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Clinical Investigations: COPD |

Long-term Effects of Outpatient Rehabilitation of COPD*: A Randomized Trial

Rosa Güell, MD; Pere Casan, MD; Jose Belda, MD; Mercé Sangenis, PT; Fatima Morante, RN; Gordon H. Guyatt, MD; Joaquin Sanchis, MD
Author and Funding Information

* From the Departament de Pneumologia (Drs. Güell, Casan, Belda, and Sanchis, Mrs. Sangenis, and Ms. Morante), Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, and Department of Clinical Epidemiology and Biostatistics (Dr. Guyatt), McMaster University, Hamilton, Ontario, Canada.

Correspondence to: Dr. Rosa Güell, Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Av Sant Antoni Ma Claret 167, 08025 Barcelona, Spain



Chest. 2000;117(4):976-983. doi:10.1378/chest.117.4.976
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Objective: To examine the short- and long-term effects of an outpatient pulmonary rehabilitation program for COPD patients on dyspnea, exercise, health-related quality of life, and hospitalization rate.

Setting: Secondary-care respiratory clinic in Barcelona.

Methods: We conducted a randomized controlled trial with blinding of outcome assessment and follow-up at 3, 6, 9, 12, 18, and 24 months. Sixty patients with moderate to severe COPD (age 65 ± 7 years; FEV1 35 ± 14%) were recruited. Thirty patients randomized to rehabilitation received 3 months of outpatient breathing retraining and chest physiotherapy, 3 months of daily supervised exercise, and 6 months of weekly supervised breathing exercises. Thirty patients randomized to the control group received standard care.

Results: We found significant differences between groups in perception of dyspnea (p < 0.0001), in 6-min walking test distance (p < 0.0001), and in day-to-day dyspnea, fatigue, and emotional function measured by the Chronic Respiratory Questionnaire (p < 0.01). The improvements were evident at the third month and continued with somewhat diminished magnitude in the second year of follow-up. The PR group experienced a significant (p < 0.0001) reduction in exacerbations, but not the number of hospitalizations. The number of patients needed to treat to achieve significant benefit in health-related quality of life for a 2-year period was approximately three.

Conclusion: Outpatient rehabilitation programs can achieve worthwhile benefits that persist for a period of 2 years.

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