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Abstract
Introduction Providing outpatient Pulmonary Rehabilitation (PR) following hospitalisation for an acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) has been found to improve exercise capacity, quality of life and a reduction in unplanned hospital admissions and mortality (Puhan, 2011). These positive effects, although studied in the short term, have led to national and international guidelines supporting the provision of post exacerbation PR (PEPR). However, uptake is poor with less than 10% of hospital discharges for AECOPD completing PEPR (Jones, 2014).
The aim of this study was to establish whether delaying the offer of rehabilitation would be effective and acceptable to patients who have recently been hospitalised for an AE of their COPD.
Methods A randomised controlled trial was conducted. Patients were randomised to PEPR or delayed PEPR (D-PEPR) following hospitalisation for an AECOPD. Both programmes were the same, consisting of twice weekly, six-week hospital based programme (exercise and education). PEPR commenced within four weeks of hospital discharge and D-PEPR commenced 7 weeks after this. The primary outcome was the Incremental Shuttle Walking test (ISWT), secondary measures were the Endurance Shuttle Walk Test (ESWT).
Results Thirty six patients consented and were assessed (14 male, mean (SD) age 66.03 (7.64) years, FEV1 1.18 (0.48) litres, ISWT 225 (160.77) metres, ESWT 222 (151.09) seconds. We observed important improvements in the PEPR group. However, only 6 patients out of 12 assessed in the D-PEPR group remained during the control time prior to the programme commencing of which 3 patients went on to complete all of D-PEPR (Table 1).
Mean changes with 95% CI for patients who completed pulmonary rehabilitation
Conclusion PEPR is effective and no natural recovery was observed. Although small numbers, acceptability and completion for D-PEPR was even worse than PEPR. D-PEPR does not seem a feasible alternative to PEPR.
Reference 1 Puhan MA, Gimeno-Santos E, Scharplatz M. et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;10:CD005305
2 Jones SE, Green SA, Clark AL. et al. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence. Thorax. 2014;69:181–2