Long-term evaluation of home-based pulmonary rehabilitation in patients with fibrotic idiopathic interstitial pneumonias

Abstract

BackgroundFew studies have examined the benefits of pulmonary rehabilitation in patients with fibrotic idiopathic pulmonary pneumonia (f-IIP). Here, we report the results of an observational study in routine clinical practice of home-based pulmonary rehabilitation for f-IIP patients.MethodsA total of 112 consecutive patients (61 with idiopathic pulmonary fibrosis and 51 with fibrotic nonspecific interstitial pneumonitis) were enrolled, of whom 65 had mild-to-moderate disease (forced vital capacity (FVC) ≥50% predicted and diffusing capacity of the lung for carbon monoxide (DLCO) ≥30% predicted) and 47 had severe disease (FVC <50% predicted and/or DLCO <30% predicted). The 2-month pulmonary rehabilitation programme consisted of a once-weekly visit with retraining, therapeutic education and psychosocial support. Patients were provided with an individualised action plan and were followed-up bimonthly for 12 months. Exercise tolerance (6-min stepper test (6MST)), mood (Hospital Anxiety and Depression Scale (HADS)) and quality of life (QoL) (Visual Simplified Respiratory Questionnaire (VSRQ)) were assessed before (T0), immediately after (T2), 6 months after (T8) and 12 months after (T14) the end of the pulmonary rehabilitation programme.Results6MST strokes, HADS Anxiety score and VSRQ score were each significantly improved at T2 (n=101), T8 (n=76) and T14 (n=62) compared with T0 values. The improvements in outcomes were not influenced by disease severity or subtype. Patients who completed the study had significantly better baseline FVC and DLCO values than those who did not.ConclusionsHome-based pulmonary rehabilitation provides long-term benefits in exercise tolerance, anxiety and QoL for patients with f-IIP. Pulmonary rehabilitation should be prescribed systematically as part of the therapeutic arsenal for these patients.

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

“…Another issue is one associated with individualisation and standardisation of the rehabilitation programme, taking into account the patient's capabilities and preferences and resulting, among others, from the degree of functional impairment, need for oxygen therapy and comorbidities. Another controversial question is that of the duration of the effects of rehabilitation, since many authors claim that the effects last up to 6 [307,313,321], 11 [326] or even 12 months [325] after completing the programme, while others do not confirm its lasting beneficial effects in a longer term [315,321]. Lack of unequivocal data confirming distant effect indicates it is necessary to use rehabilitation in a continuous and systematic way.…”

“…Attempts should be made to continue the programme at home. Supervised home rehabilitation, with optional use of telemedicine, can be an alternative to the traditional method [325].…”

Effectiveness of Early Versus Delayed Physical Rehabilitation on In‐Hospital Mortality in Interstitial Pneumonia: A Retrospective Cohort Study

“…According to one meta‐analysis, inpatient rehabilitation specifically designed for older adults potentially improves physical function and mortality outcomes 5 . Pulmonary rehabilitation, an intervention that includes exercise training, is beneficial for patients with chronic interstitial lung disease 6 . Early rehabilitation has been shown to contribute to decreasing in‐hospital mortality in patients with chronic obstructive pulmonary disease (COPD) in the acute care setting 7 .…”

Exploiting local facilities for post-pulmonary rehabilitation maintenance programs in fibrotic idiopathic interstitial pneumonia patients: A pilot study

“…Authors: Baptiste Chéhère a,b , Jean-Marie Grosbois c,d , Cécile Chenivesse e , Benoit Wallaert d,e and Valérie Bougault a,f . We previously reported the results of an 8-week home-based pulmonary rehabilitation (PR) program in patients with fibrotic interstitial idiopathic pneumonia (f-IIP), which demonstrated significant long-term (12 month) improvements in exercise capacity, anxiety, and quality of life [1]. However, most studies of f-IIP patients have shown that the benefits are lost within 6 to 9 months after the PR program [2], largely due to a failure to continue with exercise training [3].…”

“…week supervised PR program, as previously described [1,4], were recruited to this pilot study, The baseline values (before the home-based PR program) were: age 65±9 years, FVC 75±13% predicted, FEV 1 73±12% predicted, and DLCO 40±8% predicted (means ± standard deviations). Eleven subjects selected the local facility maintenance program (APA group) and 8 preferred to continue exercising at home (control group) ( Figure 1).…”