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dc.contributor.authorMarques, Aldapt_PT
dc.contributor.authorJácome, Cristinapt_PT
dc.contributor.authorRebelo, Patríciapt_PT
dc.contributor.authorPaixão, Cátiapt_PT
dc.contributor.authorOliveira, Anapt_PT
dc.contributor.authorCruz, Joanapt_PT
dc.contributor.authorFreitas, Céliapt_PT
dc.contributor.authorRua, Maríliapt_PT
dc.contributor.authorLoureiro, Helenapt_PT
dc.contributor.authorPeguinho, Cristinapt_PT
dc.contributor.authorMarques, Fábiopt_PT
dc.contributor.authorSimões, Adrianapt_PT
dc.contributor.authorSantos, Madalenapt_PT
dc.contributor.authorMartins, Paulapt_PT
dc.contributor.authorAndré, Alexandrapt_PT
dc.contributor.authorDe Francesco, Sílviapt_PT
dc.contributor.authorMartins, Vitóriapt_PT
dc.contributor.authorBrooks, Dinapt_PT
dc.contributor.authorSimão, Paulapt_PT
dc.description.abstractBackground: Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patientcaregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted.Discussion: This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration: The trial was registered in the U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666). Keywords: Exercise training, Education and psychosocial support, Chronic respiratory diseases, Primary healthcare, Cost-benefit.pt_PT
dc.description.sponsorshipThis work, was funded by Fundo Europeu de Desenvolvimento Regional (FEDER) - Comissão Diretiva do Programa Operacional Regional do Centro and by Fundação para a Ciência e Tecnologia - FCT (SAICT-POL/23926/2016), and partially funded by Programa Operacional Competitividade e Internacionalização (COMPETE), through COMPETE 2020 (POCI-01-0145- FEDER-016701 and POCI-01-0145-FEDER-007628) and FCT (UID/BIM/04501/ 2013 and UID/BIM/04501/2019). CJ has a post-doctoral grant (SFRH/BPD/ 115169/2016) funded by FCT, co-financed by the European Social Fund (POCH) and Portuguese national funds from MCTES (Ministério da Ciência, Tecnologia e Ensino Superior).pt_PT
dc.relationPOCI-01-0145- FEDER-016701pt_PT
dc.subjectExercise trainingpt_PT
dc.subjectEducation and psychosocial supportpt_PT
dc.subjectChronic respiratory diseasespt_PT
dc.subjectPrimary healthcarept_PT
dc.titleImproving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysispt_PT
degois.publication.titleBMC Public Healthpt_PT
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