The severity of acute exacerbations of COPD and the effectiveness of pulmonary rehabilitation.
Activities of daily life
Breathlessness
Exercise training
Health related quality of life
Health status
Physical performance
Journal
Respiratory medicine
ISSN: 1532-3064
Titre abrégé: Respir Med
Pays: England
ID NLM: 8908438
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
30
11
2020
revised:
03
05
2021
accepted:
08
05
2021
pubmed:
24
5
2021
medline:
28
12
2021
entrez:
23
5
2021
Statut:
ppublish
Résumé
Pulmonary rehabilitation is effective also in patients recovering from acute exacerbations of COPD (AECOPD). We aimed to evaluate whether levels of dyspnoea affect the outcome of pulmonary rehabilitation in patients recovering from AECOPD requiring different levels of care. Retrospective data analysis of 1057 patients recovering from AECOPD requiring either hospital (Hospital group: 291) or home management (Home group: 766), undergone post AECOPD in-patient pulmonary rehabilitation. The 6-min walking distance (6MWD) test was the primary outcome, stratified by the Barthel index Dyspnoea (Bid). Data of modified Medical Research Council scale, Short Physical Performance Battery, COPD Assessment Test were also analysed, when available. In overall population 6MWD improved significantly from 278 (129) to 335 (139) meters (p < 0.001). As compared to Home, 6MWD improved more in Hospital group [by 81.9 (79.6) vs 48.9 (94.4) meters respectively, p < 0.001] also when stratified by Bid levels (all: p < 0.01). In Hospital group, 6MWD improved significantly more in patients with Bid level 3 than levels 4 and 5 (p < 0.05). Hospital group showed a greater proportion of patients reaching the Minimal Clinically Important Difference for 6MWD (75.9 vs 56.7% in Hospital and Home group respectively p < 0.001). All other available outcome measures significantly (p < 0.01) improved independent of the Bid levels. There was no significant correlation between baseline severity of airflow obstruction and effect of the program. In-patient pulmonary rehabilitation results in clinically meaningful improvement in patients recovering from AECOPD, independent of severity of dyspnoea. However, the levels of dyspnoea severity and the care required by AECOPD influenced the magnitude of success.
Sections du résumé
BACKGROUND AND AIM
Pulmonary rehabilitation is effective also in patients recovering from acute exacerbations of COPD (AECOPD). We aimed to evaluate whether levels of dyspnoea affect the outcome of pulmonary rehabilitation in patients recovering from AECOPD requiring different levels of care.
MATERIALS AND METHODS
Retrospective data analysis of 1057 patients recovering from AECOPD requiring either hospital (Hospital group: 291) or home management (Home group: 766), undergone post AECOPD in-patient pulmonary rehabilitation. The 6-min walking distance (6MWD) test was the primary outcome, stratified by the Barthel index Dyspnoea (Bid). Data of modified Medical Research Council scale, Short Physical Performance Battery, COPD Assessment Test were also analysed, when available.
RESULTS
In overall population 6MWD improved significantly from 278 (129) to 335 (139) meters (p < 0.001). As compared to Home, 6MWD improved more in Hospital group [by 81.9 (79.6) vs 48.9 (94.4) meters respectively, p < 0.001] also when stratified by Bid levels (all: p < 0.01). In Hospital group, 6MWD improved significantly more in patients with Bid level 3 than levels 4 and 5 (p < 0.05). Hospital group showed a greater proportion of patients reaching the Minimal Clinically Important Difference for 6MWD (75.9 vs 56.7% in Hospital and Home group respectively p < 0.001). All other available outcome measures significantly (p < 0.01) improved independent of the Bid levels. There was no significant correlation between baseline severity of airflow obstruction and effect of the program.
CONCLUSIONS
In-patient pulmonary rehabilitation results in clinically meaningful improvement in patients recovering from AECOPD, independent of severity of dyspnoea. However, the levels of dyspnoea severity and the care required by AECOPD influenced the magnitude of success.
Identifiants
pubmed: 34023740
pii: S0954-6111(21)00171-2
doi: 10.1016/j.rmed.2021.106465
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106465Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.