Zürcher RehaZentrum Davos

in einem Fall 4, in einem anderen 9, in einem dritten 14 Grobetriebe ihre Giftstoffe, le und Fette ohne jede Vorbehandlung in die ffentlichen Gewsser einleiten! 3"Auf dem Gebiet des Gewsser- schutzes hat die zwlfte Stunde begonnen!" 4

<bold>Background:</bold> Pulmonary rehabilitation (PR) is an essential component of COPD management. However, access to traditional face-to-face PR programs is limited. Therefore, tele-PR interventions are gaining interest. <bold>Methods:</bold> This multicenter, randomized, controlled trial recruited COPD patients from 18 sites in Germany and Switzerland, aiming to evaluate the impact of 12 weeks of the fully automated Kaia COPD app (intervention group, IVG) on health-related quality of life, measured by COPD Assessment Test (CAT), and exercise capacity, assessed by 1-Minute-Sit-to-Stand-Test (1MSTST) (co-primary outcomes), compared to a control group (CTG) receiving ’enhanced standard of care’. <bold>Results:</bold> A total of 278 subjects were included in the study with median age 65 years, FEV1: 48% predicted, and 49% female. In the intention to treat analysis at week 12, CAT improved from baseline median -4 points vs -3 points in the IVG vs CTG groups, respectively (difference: 1 point [−1, 2]; p=0.7); 1MSTST improved by 1 vs 2 repetitions, respectively (difference: 1 repetition [−2.5, 2]; p=0.12). A subgroup analysis of the IVG, showed that patients with a high app adherence (≥3 days/week for ≥75% of the first 12 weeks), improved 1MSTST vs non-adherent users by 2 more repetitions (1, 3); p=0.006. App use did not raise any safety concerns. <bold>Conclusion:</bold> Overall, app-based PR did not improve outcomes in COPD. However, adherent app users had an improvement in exercise capacity vs non-adherent users. This study supports the use of the Kaia COPD app for the management of COPD, addressing the healthcare challenge of access to PR interventions.

Hintergrund Eine Dysphagie nach einem Schlaganfall führt zu einem erhöhten Risiko für Aspirationen und Pneumonien. Husten kann als Schutzmechanismus Aspirationen entgegenwirken. Das Ziel dieser Pilotstudie war es den prädiktiven Wert der Erfassung der Hustenfrequenz zusätzlich zur Erfassung des Aspirationsrisikos im Rahmen der flexiblen endoskopischen Schluckuntersuchung (FEES) zu ermitteln.

Hintergrund Kachexie bei COPD führt zu einem Anstieg der Sterblichkeit und hat negative Auswirkungen auf die klinischen Ergebnisse. Die pulmonale Rehabilitation (PR) ist bei COPD erfolgreich, doch gibt es nur wenige Daten für die kachektische Subgruppe. Es stellt sich die Frage, ob der Nutzen der PR durch das Auftreten von Kachexie bei COPD-Patienten beeinflusst wird.

Health-related quality of life (HRQoL) in patients with moderate to severe chronic obstructive pulmonary disease (COPD) is often reduced by high symptom burden and frequent exacerbations. So far, data on therapeutic success in Swiss COPD patients receiving dual bronchodilation therapy as COPD maintenance treatment are limited. Data from a recently published, non-interventional study on clinical benefit after the start of combined tiotropium–olodaterol treatment were analyzed focusing on Swiss patients compared to the overall cohort including patients from various European countries. Demographic data on the changes in Clinical COPD Questionnaire (CCQ) for the assessment of HRQoL in correlation to symptoms and the number of exacerbations, as well as physician’s global assessment (PGE), were evaluated 6 weeks after treatment start. In Switzerland (n = 61), significantly more patients had comorbidities and exacerbations but showed less symptoms compared to the overall cohort (n = 4639). HRQoL improved in both cohorts, with a negative correlation to symptom burden and number of exacerbations in the overall cohort. PGE scores improved after 6 weeks with a better general condition at baseline in Swiss patients (PGE score 4/5: 68.9% [Swiss cohort] vs. 49.0% [overall cohort]. Despite significant differences regarding the presence of symptoms and exacerbations, therapeutic success was similar in both patient groups. Highly symptomatic patients benefited mostly from tiotropium–olodaterol treatment.

Background: Pulmonary rehabilitation (PR) following severe and very severe COVID-19 infection is known to be effective, according to typical assessments. However, not all patients benefit from PR to the same extent. This analysis aimed to identify the impact of different factors on PR outcomes in post-COVID-19 patients. Methods: This prospective observational study included 184 post-COVID-19 patients. The achievement of the predicted reference walking distance (6 min walking distance (6-MWD)) served as a parameter with which to identify responders and non-responders to PR. Several parameters (e.g., Functional Independent Measurement (FIM); pulmonary function testing (Forced Vital Capacity, FVC); 6MWD) were assessed in order to estimate their impact on PR success. Logistic regression models and classification and regression trees were used for multivariate analysis. Results: A total of 94 patients (51%) reached their reference 6MWD by the end of PR. FVC (0.95 (0.93–0.97)), 6MWD at admission (0.99 (0.99–1.00)), and FIM motoric (0.96 (0.93–0.99)) correlated with the risk not reaching the reference distance. The most important variable was the 6MWD at admission. Classification and regression tree identified 6MWD ≥ 130 m at admission and FVC predicted of >83% as the strongest predictor for reaching predicted 6-MWD. Conclusion: Post-COVID-19 patients with lower 6MWD, lower motoric FIM scores and lower FVC at admission have a high risk of not reaching their target values of physical performance despite intensive rehabilitation. As well as identifying them, it is of utmost importance to develop optimal PR concepts for these patients.

Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences (p < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients (p < 0.001). Conclusion: Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.

Background: Severe COVID-19 infection often leads to impairments requiring pulmonary rehabilitation (PR) following the acute phase. Little is known about the efficacy of PR in these patients. We therefore compared post-COVID-19 patients (PG) referred to PR patients with other lung diseases (LG). Methods: 99 PG were admitted to PR. In a prospective design, the results of PG were collected and compared to the results of LG of 2019 (n = 419) according to Functional Independence Measurement (FIM), Cumulative Illness Rating Scale (CIRS), 6-min walk test (6-MWT), duration of PR, and Feeling Thermometer (FT). Results: According to age, sex, and CIRS, both groups showed no significant differences. The improvements in the 6-MWT in the pre to post comparison were on average 180 (±101) meters for PG and 102 (±89) meters for LG (p < 0.001). FT showed a significant enhancement for PG of 21 (±14) points and for LG of 17 (±16) points (p < 0.039), while FIM significantly increased by 11 (±10) points in PG and 7 (±8) points in LG (p < 0.001). Conclusions: Comprehensive PR in PG is very effective according to the results in FIM, 6-MWT and FT. Therefore, we recommend PR following severe post-COVID-19 infections.