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. 1995 Aug;50(8):824–828. doi: 10.1136/thx.50.8.824

Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease.

P J Wijkstra 1, E M Ten Vergert 1, R van Altena 1, V Otten 1, J Kraan 1, D S Postma 1, G H Koëter 1
PMCID: PMC474891  PMID: 7570431

Abstract

BACKGROUND--Pulmonary rehabilitation has been shown to have short term subjective and objective benefits for patients with chronic obstructive pulmonary disease (COPD). However, appropriately controlled studies have not previously been performed, nor have the benefits of different types of continuation programme for rehabilitation been investigated. Both these problems have been addressed in a single study of the long term effects of once monthly physiotherapy versus once weekly physiotherapy at home after a comprehensive home rehabilitation programme on quality of life and exercise tolerance in patients with COPD. METHODS--Thirty six patients with severe airways obstruction (mean SD) forced expiratory volume in one second (FEV1) 1.3(0.4) 1, FEV1/inspiratory vital capacity (IVC) 37.2(7.9)%) were studied. Twenty three patients followed a rehabilitation programme at home for 18 months consisting of physiotherapy and supervision by a nurse and general practitioner. During the first three months all 23 patients visited the physiotherapist twice a week for a 0.5 hour session. Thereafter, 11 patients (group A) received a session of physiotherapy once weekly while 12 patients (group B) received a session of physiotherapy once a month. The control group C (13 patients) received no rehabilitation at all. Quality of life was assessed by the Chronic Respiratory Questionnaire, exercise tolerance by the six minute walking distance, and lung function by FEV1 and IVC. Outcome measures were assessed at baseline and at three, six, 12, and 18 months. RESULTS--Long term improvements in quality of life were found in patients in groups A and B, but not in those in group C compared with baseline, but these only reached significance in group B at all time points. Patients in group B had a higher quality of life than those in group C only at three and 12 months. There was a decrease in both six minute walking distance (at 12 and 18 months) and IVC (at three, 12, and 18 months) in patients in group C compared with the baseline measurement. Between groups analysis showed no differences for six minute walking distance, FEV1, and IVC. CONCLUSIONS--This study is the first to show that rehabilitation at home for three months followed by once monthly physiotherapy sessions improves quality of life over 18 months. The change in quality of life was not associated with a change in exercise tolerance.

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Selected References

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  1. Alison J. A., Samios R., Anderson S. D. Evaluation of exercise training in patients with chronic airway obstruction. Phys Ther. 1981 Sep;61(9):1273–1277. doi: 10.1093/ptj/61.9.1273. [DOI] [PubMed] [Google Scholar]
  2. Alison J. A., Samios R., Anderson S. D. Evaluation of exercise training in patients with chronic airway obstruction. Phys Ther. 1981 Sep;61(9):1273–1277. doi: 10.1093/ptj/61.9.1273. [DOI] [PubMed] [Google Scholar]
  3. Atkins C. J., Kaplan R. M., Timms R. M., Reinsch S., Lofback K. Behavioral exercise programs in the management of chronic obstructive pulmonary disease. J Consult Clin Psychol. 1984 Aug;52(4):591–603. doi: 10.1037//0022-006x.52.4.591. [DOI] [PubMed] [Google Scholar]
  4. Bernstein M. L., Despars J. A., Singh N. P., Avalos K., Stansbury D. W., Light R. W. Reanalysis of the 12-minute walk in patients with chronic obstructive pulmonary disease. Chest. 1994 Jan;105(1):163–167. doi: 10.1378/chest.105.1.163. [DOI] [PubMed] [Google Scholar]
  5. Butland R. J., Pang J., Gross E. R., Woodcock A. A., Geddes D. M. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982 May 29;284(6329):1607–1608. doi: 10.1136/bmj.284.6329.1607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Casciari R. J., Fairshter R. D., Harrison A., Morrison J. T., Blackburn C., Wilson A. F. Effects of breathing retraining in patients with chronic obstructive pulmonary disease. Chest. 1981 Apr;79(4):393–398. doi: 10.1378/chest.79.4.393. [DOI] [PubMed] [Google Scholar]
  7. Emery C. F., Leatherman N. E., Burker E. J., MacIntyre N. R. Psychological outcomes of a pulmonary rehabilitation program. Chest. 1991 Sep;100(3):613–617. doi: 10.1378/chest.100.3.613. [DOI] [PubMed] [Google Scholar]
  8. Guyatt G. H., Berman L. B., Townsend M. Long-term outcome after respiratory rehabilitation. CMAJ. 1987 Dec 15;137(12):1089–1095. [PMC free article] [PubMed] [Google Scholar]
  9. Guyatt G. H., Berman L. B., Townsend M., Pugsley S. O., Chambers L. W. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987 Oct;42(10):773–778. doi: 10.1136/thx.42.10.773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Guyatt G. H., Townsend M., Keller J. L., Singer J. Should study subjects see their previous responses: data from a randomized control trial. J Clin Epidemiol. 1989;42(9):913–920. doi: 10.1016/0895-4356(89)90105-4. [DOI] [PubMed] [Google Scholar]
  11. Guyatt G. H., Townsend M., Keller J., Singer J., Nogradi S. Measuring functional status in chronic lung disease: conclusions from a randomized control trial. Respir Med. 1989 Jul;83(4):293–297. doi: 10.1016/s0954-6111(89)80199-4. [DOI] [PubMed] [Google Scholar]
  12. Guyatt G. Measuring health status in chronic airflow limitation. Eur Respir J. 1988 Jun;1(6):560–564. [PubMed] [Google Scholar]
  13. Jones P. W., Quirk F. H., Baveystock C. M., Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992 Jun;145(6):1321–1327. doi: 10.1164/ajrccm/145.6.1321. [DOI] [PubMed] [Google Scholar]
  14. McGavin C. R., Gupta S. P., Lloyd E. L., McHardy G. J. Physical rehabilitation for the chronic bronchitic: results of a controlled trial of exercises in the home. Thorax. 1977 Jun;32(3):307–311. doi: 10.1136/thx.32.3.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Petty T. L., Nett L. M., Finigan M. M., Brink G. A., Corsello P. R. A comprehensive care program for chronic airway obstruction. Methods and preliminary evaluation of symptomatic and functional improvement. Ann Intern Med. 1969 Jun;70(6):1109–1120. doi: 10.7326/0003-4819-70-6-1109. [DOI] [PubMed] [Google Scholar]
  16. Ries A. L., Ellis B., Hawkins R. W. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988 Apr;93(4):688–692. doi: 10.1378/chest.93.4.688. [DOI] [PubMed] [Google Scholar]
  17. Sinclair D. J., Ingram C. G. Controlled trial of supervised exercise training in chronic bronchitis. Br Med J. 1980 Feb 23;280(6213):519–521. doi: 10.1136/bmj.280.6213.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Vale F., Reardon J. Z., ZuWallack R. L. The long-term benefits of outpatient pulmonary rehabilitation on exercise endurance and quality of life. Chest. 1993 Jan;103(1):42–45. doi: 10.1378/chest.103.1.42. [DOI] [PubMed] [Google Scholar]
  19. Wijkstra P. J., TenVergert E. M., Van Altena R., Otten V., Postma D. S., Kraan J., Koëter G. H. Reliability and validity of the chronic respiratory questionnaire (CRQ). Thorax. 1994 May;49(5):465–467. doi: 10.1136/thx.49.5.465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wijkstra P. J., TenVergert E. M., van der Mark T. W., Postma D. S., Van Altena R., Kraan J., Koëter G. H. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax. 1994 May;49(5):468–472. doi: 10.1136/thx.49.5.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wijkstra P. J., TenVergert E. M., van der Mark T. W., Postma D. S., Van Altena R., Kraan J., Koëter G. H. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax. 1994 May;49(5):468–472. doi: 10.1136/thx.49.5.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wijkstra P. J., Van Altena R., Kraan J., Otten V., Postma D. S., Koëter G. H. Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. Eur Respir J. 1994 Feb;7(2):269–273. doi: 10.1183/09031936.94.07020269. [DOI] [PubMed] [Google Scholar]

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