A Comparison Between an Outpatient Hospital-Based Pulmonary Rehabilitation Program and a Home-Care Pulmonary Rehabilitation Program in Patients With COPD: A Follow-up of 18 Months

doi:10.1378/chest.109.2.366

Chest

Volume 109, Issue 2, February 1996, Pages 366-372

https://doi.org/10.1378/chest.109.2.366 Get rights and content

Aim

In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy.

Methods

After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV₁ percent predicted, 42.8 [8.4]).

Results

After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups.

Conclusion

Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.

Section snippets

MATERIALS AND METHODS

Fifty outpatients (43 male) in a stable phase of their disease were selected for the study. They all met the following inclusion criteria: COPD as evidenced by history, physical examination, chest radiograph, and pulmonary function test results; dyspnea on exertion, limiting activities of daily living; PaCO₂ at rest of less than 6.5 kPa, and PaO₂ at rest of more than 7.5 kPa; FEV₁ postbronchodilatation between 600 and 1800 mL and less than 65% of predicted FEV₁; and no evidence of ischemic

Subjects

Fifty patients entered in the study. Forty-one completed the full study period of 18 months.

Hospital Outpatient Rehabilitation Group: Eighteen patients were allocated to this group; 5 of them dropped out during the study. Three dropped out in the first 3 months: two patients stopped due to lack of motivation, and one person died after a car accident. After 14 months, two more patients dropped out: one died due to respiratory failure during an exacerbation, and the other was diagnosed with

DISCUSSION

This present study confirms the observations of previous investigators that patients with COPD derive subjective and objective benefits such as improved exercise tolerance from a pulmonary rehabilitation program. Yet our results add new knowledge in that patients exercising at home maintained and progressively strengthened the exercise improvement over 18 months after finishing the home-care program. In contrast, improvements were maintained only for 3 to 6 months in those who received the

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: This study was supported by a grant of the Dutch Asthma Foundation.

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Chest

Clinical Investigations: COPD/REHABA Comparison Between an Outpatient Hospital-Based Pulmonary Rehabilitation Program and a Home-Care Pulmonary Rehabilitation Program in Patients With COPD: A Follow-up of 18 Months

Aim

Methods

Results

Conclusion

Section snippets

MATERIALS AND METHODS

Subjects

DISCUSSION

Lancet

Chest

Chest

Chest

Randomised controlled trial of rehabilitation in chronic respiratory disability

Thorax

Results of a comprehensive rehabilitation program: physiologic and functional effects on patients with COPD

Arch Intern Med

Chronic obstructive pulmonary disease: rehabilitation program with continuation on an outpatient basis

J Am Geriatr Soc

Rehabilitation of patients with COPD

Am Rev Respir Dis

Pulmonary rehabilitation in COPD patients with elevated Pco2

Am Rev Respir Dis

Approaches to rehabilitation of patients with ventilatory insufficiency

Eur Respir J

Physical rehabilitation for the chronic bronchitic: results of a controlled trial of exercises in the home

Thorax

Quality of life in patients with COPD improves after rehabilitation at home

Eur Respir J

Psychophysical bases of perceived exertion

Med Sci Sports Exerc

Clinical Investigations: COPD/REHAB
A Comparison Between an Outpatient Hospital-Based Pulmonary Rehabilitation Program and a Home-Care Pulmonary Rehabilitation Program in Patients With COPD: A Follow-up of 18 Months