The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial.

BACKGROUND Patients with chronic pulmonary disease have been shown to benefit from pulmonary rehabilitation programs. Published work has often been from specialized teaching centers and has involved inpatient stay. We assessed an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic lung disease, using the St. George's Respiratory Questionnaire (SGRQ) (which measures health-related quality of life) as the primary outcome measure. METHODS We undertook a randomized, prospective, parallel-group controlled study of an outpatient rehabilitation program in 65 patients with COPD (44 men and 21 women; mean age, 69.5 years [SD, 9.2 years]; FEV(1), 41% predicted [SD, 18.5%]). The active group (n = 36) took part in a 6-week program of education (2 h weekly) and exercise (1 h weekly). The control group (n = 29) were reviewed routinely as medical outpatients. The SGRQ was administered under supervision by a blinded observer at study entry, 12 weeks, and 24 weeks. RESULTS The SGRQ in the active group was 59.9 (SE, 2.0) at study entry (n = 36), 47.4 (SE, 2.3) at 12 weeks (n = 32), and 50.6 (SE, 2.5) at 24 weeks (n = 24). The SGRQ in the control group was 59.3 (SE, 2.5) at study entry and did not change significantly over 24 weeks. There was a difference of 10.4 points (confidence interval [CI], 3.6 to 17.3) between the two groups at 12 weeks (p < 0.001) and of 8.1 points (CI, 1.4 to 14.9) at 24 weeks (p = 0.02) in favor of the active group. CONCLUSIONS A 6-week outpatient-based program significantly improved quality of life in patients with moderate-to-severe COPD. Benefit was still evident after 24 weeks.

[1]  N. Payne,et al.  Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial , 2000, The Lancet.

[2]  M. Sullivan,et al.  Long-term effects of a pulmonary rehabilitation programme in outpatients with chronic obstructive pulmonary disease: a randomized controlled study. , 1999, Scandinavian journal of rehabilitation medicine.

[3]  R. Zuwallack,et al.  Pulmonary rehabilitation - 1999 , 1999 .

[4]  E. Wouters,et al.  Weight Loss Is a Reversible Factor in the Prognosis of Chronic Obstructive Pulmonary Disease , 1998 .

[5]  M. Decramer,et al.  Exercise training in COPD patients: the basic questions. , 1997, The European respiratory journal.

[6]  Alison E. Ries.  Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. American College of Chest Physicians. American Association of Cardiovascular and Pulmonary Rehabilitation. , 1997, Chest.

[7]  J. Pounsford,et al.  Outpatient Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease , 1997, Journal of the Royal College of Physicians of London.

[8]  P. Jones,et al.  Quality of life changes in COPD patients treated with salmeterol. , 1997, American journal of respiratory and critical care medicine.

[9]  A. Tosteson,et al.  Effect of exercise training on dyspnea measures in patients with chronic obstructive pulmonary disease. , 1997, Journal of cardiopulmonary rehabilitation.

[10]  H. Kemper,et al.  The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. , 1997, The European respiratory journal.

[11]  G. Guyatt,et al.  Randomized Controlled Trial of Respiratory Rehabilitation , 1995 .

[12]  R. Garnham.  Setting up a pulmonary rehabilitation programme. , 1994, Thorax.

[13]  C. J. Clark.  Pulmonary rehabilitation in chronic respiratory insufficiency. 8. Setting up a pulmonary rehabilitation programme. , 1994, Thorax.

[14]  D. Postma,et al.  Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. , 1994, The European respiratory journal.

[15]  R. Deyo,et al.  Pulmonary rehabilitation in chronic respiratory insufficiency. 7. Health-related quality of life among patients with chronic obstructive pulmonary disease. , 1994, Thorax.

[16]  P. Jones,et al.  A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. , 1992, The American review of respiratory disease.

[17]  P. Jones,et al.  The St George's Respiratory Questionnaire. , 1991, Respiratory medicine.

[18]  P. Jones,et al.  Influence of demographic and disease related factors on the degree of distress associated with symptoms and restrictions on daily living due to asthma in six countries. , 1991, The European respiratory journal.

[19]  G. Guyatt,et al.  Measuring functional status in chronic lung disease: conclusions from a randomized control trial. , 1989, Respiratory medicine.