) 49 (3) −0.50 (−36.88, 35.89)b Some concerns Low ⨁⨁◯◯
Self-reported physical outcome short term 176 (6) 169 (6) 0.23 (0.02, 0.44) a High Low ⨁⨁◯◯
Self-reported physical outcome long term 133 (4) 126 (4) 0.11 (−0.13, 0.36)a High Low ⨁⨁◯◯
Self-reported QoL short term 176 (6) 166 (6) 0.15 (−0.07, 0.36)a High Low ⨁⨁◯◯
Self-reported QoL long term 133 (4) 126 (4) 0.19 (−0.06, 0.43)a High Low ⨁⨁◯◯

Discussion

Despite the historical emphasis on the importance of formal PT as a critical intervention after THA, this meta-analysis fails to demonstrate any benefit for PT over unsupervised home exercises aside from a small increase in short-term self-reported physical function scores. No significant differences were found with regards to short- and long-term changes from baseline for LES, aerobic capacity, and self-reported QoL scores, as well as long-term self-reported physical outcome scores. The results of our meta-analysis suggest that arthroplasty providers should question the routine use of formal PT for all primary THA patients.

Other reviews conducted on formal PT programs following THA provide mixed results. Reviews conducted by Lowe et. al. [22] and Wijnen et. al. [23] did not perform a meta-analysis of physical function due to considerable variation in their included studies and were unable to provide a definitive conclusion; however, the latter reported an association with increased hip abductor muscle strength. A review conducted by Fatoye et al. [24] including RCTs and retrospective cohorts found that formal PT improved both physical function scores and hip abduction strength, but did not differentiate between short- or long-term follow-up points (follow-up ranged from 2 weeks to 12 months). Finally, Sauressig et al. [25] similarly conducted a meta-analysis and found no differences in self-reported physical function at 4 weeks, 12 weeks, 26 weeks, and one year.

An important aspect of the current review separating it from these prior studies is the use of a clearly defined home exercise regimen, postoperative instructions, or a booklet on discharge as inclusion criteria, excluding those studies that did not specify any form of intervention for their control groups. This is important to ensure a low-cost, standardized control group to allow providers to understand the true effect of trained therapist-led PT for their patients. Without this aspect, studies with controls consisting of no intervention could potentially be included in this review, which could bias results toward the formal therapy groups and may not reflect the current state of most practices.

Although postoperative rehabilitation has long been linked to a successful outcome following THA, the use of supervised PT has several drawbacks. Copay affordability, scheduling outpatient appointments, and arranging transportation have been demonstrated to be legitimate barriers to accessibility to outpatient PT for THA patients after discharge [10,11]. PT exercises can also be painful, as one of the most commonly asked questions regarding PT in the postoperative period after THA is about pain expectations [26]. Additionally, Yayac et al. demonstrated that TJA patients who underwent supervised PT had a significantly higher readmission rate than those who were discharged with self-directed home exercise regimens [9]. After controlling for patient demographics and comorbidities, they found that patients who had supervised home PT were over three times more likely to be readmitted in the 90-day postoperative period. Finally, the added cost associated with it must be considered. Yayac et al. [9] analyzed costs and outcomes in their retrospective study; while no clinically significant difference was found between function or quality of life between groups at two years, they concluded that formal therapy costs included 8% of a 90-day episode of care costs for those receiving supervised home PT and outpatient PT and 3% for those receiving supervised home PT only [9]. The results of the current study highlight the need to re-examine the application of routine PT following primary THA, especially with post-discharge costs accounting for up to 36% of total costs in the bundle payments for TJA [27]. This is particularly salient in the context of a younger patient population, improvements in pain management, and emphasis on early mobilization postoperatively.

The difference between the short-term, self-reported physical outcome scores we observed between supervised and unsupervised groups was largely driven by the findings of the study conducted by Monaghan et al. [18]. This RCT involving an exercise intervention consisting of land- and aquatic-based therapy performed between 12 and 18 weeks after surgery differed from the other studies in this review as it was the only one to include an aquatic component. Additionally, while they found a statistically significant relationship between their formal exercise intervention and improved Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, they were unable to state whether this translated to a clinically significant difference - an issue that has been raised with the use of WOMAC scores in other literature [28,29]. Our meta-analysis reported an effect size of 0.23, falling under the category of small effect size as described by Cohen [20,21]. However, this was the only measure demonstrating a difference between the two interventions with regard to short-term outcomes and was likely driven by a single study. In the three studies that analyzed data at 12 months, no significant differences were found in any of the assessed outcomes between the two groups [7,8,19]. At the six-month time point, Mikkelson et al. [17] found a larger increase in maximal walking speed and stair climb performance in the formal therapy group, while Johnsson et al. [30] reported increased intermediate-to-moderate pain at six months in the home exercise group. Two other studies at the six-month mark found no significant differences in physical or mental outcomes between home exercise and formal PT groups.

Our results are limited by the number of studies and the quality of their respective data included in the meta-analysis. An important aspect to consider is the included patient population of each included study. Eligibility criteria may have preselected healthier and more motivated patients. In light of this, deconditioned patients with substantial functional deficits or medical comorbidities may still benefit from supervised PT. Additionally, there was substantial heterogeneity of exercise regimens across studies, including aspects such as methodology and duration of therapy, reflecting the likely variation in PT programs at different institutions. Furthermore, relying on patient-reported outcomes can be flawed, particularly in RCTs in which patients know they will be assigned to either supervised or unsupervised cohorts. It is likely that many patients in the intervention groups may be subject to bias - their assignment to formal PT protocols may influence and potentially inflate the supervised PT cohort self-reported outcome scores. The measurement of LES was also subject to variability as the studies assessing it used different methodologies to determine it. Additionally, within the unsupervised cohorts, we were unable to assess the degree of compliance; however, the intention-to-treat approach taken by most of these studies is likely to replicate true scenarios. Finally, previous studies have noted an 18-31% cross-over rate from self-directed exercise to formal supervised therapy in total joint arthroplasty populations [7,31]. We were unable to account for patients who required crossover in our study - outcomes for these patients would be an area of interest in future studies. The strengths of this study include the narrow inclusion criteria, such as the inclusion of only RCTs or that the unsupervised cohorts must have clearly delineated instructions or booklets given to them, to allow for stronger conclusions than previous reviews on this subject.



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The pleura is a vital part of the respiratory tract. Its role is to cushion the lung and reduce any friction that may develop between the lung, rib cage, and chest cavity.

Each pleura (there are two) consists of a two-layered membrane that covers each lung. The layers are separated by a small amount of viscous (thick) lubricant known as pleural fluid.

OpenStax College / Wikimedia Creative Commons

There are a number of medical conditions that can affect the pleura, including pleural effusions, a collapsed lung, and cancer. When excess fluid accumulates between the pleural membranes, various procedures may be used to either drain the fluid or eliminate the space between them.

This article outlines what the pleurae are, what they do, and what conditions can affect them and impact respiratory health.

The plural form of pleura is pleurae.

Anatomy of the Pleura

There are two pleurae, one for each lung, and each pleura is a single membrane that folds back on itself to form two layers. The space between the membranes (called the pleural cavity) is filled with a thin, lubricating liquid (called pleural fluid).

The pleura is comprised of two distinct layers:

  • The visceral pleura is the thin, slippery membrane that covers the surface of the lungs and dips into the areas separating the different lobes of the lungs (called the hilum).
  • The parietal pleura is the outer membrane that lines the inner chest wall and diaphragm (the muscle separating the chest and abdominal cavities).

The visceral and parietal pleura join at the hilum, which also serves as the point of entry for the bronchus, blood vessels, and nerves.

The pleural cavity is also known as the intrapleural space. It contains pleural fluid secreted by the mesothelial cells. The fluid allows the layers to glide over each other as the lungs inflate and deflate during respiration (breathing).

What the Pleura Do

The structure of the pleura is essential to respiration, providing the lungs with the lubrication and cushioning needed to inhale and exhale. The intrapleural space contains roughly 4 cubic centimeters (ccs) to 5 ccs of pleural fluid, which reduces friction whenever the lungs expand or contract.

The pleura fluid itself has a slightly sticky quality that helps draw the lungs outward during inhalation rather than slipping round in the chest cavity. It creates surface tension that helps maintain the position of the lungs against the chest wall.

The pleurae also serve as a division between other organs in the body, preventing them from interfering with lung function and vice versa.

Because the pleura is self-contained, it can help prevent the spread of infection to and from the lungs.

Conditions That Affect the Pleura

A number of conditions can cause injury to the pleura or undermine its function. Harm to the membranes or overload of pleural fluid can affect how you breathe and lead to adverse respiratory symptoms.

Pleurisy

Pleurisy is inflammation of the pleural membranes. It is most commonly caused by a viral infection, but may also be the result of a bacterial infection or an autoimmune disease (such as rheumatoid arthritis or lupus).

Pleuritic inflammation causes the membrane surfaces to become rough and sticky. Rather than sliding over each other, they membranes stick together, triggering sharp, stabbing pain with every breath, sneeze, or cough. The pain can get worse when inhaling cold air or taking a deep breath. It can also worsen during movement or shifts in position. Other symptoms of pleurisy include fever, chills, and loss of appetite.

Pleural Effusion

A pleural effusion occurs when excess fluid accumulates in the pleural space. When this happens, breathing can be impaired, sometimes significantly.

Congestive heart failure is the most common cause of a pleural effusion, but there is a multitude of other causes, including lung trauma or lung cancer (in which effusion is experienced in roughly half of all cases).

A pleural effusion can be very small (detectable only by a chest x-ray or CT scan) or be large and contain several pints of fluid. Common symptoms include chest pain, dry cough, shortness of breath, difficulty taking deep breaths, and persistent hiccups.

Malignant Pleural Effusion

A malignant pleural effusion refers to an effusion that contains cancer cells. It's most commonly associated with lung cancer or breast cancer that has metastasized (spread) to the lungs.

Mesothelioma

Pleural mesothelioma is a cancer of the pleura that most often is caused by occupational exposure to asbestos. Symptoms include pain in the shoulder, chest or lower back, shortness of breath, trouble swallowing, and swelling of the face and arms.

Pneumothorax

Pneumothorax, also known as a collapsed lung, can develop when air collects in the pleural cavity. It may be caused by any number of things, including chest trauma, chest surgery, and chronic obstructive pulmonary disease (COPD). In addition to shortness of breath, there may be crepitus, an abnormal crackling sound from just under the skin of the neck and chest.

Spontaneous pneumothorax is a term used to describe when a lung collapses for no apparent reason. Tall, thin adolescent males are at the greatest risk for spontaneous pneumothorax, although females can also be affected. Risk factors include smoking, connective tissue disorders, and activities such as scuba diving and flying in which atmospheric pressure changes rapidly.

Pneumothorax can often heal on its own but may sometimes require thoracentesis to extract any accumulated air from the pleural cavity.

Hemothorax

Hemothorax is a condition in which the pleural cavity fills with blood, typically as a result of traumatic injury or chest surgery. Rarely, a hemothorax can happen spontaneously due to a vascular rupture.

The main symptom of hemothorax is pain or a feeling of heaviness in the chest. Others include a rapid heartbeat, trouble breathing, cold sweats, pale skin, and a fever, all indications that prompt medical attention is needed.

Frequently Asked Questions

  • Does COVID cause pleural thickening?

    Research has demonstrated that coronaviruses, like COVID-19 and Middle Eastern respiratory syndrome coronavirus (MERS-CoV) can cause pleural thickening. In some cases, this has been associated with poorer outcomes.

  • Is pleural effusion life-threatening?

    Pleural effusion, or fluid build-up in the pleural space, is a serious but treatable condition. It can be caused by a number of diseases, including cancer. If left untreated, fluid can continue to build up and impact breathing.

  • Is pleural thickening serious?

    Not necessarily, but it depends on the underlying cause. Because multiple conditions can cause thickening of the pleurae, it's important to be evaluated by a healthcare provider and get proper treatment.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Charalampidis C, Youroukou A, Lazaridis G, et al. Pleura space anatomyJ Thorac Dis. 2015;7(Suppl 1):S27–S32. doi:10.3978/j.issn.2072-1439.2015.01.48

  2. Kass SM, Williams PM, Reamy BV. Pleurisy. Am Fam Physician. 2007;75(9):1357-64.

  3. Bintcliffe OJ, Lee GY, Rahman NM, Maskell NA. The management of benign non-infective pleural effusions. Eur Respir Rev. 2016;25(141):303-16. doi:10.1183/16000617.0026-2016

  4. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and managementOpen Access Emerg Med. 2012;4:31–52. doi:10.2147/OAEM.S29942

  5. Dixit R, Agarwal KC, Gokhroo A, et al. Diagnosis and management options in malignant pleural effusionsLung India. 2017;34(2):160-6. doi:10.4103/0970-2113.201305

  6. Rossini M, Rizzo P, Bononi I, et al. New perspectives on diagnosis and therapy of malignant pleural mesotheliomaFront Oncol. 2018;8:91. doi:10.3389/fonc.2018.00091

  7. Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and management of subcutaneous emphysema: a 10-year experienceIndian J Surg. 2015;77(Suppl 2):673–677. doi:10.1007/s12262-013-0975-4

  8. Mitani A, Hakamata Y, Hosoi M, et al. The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-upsBMC Pulm Med. 2017;17:177. doi:10.1186/s12890-017-0538-8

  9. Pumarejo Gomez L, Tran VH. Hemothorax. In: StatPearls [Internet].

  10. National Library of Medicine: Medline Plus. Hemothorax.

  11. Carotti M, Salaffi F, Sarzi-Puttini P, et al. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: Key points for radiologists. Radiol Med. 2020;125(7):636-646. doi:10.1007%2Fs11547-020-01237-4

  12. American Society of Clinical Oncology. Fluid around the lungs or malignant pleural effusion.

  13. Yale Medicine. Fluid Around the Lungs (Pleural Effusion).

  14. Alfudhili KM, Lynch DA, Laurent F, Ferretti GR, Dunet V, Beigelman-Aubry C. Focal pleural thickening mimicking pleural plaques on chest computed tomography: Tips and tricksBJR. 2016;89(1057):20150792. doi:10.1259%2Fbjr.20150792


Additional Reading


By Lynne Eldridge, MD

 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."

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Newswise — Westwood, NJ - (September 19, 2022) – Hackensack Meridian Pascack Valley Medical Center has received recertification of its Cardiac and Pulmonary Rehabilitation programs from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The recertification recognizes Pascack Valley Medical Center for commitment to improving patient outcomes and quality of life by enhancing standards of care.

The Cardiac and Pulmonary Rehabilitation Center at PVMC was established in 2014 and has been AACVPR-certified since 2015, as a leader in the field of cardiovascular rehabilitation. AACVPR’s certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other professional societies.

Cardiovascular and pulmonary rehabilitation programs are designed to help people recover quicker and improve their quality of life following a cardiovascular diagnosis or procedure (e.g., heart attack, coronary artery bypass graft surgery). Programs includes exercise, education, counseling, and support for patients and their families. 

Pascack Valley Medical Center’s Cardiac and Pulmonary Rehabilitation Center participates in a certification process every three years that requires extensive documentation and review of the program’s practices and outcomes. To learn more about Pascack Valley Medical Center’s Cardiac and Pulmonary Rehabilitation services click here.

About AACVPR

Founded in 1985, the American Association of Cardiovascular and Pulmonary Rehabilitation is a multidisciplinary organization dedicated to the mission of reducing morbidity, mortality and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research and disease management. Central to the core mission is improvement in quality of life for patients and their families.

About Hackensack Meridian Pascack Valley Medical Center

Hackensack Meridian Pascack Valley Medical Center is a 128-bed, full-service, acute-care community hospital, located in Westwood, NJ providing a caliber of care consistent with Hackensack Meridian Health’s world-class standard.  The state-of-the-art facility features a brand-new Emergency Department, state-of-the-art maternity center, a women’s imaging center, cardiac and pulmonary rehabilitation, center for joint replacement, wound care center, and an intensive/critical care unit. The hospital is the only hospital in Bergen County with all private rooms at no additional cost to the patient. Find the kind of care you’ve been looking for at Pascack Valley Medical Center. For more, please visit www.PascackMedicalCenter.com 

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Rehabilitation Therapy Services Market Trend Shows a Rapid

The most recent report published by Market Research Inc. indicates that the Rehabilitation Therapy Services Market is likely to accelerate significantly in the next few years. Specialists have studied market drivers, restraints, risks and prospects in the global market. The Rehabilitation Therapy Services Market report shows the likely direction of the market in the coming years along with its assessments. A meticulous study purposes to understand the market price. By analyzing the competitive landscape, the authors of the report have made excellent efforts to help readers understand the key business strategies that significant organizations are utilizing to keep up with market sustainability.

Rehabilitation therapy is used to improve functioning of day-to-day life, after any accident, disease, or surgery. The growth of the market can be attributed to the increasing demand for regular or close-to-regular lifestyle for differently abled individuals, along with the rising prevalence of disabilities across the world. Moreover, increasing global geriatric population is also foreseen to play a crucial role in the market growth, as older individuals are more likely to require physical therapy.

Key Players in the Rehabilitation Therapy Services Market Research Report:
Therapy Solutions, Inc., Priory Group, Hunterdon Healthcare, Genesis Rehab Services, Interim HealthCare, Inc., Prevea Health Services, SuVitas, Pivot Physical Therapy, Athletico Physical Therapy, Smart Speech Therapy, Bellefleur Physiotherapy, CORA Health Services, Inc., Upstream Rehabilitation, Inc., Sutter Health

Get a Sample Copy of Report: www.marketresearchinc.com/request-sample.php?id=115683

The report includes organizational profiles of virtually all major players in the Rehabilitation Therapy Services market. The Company Profiles segment provides important analysis of strengths and weaknesses, business trends, recent advances, mergers and acquisitions, expansion plans, global presence, market presence, and portfolios of products from significant market players. This data can be used by players and other market members to expand their productivity and streamline their business strategies.

Rehabilitation Therapy Services Market Segmentation by type:
• Speech Therapy
• Physical Therapy
• Occupational Therapy
• Respiratory Therapy
• Cognitive Behavioral Therapy
• Others

Rehabilitation Therapy Services Market Segmentation by application:
• Orthopedic
• Neurological
• Pulmonary
• Palliative Care
• Sports Related Injuries
• Integumentary Rehabilitation
• Others

𝐀 𝐬𝐲𝐧𝐨𝐩𝐬𝐢𝐬 𝐨𝐟 𝐭𝐡𝐞 𝐫𝐞𝐠𝐢𝐨𝐧𝐚𝐥 𝐥𝐚𝐧𝐝𝐬𝐜𝐚𝐩𝐞 𝐨𝐟 𝐭𝐡𝐞 𝐦𝐚𝐫𝐤𝐞𝐭:
• The research report extensively lists the regional landscape of this industry. According to the review, Rehabilitation Therapy Services Market regional landscape is bifurcated into 𝐍𝐨𝐫𝐭𝐡 𝐀𝐦𝐞𝐫𝐢𝐜𝐚, 𝐄𝐮𝐫𝐨𝐩𝐞, 𝐀𝐬𝐢𝐚 𝐏𝐚𝐜𝐢𝐟𝐢𝐜, 𝐋𝐚𝐭𝐢𝐧 𝐀𝐦𝐞𝐫𝐢𝐜𝐚, 𝐌𝐢𝐝𝐝𝐥𝐞 𝐄𝐚𝐬𝐭 and 𝐀𝐟𝐫𝐢𝐜𝐚.
• The study provides significant data relating to the market share that every region is estimated to hold, in tandem with the growth opportunities anticipated for each geography.
• The report describes the growth rate in which each geography is estimated to register over the forecast time period.

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The global market for Rehabilitation Therapy Services is segmented on the basis of product, type. These segments have been concentrated separately. The detailed examination permits evaluation of the factors influencing the Rehabilitation Therapy Services Market. Specialists have analyzed the nature of growth, investments in research and development, changing utilization patterns, and rising number of applications. Furthermore, experts have additionally assessed the changing economics around the Rehabilitation Therapy Services Market that are likely affect its course.

The report's regional analysis segment allows players to focus on high-growth regions and countries that could help them to expand their presence in the Rehabilitation Therapy Services market. Aside from expanding their footprint in the Rehabilitation Therapy Services market, the regional analysis assists players to increase their sales while having a better comprehension of customer behavior in specific regions and countries. The report provides CAGR, revenue, production, consumption and other significant measurements and figures related to the global and regional markets. It shows how different type, application, and regional segments are advancing in the Rehabilitation Therapy Services market in terms of growth.

Some of the Key benefit in the report:
• Which are the five top players of the Rehabilitation Therapy Services market?
• How might the Rehabilitation Therapy Services showcase change in the following five years?
• Which item and application will take a largest part of the Rehabilitation Therapy Services showcase?
• What are the drivers and limitations of the Rehabilitation Therapy Services market?
• Which local market will show the most elevated development?
• What will be the CAGR and size of the Rehabilitation Therapy Services market all through the estimate period?

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UPDATED guidelines for the management of chronic obstructive pulmonary disease (COPD) include both non-pharmacological and pharmacological strategies to reflect the importance of a holistic approach to clinical care for people living with the disease.

Developed by the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand, and published as a summary in the MJA, the guidelines include 26 recommendations addressing:

  • case finding and confirming diagnosis – confirmation by spirometry, blood eosinophil levels, behaviour and risk factors (smoking, treatment adherence, self-management skills, physical activity, comorbid conditions);
  • optimising function – non-pharmacological therapies, pharmacological therapies, managing comorbid conditions, palliative care, lung volume reduction surgery, pulmonary rehabilitation, non-invasive ventilation;
  • preventing deterioration – smoking cessation, immunisation, oxygen therapy, prophylactic antibiotics, biologic therapies, palliative care, home bilevel ventilation;
  • developing a plan of care; and
  • managing exacerbations – pharmacological management, non-invasive ventilation, and multidisciplinary care.

“About one in 13 Australians over the age of 40 years is estimated to have chronic obstructive pulmonary disease (COPD),” wrote the authors, led by Associate Professor Eli Dabscheck, a respiratory and sleep physician from Melbourne’s Alfred Hospital.

“In 2018, COPD was the leading cause of potentially preventable hospitalisations, the third leading specific cause of total disease burden, and the fifth leading cause of death in Australia. The impact of COPD is even greater among Indigenous Australians compared with non-Indigenous Australians.”

Non-pharmacological therapies for COPD include walking and structured exercise, as well as pulmonary rehabilitation to improve breathlessness, exercise performance, physical activity level and health status. Pharmacological therapies, including short- and long-acting inhaled bronchodilators, inhaled corticosteroids (ICS), and long-acting β-agonists, are evaluated in the guidelines.

The full guidelines are available at copdx.org.au/.

Supervised injecting centres: 21 years of evidence

TWENTY-one years after the establishment of the Uniting Sydney Medically Supervised Injecting Centre (MSIC), research shows that, rather than becoming a “honeypot”, the MSIC has led to improved and sustained public amenity, leading to a call for the establishment of more supervised injecting facilities. Associate Professor Carolyn Day, from the University of Sydney, and colleagues wrote in the MJA that they had “addressed key questions regarding [supervised injecting facility (SIF)] operations and contend that there is sufficient evidence to support SIF rollout and expansion”. “Good policy, with clear legislation and careful management of clients within a harm reduction framework, can and does alleviate problems that may be perceived as inherent to the operation of such services. Given the solid evidence, current governments, in Australia and elsewhere, should expand SIF services without unnecessary protracted trial periods. The key challenge in SIF expansion is supporting legislation. Questions regarding the scientific and operational merit of SIFs have been answered. After 21 years of success, it is time for robust support for further services to be implemented both within Australia and internationally.”

Neurological manifestations of COVID-19 in adults and children

An international group of researchers, including from Australia, have detailed the differences in neurological manifestations of COVID-19 in adults and children in an article published in Brain. Researchers analysed data from the International Severe Acute Respiratory and emerging Infection Consortium cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021 – 161 239 patients (158 267 adults, 2972 children) admitted to hospital with COVID-19 and assessed for neurological manifestations and complications were included. “In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%), and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%), and central nervous system (CNS) infection (0.2%). Each occurred more frequently in [intensive care unit (ICU)] than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU vs. non-ICU (7.1% vs. 2.3%, P < .001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease, and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure, and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age.”

Counting steps important but faster cadence matters too

Research published in JAMA Internal Medicine, including authors from the University of Sydney, has found that accumulating more steps per day (up to about 10 000) may be associated with a lower risk of all-cause, cancer, and cardiovascular disease (CVD) mortality and with lower incidence of cancer and CVD, and that higher step intensity may provide additional benefits. The authors analysed data from 78 500 participants in the UK Biobank for 2013–2015, including adults aged 40–79 years. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. “The study population … was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause ([mean rate of change (MRC)], −0.08; 95% CI, −0.11 to −0.06), CVD (MRC, −0.10; 95% CI, −0.15 to −0.06), and cancer mortality (MRC, 95% CI, −0.11; −0.15 to −0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps,” the authors reported. “Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.”

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Clinical Electrophysiotherapy in the elderly - here electrical stimulation and other tactics to promote healing in stubborn wounds such as burns, sores on diabetics, or post-amputation wounds are used.

Geriatric Physiotherapists - are prepared to deal with the special needs of the elderly and help them continue to maintain as active a lifestyle as possible.

Neurological Physiotherapy in senior citizens- patients that could have any one of many neurological illnesses or injuries are treated by neurological physiotherapy. This includes Multiple Sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, or injury to the brain or spinal cord.

Elderly women’s Health Physiotherapists - specialize in women’s health. This speciality helps women recover from such issues as incontinence, pelvic pain,

Why Physiotherapy is important in elderly?

A physiotherapy program can help senior citizens return close to their prior level of functioning, and encourage activities and lifestyle changes that can help prevent further injury and improve overall health and well-being.

Physiotherapy can help by following ways in the senior citizens.

Reduce or eliminate pain: Therapeutic exercises and manual therapy techniques such as joint and soft tissue mobilization or treatments such as ultrasound, taping or electrical stimulation can help relieve pain and restore muscle and joint function to reduce pain. Such therapies can also prevent pain from returning.

Avoid surgery: If physical therapy helps you eliminate pain or heal from an injury, surgery may not be needed. And even if surgery is required, you may benefit from pre-surgery physical therapy. If you are going into surgery stronger and in better shape, you will recover faster afterwards in many cases. 

Improve mobility: If you’re having trouble standing, walking or moving—no matter your age—physical therapy can help. Stretching and strengthening exercises help restore your ability to move. Physical therapists can properly fit individuals with a cane, crutches or any other assistive device, or assess for orthotic prescription.

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Something didn’t feel quite right in Irma Nieves-Torres’ left knee after weightlifting. She’d had surgery on that knee before, but this was different.

“When I was in the eighth grade, we discovered that my patella (kneecap) floats congenitally, meaning the back doesn’t land within the femur and tibia,” Nieves-Torres said. “I had patellofemoral syndrome reconstruction at that time where they took the ligaments and muscles from my tibia and used them like a Band-Aid to keep my kneecap from moving around.”

Nieves-Torres didn’t experience any issues with her knee after the surgery in her teens. The Puerto Rico native went through high school and committed to strength training. She played college soccer for four years at Universidad Metropolitana de Puerto Rico and earned a bachelor’s degree in exercise science before moving to the Midwest to attend Kansas State.

“I stayed active, worked at a gym, practiced and competed in Olympic weightlifting and did some CrossFit for fun,” she said.

As a certified personal trainer with a master’s degree in kinesiology, Nieves-Torres knew that she needed help to deal with the pain and swelling she developed. She turned to a physical therapist in Manhattan, but after using therapy and dry needling without success she sought out an orthopedic surgeon to help alleviate the pain.

Scans showed that Nieves-Torres didn’t have a meniscus tear as the team originally thought. It was worse. She had grade three degeneration in the knee, meaning that her knee was literally bone on bone.

“With that diagnosis, it was time for more aggressive treatment,” she said. “My surgeon recommended a cartilage restoration procedure called MACI, so we did an initial scope to clean out the knee and harvest cartilage before scheduling a second procedure after Christmas.”

MACI stands for membrane autologous chondrocyte implantation. It’s a procedure that uses a patient’s own cells to regrow cartilage for use in knee repairs. It’s most commonly used for young adults and athletes with an acute injury to the cartilage, but it’s also used for patients whose cartilage develops improperly.

Long rehabilitation process

After knee surgery, life doesn’t generally go back to normal right off the bat. Nieves-Torres was in for a long road of rehabilitation — one predicted to take up to 18 months — but she couldn’t just hit the ground running.

Patients with injuries where weight-bearing activities are limited, such as stress fractures, or those with post-operative weight limitations, as in Nieves-Torres’ case, may be good candidates for hydrotherapy.

For that, she turned to Dan Lorenz, sports medicine director at LMH Health Therapy Services.

“The extent of Irma’s injury didn’t allow for her to do any weight-bearing activities because of the post-operative instructions,” Lorenz said. But in a pool, “the water is far less compressive on the joint,” making rehabilitation activities easier.

“Having that environment meant we could still be mindful of the healing process and help improve her function through earlier weight-bearing activities,” Lorenz said.

LMH Health’s West Campus has a special pool called the Hydroworx 2000 that’s designed to allow patients with weight-bearing limitations to perform exercises in the water that they can’t do on land. The pool is equipped with warm water, adjustable depth, jets and a treadmill.

Nieves-Torres said she began working in the pool as soon as her incision closed.

“I jumped in and we started with walking,” she said. “Having my patella realigned during the surgery really changed my gait. I also discovered that I had pronation, as well as tight and underactive muscles I didn’t know about.

“Using the pool helped me gain confidence,” she added. “I became comfortable walking and got back to that heel-toe movement.”

Soon, Nieves-Torres began strength training with exercises such as lunges and squats in the pool. She progressed to running, kicking and swimming. And when the time was right, the team turned on the jets, which provided more resistance. After about 12 weeks in the water, Nieves-Torres was ready to get back to work on land.

“Dan and his team made the call when it was time for me to get back on land and into the gym setting,” she said. “I continued to work in a pool on my own with the knowledge that they provided. It built confidence and was reassuring for me to be able to jump in on my own and continue my rehab.”

The Hydroworx pool is just one of the many high-tech tools available to therapists working at the West Campus. The campus also has an isokinetic testing machine that can objectively measure joint function following injury or surgery, as well as force plates that can use sensors to detect differences in forces that a patient’s body exerts on the ground that therapists might not be able to see with the naked eye.

Looking to the future

Nieves-Torres is near the end of her rehab journey, and she said she’s mostly back to normal. She experiences occasional swelling due to the long hours she spends on her feet as a personal trainer, but taking Tylenol or Advil, elevating her legs and using ice takes care of that.

“There’s still some stuff that occasionally feels funky, but I don’t have any pain. I may have some discomfort after I’ve done a little too much or stepped wrong, and I’m very aware of my walking because it’s been a change from the way I’ve done it for 25 years,” she said.

Nieves-Torres said that when looking for a physical therapy provider, it’s important to do your research and make sure they fit your needs. That makes the rehab process easier to get through.

“There are a lot of dark times in your rehab,” she said. “Your therapist is your person, so it’s important to build a rapport with them. Dan understood where I came from and that I wanted to get back to the best level I could again — 1% better every day.”

— Autumn Bishop is the marketing manager at LMH Health, which is a major sponsor of the Journal-World’s Health section.







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This post was contributed by a community member. The views expressed here are the author's own.

Elmhurst Hospital’s pulmonary rehabilitation program has achieved certification from the Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The certification is recognition of Elmhurst Hospital’s commitment to improving the quality of life of patients by enhancing standards of care.

Cardiovascular and pulmonary rehabilitation programs are designed to help people with cardiovascular problems (e.g., heart attacks, coronary artery bypass graft surgery) and pulmonary problems (e.g., chronic obstructive pulmonary disease [COPD], respiratory symptoms) recover faster and live healthier. Both programs include exercise, education, counseling and support for patients and their families.

To earn accreditation, the Elmhurst Hospital pulmonary rehabilitation program participated in an application process that requires extensive documentation of the program’s practices. AACVPR Program Certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other related professional societies.

Find out what's happening in Elmhurstwith free, real-time updates from Patch.

For more information, about pulmonary rehabilitation services at Elmhurst Hospital and Edward-Elmhurst Health, visit www.eehealth.org/services/pulmonary/rehab.

The views expressed in this post are the author's own. Want to post on Patch?

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The Improving Care and Access to Nurses (ICAN) Act introduced by Congresswoman Lucille Roybal-Allard (D-CA) would remove barriers to practice under the Medicare and Medicaid programs by increasing access to health care services provided by advanced practice registered nurses (APRNs), as described in a press conference held on Capitol Hill, September 13, 2022.  

Currently, more than 200,000 APRNs, including nurse practitioners (NPs), clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives, are treating Medicare patients, and approximately 40% of Medicare beneficiaries are receiving care from APRNs.

The ICAN Act (HR 8812) aims to remove administrative and practice barriers by authorizing APRNs to order and supervise cardiac and pulmonary rehabilitation, order diabetic shoes, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, and perform all mandatory examinations in skilled nursing facilities. If passed, the act would allow APRN patients to fully be included in the beneficiary attribution process for the Medicare Shared Savings Program. The act would amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018.


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This legislation is consistent with the recommendations from numerous health care stakeholders, including the National Academy of Medicine (NAM) in their The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report. In this report, NAM recommends that “all relevant state, federal, and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality, and value.”

Nursing Associations Support ICAN Act

Rep Roybal-Allard was joined at the press conference by leaders from the American Association of Nurse Practitioners (AANP), American Nurses Association (ANA), American Association of Nurse Anesthesiology (AANA), and American College of Nurse-Midwives (ACNM).

April Kapu AANP
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN

“I have cared for hundreds and hundreds of patients who have undergone cardiac and thoracic surgery,” said AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, at the press conference. “Cardiac and pulmonary services are vital to their recovery and healing process. We cannot have delays in these much needed services…. It is time that Medicare and Medicaid programs fully recognize our modern health care workforce.”

“It is critical that laws and regulations facilitate the most efficient relationships between health care professionals and create systems in which midwives and other APRNs can communicate openly, practice collaboratively, and provide quality care that falls within everyone’s professional scope of practice,” stated ACNM CEO Katrina Holland. “Decades of research demonstrates that midwifery care can improve maternal health outcomes, the ICAN Act ensures that certified nurse-midwives can bring their evidenced-based skillset and knowledge to fully meet the needs of their patients.”

“Nurses play a critical role in our health care delivery system, often by serving as the primary source of care in many communities. This is especially true of APRNs who were able to practice at the top of their license during the height of the pandemic, due to waivers granted by Federal and state governments, and in doing so provided access to high-quality care for COVID-19 and non-COVID-19 patients alike,” said ANA President Ernest Grant, PhD, RN, FAAN. “Modern health care requires flexibility. We cannot not be hindered by antiquated barriers to practice or petty turf wars over perceived hierarchies. The health of our patients and communities must come first. The ICAN Act means that APRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists will be able to care for their patients at the fullest extent of their abilities while experiencing fewer disruptions and less interference.”

Sources

Nursing associations applaud legislation to remove practice. News release. American Nurse Association. September 13, 2022. Accessed September 13, 2022. www.nursingworld.org/news/news-releases/2022-news-releases/nursing-associations-applaud-legislation-to-remove-practice-barriers/

AANP applauds U.S. House legislation strengthening patient access to health care. News release. American Association of Nurse Practitioners. September 13, 2022. Accessed September 13, 2022. www.aanp.org/news-feed/aanp-applauds-us-house-legislation-strengthening-patient-access-to-health-care

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According to DelveInsight, the Chronic Obstructive Pulmonary Disease Market in 7MM is expected to witness a major change in the study period 2019-2032

“The increase in Chronic Obstructive Pulmonary Disease Market size is a direct consequence of an increase in R& D activity, increasing prevalent population, expected commercial success of upcoming therapies in the 7MM

 

The Chronic Obstructive Pulmonary Disease Market is expected to gain market growth in the forecast period of 2022 to 2032. The growing cases of tumors will directly impact the growth of the Chronic Obstructive Pulmonary Disease Market

 

The Chronic Obstructive Pulmonary Disease market report provides current treatment practices, emerging drugs, and market share of the individual therapies, current and forecasted 7MM Chronic Obstructive Pulmonary Disease market size from 2019 to 2032. The Report also covers current Chronic Obstructive Pulmonary Disease treatment practice, market drivers, market barriers, SWOT analysis, reimbursement, market access, and unmet medical needs to curate the best of the opportunities and assesses the underlying potential of the market.

 

Key takeaways from the Chronic Obstructive Pulmonary Disease Market Research Report

  • The expected launch of the Chronic Obstructive Pulmonary Disease emerging therapies and the research and development activities of pharmaceutical companies will also fuel the Chronic Obstructive Pulmonary Disease market growth during the forecast period.
  • The estimates suggest a Chronic Obstructive Pulmonary Disease higher diagnosed prevalence in the United States with 17,455,605 diagnosed cases in 2020, which might increase in 2030.
  • The total Chronic Obstructive Pulmonary Disease diagnosed prevalent population in seven major markets was found to be 31,730,590 in 2020 and is anticipated to increase in 2030.
  • Chronic Obstructive Pulmonary Disease Market Companies included Afimmune, AstraZeneca, Amgen, Circassia Pharmaceuticals Inc., Biomarck Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Chiesi Farmaceutici, Chiesi Farmaceutici S.p.A., Genentech, GlaxoSmithKline, and several others
  • Chronic Obstructive Pulmonary Disease Market Therapies included Anoro Ellipta, Incruse Ellipta/Encruse Ellipta, and several others

 

Interested to know more about the ongoing developments in the Chronic Obstructive Pulmonary Disease Market Outlook? Visit here- www.delveinsight.com/sample-request/chronic-obstructive-pulmonary-disease-copd-market

 

Chronic Obstructive Pulmonary Disease Overview

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. The most common respiratory symptoms include dyspnea, cough, and/or sputum production; these symptoms may be under-reported by patients. The main risk factor for COPD is tobacco smoking, but other environmental exposures such as biomass fuel exposure and air pollution may contribute.

Besides exposures, host factors predispose individuals to develop COPD. These include genetic abnormalities, abnormal lung development, and accelerated aging. COPD may be punctuated by periods of acute worsening of respiratory symptoms, called exacerbations. In most patients, COPD is associated with significant concomitant chronic diseases, which increase its morbidity and mortality. COPD is a long-lasting lung disease where the small airways in the lungs are damaged, making it harder for air to get in and out.

 

Chronic Obstructive Pulmonary Disease Epidemiology Insights

The Chronic Obstructive Pulmonary Disease epidemiology covered in the report provides historical as well as forecasted epidemiology segmented by Total Diagnosed Prevalent Cases of Chronic Obstructive Pulmonary Disease (COPD), Gender-specific Diagnosed Prevalent Cases of Chronic Obstructive Pulmonary Disease (COPD), Age-specific Diagnosed Prevalent Cases of Chronic Obstructive Pulmonary Disease (COPD), Diagnosed Prevalent Cases of COPD Based on Severity of Airflow Limitation, and Diagnosed Prevalent Cases of COPD Based on Symptoms and Exacerbation History scenario in the 7MM covering the United States, EU5 countries (Germany, France, Italy, Spain, and the United Kingdom) and Japan from 2019 to 2032.

 

Chronic Obstructive Pulmonary Disease Epidemiology Segmentation in the 7MM 

  • Total Chronic Obstructive Pulmonary Disease Diagnosed Prevalent Cases
  • Chronic Obstructive Pulmonary Disease Gender-specific Diagnosed Prevalent Cases
  • Chronic Obstructive Pulmonary Disease Age-specific Diagnosed Prevalent Cases
  • Chronic Obstructive Pulmonary Disease Diagnosed Prevalent Cases Based on Severity of Airflow Limitation

 

Chronic Obstructive Pulmonary Disease Treatment Market

Chronic Obstructive Pulmonary Disease treatment include drugs, for example, nicotine replacement therapy, beta-2 agonists and anticholinergic agents (bronchodilators), combined drugs using steroids and long-acting bronchodilators, mucolytic agents, oxygen therapy, and surgical procedures such as bullectomy, lung volume reduction surgery, and lung transplantation. The goals of COPD treatment are to reduce hospitalizations, reduce and prevent exacerbations, decrease dyspnea, improve quality of life, slow disease progression, and reduce mortality. The mainstays of treatment are smoking cessation, when applicable, and pharmacotherapy with inhaled bronchodilators and corticosteroids. Additional therapies include oral phosphodiesterase-4 inhibitors, vaccinations, pulmonary rehabilitation, and long-term oxygen therapy in hypoxic patients. Bronchodilators are used to treat chronic obstructive pulmonary disease (COPD). The medicines come in many forms, with some forms requiring special instructions. There are several short-acting bronchodilators for COPD.

 

Discover more relevant information on the Chronic Obstructive Pulmonary Disease Market Research Report here- www.delveinsight.com/sample-request/chronic-obstructive-pulmonary-disease-copd-market

 

Chronic Obstructive Pulmonary Disease Marketed Drugs

Anoro Ellipta: GlaxoSmithKline/Theravance/Innoviva

Anoro Ellipta is a combination of umeclidinium, an anticholinergic, and vilanterol, a long-acting beta2-adrenergic agonist (LABA), indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD) (FDA, 2013). Anoro Ellipta is a once-daily product approved in the US that combines two long-acting bronchodilators in a single inhaler for the maintenance treatment of COPD.

Incruse Ellipta/Encruse Ellipta: GlaxoSmithKline

Incruse Ellipta is an anticholinergic approved for the long-term once-daily maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema. GSK’s once-daily anticholinergic, a type of bronchodilator also known as a long-acting muscarinic antagonist (LAMA), is contained in the Ellipta inhaler. The FDA-approved strength is 62.5 mcg.

 

Chronic Obstructive Pulmonary Disease Emerging Drugs

Itepekimab (SAR440340/REGN3500/Anti-IL-33 mAb): Sanofi/Regeneron Pharmaceuticals

REGN3500 is a fully human monoclonal antibody that inhibits interleukin-33 (IL-33), a protein that is believed to play a key role in type 1 and type 2 inflammation. The drug is administered subcutaneously. Preclinical research showed REGN3500 blocked several markers of both types of inflammation. Regeneron and Sanofi are currently studying REGN3500 in respiratory and dermatological diseases where inflammation plays an underlying role.

Dupixent (Dupilumab): Regeneron Pharmaceuticals/Sanofi

Dupixent (dupilumab) is a monoclonal antibody targeting α chain of the interleukin (IL)-4 receptor. It inhibits the biological effects of the cytokines IL-4 and IL-13, which are key drivers in the TH2 response (Sastre, 2018). Dupilumab is approved in the US to treat patients aged ≥12 with moderate-to-severe atopic dermatitis (AD) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies.

 

Chronic Obstructive Pulmonary Disease Market Outlook

Many people with Chronic Obstructive Pulmonary Disease have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of the disease, effective therapy is available that can control symptoms, slow progression, reduce the risk of complications and exacerbations, and improve the ability to lead an active life. The goal in treating Chronic Obstructive Pulmonary Disease is to help the person breathe easier and get back to regular activities; many treatments and lifestyle approaches can help. The patient may also try some natural and alternative treatment options. Chronic Obstructive Pulmonary Disease treatment focuses on relieving symptoms, such as coughing, breathing problems, and avoiding respiratory infections. The treatments are often based on the stages of Chronic Obstructive Pulmonary Disease.

 

Chronic Obstructive Pulmonary Disease Market Size

The Chronic Obstructive Pulmonary Disease Market Size has been categorized into three groups based on the type of therapies that are used and that might get launched, i.e., Monotherapies, Double combination therapies, and Triple combination therapies. The monotherapies are further categorized into Long-Acting Bronchodilators (LABDs), Inhaled Corticosteroids (ICS), Phosphodiesterase Type 4 Inhibitors, and other monotherapies. In LABA, drugs like Striverdi Respimat, Arcapta/Onbrez, Serevent, and Brovana are there, and in LAMA class, molecules such as Spiriva (Spiriva HandiHaler and Spiriva Respimat), Tudorza Pressair, Incruse Ellipta, Yupelri, Seebri Neohaler, Lonhala Magnair, etc. are included.

 

Read more about the Chronic Obstructive Pulmonary Disease Market Companies and Therapies in the report- www.delveinsight.com/sample-request/chronic-obstructive-pulmonary-disease-copd-market

 

Scope of the Chronic Obstructive Pulmonary Disease Market Forecast Report

  • Coverage- 7MM
  • Study Period-2019-2032
  • Chronic Obstructive Pulmonary Disease Market Forecast Period- 2022-2032
  • Chronic Obstructive Pulmonary Disease Market Companies included Afimmune, AstraZeneca, Amgen, Circassia Pharmaceuticals Inc., Biomarck Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Chiesi Farmaceutici, Chiesi Farmaceutici S.p.A., Genentech, GlaxoSmithKline, and several others
  • Chronic Obstructive Pulmonary Disease Market Therapies included Anoro Ellipta, Incruse Ellipta/Encruse Ellipta, and several others
  • Chronic Obstructive Pulmonary Disease Market Drivers and Barriers
  • KOL Views
  • Chronic Obstructive Pulmonary Disease Market Access and Reimbursement

 

Table of Content

1. Key Insights

2. Report Introduction

3. Chronic Obstructive Pulmonary Disease (COPD) Market Overview at a Glance

4. Executive Summary of Chronic Obstructive Pulmonary Disease (COPD)

5. Key Events

6. Disease Background and Overview

7. Epidemiology and Patient Population

8. Patient Journey

9. Organizations contributing toward Chronic Obstructive Pulmonary Disease (COPD)

10. Chronic Obstructive Pulmonary Disease Marketed Therapies

11. Chronic Obstructive Pulmonary Disease Emerging Drugs

12. Potential of Emerging and Current therapies

13. Chronic Obstructive Pulmonary Disease (COPD): Seven Major Market Analysis

14. KOL Views

15. Chronic Obstructive Pulmonary Disease Market Drivers

16. Chronic Obstructive Pulmonary Disease Market Barriers

17. SWOT Analysis

18. Unmet Needs

19. Reimbursement and Chronic Obstructive Pulmonary Disease Market Access

20. Appendix

21. DelveInsight Capabilities

22. Disclaimer

23. About DelveInsight

 

Got queries? Reach out for more details on the Chronic Obstructive Pulmonary Disease Market Forecast Report- www.delveinsight.com/sample-request/chronic-obstructive-pulmonary-disease-copd-market

 

About Us

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