Weekly Evidence Update 7.30.18

The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People with COPD (Chest 5/2018).

Pulmonary rehabilitation is a key non-pharmacological component of COPD management. This is reflected in the most recent GOLD 2018 guidelines, which note pulmonary rehabilitation, “improves symptoms, quality of life, and physical and emotional participation in everyday activities”. While this may not carry the mortality sparing effects of smoking cessation and supplemental oxygen, pulmonary rehabilitation offers the opportunity to improve the quality of life of patients. However, pulmonary rehabilitation can be limited due to dyspnea. A 2015 meta-analysis in CHEST demonstrated improved components of the 6-minute walk test when participants listened to music. The authors of the above study evaluated the impact of self-selected music on participants dyspnea and symptoms during endurance walking tests. Patients were tested at a “usual walking” pace and “fast walking” pace. Music genres available included pop, classical, country and western, and big band. The selected music had a tempo of 90-120 beats per minute. The authors found a significant difference in endurance time (7.0 vs. 5.9 minutes) when listening to music. There was also a significant decrease in dyspnea at the end of exercise in participants listening to music. The authors also noted “an increase in the degree of patient calmness was evident with music listening”.

Find the article here

Take Home: Music therapy for patients with stable COPD can lead to small improvements in both endurance time and dyspnea. This may be due to music serving as a distraction from the sensory effects of dyspnea. More work is indicated to clarify the role of music in symptom management amongst patients with an acute exacerbation of COPD.

Centenarians’ End-of-Life Thoughts and Plans: Is Their Social Network on the Same Page? (JAGS 2018)

End of life (EOL) discussions are a key component of the therapeutic relationship between providers, patients, and caregivers. It is often in the most crucial of times that caregivers must advocate on behalf of their family members or friends regarding therapeutic and symptomatic based treatment decisions. In Oregon, we are fortunate to have fantastic geriatric physicians who emphasize the importance of end of life planning. The authors of the above study sought to evaluate the amount concordance or discordance between centenarians and their proxy informants regarding EOL thoughts and planning. The authors found that only about 50% of the centenarians had thought about EOL. Additionally, 81% of proxies thought the centenarian had arrangements for EOL, when only 58% of centenarians had done so. However, the authors note this latter percentage may have been falsely lower in the centenarian group due to potential recall bias. Regardless, this interesting study highlights the persistent gaps between patients and caregivers amongst our oldest living individuals. Fortunately, a great resource- The Conversation Project (shown to me by our very own Dr. Eckstrom!)- to assist in starting this discussion with patients and families is freely available.

Find the article here

Take Home: Despite the importance of discussing end of life planning, a large percentage of patients have not approached this topic. Moreover, this study found expectations surrounding end of life planning often differed between caregivers and patients. Providers should strive to communicate early and frequently with patients and families to identify and discuss discordant end of life expectations and goals.