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BMC Primary Care
Published in: BMC Primary Care 1/2013

Open Access 01-12-2013 | Research article

Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial

Authors: Miguel Román, Concepción Larraz, Amalia Gómez, Joana Ripoll, Isabel Mir, Eduardo Z Miranda, Ana Macho, Vicenç Thomas, Magdalena Esteva

Published in: BMC Primary Care | Issue 1/2013

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Abstract

Background

Pulmonary Rehabilitation for moderate Chronic Obstructive Pulmonary Disease in primary care could improve patients’ quality of life.

Methods

This study aimed to assess the efficacy of a 3-month Pulmonary Rehabilitation (PR) program with a further 9 months of maintenance (RHBM group) compared with both PR for 3 months without further maintenance (RHB group) and usual care in improving the quality of life of patients with moderate COPD.
We conducted a parallel-group, randomized clinical trial in Majorca primary health care in which 97 patients with moderate COPD were assigned to the 3 groups. Health outcomes were quality of life, exercise capacity, pulmonary function and exacerbations.

Results

We found statistically and clinically significant differences in the three groups at 3 months in the emotion dimension (0.53; 95%CI0.06-1.01) in the usual care group, (0.72; 95%CI0.26-1.18) the RHB group (0.87; 95%CI 0.44-1.30) and the RHBM group as well as in fatigue (0.47; 95%CI 0.17-0.78) in the RHBM group. After 1 year, these differences favored the long-term rehabilitation group in the domains of fatigue (0.56; 95%CI 0.22-0.91), mastery (0.79; 95%CI 0.03-1.55) and emotion (0.75; 95%CI 0.17-1.33). Between-group analysis only showed statistically and clinically significant differences between the RHB group and control group in the dyspnea dimension (0.79 95%CI 0.05-1.52). No differences were found for exacerbations, pulmonary function or exercise capacity.

Conclusions

We found that patients with moderate COPD and low level of impairment did not show meaningful changes in QoL, exercise tolerance, pulmonary function or exacerbation after a one-year, community based rehabilitation program. However, long-term improvements in the emotional, fatigue and mastery dimensions (within intervention groups) were identified.

Trial registration

ISRCTN94514482
Appendix
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Literature
1.
Miravitlles M, Soriano JB, Garcia-Rio F, Munoz L, Duran-Tauleria E, Sanchez G, et al: Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax. 2009, 64: 863-868. 10.1136/thx.2009.115725.CrossRefPubMed
2.
Global Strategy for the Diagnosis, Management and Prevention of COPD: Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2011, Available from: http://​www.​goldcopd.​org
3.
Peces-Barba G, Barbera JA, Agusti A, Casanova C, Casas A, Izquierdo JL, et al: Guía clínica de diagnostico y tratamiento de la enfermedad pulmonar obstructiva cronica. Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) y Asociacion Latinoamericana del Torax (ALAT). Arch Bronconeumol. 2008, 44: 271-81.CrossRefPubMed
4.
Scanlon PD, Connett KE, Waller LA, Altose MD, Bailey WC, Buist AS: Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med. 2000, 161: 381-390.CrossRefPubMed
5.
Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, et al: American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2006, 173: 1390-1414. 10.1164/rccm.200508-1211ST.CrossRefPubMed
6.
Lacasse Y, Goldstein R, Lasserson TJ, Martin S: Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006, 4: 18-CD003793
7.
Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J: Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011, 5 (10): CD005305-
8.
Brooks D, Sottana R, Bell B, Hanna M, Laframboise L, Selvanayagarajah S, Goldstein R: Characterization of pulmonary rehabilitation programs in Canada in 2005. Can Respir J. 2007, 14: 87-92.CrossRefPubMedPubMedCentral
9.
Cambach W, Chadwick-Straver RVM, Wagenaar RC, van Keimpema ARJ, Kemper HCG: The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J. 1997, 10: 104-113. 10.1183/09031936.97.10010104.CrossRefPubMed
10.
Hernandez MT, Rubio TM, Ruiz FO, Riera HS, Gil RS, Gómez JC: Results of a home-based training program for patients with COPD. Chest. 2000, 118: 106-114. 10.1378/chest.118.1.106.CrossRefPubMed
11.
Güell R, Casan P, Belda J, Sangenís M, Morante F, Guyatt GH, Sanchis J: Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest. 2000, 117: 976-983. 10.1378/chest.117.4.976.CrossRefPubMed
12.
Finnerty JP, Keeping I, Bullough I, Jones J: The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest. 2001, 119: 1705-1710. 10.1378/chest.119.6.1705.CrossRefPubMed
13.
Man WD, Polkey MI, Donaldson N, Gray BJ, Moxham J: Community pulmonary rehabilitation after hospitalization for acute exacerbations of chronic obstructive pulmonary disease: randomized controlled study. BMJ. 2004, 329: 1209-10.1136/bmj.38258.662720.3A.CrossRefPubMedPubMedCentral
14.
Strijbos JH, Postma DS, van Altena R, Gimeno F, Koeter GH: 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. Chest. 1996, 109: 366-372. 10.1378/chest.109.2.366.CrossRefPubMed
15.
Arnardottir RH, Sörensen S, Ringqvist I, Larsson K: Two different training programmes for patients with COPD: a randomized study with 1-year follow-up. Respir Med. 2006, 100: 130-139. 10.1016/j.rmed.2005.03.043.CrossRefPubMed
16.
Chavannes NH, Grijsen M, van den Akker M, et al: Integrated disease management improves one-year quality of life in primary care COPD patients: a controlled clinical trial. Prim Care Respir J. 2009, 18: 171-6.CrossRefPubMed
17.
Zakrisson AB, Engfeldta P, Hägglundb D, Odencrantsb S, Hasselgrena M, Arned M, Theandere K: Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial. Prim Care Respir J. 2011, 20: 427-433. 10.4104/pcrj.2011.00060.CrossRefPubMed
18.
Godtfredsen NS, Grann O, Larsen HB, Sørensen TB, Lavesen M, Pors B, Dalsgaard LS, Kristiansen LC, Andersen KK, Dollerup J: Chronic obstructive pulmonary disease (COPD) rehabilitation at primary health-care centres - the KOALA project. Clin Respir J. 2012, 6: 186-92. 10.1111/j.1752-699X.2011.00272.x.CrossRefPubMed
19.
Berry MJ, Rejeski WJ, Adair NE, Ettinger WH, Zaccaro DJ, Sevick MA: A randomized, controlled trial comparing long-term and short term exercise in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003, 23: 60-68. 10.1097/00008483-200301000-00011.CrossRefPubMed
20.
Gómez A, Román M, Larraz C, Esteva M, Mir I, Thomás V, Miranda Pacheco EZ, Macho A: Efficacy of respiratory rehabilitation on patients with moderate COPD in primary care and maintenance of benefits at 2 years. Aten Primaria. 2006, 38: 230-233. 10.1157/13092346.CrossRefPubMed
21.
Clark CJ, Cochrane L, Mackay E: Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD. Eur Respir J. 1996, 9: 2590-2596. 10.1183/09031936.96.09122590.CrossRefPubMed
22.
Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL: An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002, 121: 1085-1091. 10.1378/chest.121.4.1085.CrossRefPubMed
23.
Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N: Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Eur Respir J. 1999, 13: 125-132. 10.1183/09031936.99.13112599.CrossRefPubMed
24.
Güell R, Casan P, Sangenís M, Morante F, Belda J, Guyatt GH: Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ). Eur Respir J. 1998, 11: 55-60. 10.1183/09031936.98.11010055.CrossRefPubMed
25.
Reardon J, Awad E, Normandin E, Vale F, Clark B, ZuWallack RL: The effect of comprehensive outpatient pulmonary rehabilitation on dyspnea. Chest. 1994, 105: 1046-1052. 10.1378/chest.105.4.1046.CrossRefPubMed
26.
Peces-Barba G, Barberà JA, Agustí A, Casanova C, Casas A, Izquierdo JL, Jardim J, López Varela V, Monsó E, Montemayor T, Viejo JL: Diagnosis and management of chronic obstructive pulmonary disease: joint guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Latin American Thoracic Society (ALAT). Arch Bronconeumol. 2008, 44: 271-281.CrossRefPubMed
27.
Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH: Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997, 155: 1278-1282.CrossRefPubMed
28.
Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JÁ: Usefulness of the Medical Research Council (MRC) dyspnea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999, 54: 581-6. 10.1136/thx.54.7.581.CrossRefPubMedPubMedCentral
29.
Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, Turner-Lawlor PJ, Payne N, Newcombe RG, Ionescu AA, Thomas J, Tunbridge J: Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomized controlled trial. Lancet. 2000, 355: 362-8. 10.1016/S0140-6736(99)07042-7.CrossRefPubMed
30.
Ketelaars CA, Abu-Saad HH, Schlösser MA, Mostert R, Wouters EF: Long-term outcome of pulmonary rehabilitation in patients with COPD. Chest. 1997, 112: 363-9. 10.1378/chest.112.2.363.CrossRefPubMed
31.
Moullec G, Ninot G: An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life. Clin Rehabil. 2010, 24: 122-36. 10.1177/0269215509346088.CrossRefPubMed
32.
Karapolat H, Atasever A, Atamaz F, Kirazli J, Elmas F, Erdinç E: Do the benefits gained using a short-term pulmonary rehabilitation program remain in COPD patients after participation?. Lung. 2007, 185: 221-225. 10.1007/s00408-007-9011-4.CrossRefPubMed
33.
Riario-Sforza GG, Incorvaia C, Paterniti F, Pessina L, Caligiuri R, Pravettoni C, Di Marco F, Centanni S: Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: a number needed to treat study. Int J Chron Obstruct Pulmon Dis. 2009, 4: 315-319.PubMedPubMedCentral
34.
Kruis AL, van Adrichem J, Erkelens MR, Scheepers H, In 't Veen H, Muris JW, Chavannes NH: Sustained effects of integrated COPD management on health status and exercise capacity in primary care patients. Int J Chron Obstruct Pulmon Dis. 2010, 5: 407-13.PubMedPubMedCentral
35.
Engström CP, Persson LO, Larsson S, Sullivan M: Long-term effects of a pulmonary rehabilitation programme in outpatients with chronic obstructive pulmonary disease: a randomized controlled study. Scand J Rehabil Med. 1999, 31: 207-213. 10.1080/003655099444371.CrossRefPubMed
36.
Hoogendoorn M, van Wetering CR, Schols AM, Rutten-van Mölken MP: Is INTERdisciplinary Community-based COPD management (INTERCOM) cost effective?. Eur Respir J. 2010, 35: 79-87. 10.1183/09031936.00043309.CrossRefPubMed
37.
Maltais F, Bourbeau J, Shapiro S, Lacasse Y, Perrault H, Baltzan M, Hernandez P, Rouleau M, Julien M, Parenteau S, Paradis B, Levy RD, Camp P, Lecours R, Audet R, Hutton B, Penrod JR, Picard D, Bernard S: Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008, 149: 869-878.CrossRefPubMed
38.
Wempe JB, Wijkstra PJ: The impact of rehabilitation on behavior modification in COPD. Pat Educ Counseling. 2004, 52: 327-41.
39.
Turnock AC, Walters EH, Walters JAE, Wod-Baker R: Action plans for chronic obstructive pulmonary disease. Cochrane Database Systc Rev. 2005, 19 (4): CD005074-
40.
de Miguel DJ, Izquierdo Alonso JL, Molina París J, Bellón Cano JM, Rodríguez González-Moro JM, de Lucas RP: Factors affecting drug prescription in patients with stable COPD: results from a multicenter Spanish study (IDENTEPOC). Arch Bronconeumol. 2005, 41: 63-70.
41.
Faulkner J, Walshaw E, Campbell J, Jones R, Taylor R, Price D, Taylor AH: The feasibility of recruiting patients with early COPD to a pilot trial assessing the effects of a physical activity intervention. Prim Care Respir J. 2010, 19: 124-130. 10.4104/pcrj.2010.00008.CrossRefPubMed
42.
Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, Haselkorn JK: A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil. 2008, 89: 404-412. 10.1016/j.apmr.2007.11.003.CrossRefPubMed
Metadata
Title
Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial
Authors
Miguel Román
Concepción Larraz
Amalia Gómez
Joana Ripoll
Isabel Mir
Eduardo Z Miranda
Ana Macho
Vicenç Thomas
Magdalena Esteva
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2013
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-14-21

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