期刊论文详细信息
Respiratory Research
Low intensity, long-term outpatient rehabilitation in COPD: a randomised controlled trial
Andreas Meyer2  Tibor Schmoller4  Jan K Hennigs3  Hans Klose3  Katrin Rummel3  Stefan Kluge1  Hans Jörg Baumann3 
[1] Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Kliniken Mariahilf GmbH, Department of Pneumology, Mönchengladbach, Germany;Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Pulmonary practice Winterhude, Hamburg, Germany
关键词: Quality of life;    Pulmonary rehabilitation;    Exercise training;    COPD;   
Others  :  796644
DOI  :  10.1186/1465-9921-13-86
 received in 2012-05-25, accepted in 2012-09-25,  发布年份 2012
PDF
【 摘 要 】

Background

Most pulmonary rehabilitation programmes currently involve 2–3 sessions per week as recommended by international guidelines. We aimed to investigate whether relevant improvements in physical capabilities and quality of life in patients with chronic obstructive pulmonary disease (COPD) could be achieved by a long-term, low intensity, once weekly rehabilitation programme using limited resources.

Methods

100 patients with moderate to severe COPD were randomised to a continuous outpatient interdisciplinary rehabilitation programme or standard care. Physiotherapy-led supervised outpatient training sessions were performed once weekly in addition to educational elements. Outcome measures at baseline and after 26 weeks were 6-minute-walk-test, cycle ergometry, and health-related quality of life.

Results

37 patients in the training group and 44 patients in the control group completed the study. After 26 weeks there were clinically significant differences between the groups for 6 minute-walk-distance (+59 m, 95% CI 28–89 m), maximum work load (+7.4 Watt, 95% CI 0.5-13.4 Watt) and St. George’s Respiratory Questionnaire score (−5 points, 95% CI −10 to −1 points). Total staff costs of the programme per participant were ≤ €625.

Conclusion

Clinically meaningful improvements in physical capabilities and health-related quality of life may be achieved using long-term pulmonary rehabilitation programmes of lower intensity than currently recommended. Trial registration: clinicaltrials.gov NCT01195402.

【 授权许可】

   
2012 Baumann et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20140705235657488.pdf 286KB PDF download
Figure 1. 79KB Image download
【 图 表 】

Figure 1.

【 参考文献 】
  • [1]Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, et al.: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006, 173:1390-1413.
  • [2]Glaab T, Vogelmeier C, Hellmann A, Buhl R: Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany. Int J Chron Obstruct Pulmon Dis 2012, 7:101-108.
  • [3]Meyer A, Wendt G, Taube K, Greten H: Ambulatory sports in asthma improves physical fitness and reduces asthma-induced hospital stay. Pneumologie 1997, 51:845-849.
  • [4]Worth H, Meyer A, Folgering H, Kirsten D, Lecheler J, Magnussen H, Pleyer K, Schmidt S, Schmitz M, Taube K, Wettengel R: Recommendations of the German Respiratory League on sports and physical training for patients with obstructive respiratory tract diseases. Pneumologie 2000, 54:61-67.
  • [5]Worth H, Buhl R, Cegla U, Criee CP, Gillissen A, Kardos P, Kohler D, Magnussen H, Meister R, Nowak D, et al.: Guidelines for the diagnosis and treatment chronic obstructive Bronchitis and pulmonary emphysema issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie. Pneumologie 2002, 56:704-738.
  • [6]Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, et al.: Standardisation of spirometry. Eur Respir J 2005, 26:319-338.
  • [7]ATS: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002, 166:111-117.
  • [8]Troosters T, Gosselink R, Decramer M: Six minute walking distance in healthy elderly subjects. Eur Respir J 1999, 14:270-274.
  • [9]ERS Task Force on Standardization of Clinical Exercise Testing: Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J 1997, 10:2662-2689.
  • [10]Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Rev Respir Dis 1992, 145:1321-1327.
  • [11]Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J: A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med 1997, 19:179-186.
  • [12]Bullinger M: German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med 1995, 41:1359-1366.
  • [13]Dhein Y, Munks-Lederer C, Worth H: Evaluation of a structured education programme for patients with COPD under outpatient conditions-- a pilot study. Pneumologie 2003, 57:591-597.
  • [14]Jerman A, Campbell Haggerty M: Relaxation and biofeedback: coping skills training. In Principles and practice of pulmonary rehabilitation. Edited by Casaburi R, Petty TL. W.B. Saunders Co, Philadelphia; 1993:366-381.
  • [15]Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982, 14:377-381.
  • [16]Troosters T, Gosselink R, Decramer M: Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med 2000, 109:207-212.
  • [17]Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, Sanchis J: Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest 2000, 117:976-983.
  • [18]Cambach W, Chadwick-Straver RV, Wagenaar RC, van Keimpema AR, Kemper HC: The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J 1997, 10:104-113.
  • [19]Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH: Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med 1997, 155:1278-1282.
  • [20]Puhan MA, Chandra D, Mosenifar Z, Ries A, Make B, Hansel NN, Wise RA, Sciurba F: The minimal important difference of exercise tests in severe COPD. Eur Respir J 2011, 37:784-790.
  • [21]Jones PW: Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J 2002, 19:398-404.
  • [22]Ringbaek T, Brondum E, Martinez G, Thogersen J, Lange P: Long-term effects of 1-year maintenance training on physical functioning and health status in patients with COPD: A randomized controlled study. J Cardiopulm Rehabil Prev 2010, 30:47-52.
  • [23]Spencer LM, Alison JA, Mckeough ZJ: Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial. Eur Respir J 2010, 35:571-577.
  • [24]Van Wetering CR, Hoogendoorn M, Mol SJM, Rutten-van Mölken MPMH, Schols AM: Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax 2010, 65:7-13.
  • [25]Effing T, Zielhuis G, Kerstjens H, van der Valk P, van der Palen J: Community based physiotherapeutic exercise in COPD self-management: a randomised controlled trial. Respir Med 2011, 105:418-426.
  • [26]Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS: American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009, 41:1510-1530.
  • [27]Puhan MA, Schünemann HJ, Buesching G, Vanoort E, Spaar A, Frey M: COPD patients’ ability to follow exercise influences short-term outcomes of rehabilitation. Eur Respir J 2008, 31:304-310.
  • [28]Sabit R, Griffiths TL, Watkins AJ, Evans W, Bolton CE, Shale DJ, Lewis KE: Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med 2008, 102:819-824.
  • [29]Soicher JE, Mayo NE, Gauvin L, Hanley JA, Bernard S, Maltais F, Bourbeau J: Trajectories of endurance activity following pulmonary rehabilitation in COPD patients. Eur Respir J 2012, 39:272-278.
  • [30]Zuwallack R: The nonpharmacologic treatment of chronic obstructive pulmonary disease: advances in our understanding of pulmonary rehabilitation. Proc Am Thorac Soc 2007, 4:549-553.
  • [31]Horowitz MB, Littenberg B, Mahler DA: Dyspnea ratings for prescribing exercise intensity in patients with COPD. Chest 1996, 109:1169-1175.
  • [32]Baumann HJ, Kluge S, Klose H, Hellweger A, Braumann KM, Meyer A: Heart rate measurement for determination of training intensity in outpatient pulmonary sport groups. Pneumologie 2009, 63:72-77.
  文献评价指标  
  下载次数:13次 浏览次数:26次