Short- and long-term efficacy of a community-based COPD management program in less advanced COPD: a Randomized Controlled Trial

Carel R van Wetering ¹, Martine Hoogendoorn ², Stijn M Mol ³, Maureen P Rutten-van Mölken ² and Annemie MWJ Schols ^4*

¹ Máxima Medisch Centrum, Netherlands
² Institute for Medical Technology Assessment, Erasmus MC Rotterdam, Netherlands
³ Department of Respiratory Medicine, Máxima Medical Centre, Netherlands
⁴ Department of Respiratory Medicine Maastricht University Medical Centre, Netherlands

^* To whom correspondence should be addressed. E-mail: a.schols{at}pul.unimaas.nl.

Accepted 4 August 2009

Abstract

Rationale: The effectiveness of pulmonary rehabilitation in advanced COPD is well established. Limited data is available in less advanced disease.

Methods: In a 2-year randomized, controlled trial, 199 patients with on average moderate airflow obstruction but impaired exercise capacity (FEV1: 60% (SD 16%), Wmax<70%) were randomized to the INTERdisciplinary COMmunity-based COPD management program (INTERCOM) or Usual Care. Intervention consisted of 4 months multidisciplinary rehabilitation followed by a 20-month maintenance phase. Outcomes (4, 12, 24 months): health related quality of life (St. George’s Respiratory Questionnaire (SGRQ)), exacerbation frequency, Medical Research Council (MRC) dyspnea score, cycle endurance time (CET), 6 minute walking distance (6MWD), skeletal muscle strength and patients’ and caregivers’ perceived effectiveness.

Results: After 4 months between-group comparison (mean (SE)) revealed significant differences in favor of INTERCOM for SGRQ total score 4.06 (1.39) p=0.04, activity and impact sub scores (p<0.01), MRC score: 0.33 (0.13), p=0.01, W max: 6.0 (2.3) Watt, p=0.02, CET: 221 (104) seconds, p=0.04, 6 MWD: 13 (6) meter, p=0.02, hand grip force: 4.3 (1.5) pounds, p< 0.01 and FFMI: 0.34 (0.13) kg/m2, p=0.01. Between-group differences over two years: SGQR: 2.60 (1.3), p=0.04 and MRC: 0.21 (0.10), p=0.048, CET: 253 (104) seconds, p=0.0156, 6MWD: 18 (8) meter, p= 0.0155. Exacerbation frequency was not different (RR 1.29 (95%CI 0.89-1.87)). Patients’ and caregivers’ perceived effectiveness significantly favored the INTERCOM program (p<0.01).

Conclusions: This study shows that a multidisciplinary, community-based disease management program is also effective in COPD patients with exercise impairment but less advanced airflow obstruction.