Pulmonary rehabilitation in chronic obstructive pulmonary disease: Outcomes in a 12 week programme
European Journal of Physiotherapy
PR has been recommended as a key intervention for people with COPD (4). Signifi cant gains in exercise tolerance (5-7), dyspnoea measures (5) and improvements in quality of life (8) have been observed following outpatient PR programmes. One of the debated issues on improvements in these outcome measures arises from the huge variations in the time-frames for this type of intervention across Europe and the rest of the world (4,9-11). These programmes range from a duration of just 4 weeks (12,13)
... st 4 weeks (12,13) up to 18 months (14,15). Abstract Objective. The optimal time-frame for pulmonary rehabilitation (PR) in patients diagnosed with chronic obstructive pulmonary disease (COPD) is still debated. A 12 week programme was designed looking at whether the benefi ts were reached at or before a 12 week period of PR for COPD patients. Method . Seventy-fi ve patients (59 males, 16 females) aged 40-75 years were referred from the local general hospital in Malta. Baseline assessments were carried out on all patients 2 weeks before initiation of the programme. Sixty patients were eligible to start a twice-weekly, 12 week multidisciplinary programme delivered after the screening process. The Six-Minute Walk Test (6MWT), dyspnoea score using the Borg scale, spirometry testing, plethysmography, COPD Assessment Tool (CAT) score, St George ' s Respiratory Questionnaire (SGRQ) and Hospital and Anxiety scale score were monitored at 4 weekly intervals throughout the 12 weeks of PR for these COPD patients. Results . The 6MWT distance increased by a mean total of 132.45 m ( p Ͻ 0.001) by 12 weeks, with the highest change recorded in the fi rst 4 weeks for the milder COPD patients. Lung function test improvements were marginal. Borg scale readings at rest and following exertion decreased signifi cantly from weeks 0 to 4 but remained fairly constant thereafter. The Body mass index, airway Obstruction, Dyspnoea, and Exercise capacity (BODE) index, SGRQ and CAT score values decreased signifi cantly throughout the weeks irrespective of the initial Medical Research Council score. Anxiety scoring decreased signifi cantly by 12 weeks, while the depression rating improved by 8 weeks. Conclusion . These fi ndings show that 12 weeks of PR in this cohort of COPD patients resulted in clinically signifi cant changes in functional outcome measures which are supported by statistically signifi cant changes in health-related quality of life measures. In milder COPD cases, by 4 weeks of PR gains in exercise tolerance had already resulted. The more severe group required more time to obtain improvements. Therefore, hospitals could organize shorter PR programmes for larger numbers of patients with milder COPD.