2.50
Hdl Handle:
http://hdl.handle.net/10755/164088
Category:
Abstract
Type:
Presentation
Title:
Conducting Systematic Review: Effectiveness of Arm Exercise on Dyspnea in COPD
Author(s):
Hopp, Lisa; Walker, Jane
Author Details:
Lisa Hopp, PhD, RN, Purdue University Calumet, Hammond, Indiana, USA, email: ljhopp@calumet.purdue.edu; Jane Walker, PhD, RN
Abstract:
PURPOSE/OBJECTIVES: The purpose of this presentation is to describe the process and rigor of systematic review with an example of a systematic review of effectiveness that we recently completed. Participants will use a critical appraisal tool to understand how to assess the transparency and quality of a systematic review of the effectiveness of arm exercise on dyspnea in patients with COPD. SIGNIFICANCE: The significance of this presentation is two-fold. First, the Institute of Medicine has recently called for the United States to greatly increase our capacity to summarize evidence with the process of systematic review. Clinical nurse specialists, in their roles as facilitators of evidence-based practice, are well-positioned to assess and conduct systematic reviews. Second, the topic of the review itself is important because dyspnea is a disabling symptom that is particularly troublesome when patients with COPD perform activities of daily living that involves using their arms. DESIGN: We will describe the process of systematic review, the origins of rigor in systematic review and the secondary research method of systematic review of effectiveness. METHODS: These are the methods of systematic review that we used and we will illustrate both the process and how to appraise a systematic review, using our review as an example. Participants will have the opportunity to use a standardized appraisal tool to appraise this review. Inclusion criteria: We included any study where the effect of arm exercise could be isolated from other pulmonary rehabilitation strategies like whole body exercise, lower extremity training, and sham or control interventions. The participants were stable, moderate-to-severe patients with COPD, who were breathing without mechanical ventilation. The methods needed to include a measurement of exercise-related and/or chronic dyspnea. Search strategy: We conducted an exhaustive, comprehensive search of the published and grey literature using a three-phase approach with no language or year of publication limits. We searched CINAHL and MEDLINE to identify all key words. Subsequently, we used a structured Boolean search of all relevant bibliographic and grey literature databases. Finally, we hand-searched the reference lists of included and other highly relevant, recent articles. Two independent investigators reviewed the search results to make the decision to retrieve studies for critical appraisal. Methodological Quality: Two independent reviewers appraised all reports using standardized critical appraisal tools of the Joanna Briggs Institute, specific for the particular research design. There were no disagreements about which studies to include in the review. FINDINGS: Like many systematic reviews of effectiveness, we were unable to conduce a meta-analysis. However, we summarized the extracted data of 5 included randomized controlled trials as follows: RESULTS: The search netted 269 unique reports; we appraised 18 studies and included 5 randomized controlled trials. Eleven studies were excluded because they were of poor methodological quality or because the effect of arm exercise could not be isolated. Two studies were not available from any library source. Arm exercise regimens varied but most included some type of low resistance, high repetition arm lift combinations. No findings could be pooled for meta-analysis. Only one study found significant improvements in exercise-related dyspnea but all studies were underpowered and many had significant dropout rates. These weaknesses may have masked some of the positive effects of arm exercise. CONCLUSIONS: We will illustrate how systematic reviews provide bottom line clinical and research implications. These are the conclusions of our systematic review: Arm training is theoretically sound but evidence from these low powered randomized controlled trials only suggests that it may be effective. If data can be pooled from future studies, this common rehabilitative practice may gain further empirical support (level 2 evidence). Implications for Practice: Typically, systematic reviews end with a statement about both practice and research implications -- Implications Practice and Research: if clinicians integrate arm exercise into a program of pulmonary rehabilitation one study supported simple low resistance, high repetition training with arms at to the height of the shoulder or above. The intensity and duration of the arm exercises should be increased incrementally to symptom tolerance. Investigators need to plan for intention-to-treat analysis and report data in a manner that will allow meta-analysis.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2010
Conference Name:
CNS as Interal Consultant: Influencing Local to Global Systems
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Portland, Oregon, USA
Description:
Conference theme: CNS as Internal Consultant: Influencing Local to Global Systems, held March 3 - 6, Portland, Oregon, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleConducting Systematic Review: Effectiveness of Arm Exercise on Dyspnea in COPDen_GB
dc.contributor.authorHopp, Lisaen_US
dc.contributor.authorWalker, Janeen_US
dc.author.detailsLisa Hopp, PhD, RN, Purdue University Calumet, Hammond, Indiana, USA, email: ljhopp@calumet.purdue.edu; Jane Walker, PhD, RNen_US
dc.identifier.urihttp://hdl.handle.net/10755/164088-
dc.description.abstractPURPOSE/OBJECTIVES: The purpose of this presentation is to describe the process and rigor of systematic review with an example of a systematic review of effectiveness that we recently completed. Participants will use a critical appraisal tool to understand how to assess the transparency and quality of a systematic review of the effectiveness of arm exercise on dyspnea in patients with COPD. SIGNIFICANCE: The significance of this presentation is two-fold. First, the Institute of Medicine has recently called for the United States to greatly increase our capacity to summarize evidence with the process of systematic review. Clinical nurse specialists, in their roles as facilitators of evidence-based practice, are well-positioned to assess and conduct systematic reviews. Second, the topic of the review itself is important because dyspnea is a disabling symptom that is particularly troublesome when patients with COPD perform activities of daily living that involves using their arms. DESIGN: We will describe the process of systematic review, the origins of rigor in systematic review and the secondary research method of systematic review of effectiveness. METHODS: These are the methods of systematic review that we used and we will illustrate both the process and how to appraise a systematic review, using our review as an example. Participants will have the opportunity to use a standardized appraisal tool to appraise this review. Inclusion criteria: We included any study where the effect of arm exercise could be isolated from other pulmonary rehabilitation strategies like whole body exercise, lower extremity training, and sham or control interventions. The participants were stable, moderate-to-severe patients with COPD, who were breathing without mechanical ventilation. The methods needed to include a measurement of exercise-related and/or chronic dyspnea. Search strategy: We conducted an exhaustive, comprehensive search of the published and grey literature using a three-phase approach with no language or year of publication limits. We searched CINAHL and MEDLINE to identify all key words. Subsequently, we used a structured Boolean search of all relevant bibliographic and grey literature databases. Finally, we hand-searched the reference lists of included and other highly relevant, recent articles. Two independent investigators reviewed the search results to make the decision to retrieve studies for critical appraisal. Methodological Quality: Two independent reviewers appraised all reports using standardized critical appraisal tools of the Joanna Briggs Institute, specific for the particular research design. There were no disagreements about which studies to include in the review. FINDINGS: Like many systematic reviews of effectiveness, we were unable to conduce a meta-analysis. However, we summarized the extracted data of 5 included randomized controlled trials as follows: RESULTS: The search netted 269 unique reports; we appraised 18 studies and included 5 randomized controlled trials. Eleven studies were excluded because they were of poor methodological quality or because the effect of arm exercise could not be isolated. Two studies were not available from any library source. Arm exercise regimens varied but most included some type of low resistance, high repetition arm lift combinations. No findings could be pooled for meta-analysis. Only one study found significant improvements in exercise-related dyspnea but all studies were underpowered and many had significant dropout rates. These weaknesses may have masked some of the positive effects of arm exercise. CONCLUSIONS: We will illustrate how systematic reviews provide bottom line clinical and research implications. These are the conclusions of our systematic review: Arm training is theoretically sound but evidence from these low powered randomized controlled trials only suggests that it may be effective. If data can be pooled from future studies, this common rehabilitative practice may gain further empirical support (level 2 evidence). Implications for Practice: Typically, systematic reviews end with a statement about both practice and research implications -- Implications Practice and Research: if clinicians integrate arm exercise into a program of pulmonary rehabilitation one study supported simple low resistance, high repetition training with arms at to the height of the shoulder or above. The intensity and duration of the arm exercises should be increased incrementally to symptom tolerance. Investigators need to plan for intention-to-treat analysis and report data in a manner that will allow meta-analysis.en_GB
dc.date.available2011-10-27T11:41:48Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:41:48Z-
dc.conference.date2010en_US
dc.conference.nameCNS as Interal Consultant: Influencing Local to Global Systemsen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationPortland, Oregon, USAen_US
dc.descriptionConference theme: CNS as Internal Consultant: Influencing Local to Global Systems, held March 3 - 6, Portland, Oregon, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
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