title: Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease.
abstract: BACKGROUND
  This is a study of an outpatient programme for rehabilitation of patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD). Its main purpose was to assess the feasibility of such a programme and so no control group was included.
  
  
  METHODS
  The study included 44 patients (28 men) of mean age 66 years with COPD. They all had severe ventilatory impairment as defined by a forced expiratory volume in 1 second (FEV1) less than 40% of predicted. Initial assessment included a shuttle walking test, the Chronic Respiratory Disease Questionnaire (CRDQ), the Hospital Anxiety and Depression scale (HAD) and the Sickness Impact Profile (SIP). The patients then entered a 6-week outpatient programme during which they attended twice weekly for a 2 1/2 hour session. Assessment was repeated on completion of the study (the 3 1/2 month assessment) and at 6 months.
  
  
  RESULTS
  The shuttle walking distance improved significantly and was maintained at the improved level for 6 months. The improvement in all four dimensions of the CRDQ was statistically significant and reached clinical significance for fatigue and for mastery. On entry, a notable level of depression was found in 32% of patients, and of anxiety in 40%. There was significant reduction in both of these which was maintained at 6 months. There was no improvement in the SIP at 3 months, but significant improvement was found at 6 months.
  
  
  CONCLUSIONS
  This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that apparent benefit in physical ability and in health-related quality of life can be achieved. The improvements were maintained at 6 months.
authors.affiliation: Respiratory Department, Frenchay Hospital, Bristol.
authors.forename: R J
authors.initials: RJ
authors.lastname: White
authors.forename: S T
authors.initials: ST
authors.lastname: Rudkin
authors.forename: J
authors.initials: J
authors.lastname: Ashley
authors.forename: V A
authors.initials: VA
authors.lastname: Stevens
authors.forename: S
authors.initials: S
authors.lastname: Burrows
authors.forename: J C
authors.initials: JC
authors.lastname: Pounsford
authors.forename: G
authors.initials: G
authors.lastname: Cratchley
authors.forename: N R
authors.initials: NR
authors.lastname: Ambler
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D015397:Program Evaluation; D011788:Quality of Life; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires