Pulmonary Rehabilitation Is there evidence for speech pathology involvement

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Pulmonary Rehabilitation Is there evidence for
speech pathology involvement?
Maria Tranter Anita McKinstry Speech
Pathologists, Melbourne, Australia RCSLT
conference 2009
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What is COPD?

• Chronic
• Obstructive
• Pulmonary
• Disease

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COPD

• Irreversible lung disease characterised by
  chronic obstruction of lung airflow that
  interferes with normal breathing (WHO, 2008)
• Includes emphysema and chronic bronchitis, and
  may overlap with asthma

COPDX Guidelines, 2008
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Prevalence and costs

• Major burden for Health Systems Worldwide
  (Crockett in COPD MX Plan 2003)
• Prediction 5th leading cause of disability
  worldwide by 2020
• (Mannino 2002)
• Australia 4th common cause of death for men, 6th
  in women (Aust. Lung Foundation, 2001)
• UK 5th most common cause of death
  (National Statistics 2006)

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Pulmonary Rehabilitation

• Exercise training
• relieves dyspnoea and fatigue
• improves emotional function
• enhances patients sense of self control over
  their condition
• (Lacasse et al., 2006)

• Education
• helps patients become more active participants in
  their healthcare
• improves understanding of changes that occur in
  chronic illness
• improves QOL
• (Worth Dien, 2004)

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Pulmonary Rehabilitation

• 1hour exercise sessions provided by physiotherapy
• 1hour multidisciplinary education sessions
• Respiratory Physician
• Nurse
• Pharmacist
• Physiotherapist
• Respiratory Scientist
• Occupational therapist
• Dietitian
• Social Worker
• Speech Pathologist
• 2 x week for 8 weeks

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Dysphagia Prevalence in COPD

• Prevalence unknown
• 22-92 of patients self-report swallowing
  problems (Mokhlesi 2002 Maclean 1998)
• Maclean 1998 100 patients with COPD display
  abnormalities of swallowing on VFSS both during
  acute and stable phases of the disease

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Aim of Study

• To investigate the outcomes of dysphagia
  intervention in an outpatient Pulmonary
  Rehabilitation Program between November 2002
  March 2007

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Method Participants

• Participants enrolled in the Pulmonary
  Rehabilitation Program between November 2002
  February 2007 were eligible for inclusion
• Total enrolled 632 participants

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Method Intervention

• 1. Dysphagia Education
• 2. Dysphagia Screening
• 3. Individual outpatient dysphagia management
• ( Pulmonary Swallowing and Nutrition Clinic)

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1. Dysphagia Education

• Outcome Measure
• 11 item questionnaire (Dysphagia Knowledge)
• Pre-education
• Post-education
• 4 days post-education

• Education
• Normal Swallowing
• Swallowing with COPD
• Symptoms of dysphagia
• Consequences of aspiration
• Swallowing Strategies
• Oral hygiene
• Written information

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2. Dysphagia Screening

• Outcome Measure
• Pass/Fail Dysphagia Screen

• Swallow Screen
• Self report questionnaire on symptoms of
  dysphagia
• Water and dry biscuit test

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3. Outpatient Follow-up

• Pulmonary Swallowing
• Nutrition Clinic
• Clinical dysphagia assessment
  (/- instrumental Ax. via VFSS/FEES)
• Nutritional assessment
• Ongoing management and support

• Outcome Measure
• SWAL-QOL initial appt.
• SWAL-QOL 3 mths post initial appt

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Method Statistical Analysis

• Statistical significance was set at lt0.05 for all
  analyses.
• Wilcoxon signed ranks test for paired data
• Differences between education survey scores
• Initial and post intervention scores on the
  SWAL-QOL survey

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Results Education Pre-education and
immediately post education (Study Group 1)

• N 253
• Mean age 72
• MF 142112

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Results EducationPre- education, immediately
post and 4 days post education.

• N 78
• Mean age 72
• MF 4830

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Results Dysphagia Screening (Study Group 2)

• N 384
• Mean age 72.3 SD 9.9
• MF 223161

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Results QOL pre/post individual dysphagia
intervention (Study Group 3)

• N 60
• Mean age 74 SD 9.2
• MF 3129
• Repeat SWAL QOL survey completed a median 99.5
  days post initial (interquartile range 9 -126)

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Results SWAL QOL (Study Group 3)
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Conclusions

• Dysphagia intervention in PRP
• Increases patients knowledge of the relationship
  between COPD and dysphagia
• Contributes towards improved quality of life and
  self management with regard to swallowing
• For more information contact
• anita.mckinstry_at_austin.org.au

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References

• Australian Lung Foundation (2001) Case statement
  chronic obstructive pulmonary disease (COPD).
  Brisbane ALF.
• Lacasse Y, Goldstein R, Lasserson TJ, Martin S
  Pulmonary rehabilitation for chronic obstructive
  pulmonary disease. Cochrane Database Syst Rev
  Issue 4. Art. No. CD003793, 2006
• Maclean J Chronic airflow limitation and
  dysphagia a clinical picture of dysphagia during
  an acute exacerbation. Unpublished Thesis
  University of Sydney, 1998
• Mannino DM Epidemiology, prevalence, morbidity
  and mortality, and disease heterogeneity. Chest
  1211215-6S, 2002
• McHorneyC, RobbinsJ The SWAL-QOL and SWAL-Care
  outcome tools for dysphagia. Rockville, America
  ASHA 2003
• McKenzie DK, Abramson M, Crockett AJ, et al. The
  COPD-X Plan Australian and New Zealand
  Guidelines for the management of Chronic
  Obstructive Pulmonary Disease. 2007 Update.
  http//www.copdx.org.au/guidelines/documents/COPDX
  _Sep28_2007.pdf (Accessed 04 January 2008)
• Mokhlesi B, Logemann JA, Rademaker AW, Stangl CA,
  Corbridge TC Oropharyngeal deglutition in stable
  COPD. Chest 121(2)361-369, 2002
• National Statistics (2006) Health Statistics
  Quarterly 30 http//www.statistics.gov.uk/download
  s/theme-health/HSQ30.pdf (Accessed 02 February
  2009)
• World Health Organisation. Factsheet No 315
  Chronic obstructive pulmonary disease Online.
  Nov 2007. http//www.who.int/mediacentre/factsheet
  s/fs315/en/ (Accessed 04 January 2008)
• Worth H, Dien Y Does patient education modify
  behaviour in the management of COPD? Patient Educ
  Couns 52267-70, 2004