Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar

La hipertensión pulmonar (HP) es una enfermedad crónica y progresiva en la que los pacientes presentan disnea y fatiga, lo cual aumenta la inactividad física y el desacondicionamiento, comprometiendo significativamente la capacidad funcional y la calidad de vida (CV). La terapia de rehabilitación pu...

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Autores:: González Ducón, María del Pilar

Tipo de recurso:

Fecha de publicación:: 2025

Institución:: Universidad Autónoma de Bucaramanga - UNAB

Repositorio:: Repositorio UNAB

Idioma:: spa

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network_acronym_str	UNAB2
network_name_str	Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
dc.title.translated.spa.fl_str_mv	Effects of pulmonary rehabilitation on quality of life of patients with pulmonary hypertension
title	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
spellingShingle	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar Pulmonary hypertension Quality of life Pulmonary rehabilitation Therapy Internal medicine Medicine Medical sciences Epidemiology Pulmonary circulation Blood circulation Medicina interna Medicina Ciencias médicas Epidemiología Circulación pulmonar Circulación sanguínea Hipertensión pulmonar Calidad de vida SF-12 Rehabilitación pulmonar Terapia
title_short	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
title_full	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
title_fullStr	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
title_full_unstemmed	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
title_sort	Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar
dc.creator.fl_str_mv	González Ducón, María del Pilar
dc.contributor.advisor.none.fl_str_mv	Carvajal Estupiñan, Juan Fernando Ochoa Vera, Miguel Enrique Luna González, María Lucrecia
dc.contributor.author.none.fl_str_mv	González Ducón, María del Pilar
dc.contributor.cvlac.spa.fl_str_mv	González Dukón, María del Pilar [0002215595] Carvajal Estupiñán, Juan Fernando [0000150711] Ochoa Vera, Miguel Enrique [898465] Luna González, María Lucrecia [0001347422]
dc.contributor.googlescholar.spa.fl_str_mv	Luna González, María Lucrecia [pLIVNZYAAAAJ]
dc.contributor.orcid.spa.fl_str_mv	Ochoa Vera, Miguel Enrique [0000-0002-4552-3388] Luna González, María Lucrecia [0000-0003-2846-6868]
dc.contributor.scopus.spa.fl_str_mv	Ochoa Vera, Miguel Enrique [36987156500] Luna González, María Lucrecia [57216524897]
dc.contributor.researchgate.spa.fl_str_mv	Ochoa Vera, Miguel Enrique [Miguel_Ochoa7]
dc.contributor.apolounab.spa.fl_str_mv	Ochoa Vera, Miguel Enrique [miguel-enrique-ochoa-vera] Luna González, María Lucrecia [maría-lucrecia-luna-gonzález]
dc.subject.keywords.spa.fl_str_mv	Pulmonary hypertension Quality of life Pulmonary rehabilitation Therapy Internal medicine Medicine Medical sciences Epidemiology Pulmonary circulation Blood circulation
topic	Pulmonary hypertension Quality of life Pulmonary rehabilitation Therapy Internal medicine Medicine Medical sciences Epidemiology Pulmonary circulation Blood circulation Medicina interna Medicina Ciencias médicas Epidemiología Circulación pulmonar Circulación sanguínea Hipertensión pulmonar Calidad de vida SF-12 Rehabilitación pulmonar Terapia
dc.subject.lemb.spa.fl_str_mv	Medicina interna Medicina Ciencias médicas Epidemiología Circulación pulmonar Circulación sanguínea
dc.subject.proposal.spa.fl_str_mv	Hipertensión pulmonar Calidad de vida SF-12 Rehabilitación pulmonar Terapia
description	La hipertensión pulmonar (HP) es una enfermedad crónica y progresiva en la que los pacientes presentan disnea y fatiga, lo cual aumenta la inactividad física y el desacondicionamiento, comprometiendo significativamente la capacidad funcional y la calidad de vida (CV). La terapia de rehabilitación pulmonar con ejercicio (TRPE) ha demostrado tener beneficio sobre la capacidad física, el desempeño en pruebas de función pulmonar y CV en pacientes con enfermedades respiratorias crónicas (ERC) como la EPOC y EPID; sin embargo, la evidencia de esta intervención en pacientes con HP es limitada. Objetivo: Evaluar el efecto de un programa de 48 sesiones de TRPE sobre la calidad de vida de una cohorte de pacientes con HP. Metodología: Estudio retrospectivo de cohorte a partir de una base de datos de pacientes con HP atendidos entre 2021 y 2024. Se incluyeron pacientes ≥18 años con diagnóstico de HP y con datos de evaluación de CV medida a través del cuestionario SF - 12 antes y después de participar en un programa de HP de 12 meses. Se evaluaron los puntajes global, del resumen componente físico (PCS) y resumen componente mental (MCS) del cuestionario antes y después de participar en el programa, y se comparó el cambio pre y pos entre los pacientes que realizaron la TRPE completa, incompleta y quienes no la realizaron a través de medidas de asociación como riesgo relativo y se utilizó regresión lineal y cuantílica para determinar factores con influencia sobre la CV. Se consideró TRPE completa el realizar 33 o más sesiones de rehabilitación pulmonar en un periodo de 12 meses, y se definió como mejoría el aumento de al menos 5 puntos en cualquiera de los puntajes del cuestionario. Análisis en STATA v14.0 (α = 0,05). Aprobación del comité de ética: CEINO N° 213 del 14 de julio de 2015. Resultados: Se analizaron los datos de 183 pacientes, de los cuales 138 (75,41%) fueron mujeres, con mediana de edad de 59 años (RIQ 61 a 73). El 36,06% realizó TRPE completa, 21,31% incompleta y el 42,62% no la realizó. Los pacientes que completaron la TRPE mejoraron significativamente en los puntajes global (65,36±1,86 a 72,67±1,76; p<0,0001), mental (72,36±17,6 a 80,3±15,75; p=0,0002) y física (55 [RIC 40-70] a 65 [55-70]; p<0,0001), mientras que los sujetos que no completaron o no hicieron TRPE tuvieron de los mismos: global (62,17±1,66 a 57,06±1,82; p=0,0002), MCS (68,99±19,99 a 64,2±21,31; p=0,0031) y PCS (55 [40-70] a 45 [20-65]; p=0,0008). No hubo diferencia en la probabilidad de mejoría con las modalidades virtual e híbrida respecto a la presencial. Se hizo análisis multivariado que mostró aumento de 0,23 ± 0,13 puntos en el puntaje global, 0,17 ± 0,14 puntos en el MCS y 0,25 ± 0,12 puntos en el PCS por cada sesión de TRPE realizada.
publishDate	2025
dc.date.accessioned.none.fl_str_mv	2025-09-16T21:44:59Z
dc.date.available.none.fl_str_mv	2025-09-16T21:44:59Z
dc.date.issued.none.fl_str_mv	2025-09-16
dc.type.driver.none.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv	Tesis
dc.type.hasversion.none.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.redcol.none.fl_str_mv	http://purl.org/redcol/resource_type/TM
status_str	acceptedVersion
dc.identifier.uri.none.fl_str_mv	http://hdl.handle.net/20.500.12749/31177
dc.identifier.instname.spa.fl_str_mv	instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv	repourl:https://repository.unab.edu.co
url	http://hdl.handle.net/20.500.12749/31177
identifier_str_mv	instname:Universidad Autónoma de Bucaramanga - UNAB reponame:Repositorio Institucional UNAB repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv	spa
language	spa
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Long-Term Effect of an Exercise Training Program on Physical Functioning and Quality of Life in Pulmonary Hypertension: A Randomized Controlled Trial. Biomed Res Int. 2021 Feb 26;2021:8870615. Guerrero-Serrano PA, Bolívar-Grimaldos F, Cano-Rosales DJ, Rodríguez-Corredor LC. Efectos de la rehabilitación pulmonar en la tolerancia al ejercicio y la calidad de vida de pacientes con enfermedad pulmonar del nororiente colombiano en el año 2017. Revista Médicas UIS. 2018 Sep 24;31(3). Betancourt-Peña J, Ávila-Valencia JC, Muñoz-Erazo BE, Hurtado-Gutiérrez H, Benavides-Córdoba V. Efectos de la rehabilitación pulmonar sobre calidad de vida y tolerancia al esfuerzo. Univ Salud. 2020 May 1;22(2):157–65. Calidad de vida de pacientes de un programa integral de enfermedad pulmonar obstructiva crónica en Bogotá (Colombia). Heredia1 RA, José M, Sánchez2 F, Andrés C, Preciado3 C, Morantes-Ariza4 C, et al. Health and longevity: benefits of pulmonary rehabilitation on exercise tolerance and quality of life in elderly COPD patients. Greenland S. Commentary: Modeling and variable selection in epidemiologic analysis. 1989 Mar;79(3):340–9. Serpa-Anaya DC, Hoyos-Quintero AM, Hernandez NL. Adherence to pulmonary rehabilitation: An exploratory review. Vol. 55, Rehabilitacion. Ediciones Doyma, S.L.; 2021. p. 138–52.
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dc.coverage.spatial.spa.fl_str_mv	Santander (Colombia)
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dc.coverage.campus.spa.fl_str_mv	UNAB Campus Bucaramanga
dc.publisher.grantor.spa.fl_str_mv	Universidad Autónoma de Bucaramanga UNAB
dc.publisher.faculty.spa.fl_str_mv	Facultad Ciencias de la Salud
dc.publisher.program.spa.fl_str_mv	Especialización en Medicina Interna
dc.publisher.programid.none.fl_str_mv	EMIN-1050
institution	Universidad Autónoma de Bucaramanga - UNAB
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repository.name.fl_str_mv	Repositorio Institucional \| Universidad Autónoma de Bucaramanga - UNAB
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spelling	Carvajal Estupiñan, Juan Fernandob2d0f38e-39d0-41c7-9265-74db6e6d6441Ochoa Vera, Miguel Enriquebf83ca83-93c9-401e-91d3-b424889e868fLuna González, María Lucrecia7f524da3-dbfd-4a5c-9e72-4ea55989230aGonzález Ducón, María del Pilar118aec85-da9e-475a-a0e3-f258e3db7115González Dukón, María del Pilar [0002215595]Carvajal Estupiñán, Juan Fernando [0000150711]Ochoa Vera, Miguel Enrique [898465]Luna González, María Lucrecia [0001347422]Luna González, María Lucrecia [pLIVNZYAAAAJ]Ochoa Vera, Miguel Enrique [0000-0002-4552-3388]Luna González, María Lucrecia [0000-0003-2846-6868]Ochoa Vera, Miguel Enrique [36987156500]Luna González, María Lucrecia [57216524897]Ochoa Vera, Miguel Enrique [Miguel_Ochoa7]Ochoa Vera, Miguel Enrique [miguel-enrique-ochoa-vera]Luna González, María Lucrecia [maría-lucrecia-luna-gonzález]Santander (Colombia)2025UNAB Campus Bucaramanga2025-09-16T21:44:59Z2025-09-16T21:44:59Z2025-09-16http://hdl.handle.net/20.500.12749/31177instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coLa hipertensión pulmonar (HP) es una enfermedad crónica y progresiva en la que los pacientes presentan disnea y fatiga, lo cual aumenta la inactividad física y el desacondicionamiento, comprometiendo significativamente la capacidad funcional y la calidad de vida (CV). La terapia de rehabilitación pulmonar con ejercicio (TRPE) ha demostrado tener beneficio sobre la capacidad física, el desempeño en pruebas de función pulmonar y CV en pacientes con enfermedades respiratorias crónicas (ERC) como la EPOC y EPID; sin embargo, la evidencia de esta intervención en pacientes con HP es limitada. Objetivo: Evaluar el efecto de un programa de 48 sesiones de TRPE sobre la calidad de vida de una cohorte de pacientes con HP. Metodología: Estudio retrospectivo de cohorte a partir de una base de datos de pacientes con HP atendidos entre 2021 y 2024. Se incluyeron pacientes ≥18 años con diagnóstico de HP y con datos de evaluación de CV medida a través del cuestionario SF - 12 antes y después de participar en un programa de HP de 12 meses. Se evaluaron los puntajes global, del resumen componente físico (PCS) y resumen componente mental (MCS) del cuestionario antes y después de participar en el programa, y se comparó el cambio pre y pos entre los pacientes que realizaron la TRPE completa, incompleta y quienes no la realizaron a través de medidas de asociación como riesgo relativo y se utilizó regresión lineal y cuantílica para determinar factores con influencia sobre la CV. Se consideró TRPE completa el realizar 33 o más sesiones de rehabilitación pulmonar en un periodo de 12 meses, y se definió como mejoría el aumento de al menos 5 puntos en cualquiera de los puntajes del cuestionario. Análisis en STATA v14.0 (α = 0,05). Aprobación del comité de ética: CEINO N° 213 del 14 de julio de 2015. Resultados: Se analizaron los datos de 183 pacientes, de los cuales 138 (75,41%) fueron mujeres, con mediana de edad de 59 años (RIQ 61 a 73). El 36,06% realizó TRPE completa, 21,31% incompleta y el 42,62% no la realizó. Los pacientes que completaron la TRPE mejoraron significativamente en los puntajes global (65,36±1,86 a 72,67±1,76; p<0,0001), mental (72,36±17,6 a 80,3±15,75; p=0,0002) y física (55 [RIC 40-70] a 65 [55-70]; p<0,0001), mientras que los sujetos que no completaron o no hicieron TRPE tuvieron de los mismos: global (62,17±1,66 a 57,06±1,82; p=0,0002), MCS (68,99±19,99 a 64,2±21,31; p=0,0031) y PCS (55 [40-70] a 45 [20-65]; p=0,0008). No hubo diferencia en la probabilidad de mejoría con las modalidades virtual e híbrida respecto a la presencial. Se hizo análisis multivariado que mostró aumento de 0,23 ± 0,13 puntos en el puntaje global, 0,17 ± 0,14 puntos en el MCS y 0,25 ± 0,12 puntos en el PCS por cada sesión de TRPE realizada.Planteamiento y Justificación del Problema ....................................................................... 8 Marco Teórico ...................................................................................................................11 Hipertensión pulmonar ..................................................................................................11 Definición .......................................................................................................11 Epidemiología ............................................................................................... 12 Fisiopatología y clasificación......................................................................... 14 Diagnóstico ................................................................................................... 21 Tratamiento................................................................................................... 23 Calidad de vida (CV) .................................................................................................... 25 Short Form 36 Health Survey Questionnaire (SF-36) .................................... 26 Short Form 12 Health Survey Questionnaire (SF-12) .................................... 27 Estado del arte................................................................................................................. 28 Pregunta de investigación................................................................................................ 36 Hipótesis.......................................................................................................................... 36 Objetivos.......................................................................................................................... 36 Objetivo General .......................................................................................................... 36 Objetivos Específicos ................................................................................................... 36 Metodología..................................................................................................................... 37 Tipo de estudio............................................................................................................. 37 Población ..................................................................................................................... 37 Criterios de selección................................................................................................... 37 Criterios de inclusión..................................................................................... 37 Criterios de exclusión.................................................................................... 37 Cálculo de tamaño de muestra..................................................................................... 38 Proceso de atención a los participantes del programa de rehabilitación pulmonar en el INO .............................................................................................................................. 38 Variables ...................................................................................................................... 38 Definiciones del estudio ............................................................................................... 42 Plan de análisis de datos.............................................................................................. 43 Análisis univariado ........................................................................................ 43 Análisis bivariado .......................................................................................... 43 Análisis multivariado...................................................................................... 43 Consideraciones éticas ................................................................................................ 44 Resultados....................................................................................................................... 45 Características sociodemográficas de la población a estudio....................................... 45 Características clínicas ................................................................................................ 46 Hallazgos ecocardiográficos y hemodinámicos ............................................................ 49 Completitud y modalidad de la TRPE........................................................................... 50 Análisis bivariado ......................................................................................................... 51 Puntaje global del SF-12 ............................................................................... 52 Puntaje resumen del componente mental (MCS) del SF-12.......................... 54 Puntaje del componente resumen físico (PCS) del SF-12............................. 56 Análisis multivariado..................................................................................................... 58 Puntaje global del SF-12 ............................................................................... 58 Puntaje del componente resumen mental (MCS) del SF-12.......................... 59 Puntaje del componente resumen físico (PCS) del SF-12............................. 59 Discusión ..................................................................................................................... 61 Fortalezas y limitaciones .............................................................................................. 65 Conclusión....................................................................................................................... 65 Referencias ..................................................................................................................... 70EspecializaciónPulmonary hypertension (PH) is a chronic progressive disease in which patients suffer from dyspnea and fatigue, increasing inactivity and physical deconditioning that compromises functional capacity and quality of life (QoL). Pulmonary rehabilitation (PR) has shown benefits over physical capacity, performance on pulmonary function tests and QoL in patients with chronic respiratory diseases (CRD) such as chronic obstructive pulmonary disease and interstitial lung disease; however, evidence supporting this intervention is limited. Objective: To evaluate the effect of a 48 session PR program on the QoL of patients with PH. Methods: A retrospective cohort analysis was conducted using a database of adult PH patients attended between 2021 and 2024. Individuals aged ≥18 years diagnosed with PH and who had QoL evaluation with SF-12 questionnaire before and after participation in a 12-month PH program were included. Global, physical summary component (PSC) and mental summary component (MSC) scores of the questionnaire before and after participation in the program were measured, and the change in the SF-12 scores was compared between subjects who completed PR, those who did it incomplete and those who didn't do it at all. Complete PR was defined as completing 33 sessions or more over a 12-month period, and significant improvement was considered if there was a change of at least 5 points in any of the three SF-12 scores. Relative risk was calculated to assess association, and linear and quantile regression were used to determine possible factors that influence QoL. Analysis were done with STATA v14.0 (α = 0,05). Ethics Committee Approval: CEINO N° 213 14th july of 2015. Results: Data of 183 stable patients was analyzed (75,4% female), median age 59 years (intercuartile range 61 to 73 years). 36,1% of the studied population completed 33 sessions or more, 21,3% did less than 33 and 42,6% didn’t participate at all. Patients who completed PR significantly improved global (65,36±1,86 to 72,67±1,76; p<0,0001), mental (72,36±17,6 to 80,3±15,75; p=0,0002) and physical scores (55 [IQR 40–70] to 65 [55–70]; p<0,0001), while subjects that didn’t complete or didn’t do PR had reduction of the three scores: global (62,17±1,66 to 57,06±1,82; p=0,0002), MCS (68,99±19,99 a 64,2±21,31; p=0,0031) and PCS (55 [40–70] to 45 [20–65]; p=0,0008). Virtual and hybrid PR didn’t have significant differences over the effect on either of the QoL scores compared to in-person PR. A multivariate analysis was done, showing a 0,23±0,13 (global), 0,17±0,14 (MCS) and 0,25±0,12 (PCS) point increase for each PR session.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonarEffects of pulmonary rehabilitation on quality of life of patients with pulmonary hypertensionEspecialista en Medicina InternaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina InternaEMIN-1050info:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMPulmonary hypertensionQuality of lifePulmonary rehabilitationTherapyInternal medicineMedicineMedical sciencesEpidemiologyPulmonary circulationBlood circulationMedicina internaMedicinaCiencias médicasEpidemiologíaCirculación pulmonarCirculación sanguíneaHipertensión pulmonarCalidad de vidaSF-12Rehabilitación pulmonarTerapiaKovacs G, Bartolome S, Denton CP, Gatzoulis MA, Gu S, Khanna D, et al. 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Ediciones Doyma, S.L.; 2021. p. 138–52.https://apolo.unab.edu.co/en/persons/miguel-enrique-ochoa-veraORIGINALTrabajo de grado final MPGD.pdfTrabajo de grado final MPGD.pdfTesisapplication/pdf1739573https://repository.unab.edu.co/bitstream/20.500.12749/31177/1/Trabajo%20de%20grado%20final%20MPGD.pdf1a11620159f79e3ca1129e8600c3d960MD51open accessLicencia.pdfLicencia.pdfLicenciaapplication/pdf295993https://repository.unab.edu.co/bitstream/20.500.12749/31177/6/Licencia.pdfb6354a738033a3b5b8707c9ae6ac38edMD56metadata only accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8829https://repository.unab.edu.co/bitstream/20.500.12749/31177/5/license.txt3755c0cfdb77e29f2b9125d7a45dd316MD55open accessTHUMBNAILTrabajo de grado final MPGD.pdf.jpgTrabajo de grado final MPGD.pdf.jpgIM Thumbnailimage/jpeg5076https://repository.unab.edu.co/bitstream/20.500.12749/31177/7/Trabajo%20de%20grado%20final%20MPGD.pdf.jpg3701569ecd42d18975045a9903ed239bMD57open accessLicencia.pdf.jpgLicencia.pdf.jpgIM Thumbnailimage/jpeg9834https://repository.unab.edu.co/bitstream/20.500.12749/31177/8/Licencia.pdf.jpg4385b18c5609dc6b4a699cf07c790536MD58metadata only access20.500.12749/31177oai:repository.unab.edu.co:20.500.12749/311772025-09-16 22:00:32.35open accessRepositorio Institucional \| Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.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

Efecto de la terapia de rehabilitación pulmonar sobre la calidad de vida de pacientes con hipertensión pulmonar

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