Sciriha A1, Lungaro-Mifsud S1, Fsadni P2, Scerri J3, Montefort S2
1University of Malta, Physiotherapy Department, Msida, Malta, 2University of Malta, Faculty of Medicine and Surgery, Msida, Malta, 3University of Malta, Department of Mental Health Nursing, Msida, Malta
Background: Pulmonary Rehabilitation is an evidence-based therapy in the management of COPD. Benefits are well-documented and listed in several recently published guidelines. With the rise in chronic respiratory diseases, it is reasonable to investigate whether the same Pulmonary Rehabilitation intervention leads to similar improvements in both COPD and Pulmonary Fibrosis patients.
Purpose: Evidence for the use of physiotherapy in the form of exercise training has grown in many areas especially in the management of chronic respiratory conditions. With clinical trials showing a large amount of evidence to support Pulmonary Rehabilitation in people with COPD, a call to look into whether such effects are similar in Pulmonary Fibrosis is required, noting that studies are inconclusive. This study adds more information that will guide further research, leading towards an evidence-based system of management for such patients.
Methods: 120 COPD and 120 Pulmonary Fibrosis patients were referred from the main general hospital in Malta. Each condition had 60 patients enrolled in an active group and 60 patients in a control inactive group. Baseline assessments were carried out on all patients 2 weeks before initiation of the multidisciplinary rehabilitation programme which included a 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: A 12-week PR programme in COPD patients resulted in statistically significant improvements in functional measures and health status but not in lung function measures. Mild COPD patients had improvements in functional measures as early as 4 weeks. Severe COPD patients improved at a later point but improvements in quality of life measures happened earlier than the milder group and with more impressive changes. Pulmonary rehabilitation in pulmonary fibrosis patients also led to significant changes in exercise tolerance, changes which occurred at the 8th week time point. Improvements in health status as measured using the St. George's Respiratory Questionnaire were also noted for the whole cohort of patients and those with an mMRC score of 3-4. Dyspnoea measures improved by the 4th week.
Conclusion(s): Clinically significant improvements in functional outcome measures, supported with statistically significant improvements in health-related quality of life scores were reported in COPD patients. Milder COPD patients reported gains in exercise tolerance by the 4th week. The more severe group required more time to obtain improvements. This would facilitate the local hospital to organise shorter pulmonary rehabilitation programmes on larger numbers of milder COPD patients. In pulmonary fibrosis patients, a PR programme with the same components delivered to COPD patients, led to some significant but less marked improvements in exercise tolerance, dyspnoea scores and the total and impact domain of the SGRQ. Such an intervention looks very promising and further research in this field is highly recommended.
Implications: Such research work will help provide further insights of better management of both COPD when looking at the time frame of the intervention depending on severity and also on a disabling respiratory condition such a Pulmonary Fibrosis.
Keywords: Pulmonary Rehabiltiation, COPD, Pulmonary Fibrosis
Funding acknowledgements: This study was self-funded
Purpose: Evidence for the use of physiotherapy in the form of exercise training has grown in many areas especially in the management of chronic respiratory conditions. With clinical trials showing a large amount of evidence to support Pulmonary Rehabilitation in people with COPD, a call to look into whether such effects are similar in Pulmonary Fibrosis is required, noting that studies are inconclusive. This study adds more information that will guide further research, leading towards an evidence-based system of management for such patients.
Methods: 120 COPD and 120 Pulmonary Fibrosis patients were referred from the main general hospital in Malta. Each condition had 60 patients enrolled in an active group and 60 patients in a control inactive group. Baseline assessments were carried out on all patients 2 weeks before initiation of the multidisciplinary rehabilitation programme which included a 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: A 12-week PR programme in COPD patients resulted in statistically significant improvements in functional measures and health status but not in lung function measures. Mild COPD patients had improvements in functional measures as early as 4 weeks. Severe COPD patients improved at a later point but improvements in quality of life measures happened earlier than the milder group and with more impressive changes. Pulmonary rehabilitation in pulmonary fibrosis patients also led to significant changes in exercise tolerance, changes which occurred at the 8th week time point. Improvements in health status as measured using the St. George's Respiratory Questionnaire were also noted for the whole cohort of patients and those with an mMRC score of 3-4. Dyspnoea measures improved by the 4th week.
Conclusion(s): Clinically significant improvements in functional outcome measures, supported with statistically significant improvements in health-related quality of life scores were reported in COPD patients. Milder COPD patients reported gains in exercise tolerance by the 4th week. The more severe group required more time to obtain improvements. This would facilitate the local hospital to organise shorter pulmonary rehabilitation programmes on larger numbers of milder COPD patients. In pulmonary fibrosis patients, a PR programme with the same components delivered to COPD patients, led to some significant but less marked improvements in exercise tolerance, dyspnoea scores and the total and impact domain of the SGRQ. Such an intervention looks very promising and further research in this field is highly recommended.
Implications: Such research work will help provide further insights of better management of both COPD when looking at the time frame of the intervention depending on severity and also on a disabling respiratory condition such a Pulmonary Fibrosis.
Keywords: Pulmonary Rehabiltiation, COPD, Pulmonary Fibrosis
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.
