Purpose:To evaluate an app-based follow-up care program for individuals with chronic obstructive pulmonary disease (COPD) post-rehabilitation. Methods:After a 3-week inpatient pulmonary rehabilitation, a 12-week app-based follow-up care program was conducted. The app-based program was based on the model of physical activity-related health competence. The core components were: (1) personalized endurance and resistance training plans, (2) activity monitors for self-monitoring, (3) e-learning modules, and (4) 1:1 coaching by sports therapists and physiotherapists of the rehabilitation clinic. The following outcomes were assessed with questionnaires at the start and the end of rehabilitation as well as after follow-up care: COPD Assessment Test, quality of life, depression, anxiety, fatigue, key symptoms of COPD, pain, sport-/exercise-related activities, leisure-time/transportation physical activity, physical activity-related health competence, and experiences with the follow-up care. An exploratory analysis examined changes in outcomes during rehabilitation and follow-up care (Wilcoxon signed-rank tests, α<0.05). Experiences with the follow-up care were analyzed descriptively. Results:42 participants (age: M=57.5; SD=5.6; BMI: M=29.1; SD=6.5; GOLD stage 1/2/3/4: 2.4%/50.0%/38.1%/9.5%) provided data at all measurement time points. Except for leisure-time/transportation physical activity and partnership-related anxiety, the outcomes improved significantly during rehabilitation. Exercise-induced dyspnea (d=-0.45) as well as the sub-competencies of physical activity-related health competence (movement competence: d=-0.69; control competence: d=-0.68; self-regulation competence: d=-0.80) showed further improvements during follow-up care. Sport- and exercise-related activity (d=-1.28) and sputum quantity (d=-0.64) improved during rehabilitation, but deteriorated during follow-up care (sport-/exercise related activity: d=-0.52; sputum quantity: d=-0.55). However, the values of sport- and exercise-related activity after follow-up care were higher than at the beginning of rehabilitation (d=-0.65). App-usability and the atmosphere during aftercare were high. Conclusion:The effects of pulmonary rehabilitation were maintained or further improved in most outcomes over the course of the app-based intervention. These findings provide initial indications of the efficacy of the developed app-based follow-up care program.

Die Evaluation einer appbasierten Nachsorge für Personen mit chronisch obstruktiver Lungenerkrankung (COPD). COPD-Rehabilitand:innen absolvierten eine dreiwöchige stationäre pneumologische Rehabilitation mit anschließender zwölfwöchiger appbasierter Nachsorge, entwickelt auf Basis des Modells der Bewegungsbezogenen Gesundheitskompetenz. Hauptkomponenten der Nachsorge waren (1) individuelle Pläne für Kraft- und Ausdauertraining, (2) Fitnesstracker zum Selbstmonitoring, (3) Online-Lernmodule, sowie (4) 1:1-Betreuung durch Sport- bzw. Physiotherapeut:innen der Rehabilitationsklinik. Per Fragebogen wurden unter anderem folgende Outcomes erhoben: COPD-Assessmenttest, Lebensqualität, Depressivität, Angst, Fatigue, COPD-Leitsymptome, Schmerz, Sport- und Freizeitaktivität, Bewegungsbezogene Gesundheitskompetenz, Erfahrungen der Rehabilitand:innen mit der Nachsorge. Messzeitpunkte waren Beginn und Ende der Rehabilitation sowie Ende der Nachsorge. Veränderungen der Outcomes während der Rehabilitation und Nachsorge wurden explorativ untersucht (Wilcoxon-Vorzeichen-Rang-Test, α<0,05). Die Erfahrungen mit der Nachsorge wurden deskriptiv analysiert. Von 42 Personen mit COPD lagen zu allen Messzeitpunkten Daten vor (Alter: M=57,5; SD=5,6; BMI: M=29,1; SD=6,5; GOLD-Stadium 1/2/3/4: 2,4%/50,0%/38,1%/9,5%). Alle Outcomes außer Freizeitaktivität und Angst bezüglich Partnerschaft verbesserten sich im Verlauf der Rehabilitation signifikant und verblieben fast alle auch am Ende der Nachsorge auf dem Level des Reha-Ende. Belastungsatemnot (d=−0,45) sowie die Subkompetenzen der Bewegungsbezogenen Gesundheitskompetenz (Bewegungskompetenz: d=−0,69; Steuerungskompetenz: d=−0,68; Selbstregulationskompetenz: d=−0,80) verbesserten sich zusätzlich während der Nachsorge. Sportliche Aktivität (d=−1,28) und Sputummenge (d=−0,64) verbesserten sich während der Reha, waren jedoch während der Nachsorge wieder rückläufig (sportliche Aktivität: d=−0,52; Sputummenge: d=−0,55). Absolut liegt die sportliche Aktivität nach der Nachsorge jedoch noch deutlich über der zu Reha-Beginn (d=−0,65). Die Benutzerfreundlichkeit der App und die Atmosphäre während der Nachsorge waren hoch. Die Reha-Effekte konnten während der App-basierten Reha-Nachsorge bei den meisten Outcomes gehalten oder gesteigert werden. Die durchgeführte Studie liefert somit erste Hinweise für die Effektivität der entwickelten appbasierten Reha-Nachsorge.

Background:Many patients with COPD (chronic obstructive pulmonary disease) do not participate in outpatient educational programmes. Online education might help increase participation rates, and knowledge about COPD self-management. Objectives:We developed a new online digital COPD self-management programme (dCSP). The aim was to evaluate its effect on increasing knowledge about COPD self-management. Methods:A non-controlled single-centre pilot study (DRKS00024956) was conducted in a pulmonary rehabilitation clinic. The increase in knowledge from baseline (T0) to the post-online-training (T1) and the final face-to-face training (T2) was determined using the Bristol COPD Knowledge Questionnaire (BCKQ), a 65-item instrument with a maximum score of 65 points). The BCKQ difference was tested for statistical significance using the Wilcoxon signed-rank test. The influence of age, gender, education, previous participation in COPD training and baseline knowledge T0 on the baseline knowledge T0, the increase in knowledge T1-T0 and total increase in knowledge T2-T0 in the BCKQ was examined using univariable and multivariable regression models. Furthermore, participants were invited to provide feedback on their satisfaction with the dCSP and its user-friendliness. Results:Among patients (n=50), the number of correct answers in the BCKQ increased from 34.7±9.1 (mean ± standard deviation) at the beginning to 43.9±6.5 after completing the dCSP (p<0.001) and further to 46.4±6.4 after completing face-to-face training (p=0.001). The increase in knowledge through the dCSP was greatest among secondary school graduates (p=0.048). Low prior knowledge was also associated with a greater increase in knowledge (p<0.001). Overall, the dCSP received very positive evaluations. Conclusions:A dCSP could be helpful in compensating for knowledge deficits in patients with COPD facilitating access to COPD knowledge. Patients with lower levels of education and prior knowledge seem to benefit particularly. The benefits of a dCSP would need to be validated in future comparative studies.

Viele Patienten mit COPD (chronic obstructive pulmonary disease) nehmen nicht an ambulanten Schulungsprogrammen teil. Onlineschulungen könnten möglicherweise dazu beitragen, die Teilnahmeraten und das Wissen zum Selbstmanagement zu erhöhen. Ein neu entwickeltes online abrufbares digitales COPD-Selbstmanagementprogramm (dCSP) sollte hinsichtlich des Effekts auf den Wissenszuwachs zum COPD-Selbstmanagement untersucht werden. Es wurde eine nicht-kontrollierte, monozentrische Pilotstudie (DRKS00024956) in einer pneumologischen Rehabilitationsklinik durchgeführt. Der Wissenszuwachs von Baseline (T0) nach Onlineschulung (T1) und abschließender Präsenzschulung (T2) wurde mithilfe des Bristol COPD Knowledge Questionnaire (BCKQ) bestimmt (65 Items, maximale Punktzahl 65 Punkte). Der BCKQ-Unterschied wurde mit dem Wilcoxon-Vorzeichen-Rang-Test auf statistische Signifikanz geprüft. Der Einfluss von Alter, Geschlecht, Schulbildung und bisheriger Teilnahme an einer COPD-Schulung auf den Wissenszuwachs T1–T0 und Gesamt-Wissenszuwachs T2–T0 im BCKQ wurde mit uni- und multivariaten Regressionsmodellen untersucht. Zusätzlich wurden die Patienten hinsichtlich der Zufriedenheit mit dem dCSP und der Benutzerfreundlichkeit des dCSP befragt. Bei den Patienten (n=50) stieg die Anzahl der richtigen Antworten im BCKQ von 34,7±9,1 (Mittelwert ± Standardabweichung) zu Beginn auf 43,9±6,5 nach Abschluss des dCSP (p<0,001) und zusätzlich weiter auf 46,4±6,4 nach Abschluss einer Präsenzschulung (p=0,001). Der Wissenszuwachs durch das dCSP war bei Haupt- und Realschulabsolventen am größten (p=0,048), niedriges Vorwissen war ebenfalls mit einer größeren Wissenszunahme assoziiert (p<0,001). Das dCSP erhielt insgesamt sehr zustimmende Evaluationen. Ein dCSP könnte hilfreich sein, um Wissensdefizite bei Patienten mit COPD zu reduzieren und den Zugang zu COPD-Wissen zu erleichtern. Besonders scheinen Patienten mit niedrigerer Schulbildung und niedrigen Vorkenntnissen zu profitieren. Der Nutzen eines dCSP müsste in nachfolgenden Vergleichsstudien validiert werden.

BACKGROUND:Asthma education programs (AEPs) are crucial to improving patient outcomes, but few patients participate. Therefore, an online asthma education program (electronic AEP, eAEP) has been developed. We aimed to investigate the effectiveness of the eAEP in adults with asthma in terms of asthma knowledge, symptom control and emergency treatments. METHODS:In a cluster randomised controlled trial, general practitioner (GP) practices were randomly assigned to either access to the intervention (eAEP), or usual care (UC) control. Outcomes were assessed at baseline, two weeks, three and six months. Primary endpoint was the difference in Asthma Knowledge Test (AKT) scores after completion of the eAEP/UC. Secondary outcomes included symptom control (Asthma Control Test, ACT) and emergency treatments. FINDINGS:62 patients from 10 intervention practices and 46 patients from 11 control practices were analysed. The intervention group had significantly greater improvements in mean AKT scores (between-group adjusted mean difference (AMD), 9.3 (95 % CI 6.3-12.3), p < 0.001) at the primary endpoint. Differences remained relatively stable during the six-month follow-up. Between-group AMD in the ACT was 1.4 (95 % CI -0.1-2.8, p < 0.062) three months after the eAEP/UC and 1.6 (95 % CI 0.2-2.9, p < 0.023) at study end. More intervention group patients demonstrated the inhalation technique correctly (98 % vs. 79 %, p = 0.007), received peak expiratory flow instructions (94 % vs. 32 %, p < 0.001) and an asthma action plan (96 % vs. 50 %, p < 0.001). INTERPRETATION:The eAEP was effective in improving knowledge over six months and showed beneficial effects on symptom control. The eAEP may contribute to improved asthma care in GP settings.

Zusammenfassung Einleitung Wie bei anderen chronischen Erkrankungen ist auch bei der chronisch-obstruktiven Lungenerkrankung (COPD) zu erwarten, dass der Verlauf positiv beeinflusst wird, wenn die Patienten gut über ihre Erkrankung informiert sind und angemessen damit umgehen. Hierbei dürfte eine vergleichbare Einschätzung des Wissensstands und Umgangs von strukturierten, systematisch entwickelten Fragebögen profitieren, die allerdings bislang in Deutschland nicht publiziert sind. Methoden Zur Entwicklung der Fragebögen wurden insgesamt 310 Patienten mit COPD in drei pneumologischen Praxen und einer Klinik rekrutiert. Basierend auf statistischen Kriterien und inhaltlichen Bewertungen durch Fachärzte wurden durch Auswahl und Modifikation aus publizierten Studien und Schulungsunterlagen jeweils zwei Fragebögen zum Wissen (17 Fragen) bzw. Umgang (25 Fragen) erstellt. Aus diesen Fragebögen wurden darüber hinaus zwei kurze Versionen mit 5 bzw. 3 Fragen erstellt, um eine extrem schnelle Einschätzung des Wissens und des Umgangs der Patienten zu ermöglichen. Alle Fragebögen beinhalteten außerdem eine visuelle Analogskala zur Selbsteinschätzung von Wissen und Umgang. Als statistische Verfahren zur systematisch geleiteten Auswahl wurden Korrelations- und Regressionsanalysen eingesetzt. Ergebnisse Die Fragebögen zeigten teils erhebliche Wissensdefizite und v.a. ein unsystematisches, wenig zusammenhängendes Wissen. Der Umfang dieses Wissens war mit dem Lebensalter negativ und mit der Teilnahme an Schulungen positiv korreliert. Dies galt ebenfalls für den Umgang mit der Erkrankung. Auch der Zusammenhang der Antworten auf die Wissensfragen profitierte von der Teilnahme an Schulungen. In jedem Fall korrelierten die visuellen Analogskalen der Selbsteinschätzung von Wissen und Umgang mit den Gesamtpunktzahlen korrekter Antworten. Diskussion Die Fragebögen zu Wissen und Umgang mit der COPD könnten u.a. im ambulanten Bereich eingesetzt werden, gegebenenfalls auch durch nicht-ärztliches Personal, um Defizite rasch zu erkennen und zu beheben oder als Anlass zu nehmen, eine Schulung zu empfehlen. Die Kurzversionen sowie die Analogskalen der Selbsteinschätzung erlauben zumindest eine orientierende Einschätzung. Möglicherweise sollten Schulungen mehr darauf abzielen, den Zusammenhang des Wissens durch besseres Verständnis zu fördern, da dies vermutlich das Memorieren begünstigt. Hierbei erscheinen ältere Patienten und solche mit geringem Bildungsstand auf sie angepasster Schulungen besonders bedürftig.

Zusammenfassung Ziel der Studie Als dysfunktionale Atemmuster (DAM) werden Abweichungen vom physiologischen Atemmuster bezeichnet. DAM scheinen mit einer geringeren Asthmakontrolle verbunden zu sein. Bisher ist unklar, welchen Einfluss eine stationäre Rehabilitation auf diese Problematik nehmen kann. Ziel dieser Arbeit ist es, den Effekt einer pneumologischen Rehabilitation (PR) auf DAM zu untersuchen. Methodik Die Daten basieren auf einer randomisierten kontrollieren Studie mit Wartekontrollgruppe. Die Interventionsgruppe (IG) erhielt 4 Wochen nach Antragsbewilligung eine PR, die Kontrollgruppe (KG) nach 5 Monaten. Dysfunktionale Atmung wurde mittels Nijmegen-Questionnaire (NQ) erfasst. Werte ≥ 23 Punkte weisen auf ein existentes DAM hin. Verglichen werden Werte zu Reha-Ende (T2) und nach drei Monaten (T3) (Kovarianzanalyse). Ergänzend wurde eine Moderatoranalyse durchgeführt, um zu prüfen, ob der Effekt der PR mit den Ausgangswerten des NQ-Score zusammenhängt. Ergebnisse Zwischen IG (n=202) und KG (n=210) finden sich signifikante Unterschiede im NQ-Score zu T2 (AMD=10,5; 95%CI [9; 12]; d=1,4; p<0,001) und zu T3 (AMD=5,8; 95%CI [4,3; 7,3]; d=0,8; p<0,001). Es zeigt sich ein Interaktionseffekt zwischen der Differenz im NQ-Score der Gruppen zu T2 und dem Ausgangswert zu T0 (b=5,6; 95%CI [2,2; 11,9]; p<0,001). Zu T3 ist dieser Interaktionseffekt nicht mehr nachweisbar (b=4,5; 95%CI [−3,1; 14,1]; p=807). Schlussfolgerung Die stationäre, multimodale und interdisziplinäre PR geht sowohl zum Entlassungszeitpunkt als auch 3 Monate danach mit einer signifikanten und klinisch relevanten Verbesserung der DAM einher. Kurzfristig profitieren Patienten mit bestehenden DAM mehr von der PR als Patienten ohne DAM.

Purpose Dysfunctional breathing patterns (DAM) are deviations from physiologic breathing patterns. DAM seem to be associated with lower asthma control. To date, it is unclear what effect inpatient rehabilitation can have on this problem. The aim of this work is to investigate the effect of pulmonary rehabilitation (PR) on DAM.Methods The data are based on a randomized controlled trial with a waiting control group. The intervention group (IG) received PR 4 weeks after application approval and the control group (KG) after 5 months. Dysfunctional breathing was assessed by Nijmegen-Questionnaire (NQ). Values >= 23 points indicate an existing DAM. Values at the end of rehabilitation (T2) and after three months (T3) were compared (analysis of covariance). Supplemental moderator analysis was performed to examine whether the effect of PR was related to baseline NQ scores.Results Significant differences in NQ score are found between IG (n=202) and KG (n=210) at T2 (AMD=10.5; 95%CI [9; 12]; d=1.4; p<0.001) and at T3 (AMD=5.8; 95%CI [4.3; 7.3]; d=0.8; p<0.001). There is an interaction effect between the difference in NQ score between the groups at T2 and baseline at T0 (b=5.6; 95%CI [2.2; 11.9]; p<0.001). At T3, this interaction effect was no longer detectable (b=4.5; 95%CI [-3.1; 14.1]; p=807).Conclusion Inpatient, multimodality, and interdisciplinary PR is associated with significant and clinically relevant improvement in DAM both at discharge and 3 months later. In the short term, patients with existing DAM benefit more from PR than patients without DAM.

Background Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness. Methods Participants ( n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module “Asthma and Work” while the control group will participate in a program on " Eating behaviour” (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance. Discussion Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave. Trial registration German Clinical Trials Register (ID: DRKS00031843)

INTRODUCTION:As with other chronic diseases, the course of chronic obstructive pulmonary disease (COPD) can be expected to be positively influenced if patients are well informed about their disease and undertake appropriate self-management. Assessments of the level of knowledge and management that are comparable should benefit from structured, systematically developed questionnaires. These, however, have not been published in Germany. METHODS:A total of 310 patients with COPD were recruited from three pneumological practices and one hospital to develop the questionnaires. Based on statistical criteria and content assessments by medical specialists, two questionnaires on knowledge (17 questions) and self-management (25 questions) were developed by selecting and modifying questions from published studies and training programs. In addition, two short versions with 5 and 3 questions were created to enable a quick assessment of the patients' knowledge and self-management. All questionnaires also included a visual analogue scale for self-assessment of knowledge and self-management. The statistical procedures for systematically guided selection comprised correlation and regression analyses. RESULTS:The questionnaires revealed considerable knowledge deficits in many patients and remarkably unsystematic, incoherent knowledge. The extent of this knowledge was negatively correlated with higher age and positively correlated with participation in training programs; this also applied to self-management. Correlations between the answers to the knowledge questions were higher in patients who had participated in training programs. The visual analogue scales for self-assessment of knowledge and management always correlated with the total number of correct answers. DISCUSSION:The questionnaires on knowledge and self-management in patients with COPD could be used in outpatient settings, including by non-medical staff, in order to quickly identify and correct deficits or as a reason to recommend training programs. The short versions and the analogue scales for self-assessment can give at least first hints. Potentially, training programs should focus more on promoting the coherence of knowledge through better understanding, as this presumably favors long-term knowledge. Older patients and those with a low level of education appear to be particularly in need of specially adapted training programs.

Zusammenfassung Ziel der Studie Wenn teilhaberelevante COVID-19-Krankheitsfolgen auch die Atmungsorgane (mit-)betreffen, wird in nationalen und internationalen Leitlinien eine pneumologische Rehabilitation (PR) empfohlen. Bisher liegen jedoch aus Deutschland keine Studien über den Verlauf nach PR vor, ebenso wenig wie über mögliche Verlaufsunterschiede zwischen den beiden Long-Covid-Subgruppen „Fortwährend-symptomatische-COVID-19“ und “Post-COVID-Syndrom” (PCS). Methodik In einer prospektiven Beobachtungsstudie wurden Patient-Reported Outcomes (PROs) bezüglich Belastungsdyspnoe, Lebensqualität, Schmerz, Fatigue, Depressivität und Angst zu PR-Beginn (T1), PR-Ende (T2) sowie nach 3 (T3) und 6 Monaten (T4) erfasst. Die statistische Auswertung erfolgte mittels latenter Differenzenmodelle. Ergebnisse Es wurden 224 Rehabilitanden (MAlter=54,4; SDAlter=10,4; 42,0% weiblich) in die Studie eingeschlossen. Während der PR verbesserten sich alle PROs signifikant. Nach der PR blieben die Verbesserungen entweder mit großer Prä-Post-Effektstärke erhalten (Belastungsdyspnoe, Lebensqualität), verringerten sich leichtgradig auf kleine Prä-Post-Effektstärken (Depressivität, Fatigue) oder reduzierten sich auf Ausgangsniveau (Angst, Schmerzen). PCS-Patienten hatten zu T1 stärkere Belastungen in Depressivität, Fatigue und Schmerzen, unterschieden sich aber nicht in den Verläufen. Indikatoren der Schwere der vorausgegangenen akuten COVID-Phase (Sauerstofftherapie, Behandlung auf Intensivstation, Beatmung) waren zu T1 mit höheren Belastungen in Depressivität, Fatigue und Schmerzen assoziiert, aber nicht mit den Verläufen während und nach der PR. Patientinnen zeigten hingegen sowohl zu T1 höhere Belastungen in Depressivität und Fatigue als auch höhere Prä-Post-Effekte als männliche Patienten. Schlussfolgerung Verbesserungen in den PROs traten in beiden Subgruppen nur während der PR, nicht jedoch im Nachbeobachtungszeitraum auf. Dies legt nahe, dass die Veränderungen nicht durch den natürlichen Heilungsverlauf, sondern zumindest teilweise durch die PR bedingt sind. Überdies legen die Ergebnisse nahe, dass beide Patientengruppen von einer PR profitieren können. Verbesserungen hinsichtlich Belastungsdyspnoe und Lebensqualität sowie in einem reduzierten Ausmaß auch hinsichtlich Depressivität und Fatigue persistierten bis 6 Monate nach der PR, allerdings nicht hinsichtlich Schmerzen und Ängstlichkeit. Um diese Effekte aufrechtzuerhalten sind möglicherweise zusätzliche multimodale Interventionen erforderlich.

Purpose If COVID-19 disease sequelae also (co-)affect the respiratory organs, national and international guidelines recommend pulmonary rehabilitation (PR). So far, however, no studies are available from Germany on the course after PR, nor on possible course differences between the two Long COVID subgroups "Ongoing symptomatic COVID-19" and "Post-COVID-19 syndrome" (PCS).Methods In a prospective observational study, patient-reported outcomes (PROs) regarding exertional dyspnea, quality of life, pain, fatigue, depression, and anxiety were assessed at the beginning of PR (T1), end of PR (T2), and after 3 (T3) and 6 months (T4). Statistical analyses were performed using latent difference models.Results There were 224 rehabilitation patients (M-Age =54.4; SDAge =10.4; 42.0% female) included in the study. During PR, all PROs improved significantly. After PR, improvements either persisted with large pre-post effect sizes (exertional dyspnea, quality of life), decreased slightly to small pre-post effect sizes (depression, fatigue), or decreased to baseline levels (anxiety, pain). PCS patients had greater burdens in depression, fatigue, and pain at baseline, but did not differ in trajectories. Indicators of the severity of the preceding acute phase (oxygen therapy, ICU treatment, ventilation) were associated with higher burdens at T0 in depression, fatigue, and pain, but not with the courses during and after PR. In contrast, female patients showed higher burdens in both depression and fatigue at T1 and higher pre-post effects than male patients.Conclusion The fact that improvements in PROs occurred in both subgroups only during PR, but not during the follow-up period suggests that the changes are not due to the natural healing process but at least partly due to PR. Moreover, the results suggest that both patient groups may benefit from PR. Persisting improvements in exertional dyspnea and quality of life and, to a reduced extent, in depression and fatigue until 6 months after PR, but not in pain and anxiety warrant study of additional multimodal interventions that may be needed to maintain these effects.

Hintergrund Die Effektivität pneumologischer Rehabilitation (PR) bei COPD ist gut belegt. COPD-Reha-Nachsorge-Programme sollen diese Effekte verstetigen. Die Studienlage zu deren Effektivität ist jedoch uneinheitlich, zudem fehlt ein flächendeckendes Angebot. App-basierte Programme könnten das Nachsorgeangebot erweitern und ergänzen.

BACKGROUND:Fractional exhaled nitric oxide (FeNO) is known as effective for ruling-in asthma. The diagnostic value might be increased in combination with clinical signs and symptoms (CSS). The aim was to develop a new model for ruling-in and ruling-out asthma.METHODS:Diagnostic multi-centre study in three practices of pneumologists in Germany. Whole-body plethysmography was combined with bronchodilation tests or bronchial provocation as diagnostic reference standard. Follow-up was performed after 3 months. An expert committee evaluated test results, symptoms, and course of disease for the final diagnosis. Relevant CSS known from guidelines were used to enable combinatorial development of decision rules. Outcomes of multiple logistic regression modeling were translated into a diagnostic score and internally validated by ten-fold cross validation.RESULTS:308 patients with complete follow-up were included. 186 (60.4%) were female, average age was 44.7 years and 161 (52.5%) had asthma. The average area under the receiver operating curve (AUC) of the diagnostic score was 0.755 (interquartile range 0.721-0.814). Allergic rhinitis, wheezing, dyspnea on exertion, coughing attacks at night, and awakening by shortness of breath were leading symptoms for ruling-in asthma. Frequent coughing and frequent respiratory infections were leading symptoms for ruling-out. The combination of FeNO and CSS allowed ruling-in asthma with a probability of up to 99%, and ruling-out with a post-test probability down to 9%.CONCLUSION:The diagnostic scoring model increased the diagnostic value of FeNO in combination with CSS. The new decision rule allowed to rule-in asthma with high certainty, and also to rule-out with acceptable certainty.

The consensus-based SARS-CoV-2, COVID-19, and Rehabilitation Practice Guideline provides recommendations that take both infection prevention and the pursuit of therapeutic goals in rehabilitation settings during the coronavirus pandemic into account. The Practice Guideline provides guidance how to prevent SARS-CoV-2 infections in rehabilitation settings in a first part. The guideline's second part addresses rehabilitation for patients affected by COVID-19 starting with interventions on intensive care units, during early rehabilitation, post-acute rehabilitation, in outpatient and community rehabilitation settings, as well as long-term care, e. g. for COVID-19 survivors with Long- or Post-COVID. The updated second version of the Practice Guideline (dating from 01.11.2021) is a consensus-based guideline developed by a representative panel of healthcare professionals from 15 medical societies covering various rehabilitation disciplines, infectious diseases, hospital hygiene, and epidemiology. The abbreviated version provides an overview of all recommendations given.

Compared to the general population, there are increased apnoea-hypopnoea indices in patients recovering from #COVID19, yet there is a negative correlation to symptoms of fatigue and no significant correlation to daytime sleepiness https://bit.ly/3pEl9C8.

OBJECTIVE:Work engagement is considered a constructive and satisfying state of mind promoting well-being, whereas overcommitment contributes to ill-health. We investigated if these psychosocial factors are related to asthma self-management at the workplace (i.e. physical activity, trigger avoidance, acute symptom management, communication), asthma control, asthma-specific quality of life, and the subjective prognosis of gainful employment among employees with asthma.METHODS:Questionnaires were distributed in three pulmonary rehabilitation clinics (10/2017-05/2018) in Germany. Work engagement was measured by three items from the Copenhagen Psychosocial Questionnaire and overcommitment by six items from the effort-reward imbalance questionnaire. Asthma self-management was mainly assessed by self-developed items, asthma morbidity by the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire, and the subjective prognosis of gainful employment by a validated three-item scale. After dichotomization of all variables we ran Poisson regression analyses to calculate multivariable prevalence ratios with 95% confidence intervals.RESULTS:The sample comprised 221 individuals with asthma. Low work engagement was related to physical inactivity. Low work engagement and high overcommitment were associated with inadequate trigger avoidance and acute symptom management, reduced asthma-specific quality of life, and a poor prognosis of gainful employment. No relationships were observed with communication or asthma control.CONCLUSIONS:Our findings highlight the potential contribution of high levels of work engagement to adequate asthma self-management, good quality of life, and a positive subjective prognosis of gainful employment among employees with asthma. Overcommitment shows associations with those outcomes in the opposite direction, which suggests a detrimental role in asthma.

Asthma education programs (AEPs) have been shown to increase quality of life and reduce emergency treatments and hospital admissions. Despite the proven benefits, only a minority of asthma patients attend such programs. To increase the number of educated patients, an online education program (electronic AEP, eAEP) for asthma patients has been developed. The present study aims to investigate the effectiveness of the eAEP in terms of asthma knowledge, asthma control and emergency treatments in general practice settings. This is a cluster randomized controlled trial including 100 patients with bronchial asthma from 20 general practices in Bavaria, Germany. General practices will be randomly assigned to either the intervention or control group. Patients in the intervention group will receive access to the eAEP and instructions to complete this program within two weeks. Patients in the control group will receive usual care including a referral to face-to-face AEP (fAEP) by a certified primary care physician or a pulmonologist according to guideline recommendations. Furthermore, patients of both the intervention and control groups will be invited to a follow-up consultation in their general practice after completion of the eAEP and fAEP (three weeks and twelve weeks after study inclusion, respectively) to discuss any open issues. Outcomes for both groups will be assessed at baseline (t0), after two weeks (t1), three months (t2) and six months (t3). The primary outcome is the comparison of asthma knowledge gain between intervention and control groups after completion of the eAEP (two weeks after study inclusion) and fAEP (twelve weeks after study inclusion), respectively. Secondary outcomes include asthma control, frequency of emergency treatments, patient autonomy as well as attitudes towards asthma medication. The results of the present trial will provide knowledge about the effectiveness of an online education program for asthma patients compared to usual care in primary care. German Clinical Trials Register (DRKS), DRKS00028805 . Registered 22 April 2022.