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Maintaining Gains Following Pulmonary Rehabilitation

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Abstract

Purpose

Pulmonary rehabilitation (PR) is an accepted intervention for individuals with chronic obstructive pulmonary disease. Despite initial improvements following PR, many patients eventually return to baseline function or decline even further. The aim of this study is to look at long-term (>1 year) outcomes following PR.

Methods

This was a prospective cohort study of patients who had completed PR. Participants were invited for an assessment consisting of participant interviews and clinical assessments using standardised instruments.

Results

129 patients between 2003 and 2012 completed rehabilitation and were eligible. 88 patients were included in the analysis. The mean time of the long-term assessment was 22 months following PR. The mean age was 71 years. Mean FEV1 was 46 %. There was a statistically significant (p < 0.001) increase in the incremental shuttle walk test distance of 29.0 m following PR but this gain was lost at the long-term reassessment. Chronic Respiratory Questionnaire (CRQ) scores showed a statistically significant (p < 0.001) increase in all four domains but only the domains of dyspnoea and fatigue remained statistically significant (p < 0.001, p < 0.01, respectively) at the long-term reassessment. Hospital Anxiety and Depression Scale scores reduced following rehabilitation but only the anxiety component was statistically significant (p < 0.01). These improvements persisted at the long-term reassessment but were not statically significant.

Conclusions

This study confirms that many of the functional gains achieved in PR are lost in the longer term. Regular surveillance or monitoring of these patients post-PR is important to identify those requiring further intervention.

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References

  1. Lacasse Y, Goldstein R, Lasserson TJ, Martin S (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 4:CD003793. doi:10.1002/14651858.CD003793.pub2

    PubMed  Google Scholar 

  2. Beauchamp MK, Hill K, Goldstein RS, Janaudis-Ferreira T, Brooks D (2009) Impairments in balance discriminate fallers from non-fallers in COPD. Respir Med 103(12):1885–1891. doi:10.1016/j.rmed.2009.06.008

    Article  CAS  PubMed  Google Scholar 

  3. Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, Dekhuijzen PN, Franssen F, Gayan-Ramirez G, Gea J, Gosker HR, Gosselink R, Hayot M, Hussain SN, Janssens W, Polkey MI, Roca J, Saey D, Schols AM, Spruit MA, Steiner M, Taivassalo T, Troosters T, Vogiatzis I, Wagner PD (2014) An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 189(9):e15–62. doi:10.1164/rccm.201402-0373ST

    Article  PubMed Central  PubMed  Google Scholar 

  4. Monninkhof E, van der Valk P, van der Palen J, van Herwaarden C, Zielhuis G (2003) Effects of a comprehensive self-management programme in patients with chronic obstructive pulmonary disease. Eur Respir J 22(5):815–820

    Article  CAS  PubMed  Google Scholar 

  5. Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupre A, Begin R, Renzi P, Nault D, Borycki E, Schwartzman K, Singh R, Collet JP (2003) Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med 163(5):585–591

    Article  PubMed  Google Scholar 

  6. Eisner MD, Iribarren C, Blanc PD, Yelin EH, Ackerson L, Byl N, Omachi TA, Sidney S, Katz PP (2011) Development of disability in chronic obstructive pulmonary disease: beyond lung function. Thorax 66(2):108–114. doi:10.1136/thx.2010.137661

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, Make B, Rochester CL, Zuwallack R, Herrerias C (2007) Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 131(5 Suppl):4S–42S. doi:10.1378/chest.06-2418

    Article  PubMed  Google Scholar 

  8. Abramson MJ, Crockett AJ, Frith PA, McDonald CF (2006) COPDX: an update of guidelines for the management of chronic obstructive pulmonary disease with a review of recent evidence. Med J Aust 184(7):342–345

    PubMed  Google Scholar 

  9. The COPD-X Plan (2008) The Australian Lung Foundation. http://www.copdx.com.au/home. Accessed 1 Nov 2012

  10. Strijbos JH, Postma DS, vanAltena R, Gimeno F, Koeter GH (1996) A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest 109(2):366–372

    Article  CAS  PubMed  Google Scholar 

  11. Singh SJ, Smith DL, Hyland ME, Morgan MD (1998) A short outpatient pulmonary rehabilitation programme: immediate and longer-term effects on exercise performance and quality of life. Respir Med 92(9):1146–1154

    Article  CAS  PubMed  Google Scholar 

  12. Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N (1999) Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Eur Respir J 13(1):125–132

    Article  CAS  PubMed  Google Scholar 

  13. Troosters T, Gosselink R, Decramer M (2000) Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med 109(3):207–212

    Article  CAS  PubMed  Google Scholar 

  14. Cockram J, Cecins N, Jenkins S (2006) Maintaining exercise capacity and quality of life following pulmonary rehabilitation. Respirology 11(1):98–104. doi:10.1111/j.1440-1843.2006.00791.x

    Article  PubMed  Google Scholar 

  15. Ries AL, Kaplan RM, Myers R, Prewitt LM (2003) Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial. Am J Respir Crit Care Med 167(6):880–888. doi:10.1164/rccm.200204-318OC

    Article  PubMed  Google Scholar 

  16. Brooks D, Krip B, Mangovski-Alzamora S, Goldstein RS (2002) The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. Eur Respir J 20(1):20–29

    Article  CAS  PubMed  Google Scholar 

  17. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, Turner-Lawlor PJ, Payne N, Newcombe RG, Ionescu AA, Thomas J, Tunbridge J (2000) Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 355(9201):362–368

    Article  CAS  PubMed  Google Scholar 

  18. Elliott M, Watson C, Wilkinson E, Musk AW, Lake FR (2004) Short- and long-term hospital and community exercise programmes for patients with chronic obstructive pulmonary disease. Respirology 9(3):345–351. doi:10.1111/j.1440-1843.2004.00595.x

    Article  PubMed  Google Scholar 

  19. NHLBI/WHO Workshop Report (2001) Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD): global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/Guidelines/guideline-2010-gold-report.html

  20. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Molken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF (2013) An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 188(8):e13–64. doi:10.1164/rccm.201309-1634ST

    Article  PubMed  Google Scholar 

  21. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE (1992) Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 47(12):1019–1024

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW (1987) A measure of quality of life for clinical trials in chronic lung disease. Thorax 42(10):773–778

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    Article  CAS  PubMed  Google Scholar 

  24. Schunemann HJ, Puhan M, Goldstein R, Jaeschke R, Guyatt GH (2005) Measurement properties and interpretability of the Chronic respiratory disease questionnaire (CRQ). COPD 2(1):81–89

    Article  PubMed  Google Scholar 

  25. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Goncalves CG, Hayashi D, Singh S, Pitta F (2012) Reference values for the incremental shuttle walking test. Respir Med 106(2):243–248. doi:10.1016/j.rmed.2011.07.023

    Article  PubMed  Google Scholar 

  26. Singh SJ, Jones PW, Evans R, Morgan MD (2008) Minimum clinically important improvement for the incremental shuttle walking test. Thorax 63(9):775–777. doi:10.1136/thx.2007.081208

    Article  CAS  PubMed  Google Scholar 

  27. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52(2):69–77

    Article  PubMed  Google Scholar 

  28. Puhan MA, Frey M, Buchi S, Schunemann HJ (2008) The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes 6:46. doi:10.1186/1477-7525-6-46

    Article  PubMed Central  PubMed  Google Scholar 

  29. Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2011) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf

  30. Bestall JC, Paul EA, Garrod R, Garnham R, Jones RW, Wedzicha AJ (2003) Longitudinal trends in exercise capacity and health status after pulmonary rehabilitation in patients with COPD. Respir Med 97(2):173–180

    Article  CAS  PubMed  Google Scholar 

  31. Ige OM, Olarewaju RK, Lasebikan VO, Adeniyi YO (2010) Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 52(4):197–201

    CAS  PubMed  Google Scholar 

  32. Young P, Dewse M, Fergusson W, Kolbe J (1999) Improvements in outcomes for chronic obstructive pulmonary disease (COPD) attributable to a hospital-based respiratory rehabilitation programme. Aust N Z J Med 29(1):59–65

    Article  CAS  PubMed  Google Scholar 

  33. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y (2015) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2:CD003793. doi:10.1002/14651858.CD003793.pub3

    PubMed  Google Scholar 

  34. Jenkins S, Cecins N, Collins G (2001) Outcomes and direct costs of a pulmonary rehabilitation service. Physiother Theory Pract 17:67–76

    Article  Google Scholar 

  35. Alison J (2009) The pulmonary rehabilitation toolkit on behalf of the Australian Lung Foundation. http://www.pulmonaryrehab.com.au/welcome.asp

  36. Doyle C, Dunt D, Ames D, Selvarajah S (2013) Managing mood disorders in patients attending pulmonary rehabilitation clinics. Int. J Chronic Obstr Pulm Dis 8:15–20. doi:10.2147/COPD.S36378

    Article  Google Scholar 

  37. Keating A, Lee A, Holland AE (2011) What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis 8(2):89–99. doi:10.1177/1479972310393756

    PubMed  Google Scholar 

  38. Hornikx M, Van Remoortel H, Demeyer H, Marcal Camillo CA, Decramer M, Janssens W, Troosters T (2013) The influence of comorbidities on outcomes of pulmonary rehabilitation programs in patients with COPD: a systematic review. Biomed Res Int 2013:146148. doi:10.1155/2013/146148

    Article  PubMed Central  PubMed  Google Scholar 

  39. Bentsen SB, Wentzel-Larsen T, Henriksen AH, Rokne B, Wahl AK (2013) Anxiety and depression following pulmonary rehabilitation. Scand J Caring Sci 27(3):541–550. doi:10.1111/j.1471-6712.2012.01064.x

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to all participants in this study. We thank the team at Melbourne Easy Breathers and Dr. S. Kofoed for patient assessments, Ms A. Gorelik for statistical analysis and Dr. L. Ng for assistance with ethics submission.

Conflict of interest

None.

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Authors and Affiliations

  1. Royal Melbourne Hospital – Royal Park Campus, 34 Poplar Road, Parkville, VIC, 3052, Australia

    Edwin K. Luk & Fary Khan

  2. Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia

    Louis Irving

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  1. Edwin K. Luk
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  2. Fary Khan
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Correspondence to Edwin K. Luk.

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Luk, E.K., Khan, F. & Irving, L. Maintaining Gains Following Pulmonary Rehabilitation. Lung 193, 709–715 (2015). https://doi.org/10.1007/s00408-015-9751-5

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  • DOI: https://doi.org/10.1007/s00408-015-9751-5

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