过敏与治疗杂志

抽象的

Therapeutic Consequences for Physical Therapy of Comorbidity Highly Prevalent in COPD: A Multi-case Study

Emmylou Beekman, Ilse Mesters, Mariëtte de Rooij, Nienke de Vries, Erik Hulzebos, Marike van der Leeden, Staal J, Joost Dekker, RiaNijhuis-van der Sanden and Rob A de Bie

Introduction: Comorbidities are prevalent in patients with chronic obstructive pulmonary disease (COPD), but current physical therapy guidelines do not incorporate clear actions related to multimorbidity. Comorbidity (e.g. diabetes mellitus) may require adaptations in intervention strategies, as comorbidity negatively affect treatment results of the index disease (e.g. COPD) or treatment for one disease (e.g. cardiopulmonary endurance training for COPD) may negatively interact with the treatment or natural course of a coexisting disease (e.g. severe osteoarthritis of the knee). Therefore, insight of considerations required when applying physical therapy in comorbid-COPD patients and suggestions to enhance and accelerate clinical reasoning may be helpful for health care providers to obtain optimal treatment and results.

Case description: Two case studies illustrated possible consequences of COPD (index disease) and comorbidity for physical therapy in a primary care setting. Avoidable and inescapable problems were both unfolded in different steps in the clinical decision-making process.

One very severe COPD patient (FEV1 = 46% predicted, with chronic respiratory failure) with decompensated heart failure, using a beta-adrenergic blocker, demonstrated the danger of missing relevant information about a comorbid condition and related medication during the intake and its consequences for physical therapy. Another mild COPD patient (FEV1 = 86% predicted) with multiple inter-related comorbidities showed the importance of monitoring outcomes of multiple diseases and adjustments to the plan-of care and interventions.

Discussion: Dealing with comorbidity in COPD management needs a patient-centred rather than a diseaseoriented approach in order to obtain optimal treatment and results. Physical therapists should improve their skills and knowledge of high prevalent comorbidities, be fully informed, monitor more than COPD-outcomes alone and adequately adjust interventions. General practitioners and physicians can improve the level of information given in their referral of a patient to a physical therapist, by providing information on all coexisting diseases and related medication.