Pulmonary rehabilitation: analysis of a clinical service.
OBJECTIVE
There is significant research supporting the role of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD). However, less is known about real-life clinical rehabilitation services. Data were analysed from a clinical pulmonary rehabilitation service provided in the UK, consisting of seven weeks' twice-weekly training and education.


METHODS
A retrospective study. Baseline measures consisted of activity of daily living, mood state, spirometry, exercise tolerance using the Incremental Shuttle Walk Test (ISWT) and health status using the St George's Hospital Respiratory Questionnaire (SGRQ). Responders to pulmonary rehabilitation were defined as those with a mean reduction of four points on the SGRQ and a mean increase of 48 metres on the ISWT.


RESULTS
One hundred and eight patients entered the programme and 91 completed it. All outcomes showed statistically and clinically significant change after the rehabilitation programme. Responder analysis showed that 37% of patients achieved benefits for both the SGRQ and the ISWT. Twenty-eight per cent of patients were non-responders for both; 17% benefited for the SGRO only and 14% improved their exercise tolerance. Patients with restrictive disease (n = 11) showed large mean ISWT score of 98.2 m (Standard deviation (SD) 69.4 m) (p < 0.01), as did patients with moderate COPD (n = 30), who scored a mean ISWT change of 77.3 m (SD 92.0 m) (p < 0.01) and a SGRQ score of -7.6 (SD 13.7) (p < 0.01), and those with mild COPD (n = 12), who scored a mean ISWT change of 62.5 m (SD 87.4 m) (p < 0.01) and a mean SGRQ change of -3. 7 (SD 8.1) (p < 0.01). Patients with severe COPD (n = 23) showed a smaller mean change in ISWT of 32.6 m (SD 79.4 m) and in SGRQ of -2.8 (SD 7.1). However, analysis of variance (ANOVA) showed no statistical differences between the groups (p = 0.13).


CONCLUSIONS
Clinical pulmonary rehabilitation programmes are effective for most patients. However for patients with more severe impairment, maximal gains may be harder, or take longer, to achieve. Patients with restrictive disease appear to do well, although future trials will be needed to test this supposition.
Garrod
Rachel
R
School of Physiotherapy, Kingston University, London, UK. rgarrod@hscs.sghms.ac.uk
Ford
Katie
K
Daly
Cecilia
C
Hoareau
Clare
C
Howard
Michael
M
Simmonds
Claire
C
D000368:Aged; D000369:Aged, 80 and over; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013222:State Medicine; D006113:United Kingdom