Article Text

PDF

P118 Post discharge pulmonary rehabilitation for acute exacerbation COPD does not always reduce re-admission rates
  1. SE Roberts1,
  2. N Kodumooru1,
  3. S Purcell2,
  4. A Williamson2,
  5. H Broomfield2,
  6. LJ Restrick3,
  7. M Stern3
  1. 1Whittington Hospital Physiotherapy, Whittington Health, London, UK
  2. 2Community Respiratory Team, Whittington Health, London, UK
  3. 3Dept Respiratory Medicine, Whittington Health, London, UK

Abstract

Introduction Post-discharge pulmonary rehabilitation (PR) within 7–10 days after discharge from hospital admission for acute exacerbation of COPD (AECOPD) has been shown not only to result in the well-described benefits of PR (reduced breathlessness, improved exercise performance and health-related quality of life), but also to reduce emergency department attendances over a 3 month period. We report the outcomes of a locally-provided post-exacerbation PR (PEPR) pilot study for patients admitted to hospital with AECOPD, and compares outcomes and subsequent 90-day re-admission rates with published RCT data showing re-admission reduction from 33 to 7%1.

Methods Patients were recruited during AECOPD admission to start PR within 10 days of discharge from hospital. Taxi transport was offered to all patients.Outcome measures chosen were change in: 6-Minute Walking Test (6MWT), Hospital Anxiety and Depression Score (HADS), Chronic Respiratory Disease Questionnaire (CRDQ), and 90-day re-admission rates.

Results 43 patients were offered PEPR, 32 started and 21/32 (66% of starters, 49% of all referrals) completed the course (>11/16 sessions). Mean (range) age was 67(40–86) years and mean (SD) %predicted FEV1 32(15)%. Median time (range) between discharge from hospital and starting PEPR was 8(0–17) days. There were clinically significant improvements in 6MWT median (range) 27%(-40- + 233) and CRDQ dyspnoea domain 0.79(-0.60– + 3.00). There was no clear effect on 90-day re-admission rate: 45% patients who started PEPR were re-admitted v 58% who were offered but declined PEPR. Local 90-day re-admission rate for all 2012 AECOPD admissions was 39%.

Conclusion This study failedto replicate published reductions in re-admission rates in a patient population that was more severe than the comparison study, mean%predicted FEV1 32% v 52%1. Value of PEPR programmes in reducing AECOPD re-admission rates needs further investigation across disease severity spectrum. An additional area that would benefit from further investigation is completion rate for PEPR2; completion rate from referral for PEPR at 49% compares to 43% for our standard PR programme.

References

  1. Seymour et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax 2010;65:423–428

  2. National Institute of Health Research, HTA no 13/24 ‘does starting PR early following AECOPD improve adherence and outcomes compared to starting rehabilitation later?’

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.