The effect of pulmonary rehabilitation on cardio-respiratory function of patients with chronic lung diseases identified during chest X-ray screening for pulmonary tuberculosis
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Date
11-03-22
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Publisher
Kamuzu University of Health Sciences
Abstract
Type of Research Study
This study will use an Experimental Study-it is a Randomized Controlled Trial (RCT) with 1:1 allocation to assess The Effect of Pulmonary Rehabilitation (PR) on Cardio-Respiratory Function of Patients with Pulmonary Tuberculosis in Blantyre.
Problem to be studied
The prevalence of Chronic Lung Diseases (CLDs) is high in patients undergoing Tuberculosis (TB) screening mostly due to previous pulmonary infections including pulmonary Tuberculosis (pTB). In order to prevent progressive loss of pulmonary function in these patients, interventions that prevent CLDs need to be employed. The National Tuberculosis Control Program (NTP) in Malawi does not have established guidelines in the management of pTB to prevent CLDs.
Previous TB infection usually causes lung damage and post pTB survivors frequently present with persistent respiratory symptoms which clinically present as CLDs. Even though PR has shown to be effective in the management of CLDs by improving respiratory symptoms, physical function and health related quality of life (HRQoL), there is still limited evidence on the effect of PR during TB treatment. Furthermore the few studies performed so far with regard to PR in TB sequelae have confirmed the same positive results as those that are found with PR use in CLDs.
Objectives
Broad objective
To compare the effect of PR (breathing exercises, strengthening and aerobic training PR
techniques used in chronic lung diseases) at 6 weeks of treatment with no PR in the management of patients with TB.
Specific objectives
1. To compare changes in spirometry Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) values in Litres (L) between participants receiving PR with those not receiving PR.
2. To assess the effect of PR on exercise tolerance in participants receiving PR in comparison to those not receiving PR.
3. To compare respiratory symptoms improvement of pTB between participants receiving PR with participants not receiving PR.
Methodology
This study will be conducted from 1st March to 31st May 2022 at the physiotherapy clinics based at Queen Elizabeth Central Hospital (QECH), Kamuzu University of Health Sciences (KUHES), and private practitioners in Blantyre. The study participants who will be selected will include a total of 240 participants. These participants will include pTB patients (≥18 years) who have initiated TB treatment with known HIV status from Blantyre District. Data on spirometry, physical function and HRQOL will be collected. Study Participants will then be randomly assigned to receive PR (the intervention) and no PR (control arm) using a sequence pre-generated by a statistician. The PR program will run for 6 weeks with a 90 min–120min supervised session at week one and week three. Continuous data will be analysed using a T test and Analysis of Variance (ANOVA) if
normally distributed, and if skewed a Wilcoxon Rank Sum Test will be used. Furthermore, categorical variables will be analysed using a Fisher's exact test. Finally Logistic regression will be done to show differences between the intervention and control group.
Expected findings and their dissemination
It is expected that at the end of the study there will be evidence of clinically significant
improvements in HRQoL, exercise tolerance, respiratory symptoms and lung function in patients receiving PR. These findings will be disseminated at District level, national conferences, the health facilities of the TB patients, College of Medicine Research and Ethics Committee (COMREC), Blantyre District Health Office (DHO), NTP and wider audiences through journal publications such as the Malawi Medical Journal.
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Keywords
The Effect of Pulmonary Rehabilitation on Cardio-Respiratory