Trajectories of COPD patients’ response to repeated pulmonary rehabilitation programs

Chikhanie, Yara Al; Bailly, Sébastien; Amroussia, I.; Veale, D; Hérengt, F.; Vergès, Samuel

doi:10.1016/j.rmed.2021.106678

Cited by 5 publications

(15 citation statements)

References 21 publications

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“… 27 The study looking at five programs used a 54m threshold and demonstrated consistent results over the first three programs (31–33% achieving the MID) with a decrease evident in the final two programs (first vs fourth program 12.5%, p<0.01; first vs fifth program 14.6%, p=0.03). 21 …”

Section: Resultsmentioning

confidence: 76%

“… 20 , 23 , 25 Two studies reported outcomes for participants who did and did not repeat programs following the initial program, as well as outcomes for participants following the second 18 , 26 and third programs. 18 Three other studies reported outcomes for participants who undertook three 19 , 27 and five programs 21 ( Supplemental Table 5 ). Time between the first and subsequent programs in retrospective studies varied from mean 17 (SD 6) months 21 to 45 (24) months 26 ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Results for studies using 25–35m thresholds demonstrated consistent results across second programs, with 61–67% of the participants achieving the MID. 18 , 19 , 26 , 27 One study demonstrated that of the 41/190 non-responders to the initial program, 23 (56%) did respond to the second program and of the 149/190 responders to the initial program, 44 (30%) became non-responders in the second program. 27 The study looking at five programs used a 54m threshold and demonstrated consistent results over the first three programs (31–33% achieving the MID) with a decrease evident in the final two programs (first vs fourth program 12.5%, p<0.01; first vs fifth program 14.6%, p=0.03).…”

Section: Resultsmentioning

confidence: 99%

“… 18–21 , 26 , 27 Four studies reported differences in 6MWD outcomes between the first and third programs ranging from 2 to 65 m less improvement on the third program. 18 , 19 , 21 , 27 One longitudinal study also reported less improvement in fourth and fifth programs compared to the first program ( Supplemental Table 10 ). 21 …”

Section: Resultsmentioning

confidence: 99%

“… 37 Current guidelines state that re-referral may be considered from 12 months following pulmonary rehabilitation 1 but may be appropriate earlier in the case of clinical indication. 6 Included studies that sought to repeat pulmonary rehabilitation at scheduled intervals following initial programs (6- and 12-months, 22 12 months, 27 12 to 18 months 21 ) demonstrated benefits for health-related quality of life, 22 consistent proportions of 6MWD responders across the first three programs 21 , 27 and ongoing benefits in terms of reducing both exacerbations and hospitalizations over five programs. 21 Whilst the amount and quality of data preclude firm conclusions, studies in this review do signal that there may be benefits to this approach.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review

Burge¹,

Malaguti²,

Hoffman³

et al. 2022

COPD

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Background Pulmonary rehabilitation is an effective intervention for people with chronic obstructive pulmonary disease (COPD). People with COPD undertake repeat programs, but synthesis of evidence regarding such practice has not been undertaken. The aim of this systematic review was to establish the effects of repeating pulmonary rehabilitation subsequent to an initial program in people with COPD. Methods Studies where participants with COPD undertook >1 pulmonary rehabilitation program were included, incorporating RCT (randomized controlled trial) and non-randomized studies. Electronic database searches were undertaken. Two authors independently undertook study identification, data extraction and risk of bias assessment. The primary outcome was health-related quality of life (HRQoL); secondary outcomes were exercise capacity, hospitalizations and exacerbations, adherence, mortality and adverse events. Narrative synthesis was undertaken for clinically heterogeneous trials. Data from RCTs and non-randomized studies were not combined for analysis. Results Ten included studies (2 RCTs) involved 907 participants with COPD (n=653 had undertaken >1 program). The majority of studies were at high risk of bias. One RCT (n=33) reported no difference in HRQol after a repeat program vs usual care following exacerbation (Chronic Respiratory Disease Questionnaire dyspnea domain score MD 0.4, 95% CI −0.5 to 3). In stable patients, clinically important and statistically significant improvements in HRQoL and exercise capacity were reported after repeat programs, but of a smaller magnitude than initial programs. There was evidence for reductions in exacerbations and hospitalizations, and shorter hospital length of stay for patients who repeated a program twice in 12 months compared to those who repeated once. No data for mortality or adverse events were available. Conclusion This systematic review provides limited evidence for benefits of repeating pulmonary rehabilitation in people with COPD, including improved HRQoL and exercise capacity, and reduced hospitalizations. However, most studies have high risk of bias, which reduces the certainty of these conclusions. Study Registration PROSPERO (CRD42020215093).

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Section: Resultsmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review

Burge¹,

Malaguti²,

Hoffman³

et al. 2022

COPD

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Development of a behavior change intervention to improve physical activity in patients with COPD using the behavior change wheel: a non-randomized trial

Xiang,

Han,

Luo

et al. 2023

Sci Rep

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The aim of this study was to evaluate whether a theory-based behavior change intervention could promote changes in physical activity (PA) and sedentary behavior (SB) among patients with chronic obstructive pulmonary disease (COPD), as well as its effects on symptoms of dyspnea, lung function, exercise capacity, self-efficacy, and health-related quality of life (HRQoL). A quasi-experimental design and convenience sampling were adopted. A total of 92 patients with stable COPD were recruited from outpatient and inpatient centers of two hospitals in Zhejiang Province, China. Both the experimental and control groups received standard medical care provided in the hospital. The experimental group performed a PA program based on the behavior change wheel theory. Outcomes were measured at baseline (T0) and after 4 weeks (T1), 8 weeks (T2), and 12 weeks of the intervention (T3). The primary outcome was PA measured by the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included SB measured by the IPAQ, dyspnea measured by the modified Medical Research Council (mMRC) questionnaire, exercise capacity assessed by 6-min walk distance (6MWD), self-efficacy measured by the Exercise Self-Regulatory Efficacy Scale (EX-SRES), and HRQoL measured by the COPD Assessment Test (CAT). In addition, we measured lung function using a spirometer at baseline and 12 weeks. Of the 89 patients included in this study, 64 were male (71.91%), with a mean age of 67.03 ± 6.15 years. At 12 weeks, the improvements in PA, SB, mMRC, 6MWD, EX-SRES and CAT were all statistically significant (P < 0.05) in the experimental group compared to the control group. Repeated measures analysis of variance showed that there were group effects and time effects on total PA, SB, mMRC, 6MWD, EX-SRES, and CAT in both groups (P < 0.001). However, there was no significant difference in pulmonary function between the two groups before and after intervention (P < 0.05). The PA program based on theory significantly increased PA levels, reduced sedentary time, enhanced exercise capacity and self-efficacy as well as HRQoL in patients with stable COPD. Due to the limited intervention time in this study, the pulmonary function of COPD patients may not be reversed in a short time, and the long-term effect of this program on the pulmonary function of patients needs to be further explored.Trial registration: Clinical Trials.gov (ChiCTR2200060590). Registered 05/06/2022.

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Changes in the physical and affective dimensions of dyspnoea after a home-based pulmonary rehabilitation in fibrotic idiopathic interstitial pneumonias

Chenivesse,

Gephine,

Dornbierer

et al. 2024

ERJ Open Res

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ObjectiveTo evaluate the short-, medium- and long-term benefits of home-based PR on the physical and affective components of dyspnea in people with fibrotic idiopathic interstitial pneumonias (f-IIPs). Anxiety and depressive symptoms, fatigue, health-related quality of life and exercise tolerance were also assessed.MethodsData on 166 individuals with f-IIPs who enrolled in an 8-week home-based PR programme (weekly supervised 90-minute session) was retrospectively analysed. Assessments included the Dyspnea-12 questionnaire, Hospital Anxiety and Depression Scale, Fatigue Assessment Scale, Visual Simplified Respiratory Questionnaire and Six-Minute Stepper Test and were performed at home at short-, medium- (6 months) and long- (12 months) term.ResultsAmong the 166 individuals with f-IIPs who enrolled in PR, 75 (45%) and 91 (55%) participants had a diagnosis of idiopathic pulmonary fibrosis and fibrosing non-specific interstitial pneumonia, respectively and 87 (52%) participants concluded a full year of follow-up. In the total group, both physical and affective components of dyspnea were improved, at short-, medium- and long-term, after PR. Overall, half of the participants reached the minimally important difference of 3 points of the dyspnea-12 questionnaire at the end of PR, and at the 6- and 12-month follow-up. Anxiety and depressive symptoms, fatigue and health-related quality of life were also improved, while the short benefits in exercise tolerance were not maintained one-year after PR.ConclusionIndividualised home-based PR programme resulted in short-, medium- and long-term improvements in both physical and affective components of dyspnea assessed by the D-12 questionnaire.

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Trajectories of COPD patients’ response to repeated pulmonary rehabilitation programs

Cited by 5 publications

References 21 publications

Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review

Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review

Development of a behavior change intervention to improve physical activity in patients with COPD using the behavior change wheel: a non-randomized trial

Changes in the physical and affective dimensions of dyspnoea after a home-based pulmonary rehabilitation in fibrotic idiopathic interstitial pneumonias

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