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Evidence of the Efficacy of Respiratory Rehabilitation

Evidence of the Efficacy of Respiratory Rehabilitation

A study proved the efficacy of a 6-week multidisciplinary rehabilitation program for Chronic Obstructive Pulmonary Disease patients.

A landmark randomized controlled trial by Griffiths and colleagues, published in The Lancet in 2000, tested the efficacy of a multidisciplinary program based on physical exercise, nutritional advice, smoking cessation and therapeutic education among 180 patients suffering from COPD. The results evidenced the improvement of the clinical characteristics, autonomy and quality of life of the 92 program participants. After one year, these improvements continued and the number of hospital days was reduced by 50%. This study proved that a COPD rehabilitation program can positively impact biological and psychological factors while reducing the healthcare costs related to hospitalization.


The Study Rationale

Chronic Obstructive Pulmonary Disease (COPD) is ranked as the fifth-leading cause of death worldwide. Approximately as many people confuse COPD symptoms with those of bronchitis, or attribute them to fatigue or aging. COPD is generally caused by active tobacco smoking or exposure to secondhand smoke. There is no known cure at this time (hence the “C” for “Chronic”). Dyspnea, its main symptom, is akin to a feeling of breathlessness. In the first stage of the disease, it is felt during physical exercise; for example, when climbing stairs quickly. Dyspnea gradually leads to a general lack of physical fitness and to psychosocial withdrawal – the later the COPD diagnosis, the more critical the collateral damage.

Pulmonary rehabilitation is promising in reducing symptoms of chronic obstructive pulmonary disease. 

The Question

Can an 18-session hospital outpatient rehabilitation program effectively reduce the effects of dyspnea, increase the autonomy and improve the quality of life of COPD patients?

The Protocol

This British randomized controlled trial tested the efficacy of a multidisciplinary program consisting of three weekly hospitals sessions over the course of a month and a half. The sessions were personalized and lasted two hours each; they included endurance exercise (indoor walking and biking), muscle training with resistance elastics, smoking cessation for smokers, and therapeutic education (disease and stress management). Participants were incited to pursue these activities at home. All participants were randomly assigned to either the Rehabilitation Group or the Control Group. The control group followed traditional recommendations and treatments. Ninety-two COPD patients aged 68.3 years (Rehabilitation Group) and eighty-eight patients aged 68.2 years (Control Group) were tested at the end of the six-week program (T1), and at one year (T2). The study assessed the main clinical medical and psychosocial characteristics of the participants, as well as the number of hospital days and home consultations.

Main Results

At the end of the program, the results of this non-pharmacological trial showed that the Rehabilitation Group benefited more positively that the control group. This positive impact lasted through the following year, with reduced dyspnea (2-point reduction on the CRQ scale for the Rehabilitation Group), improved effort tolerance (8-minute increase on the 6-Minute Walk Test for the Rehabilitation Group), reduced depression symptoms (1.1-point reduction on the HADS scale for the Rehabilitation Group), and improved quality of life (increase of 3.4 on the Saint George Respiratory Questionnaire for the Rehabilitation Group). Furthermore, the results evidenced a significant difference in the number of hospital days in the year following the rehabilitation program (10.4 days on average vs. 21.0 days for the control group).

graphique

Figure: 6-Minute Walk Test performance according to group (distance, in meters, walked by participants during 6 minutes)

The study demonstrates the improvement of the health status and quality of life of patients with COPD and a halving of the number of days of hospitalization in the year following pulmonary rehabilitation program.


What it means for Patients

While rehabilitation cannot cure COPD, it does help reduce its primary symptom (dyspnea). Rehabilitation can also improve autonomy, the mood and the quality of life of people with COPD. Finally, it reduces the risk of hospitalization during the year following the rehabilitation period.

What it means for Healthcare Professionals

A 6-week rehabilitation program offering three 2-hour sessions per week improves the clinical factors, functional autonomy and quality of life of COPD patients; it also reduces the number of hospital days by 50%. This total number of sessions (18) represents a minimum threshold to obtain significant benefits. Using a multidisciplinary approach allows professionals to depart from the reductionist re-training approach and to effectively deal with all facets of COPD.

What it means for Researchers

This protocol tested the efficacy of a hospital-based rehabilitation program in which participants were required to attend three sessions per week for six weeks. While the authors did not distinguish between refusal to participate and lack of inclusion criteria match, they reported that more than a third of the patients who were offered the program did not participate. It would therefore be interesting to test the efficacy and acceptability of other types of rehabilitation, such as office-based/multidisciplinary network rehabilitation or full hospitalization for one month. Including a cost-benefit analysis in this study would have also added a financial dimension. The authors provided one in 2001 in a Thorax journal article.

What it means for Policymakers

A center-offered rehabilitation program can improve the health status and autonomy of COPD patients, while reducing healthcare costs after one year (average reduction of hospital stays per year per COPD patient of 10 days). This type of program relies on the coordinated effort of a COPD-trained and qualified multidisciplinary team.


The reference

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 (2000). Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. The Lancet, 355(9201), 362-368.


To reference this Blog en Sante © article.

Ninot G (2014). Evidence of the Efficacy of Respiratory Rehabilitation. Blog en Sante, A1.

© Copyright 2014 Grégory Ninot. All rights reserved.

Thanks to Syl Billere for the English Revision.

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