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Improvements in functional and cognitive status following short-term pulmonary rehabilitation in COPD lung transplant recipients: a pilot study

Vasileios Andrianopoulos, Rainer Gloeckl, Martina Boensch, Katharina Hoster, Tessa Schneeberger, Inga Jarosch, Rembert A. Koczulla, Klaus Kenn
ERJ Open Research 2019 5: 00060-2019; DOI: 10.1183/23120541.00060-2019
Vasileios Andrianopoulos
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
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  • ORCID record for Vasileios Andrianopoulos
  • For correspondence: vasileios.andrianopoulos@web.de
Rainer Gloeckl
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
2Dept of Prevention, Rehabilitation and Sport Medicine, Technical University Munich, Munich, Germany
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Martina Boensch
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
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Katharina Hoster
3Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
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Tessa Schneeberger
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
3Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
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Inga Jarosch
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
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Rembert A. Koczulla
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
3Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
4German Center of Lung Research (DZL), Giessen-Marburg, Germany
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Klaus Kenn
1Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
3Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
4German Center of Lung Research (DZL), Giessen-Marburg, Germany
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  • FIGURE 1
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    FIGURE 1

    Flowchart of study methodology. PR: pulmonary rehabilitation.

  • FIGURE 2
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    FIGURE 2

    The effects of pulmonary rehabilitation on cognitive function in lung transplantation (LTx) recipients: a) total population (n=24), b) single LTx recipients (n=8 (33%)), c) bilateral LTx recipients (n=16 (66%)), d) male LTx recipients (n=14 (58%)) and e) female LTx recipients (n=10 (42%)). The dashed line indicates the mean effect size. *: p<0.05; **: p<0.001; ns: nonsignificant.

Tables

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  • TABLE 1

    Demographics and clinical characteristics of the lung transplantation (LTx) recipients

    Subjects24
    Female10 (42)
    Age years58.2±6.3
    BMI kg·m−222.0±3.5
    FEV1 % pred75.4±22.0
    FEV1/VC % pred75.0±14.1
    DLCO % pred53.5±16.4
    RV/TLC % pred55.6±12.1
    CRQ domain score
     Dyspnoea4.7±2.1
     Fatigue4.9±1.5
     Emotion5.5±1.4
     Mastery5.8±1.4
    HADS domain score
     Anxiety4.4±4.2
     Depression3.8±3.5
    Education years8.0±2.6
    IQ score110.0±12.4
    Single or bilateral LTx
     Single8 (33)
     Bilateral16 (67)
    α1-antitrypsin deficiency8 (33)

    Data are presented as n, n (%) or mean±sd. BMI: body mass index; FEV1: forced expiratory volume in 1 s; VC: vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; RV: residual volume; TLC: total lung capacity; CRQ: Chronic Respiratory Disease Questionnaire; HADS: Hospital Anxiety and Depression Scale; IQ: Intelligence Quotient.

    • TABLE 2

      Lung function and exercise responses before and after the pulmonary rehabilitation (PR) programme in the 24 lung transplantation recipients

      Pre-PRPost-PRMean differenceESp-value
      FEV1 % pred75.4±22.076.6±22.71.2±5.20.06ns
      DLCO % pred53.5±16.457.8±17.54.3±4.60.270.012
      RV/TLC % pred55.6±12.153.3±11.9−2.3±3.20.200.017
      Exercise data
       6MWD m346±127432±11386±770.73<0.001
       6MWD % pred51.0±17.764.0±14.713.0±10.60.81<0.001
       SpO2 baseline %96.5±1.497.0±1.40.5±1.50.36ns
       SpO2 end-exercise %92.6±6.393.9±3.91.3±5.10.08ns
       ΔSpO2 percentage points−3.9±5.7−3.1±3.30.8±4.80.17ns
       HR baseline beats·min−187±1387±120±120.01ns
       HR end-exercise beats·min−1108±18116±178±100.470.002
       ΔHR beats·min−121±1929±148±150.490.029
       DSP m%326±124406±10980±63.90.70<0.001
       Unintended stop point m340±130424±11584±75.60.70<0.001

      Data are presented as mean±sd, unless otherwise stated. ES: effect size; FEV1: forced expiratory volume in 1 s; DLCO: diffusing capacity of the lung for carbon monoxide; RV: residual volume; TLC: total lung capacity; 6MWD: 6-min walk distance; SpO2: arterial oxygen saturation measured by pulse oximetry; HR: heart rate; DSP: distance–saturation product. Level of significance was set at p≤0.05; ns: nonsignificant.

      • TABLE 3

        Cognitive function assessment before and after the pulmonary rehabilitation (PR) programme in the 24 lung transplantation recipients

        Domain-specific evaluationPre-PRPost-PRMean differenceESp-value
        Memory ability
         WMS Logical Memory I score11.0±2.712.9±2.41.9±2.70.760.004
         WMS Logical Memory II score9.7±3.011.9±3.82.2±2.90.660.003
         CVLT Free recall: list 1 score30.4±28.251.7±34.721.3±28.50.690.003
         CVLT Free recall: list 2 score33.3±31.147.8±34.114.5±26.00.450.022
         CVLT Recall with help: list 1 score38.7±26.650.9±33.612.2±31.60.41ns
         CVLT Recall with help: list 2 score38.5±28.750.7±30.912.2±23.90.420.034
         CVLT Repeating errors score68.6±21.870.9±27.52.3±26.40.09ns
         Composite score32.7±29.242.1±33.69.3±23.60.310.001
        Learning skills
         CVLT Learning ability %33.4±31.857.1±33.923.7±28.20.740.020
         CVLT Passage 1 %32.1±23.461.0±34.228.9±34.91.000.001
         CVLT Passage 5 %20.8±25.440.3±34.619.5±24.20.660.001
         CVLT List B %23.0±28.425.6±22.02.6±28.20.10ns
         Composite score27.5±27.546.4±34.218.9±30.40.620.001
        Attention and flexibility
         TAP Speed/accuracy %56.2±31.556.5±32.90.3±27.60.01ns
         TAP Shared attention ability %50.4±28.345.8±28.9−4.6±33.00.16ns
         Composite score54.1±29.851.3±31.1−2.8±30.10.09ns
        Visuospatial and processing speed
         TMT-A score42.8±14.938.3±20.1−4.5±27.90.26ns
         TMT-B score99.0±52.284.9±35.2−14.1±36.90.32ns
         Composite score70.9±47.461.6±36.9−9.3±32.70.22ns
        Visuospatial and praxis ability
         CDT Clock test score13.1±1.213.1±1.30.0±0.70.01ns
        Psychomotor speed
         Stroop colour-word read points48.5±7.551.3±7.72.8±4.90.380.015
         Stroop colour recognition points54.4±8.157.4±9.33.0±6.00.350.027
         Stroop interference points55.0±9.755.3±9.30.3±7.70.03ns
         Composite score52.6±8.854.6±9.02.0±6.30.230.012
        Behavioural activation
         BADS version 1 score6.8±1.66.1±1.6−0.7±2.60.42ns
         BADS version 2 score7.6±0.77.6±0.7−0.0±0.90.01ns
         Composite score7.1±1.36.8±1.4−0.3±1.90.23ns

        Data are presented as mean±sd, unless otherwise stated. ES: effect size; WMS: Wechsler Memory Scales IV; CVLT: California Verbal Learning Test; TAP: Test of Attentional Performance; TMT: Trail Making Test; CDT: Clock-Drawing Test; BADS: Behavioural Assessment of the Dysexecutive Syndrome. Positive values (better scores) determine improvement for memory ability, learning skills, psychomotor speed (points) and visuospatial/praxis ability, while negative values (faster responses) determine improvement (expressed as positive ES) for behavioural activation, visuospatial and processing speed, and attention/flexibility. Level of significance was set at p≤0.05; ns: nonsignificant.

        • TABLE 4

          Mean effect sizes (ESs) for the relationship between the magnitude of improvement in cognitive function and the time interval between lung transplantation (LTx) and the pulmonary rehabilitation (PR) programme

          Time to PR monthsLTx recipients ntESp-value
          Mean±sd95% CI
          1–263.660.15±0.110.05–0.250.011
          2–1252.670.28±0.280.02–0.540.037
          >12133.120.34±0.280.07–0.600.020

          Mean ES was defined as the mean value of all cognitive domain ESs. A significant mean ES indicates a directional trend of global improvement in cognitive function.

          Supplementary Materials

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          • Supplementary Material

            Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

            Supplementary material 00060-2019.SUPPLEMENT

            Figure S1 00060-2019.figureS1

            Figure S2 00060-2019.figureS2

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          Improvements in functional and cognitive status following short-term pulmonary rehabilitation in COPD lung transplant recipients: a pilot study
          Vasileios Andrianopoulos, Rainer Gloeckl, Martina Boensch, Katharina Hoster, Tessa Schneeberger, Inga Jarosch, Rembert A. Koczulla, Klaus Kenn
          ERJ Open Research Jul 2019, 5 (3) 00060-2019; DOI: 10.1183/23120541.00060-2019

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          Improvements in functional and cognitive status following short-term pulmonary rehabilitation in COPD lung transplant recipients: a pilot study
          Vasileios Andrianopoulos, Rainer Gloeckl, Martina Boensch, Katharina Hoster, Tessa Schneeberger, Inga Jarosch, Rembert A. Koczulla, Klaus Kenn
          ERJ Open Research Jul 2019, 5 (3) 00060-2019; DOI: 10.1183/23120541.00060-2019
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