Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study

Abstract

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.

Keywords: COPD; frailty; geriatric rehabilitation; malnutrition; physical activity.