None listed
Conditions
Brief summary
The stroke population frequently present with a number of risk factors including smoking, central obesity, obstructive sleep apnoea, cardiovascular disease, chronic respiratory disease and a sedentary lifestyle. These subsequently contribute to poor outcomes following stroke. Compelling evidence of benefit and cost-effectiveness has been identified in the literature to support pulmonary rehabilitation in chronic respiratory diseases. No large studies were identified that targeted stroke patients specifically, even though a large volume of evidence exists in regards to the impact of stroke on respiratory function, fatigue and exercise tolerance The proposed programme is simple to deliver, requires limited resources, takes fifteen minutes to deliver and can be done as part of the routine care delivered to the patient. This ultimately will increase vigilance from nursing in regards to the impact of respiratory muscle weakness following stroke and support patient self management in the sub-acute phase of stroke, and in the long term rehabilitation process in the home environment. Patient education is a core component to the success of this project. Nursing plays a pivotal role within the interdisciplinary team in supporting patient self management skills in all aspects of the individuals’ health needs post stroke. Pulmonary rehabilitation and well-being is a fundamental step in the reduction of complications following a stroke and in improving long term outcomes. Nurses play a pivotal role in all phases of care in the stroke patient and are present 24 hours a day. The proposed pulmonary rehabilitation interventions build on previous work but embed it within Nursing and therefore if successful can be readily introduced by nursing staff. This positions them well to play an active role in supporting pulmonary rehabilitation.
Interventions
30 patients in the intervention group who will receive the intended pulmonary rehabilitation programme together with the usual standard stroke care, and 30 patients in the control group who will receive the usual standard stroke care. The respiratory intervention of incentive spirometry and or the active cycle of breathing technique will be delivered three times a day five days a week whilst an inpatient by the Principle Investigator or the Nurse Educator . The intervention takes approximately 1
30 patients in the intervention group who will receive the intended pulmonary rehabilitation programme together with the usual standard stroke care, and 30 patients in the control group who will receive the usual standard stroke care. The respiratory intervention of incentive spirometry and or the active cycle of breathing technique will be delivered three times a day five days a week whilst an inpatient by the Principle Investigator or the Nurse Educator . The intervention takes approximately 15 minutes to perform. The participant and significant other will be educated in continuing the programme once discharged home. They will be supported by telephone to continue the programme and keep a diary until followed up in an outpatient clinic six weeks post initiation of the intervention. Inclusion and exclusion criteria will be applied to exert control over extraneous variables. A single-blind approach will be used. Interventions: 1. Incentive spirometry - inspiratory muscle training 2. Active Cycle of Breathing technique 1. Incentive spirometers are used to promote deep breathing. They measure the flow of air inhaled through the mouthpiece and enhance pulmonary ventilation, overcome the effects of hypoventilation, loosen respiratory secretions, assist respiratory gas exchange and help with the re-expansion of collapsed alveoli. Incentive spirometry is designed to mimic natural sighing or yawning by encouraging the patient to take long, slow, deep breaths. This decreases pleural pressure, promoting increased lung expansion and better gas exchange (Davis, 2012). Risks associated with insentive spirometry: 1). Fatigue 2). Hyperventilation 3). Ineffective unless performed as instructed (Restrepo, Wettstein, Wittnebel & Tracy, 2011). 2. Active Cycle of Breathing technique The active cycle of breathing technique has three parts to it: 1). Breathing control 2). Deep breathing exercises 3). Huffing (Lewis, Williams & Olds, 2012) The Active Cycle of Breathing technique has been shown to be an effective treatment in improving pulmonary function, airway clearance and oxygenation in chronic obstructive pulmonary disease, cystic fibrosis and acute respiratory failure. This technique is commonly used for the prophylaxis and treatment of respiratory complications in post-surgical patients and has been found to be effective (Lewis, Williams & Olds, 2011). Risks associated with the Active Cycle of Breathing technique: 1). Fatigue
Sponsors
University of Auckland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
55 Years to 95 Years
Healthy volunteers
No
Inclusion criteria
1. Ischaemic or haemorrhagic stroke patients confirmed on imaging, presenting with any symptoms of dysphasia, dysphagia, hemiplegia and has the ability to form a mouth seal to perform spirometry; 2. 55 years of age or older; 3. National Institute Health Stroke Score (NIHSS) between 5-20 and considered suitable for inpatient rehabilitation; 4. Able to engage in a respiratory programme; 5. All participants or their main caregiver must provide and be capable of providing a declaration of Informed Consent; 6. All participants must be English-speaking or provide a family member who can act as an interpreter; 7. Medically stable with potential for improvement; and 8. Male and female, ethnicity.
Exclusion criteria
1. Medically unstable patients; 2. Unable to give consent or refusing consent; 3. Unable to follow simple commands or instructions; 4. Impaired level of consciousness; and 5. Evidence of significant cognitive impairment (AMTS lower or equal to 7/10).
Outcome results
None listed