Does an Immediate Commencement of Pulmonary Rehabilitation Following Hospitalization for an Exacerbation of Chronic Obstructive Pulmonary Disease Positively Impact Attendance and Completion Rates: A Pilot Randomized Controlled Trial?

Tang, Clarice Y; Southcott, A.; Barker, Kathryn; Pazsa, Fiona; Skinner, Elizabeth H; Blackstock, Felicity

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4270

Cited by 3 publications

(4 citation statements)

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“…We found 17 RCTs ( 94 – 110 ) (1,724 participants) reporting the effects of usual care versus PR delivered after hospital discharge for an AECOPD. The mean FEV 1 of participants ranged from 31% to 57% predicted.…”

Section: Resultsmentioning

confidence: 99%

“…The mean FEV 1 of participants ranged from 31% to 57% predicted. Six studies commenced PR during the inpatient stay and continued after discharge ( 94 , 103 , 106 , 108 – 110 ), eight commenced outpatient PR within 2 weeks of discharge ( 95 , 97 , 99 – 101 , 104 , 105 , 107 ), and three commenced PR between 2 and 4 weeks after discharge, with most participants in these studies starting by Week 3 ( 96 , 98 , 102 ). Program duration ranged from 2 weeks to 24 months.…”

Section: Resultsmentioning

confidence: 99%

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Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

Rochester¹,

Alison²,

Carlin³

et al. 2023

Am J Respir Crit Care Med

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Background Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

Rochester¹,

Alison²,

Carlin³

et al. 2023

Am J Respir Crit Care Med

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“…Whilst they were not considered eligible for this review; three additional small trials (n=134 participants in total) were identified which explored the effect of timing of the PR program in relation to an AECOPD. [75][76][77] The studies hypothesized that commencing PR in hospital or soon after discharge might increase uptake. One RCT compared early PR (within 4 weeks of discharge following AECOPD) with delayed PR (at 11 weeks post discharge); however; the trial failed to recruit sufficiently and it was concluded that recruitment to PR and retention due to an early PR program was problematic.…”

Section: Timing Of Pulmonary Rehabilitation Programsmentioning

confidence: 99%

“…76 Another RCT of 36 participants randomized to either early PR (commencing within 2 weeks of AECOPD in hospital) or late PR (at 6-months) demonstrated similar commencement rates (78.9% and 76.5% respectively). 75 The third study was a three arm RCT comparing PR commencement during hospital admission; 4 weeks and 8 weeks post discharge; 77 where participants randomized to the early PR program were more likely to commence PR compared to those allocated to PR at 8 weeks (OR for 8 weeks vs in-hospital 0.25 (95% CI 0.1 to 0.9; p=0.048)). Completion rates for the programs commencing at hospital admission; 4 weeks and 8 weeks were 60%; 40% and 46% respectively.…”

Section: Timing Of Pulmonary Rehabilitation Programsmentioning

confidence: 99%

A Systematic Review of the Effectiveness of Interventions to Promote Referral; Adherence; and Uptake of Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease

Watson¹,

Jordan²,

Gardiner³

et al. 2023

COPD

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Background: Pulmonary rehabilitation (PR) is an effective treatment for patients with chronic obstructive pulmonary disease (COPD). However, referral, uptake, and adherence remain low. Objective: To determine effectiveness of interventions to increase patient referral, uptake, and adherence to PR programs for patients with COPD. Methods: Randomized controlled trials (RCTs), non-randomized controlled trials, pre-post studies, and uncontrolled studies were sought from 7 databases and 3 clinical trial registries, to end August 2021. Full articles/conference abstracts were included if a coordinated set of activities was targeted to healthcare professionals (HCPs) caring for COPD patients, adults with COPD or their carers, to increase referral, uptake or adherence to any type of PR program. Two review authors independently screened titles, abstracts and full texts, extracted data and critically appraised studies using standard risk of bias tools. Results: From 11,272 records, 30 studies (23 full-text; 7 abstracts) met inclusion criteria: study interventions and designs were varied and generally low quality, targeting patients (n=13), HCPs (n=14) or both (n=3 studies). A CCT of patient held evidence score cards increased referral by 7.3% compared to 1.3% for usual care (p-0.03). A cluster RCT involving COPD nurse home visits with individualized care plans increased uptake to 31% compared to 10% in usual care (p=0.002). For people with anxiety or depression, one RCT of cognitive behavioral therapy alongside PR increased adherence (mean sessions 14.0 (sd 1.7) compared to 12.4 (sd 2.6)). Conclusion: Although a small number of studies, the weight of evidence suggested that interventions incorporating partnership working between patients and HCPs appeared to increase referral, uptake, and adherence with greater effectiveness than those targeting single populations. Increasing knowledge and empowering HCPs and patients may be important strategies. Concerns about study design and risk of bias suggest clear need for well-designed trials of interventions to report full pathway outcomes.

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Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis

Jenkins,

Burtin,

Camp

et al. 2024

Thorax

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IntroductionPrevious systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD.MethodsAn update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method.ResultsSeventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I2=67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I2=89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I2=81%), health-related quality of life (St. George’s Respiratory Questionnaire, MD −8.7 points, 95% CI −12.5 to −4.9, I2=59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I2=74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I2=91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I2=87%; modified Medical Research Council Dyspnoea Scale, MD −0.3 points, 95% CI −0.5 to −0.1, I2=60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported.DiscussionPulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events.Trial registration numberCRD42023406397.

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Does an Immediate Commencement of Pulmonary Rehabilitation Following Hospitalization for an Exacerbation of Chronic Obstructive Pulmonary Disease Positively Impact Attendance and Completion Rates: A Pilot Randomized Controlled Trial?

Cited by 3 publications

References 0 publications

Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

A Systematic Review of the Effectiveness of Interventions to Promote Referral; Adherence; and Uptake of Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease

Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis

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