151 patients completed pulmonary rehabilitation over a period of over 4 years at our hospital. Retrospective analysis of 71 patients from this group was done. This showed that there was a significant difference between pre and post rehabilitation in FVC, VC, HADS depression score & SWT (shuttle walk test distance). Analysis of a sub group of 37 patients at 6 months after pulmonary rehabilitation showed that there were still significant differences in HADS depression & SWT, but not the other variables. We were able to establish a significant reduction in healthcare utilisation, both in hospital admissions and in out patient attendances. This was independent of the reported level of benefit on CRDQ scores. “Responders” (patients with a more than 1.5 increase in each of their CRDQ scores) had similar reduction in healthcare utilisation compared to “non-responders” (patients with <0.5 difference or deterioration in their CRDQ scores). At our hospital the approximate cost of pulmonary rehabilitation is 375 pounds per person. Out patient (respiratory) appointments and hospital admissions were noted for 1 year prior to and 1 year post rehabilitation. Our data showed that there was a 74% reduction in hospital admissions and a 51% reduction in out patient follow-up appointments in the 1-year after pulmonary rehabilitation. Our calculations showed that pulmonary rehabilitation was a cost effective intervention. In an attempt to identify patients who would respond well/poorly to pulmonary rehabilitation we looked at the baseline characteristics of “responders” vs “non responders”.
Responders Mean age 67.4 (range 50–82), mean FEV1 −0.84 (range 0.38–1.6), (FEV1%−37.2), mean FVC −1.93 (range 0.8–2.96), (FVC% 64), mean VC −2.08 (range 1.03–3.17), 54% were male, 46% female, 36% lived alone, mean pack years smoked 36.9 (range 0–80).
Non responders Mean age 68 (range 44–80), mean FEV1 −1.29 (range 0.65–3.11), (FEV1%−45.9), mean FVC −2.51 (range 0.86–3.65), (FVC% 79.1), mean VC −2.71 (range 0.98–4.67), 50% were male, 50% female, 31% lived alone, mean pack years smoked 27.46 (range 1–80). This study raises questions with regard to the importance of current CRDQ assessment in rehabilitation. It also shows that the cost of pulmonary rehabilitation is at least offset by reduction in healthcare utilisation.
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