Effects of pulmonary rehabilitation on dyspnea, quality of life, and healthcare costs in California.
OBJECTIVE
This study evaluated pulmonary rehabilitation as practiced in the general California medical community to determine its effectiveness in improving dyspnea and health-related quality of life and reducing the use of healthcare resources.


METHODS
For this study, 10 established pulmonary rehabilitation programs agreed to collect common clinical health outcome data on consecutive patients over 2 years. The following three self-administered questionnaires were obtained before and after rehabilitation, then at 3-, 6-, 12-, and 18-month follow-up assessments: Medical Outcomes Survey Short Form (SF-36), University of California, San Diego Shortness of Breath Questionnaire (SOBQ), and Health Care Utilization in the preceding 3 months. Information also was collected on patient demographics, diagnostic categories, use of supplemental oxygen, and available spirometry and 6-minute walk tests.


RESULTS
Nine centers enrolled 647 patients that met prespecified inclusion criteria. Of these, 521 completed the rehabilitation program and both the pre- and the postprogram assessment. At least two of the four follow-up assessments were completed by 415 patients in eight centers. The mean age of the patients was 68 years, and 42% were men. Overall, the forced expiratory volume in 1 second was 44% of the predicted value. There were few significant differences between the centers. The baseline outcome measures demonstrated marked symptoms, as evidenced by the mean SOBQ score (56.8) and the mean impaired quality of life results (SF-36 physical component score, 31.2; SF-36 mental component score, 47.5). These measures also showed high utilization of healthcare services over the preceding 3 months in terms of mean hospital stay (2.4 days), urgent care visits (0.4), physician visits (4.4), and telephone calls (2.7). After rehabilitation, there were significant improvements in symptoms and quality of life in all the centers, as evidence by mean changes of -6.8 for the SOBQ, 7.5 for the physical component score, and 3.9 for the mental component score). Over 18 months, benefits gradually declined, but levels remained above baseline values. There also were significant reductions in all measures of healthcare utilization.


CONCLUSIONS
Pulmonary rehabilitation was effective in improving symptoms and quality of life and reducing the utilization of healthcare resources over 18 months. The results were consistent across participating centers despite variations in practice settings, patient referral patterns, and program structure.
D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D004417:Dyspnea / Q000191:economics* / Q000503:physiopathology / Q000534:rehabilitation*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome