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Sciriha A1, Lungaro-Mifsud S1, Scerri J2, Montefort S3
1University of Malta, Physiotherapy Department, Msida, Malta, 2University of Malta, Department of Mental Health Nursing, Msida, Malta, 3University of Malta, Faculty of Medicine and Surgery, Msida, Malta
Background: Pulmonary Rehabilitation today is an established form of evidence-based therapy, listed in most respiratory guidelines for the management of COPD and documented in several publications. One of the areas which is still inconclusive is the duration for such a programme with huge variations noted across Europe and the rest of the world. In these guidelines, the recommended duration is that between 6 to 12 weeks, but programmes longer than 12 weeks in duration are optimal to promote maintenance of the pulmonary rehabiltiation benefits over time.
Purpose: The maintenance effects of a 12-week PR programme, at week 28 and week 52 post completion were investigated. This study adds more information to help guide further research, leading towards a more uniform and evidence-based system of management for such patients.
Methods: Forty-nine COPD patients who completed a 12-week PR programme at the main general hospital in Malta, were followed up at 28weeks and 52weeks post completion for functional measures which included the 6-minute walk test, dyspnoea score using Borg Scale, spirometry testing, plethysmography, St. George´s Respiratory Questionnaire (SGRQ) and Hospital and Anxiety score (HAD score).
Results: Scores for the 6MWD, dyspnoea score at rest, SGRQ and HAD score, 1-year post completion of the PR programme, did not result in statistically significant changes in the benefits obtained through such an intervention. All gains were maintained. A 41% increase in the 6WMD throughout the programme decreased slightly by 3% after 28weeks and 8% after 1 year, still a net gain. Dyspnoea scores at rest were maintained at the 28 and 52 weeks post-completion of the programme, with slight non-significant increases in scores being noted. On exertion, despite the gains in exercise tolerance, significant increases in dyspnoea levels were observed as of the 28th week (p = .013). Significant improvements in the SGRQ throughout the programme were also maintained. Scores rated on the CAT score though were noted to significantly increase by 22% (p = .038). Together with these, even anxiety and depressions scores were maintained at the 52nd week assessment with improvements in anxiety of 59% at the 12th week (p .001) and 27% for depression scores upon completion of the pulmonary rehabilitation programme at the 12th week (p .001) being maintained with slight worsening of scores on the 52nd week, one which though did not reach statistical significance.
Conclusion(s): Findings show that gains obtained following a 12-week pulmonary rehabilitation in a COPD patients were maintained in nearly all outcome measures except for dyspnoea upon exertion. Such results prove that such a programme would not require to be repeated regularly and one might need to monitor the extended effects post the 1year timeframe.
Implications: Through this longitudinal observational study, one can state that the time frame for such a programme was adequate to not only result in highly significant improvements but also for such benefits to be maintained for up to a one-year period. Further research on the longer effects of such an intervention would help in identifying the frequency such programmes should be repeated at.
Keywords: Pulmonary Rehabilitation, COPD, Maintenance
Funding acknowledgements: This study was self-funded
Purpose: The maintenance effects of a 12-week PR programme, at week 28 and week 52 post completion were investigated. This study adds more information to help guide further research, leading towards a more uniform and evidence-based system of management for such patients.
Methods: Forty-nine COPD patients who completed a 12-week PR programme at the main general hospital in Malta, were followed up at 28weeks and 52weeks post completion for functional measures which included the 6-minute walk test, dyspnoea score using Borg Scale, spirometry testing, plethysmography, St. George´s Respiratory Questionnaire (SGRQ) and Hospital and Anxiety score (HAD score).
Results: Scores for the 6MWD, dyspnoea score at rest, SGRQ and HAD score, 1-year post completion of the PR programme, did not result in statistically significant changes in the benefits obtained through such an intervention. All gains were maintained. A 41% increase in the 6WMD throughout the programme decreased slightly by 3% after 28weeks and 8% after 1 year, still a net gain. Dyspnoea scores at rest were maintained at the 28 and 52 weeks post-completion of the programme, with slight non-significant increases in scores being noted. On exertion, despite the gains in exercise tolerance, significant increases in dyspnoea levels were observed as of the 28th week (p = .013). Significant improvements in the SGRQ throughout the programme were also maintained. Scores rated on the CAT score though were noted to significantly increase by 22% (p = .038). Together with these, even anxiety and depressions scores were maintained at the 52nd week assessment with improvements in anxiety of 59% at the 12th week (p .001) and 27% for depression scores upon completion of the pulmonary rehabilitation programme at the 12th week (p .001) being maintained with slight worsening of scores on the 52nd week, one which though did not reach statistical significance.
Conclusion(s): Findings show that gains obtained following a 12-week pulmonary rehabilitation in a COPD patients were maintained in nearly all outcome measures except for dyspnoea upon exertion. Such results prove that such a programme would not require to be repeated regularly and one might need to monitor the extended effects post the 1year timeframe.
Implications: Through this longitudinal observational study, one can state that the time frame for such a programme was adequate to not only result in highly significant improvements but also for such benefits to be maintained for up to a one-year period. Further research on the longer effects of such an intervention would help in identifying the frequency such programmes should be repeated at.
Keywords: Pulmonary Rehabilitation, COPD, Maintenance
Funding acknowledgements: This study was self-funded
Topic: Cardiorespiratory
Ethics approval required: Yes
Institution: University of Malta
Ethics committee: Research Ethics Committee
Ethics number: 191/2011
All authors, affiliations and abstracts have been published as submitted.
