Introduction and Objectives NICE guidance recommends that patients are offered between six and twelve weeks of pulmonary rehabilitation as effective treatment option for chronic obstructive pulmonary disease (NICE, 2010). While there is good evidence for programme content, evidence is less on the optimum duration or comparative efficacy in different settings.
Two English NHS pulmonary rehabilitation services used different service models for COPD patients. An acute based service offered up to nine weekly sessions of pulmonary rehabilitation using a multi-disciplinary team. Another service based in a community gym offered up to ten sessions provided by respiratory nurses and a physical activity co-ordinator.
We hypothesised that outcomes would not improve after eight pulmonary rehabilitation sessions and would be similar for the two services.
Methods A pragmatic service evaluation with before-after design was used. Self-reported chronic respiratory questionnaires (CRQ) measuring four quality of life domains (dyspnoea, fatigue, emotional function, mastery) were completed by patients at baseline and again on completion of pulmonary rehabilitation. For each service, baseline scores were subtracted from completion scores to measure change in respiratory related quality of life outcomes and compared to minimum clinically important difference (MICD) of 0.5 (Williams et al, 2003).
The effect of number of sessions attended by patients on respiratory outcome scores was tested using linear regression.
Results Baseline and follow-up CRQ scores were available for 149 patients (89 in the acute based service).
In the community based service, improvements in dyspnoea and emotion were statistically significantly greater than the MCID whereas for the acute service, improvements in emotional function and mastery were significantly greater than MCID (Table 1). The overall proportion of patients experiencing CRQ increases greater than the MCID for both services were dyspnoea: 62.4%; fatigue: 57.7%; emotional function: 61.7%; mastery: 59.1% at follow up.
The effect of duration on CRQ outcomes will be reported.
Conclusions A community based pulmonary rehabilitation service obtained similar CRQ outcomes to an acute based service suggesting community based services may achieve equally good outcomes to acute based services.