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Maintaining exercise capacity and quality of life following pulmonary rehabilitation
Author(s) -
COCKRAM Joanne,
CECINS Nola,
JENKINS Sue
Publication year - 2006
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2006.00791.x
Subject(s) - medicine , pulmonary rehabilitation , copd , physical therapy , quality of life (healthcare) , referral , minimal clinically important difference , rehabilitation , pulmonary disease , confidence interval , randomized controlled trial , family medicine , nursing
Objective: The optimum method for sustaining the benefits gained from pulmonary rehabilitation (PR) has not been determined. In this report the authors describe the 4‐year referral and uptake patterns to a hospital‐based outpatient PR programme, and the sustained benefits of PR in patients with COPD attending a community‐based maintenance exercise programme. Methods: Entry and exit data were mapped for all patients referred to the PR service over the review period. All eligible patients were offered a community‐based maintenance exercise programme upon completion of PR. A total of 21 patients underwent follow‐up assessment of functional exercise capacity, quality of life (QOL) and health‐care utilization. Results: Over a 4‐year period, 467 patients (80% with COPD) were referred to the programme, of whom 230 entered PR. In total, 172 patients completed PR, with attrition (25%) being mostly due to medical problems. Of the 84 patients who elected for the community‐based programme, 46 were still attending at follow up and 21 patients with moderate‐to‐severe COPD (44.9 ± 12.6 (mean ± SD) FEV 1 % predicted) were reassessed at 18.4 ± 11.9 months post PR. Significant improvements (mean change (95% confidence interval)) persisted in 6‐min walk distance (41.1 m (15.7–66.5)), distance walked in 20 min (195.1 m (82.3–308)) and in QOL (Chronic Respiratory Disease Questionnaire) (11.0 points (4.4–17.6)) ( P < 0.01). The QOL improvements exceeded the minimum clinically important difference. A trend towards a reduction in COPD‐related hospital admissions, bed‐days and emergency department presentations was observed in the 12 months following PR. Self‐reported adherence with the home exercise programme indicated that 67% of patients were exercising at least 3–5 days each week in addition to attending a class. Conclusion: For patients with moderate‐to‐severe COPD, a weekly community‐based maintenance exercise class, supervised by a physiotherapist, combined with a home exercise programme is an effective intervention for maintaining improvements following PR.