SESSION TYPE: Physiology/PFTs/ Rehabilitation II
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: To determine whether an as-needed repeated pulmonary rehabilitation intervention produces a clinically important improvement in exercise capacity.
METHODS: The study entailed a retrospective analysis of characteristics and six minute walk distance (6MWD) of COPD patients who completed pulmonary rehabilitation. Data were abstracted from files of all COPD patients completing 2 courses of rehabilitation (repeaters) and from those of randomly sampled COPD patients completing one course of rehabilitation (non-repeaters).
RESULTS: We identified 37 repeaters and selected 69 non-repeaters . No significant difference was observed between the two groups with regards to age (70 ± 10 vs. 67 ± 8 years), FEV1% predicted (50.7% ± 21.6 vs. 43.5% ± 16.8), and gender (54% female repeaters vs. 56% female non-repeaters). A mean gap of 45 ± 24.7 months occurred between the first and second intervention for the repeaters. There was no significant difference in 6MWD between the repeaters and non-repeaters at baseline (314 ± 96 m vs. 317± 108 m), in improvement at the end of the first course of rehabilitation (66 ± 47 m vs. 57 ± 45 m) or in the percentage improving the minimal important difference (MID) of ≥ 35 m (86% vs. 74%) (Puhan et al, Eur Respir J 2008). Repeaters declined 94 ± 74.5 meters in 6MWD at the beginning of the second rehabilitation course compared to the end of the first course (p<.0001). Twenty-four (65%) of repeaters achieved the MID at the end of second rehabilitation course. The mean gain in 6MWD decreased 19 ± 55.7 meters (p = 0.042) compared to the first rehabilitation course.
CONCLUSIONS: Two-thirds of COPD patients undergoing repeat pulmonary rehabilitation experienced significant improvement, although the mean gain was less than that observed after their first course of rehabilitation.
CLINICAL IMPLICATIONS: Patients with COPD may experience exercise improvement from participation in a second course of pulmonary rehabilitation. Further research is needed to identify those patients most likely to benefit from this intervention.
DISCLOSURE: The following authors have nothing to disclose: Ali Atabaki, Margaret Haggerty, Corliss Marolda, Jonathan Fine, Richard ZuWallack
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