Avaliação e reabilitação de pacientes hospitalizados por doenças pulmonares agudas e crônicas agudizadas

Abstract

Background: The effects of exercise training have not been evaluated in patients hospitalized with acquired pneumonia (CAP). Additionally, the field tests that assess functional capacity (FC) need to be more solidly studied in patients hospitalized for acute pulmonary diseases. Objectives: Article 1: To assess the reproducibility of the six-minute walk test (6MWT) and Glittre ADL-test (GT) in patients hospitalized for acute pulmonary diseases; Article 2: To evaluate FC and safety of the Chester step test (CST) and the modified incremental step test (MIST) in patients hospitalized for acute lung diseases and Article 3: Compare the effects of a physical training program with respiratory physiotherapy in patients hospitalized for CAP on peripheral muscle strength, functional capacity and quality of life. Methods: Article 1: 81 patients underwent two 6MWT and GT, in randomized order on two visits. Article 2: 77 patients underwent CST and MIST and were compared to a control group of 20 healthy volunteers. Article 3: 41 patients were randomized into two groups: For eight consecutive days, the control group (CG, 14 patients) performed respiratory physiotherapy program and the experimental group (EG, 27 patients) performed physical training program. Results: Article 1: 6MWT was reproducible [349 m (285-419) and 363 m (288-432); ICC: 0.97(0.95-0.98)], and time in GT [286s (220-378) and 244s (197-323); ICC: 0.91(0.95-0.96)], but with a huge variability in the results was observed by the large limits of agreement in the Bland-Altman analysis. Article. 2: patients in CST climbed 66±63 steps and 113±121 steps in MIST (P < 0.05). The tests correlated with the 6MWT (CST, r=0.54 and MIST, r= 0.61) and no adverse events were observed. Compared to the control group, patients had a lower number of steps in the two tests. Article 3: The FC tests initial and final of CG and EG, respectively, were: Shuttle Walk Teste Incremental (ISWT): from 327±93m and 367±88m (P=0.87) to 363±131m and 555±171m (P<0.0001); GT: from 219±47s and 205±38s (P=0.77) to 213±46s and 152±33s (P<0.0001). EG patients also showed significant improvement in the quality of life (QoL), increase in peripheral muscle strength (PMS) and decrease in dyspnea. The groups did not differ in terms of lung function, evolution, and time of hospitalization. Conclusion: The 6MWT and the GT were reproducible, however, due to the large variability of the results, two tests are needed to obtain reliable measurements. The CST and MIST showed to be safe and can be used to assess FC in hospitalized patients. The effects of exercise training program compared to physiotherapy treatment promoted an improvement in FC, increase in PMS, improve dyspnea and QoL. The treatment was not associated with the time of hospitalization.