Journal
RESPIRATORY MEDICINE
Volume 102, Issue 4, Pages 556-566Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.rmed.2007.11.012
Keywords
follow-up studies; chronic obstructive; pulmonary disease; health-care networks; pulmonary rehabilitation; costs and benefits; quality of life
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Although the benefits of pulmonary rehabilitation (PR) have been demonstrated in patients with COPD, most studies suggest that short-term programs are insufficient to maintain the benefits beyond a post-discharge period of 6 months to 1 year. We were interested to evaluate the effects of an innovative maintenance intervention compared with a usual after-care. Forty moderate to severe COPD patients, who had just completed their first inpatient PR, were consecutively included in either a maintenance group (MG) or a standard after-care group. The maintenance program was coordinated within a health-care network including self-help associations, and offered weekly activities. We measured the 6-min walk distance (6MWD), the quality of life using the St George Respiratory Questionnaire (SGRQ), the dyspnea, the maximal workload and the health-care utilization. Data were collected at respiratory clinic admission and discharge, and at 6- and 12-month visits after the PR. After 12 months, we found statistically and clinically significant differences in favor of the MG in 6MWD (74m; p <= 0.01) and in the three domains of SGRQ: symptom (19%; p <= 0.01), activity (27%; p <= 0.01) and impact (32%; p <= 0.01). The results showed no difference between groups in dyspnea and maximal workload. We also found that the number of days spent in hospital for respiratory disorders was significantly tower in the MG after 12 months (p <= 0.03). The multidisciplinary management of COPD patients in the post-rehabilitation period within a health-care network including self-help associations seems to be an effective strategy for maintaining, and even improving, the benefits of a first initial structured program. (C) 2007 Elsevier Ltd. All rights reserved.
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