[Patient education in COPD during inpatient rehabilitation improves quality of life and morbidity].
BACKGROUND
Pulmonary rehabilitation is recommended for the treatment of COPD in international guidelines. However, patient education as an important part of pulmonary rehabilitation has not been addressed sufficiently to show its benefit. The aim of this study was to find out whether education improves the effectiveness of rehabilitation with regard to quality of life (QoL) and morbidity in the year following rehabilitation.


METHODS
COPD patients of multidisciplinary pulmonary inpatient rehabilitation programme participated in this prospective, randomised and controlled trial. To the education group we offered a programme of patient education (4 x 1.5 hours) and an individual action plan on how to cope with exacerbations. Pulmonary function tests and QoL as measured by the Saint George Respiratory Questionnaire (SGRQ) were tested at baseline and at follow-up after 1 year.


RESULTS
90 patients were randomly assigned to the multidisciplinary rehabilitation programme with the usual care (control group, CG) and 94 patients received additional patient education (education group, EG). In both groups the total number of hospital admissions was diminished after 1 year (CG: 24.7% to 11.5%, p = 0.02; EG: 30.8% to 9.9%, p = 0,001). Only the EG needed less intensive care (11.8 days to 2.2, p = 0.02), received less home emergency medical service (18.3 to 5.5%, p = 0.01) and had less emergency hospital admissions (19.6% to 8.7%, p = 0.03). One year after rehabilitation, patients of the EG had a higher chance of improved quality of life (OR = 2.5; CI 1.07-5.84), and they could maintain a longer duration of weekly exercise training (more than 1 hour/week: EG n = 58, CG n = 34, p < 0.01).


CONCLUSIONS
Patient education for COPD has been shown to improve the effectiveness of an inpatient rehabilitation programme regarding quality of life. It also reduces morbidity and supports a change of lifestyle. Therefore, education should be an essential component of rehabilitation in COPD.
Wittmann
M
M
Klinik Bad Reichenhall, Zentrum für Rehabilitation Pneumologie und Orthopädie der Deutschen Rentenversicherung Bayern Süd. michael.wittmann@klinik-bad-reichenhall.de
Spohn
S
S
Schultz
K
K
Pfeifer
M
M
Petro
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D004521:Educational Measurement; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome