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Projeto de investigação
Treino de exercicio dos membros superiores na doença pulmonar obstrutiva crónica e na insuficiênica cardíaca
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Novel input for designing patient-tailored pulmonary rehabilitation : telemonitoring physical activity as a vital sign - SMARTREAB Study
Publication . Santos, Catarina; César Das Neves, Rui; Ribeiro, Ruy M.; Caneiras, Catia; Rodrigues, Fatima; Spruit, Martijn A.; Bárbara, Cristina
Physical inactivity may be a consequence of chronic diseases but also a potential modifiable risk factor. Therefore, it should be clinically assessed as a vital sign of patients’ general physical condition prior to any exercise-based intervention. This cross-sectional study describes physical activity in the daily life of 100 chronic respiratory patients before pulmonary rehabilitation, comparing subjective and objective measures. The assessment combined the International Physical Activity Questionnaire (IPAQ) and 4-day accelerometer and oximeter telemonitoring with SMARTREAB technology, assessing heart rate, transcutaneous oxygen saturation and activity-related energy expenditure by metabolic equivalent of task (MET). According to IPAQ, 49% of patients had a moderate level of physical activity in daily life (PADL), a weekly mean level of 2844 ± 2925 MET.min/week, and a mean sedentary time of 5.8 ± 2.7 h/day. Alongside this, SMARTREAB telemonitoring assessed maximum activity ranging from 1.51 to 4.64 METs, with 99.6% daytime spent on PADL below 3 METs and 93% of patients with daily desaturation episodes. Regardless of the self-reported IPAQ, patients spend at least 70% of daytime on PADL below 2 METs. SMARTREAB was demonstrated to be an innovative methodology to measure PADL as a vital sign, combining oximetry with accelerometry, crossmatched with qualitative patient data, providing important input for designing patient-tailored pulmonary rehabilitation.
From inception to implementation: strategies for setting up pulmonary telerehabilitation
Publication . Santos, Catarina; Rodrigues, Fatima; Caneiras, Catia; Bárbara, Cristina
Smaug is a conserved translational regulator that binds numerous mRNAs, including nuclear transcripts that encode mitochondrial enzymes. Smaug orthologs form cytosolic membrane-less organelles (MLOs) in several organisms and cell types. We have performed single-molecule fluorescence in situ hybridization (FISH) assays that revealed that SDHB and UQCRC1 mRNAs associate with Smaug1 bodies in U2OS cells. Loss of function of Smaug1 and Smaug2 (also known as SAMD4A and SAMD4B, respectively) affected both mitochondrial respiration and morphology of the mitochondrial network. Phenotype rescue by Smaug1 transfection depends on the presence of its RNA-binding domain. Moreover, we identified specific Smaug1 domains involved in MLO formation, and found that impaired Smaug1 MLO condensation correlates with mitochondrial defects. Mitochondrial complex I inhibition upon exposure to rotenone, but not strong mitochondrial uncoupling upon exposure to CCCP, rapidly induced the dissolution of Smaug1 MLOs. Metformin and rapamycin elicited similar effects, which were blocked by pharmacological inhibition of AMP-activated protein kinase (AMPK). Finally, we found that Smaug1 MLO dissolution weakens the interaction with target mRNAs, thus enabling their release. We propose that mitochondrial respiration and the AMPK-mTOR balance controls the condensation and dissolution of Smaug1 MLOs, thus regulating nuclear mRNAs that encode key mitochondrial proteins. This article has an associated First Person interview with the first authors of the paper.
Telemonitoring of daily activities compared to the six-minute walk test further completes the puzzle of oximetry-guided interventions
Publication . Santos, Catarina; Santos, Ana Filipe; das Neves, Rui César; Ribeiro, Ruy; Rodrigues, Fatima; Caneiras, Catia; Spruit, Martijn A.; Bárbara, Cristina
Pulmonary rehabilitation is based on a thorough patient assessment, including peripheral oxygen saturation (SpO2) and heart rate (HR) at rest and on exertion. To understand whether exercise-field tests identify patients who desaturate (SpO2 < 90%) during physical activities, this study compared the six-minute walk test (6MWT) and daily-life telemonitoring. Cross-sectional study including 100 patients referred for pulmonary rehabilitation. The 6MWT was performed in hospital with continuous assessment of SpO2, HR, walked distance and calculated metabolic equivalent of tasks (METs). Patients were also evaluated in real-life by SMARTREAB telemonitoring, a combined oximetry-accelerometery with remote continuous assessment of SpO2, HR and METs. SMARTREAB telemonitoring identified 24% more desaturators compared with the 6MWT. Moreover, there were significant mean differences between 6MWT and SMARTREAB in lowest SpO2 of 7.2 ± 8.4% (P < 0.0005), in peak HR of - 9.3 ± 15.5% (P < 0.0005) and also in activity intensity of - 0.3 ± 0.8 METs (P < 0.0005). The 6MWT underestimates the proportion of patients with exercise-induced oxygen desaturation compared to real-life telemonitoring. These results help defining oximetry-guided interventions, such as telemedicine algorithms, oxygen therapy titration and regular physical activity assessment in pulmonary rehabilitation.
Pulmonary rehabilitation in chronic obstructive pulmonary disease : impact on patients' self-efficacy
Publication . Santos, Catarina; Caetano, Maria Cristina de Brito Eusébio Bárbara Prista; Rodrigues, Maria de Fátima Miguel; Caneiras, Cátia Sofia Gabriel
Integrated care of chronic lung disease management comprises pulmonary rehabilitation (PR), which is an individually tailored intervention including exercise training and self-management education, purposeful on long-term adherence to health behaviour change. There is high scientific evidence that PR improves dyspnea, health status, exercise tolerance and anxiety and depression levels in people with chronic obstructive pulmonary disease (COPD), one of the most prevalent respiratory conditions worldwide. Self-efficacy (SE), defined as one’s belief of being capable of doing something to accomplish a desired goal, is considered a core outcome of self-management interventions, and a clinical and functional determinant of physical activity (PA) in people with COPD. Telemonitoring (TM) and telerehabilitation are telemedicine subsets of digital health supportive environments, that can be designed to meet high ecological validity of assessments and interventions, with potential impact on healthcare effectiveness. The aim of this thesis was to study the impact of PR on SE of people with COPD, including digitally health supportive environments such as TM and pulmonary telerehabilitation (PTR).
Study I accomplished the Portuguese validation of the Pulmonary Rehabilitation Adapted-Index of Self-Efficacy (PRAISE) tool, translating, and culturally adapting this SE instrument specific to PR into European Portuguese, by means of forward-backward translation, pilot testing and content validity through a multidisciplinary panel of expert judges. Reliability and construct validity was investigated on a cross-sectional study with 150 Portuguese PR outpatients by means of statistical exploratory factorial analysis. Results were a 4-factor solution suggesting discriminative SE qualities that cumulatively explained 52.3% of SE total variance and showed a PRAISE reliability of Cronbach alpha of 0.78.
To refine the accuracy of daily PA assessment methodology, Study II was a cross-sectional study with 100 PR outpatients comparing subjective and objective measures of PA as a vital sign before an exercise-based intervention. Regardless of self-reported PA and International Physical Activity Questionnaire (IPAQ) results, a 4-day continuous combined oximetry-accelerometery TM showed that patients spend at least a mean of 70% of daytime with activities below 2 metabolic equivalent of task (METs) and a mean sedentary time of 5.8 ± 2.7h/day. Moreover, as it was found that 93% of patients had daily episodes of oxygen desaturation, Study III further extended the same research by comparing free-living TM assessments with hospital six-minute walk test (6MWT) results. TM identified 24% more cases of oxygen desaturation compared with the 6MWT, detecting lower 7.2 ± 8.4% peripheral oxygen saturation, higher 9.3 ± 15.5% peak heart rate for more intense 0.3 ± 0.8 METs engaged PA. Also, there were 27% of patients with TM daily oxygen desaturation episodes undetected by the 6MWT, a finding that requires further attention on oximetry-guided interventions, such as telemedicine algorithms, oxygen therapy titration and regular PA assessment in PR.
Study IV was a participatory research on PTR including patients within stakeholders, aiming to develop strategies for setting up a person-centred digitally enabled model of care purposeful to enhance SE. This was a proof-of-concept and proof-of-implementation research, providing tacit knowledge about five types of requirements for PTR implementation and related operational strategies: PR core principles, quality and security standards, technological functionality, home environment appropriateness and telesetting skills. Patient’s mean level of satisfaction about PR goals achievement was of 88.1 ± 8.6% and of 95.4 ± 6.3% regarding experienced PTR.
Upon the arrival of COVID-19 pandemic, Study V included 100 PR hospital outpatients with suspended face-to-face PR in a prospective quasi-experimental design, including patients discharged and those shifted from face-to-face to PTR. PRAISE was applied as a follow-up screening criteria, together with surveys on the beginning of the outbreak and at 4-month follow-up. Results were that in response to the first ever COVID-19 lockdown, highest follow-up priority should be given to sedentary patients with lower SE, focusing on self-management to increase PA. At 4 months follow-up, 66% of patients suspended breathing exercise routines and 47% discontinued PA, with SE preserved on at least 70% of patients. Patient reported experience about shifting to PTR included «no need for time or means of transportation» and «sense of not being forgotten or left behind» as enablers, whereas «self-execution of the exercises» and «lack of equipment for exercise» as barriers. PTR would be recommended to others by 97.9% of these patients. Overall, 40% of patients who experienced PTR would prefer a hybrid model on a pandemic-free future, whereas 49.2% of those who had been discharged have future interest in PTR.
Overall, it can be concluded that PR integrating digital health supportive environments such as TM and telerehabilitation, has potential impact on SE enhancement of people with chronic respiratory disease, including people with COPD.
Pulmonary rehabilitation adapted index of self-efficacy (PRAISE) validated to Portuguese respiratory patients
Publication . Santos, Catarina Duarte; Santos, Ana João; Santos, Margarida; Rodrigues, Fatima; Bárbara, Cristina
INTRODUCTION AND OBJECTIVES: Recent updates on Pulmonary Rehabilitation highlight the importance of patients' self-efficacy on long-term adherence to health-enhancing behaviors. The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) is an adaptation of the General Self-Efficacy Scale. This study aimed to translate, culturally adapt and evaluate reliability and validity of PRAISE in Portuguese respiratory patients.
PATIENTS OR MATERIALS AND METHODS: Forward-backward translation and pilot testing were performed. Content validity was assessed by a multidisciplinary panel of expert judges. To evaluate reliability and validity, 150 respiratory outpatients on Pulmonary Rehabilitation participated in a cross-sectional study. Descriptive and reliability analyses, and exploratory factorial analysis using principal axis factoring, followed by oblique oblimin factor rotation were conducted to identify construct validity. IBM® SPSS® version 22 was used to perform statistical analysis.
RESULTS: 150 patients with a mean age of 67 years, 54% male and 83% currently on Pulmonary Rehabilitation participated in the study. These included mainly Chronic Obstructive Pulmonary Disease patients (46.7%) but also Bronchiectasis (20%), Interstitial Lung Disease (20%) and other respiratory diseases. PRAISE mean score was 49. Exploratory factor analysis extraction provided a 4-factor solution that cumulatively explained 52.3% of total variance (F1: 26.6%; F2: 9.7%; F3: 8.7%; F4: 7.3%). Portuguese PRAISE showed a reliability of 0.78 (Chronbach alpha).
CONCLUSIONS: The Portuguese version of PRAISE showed adequate psychometric properties for it to be used as an instrument to measure self-efficacy as a patient-centered outcome on Pulmonary Rehabilitation.
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Fundação para a Ciência e a Tecnologia
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PDE/BDE/127785/2016