title: Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade.
abstract: BACKGROUND
  It is not clear whether the benefits of pulmonary rehabilitation (PR) apply equally to patients with Chronic Obstructive Pulmonary Disease (COPD) with different levels of starting disability. We have therefore investigated the effect of pulmonary rehabilitation stratified by the MRC dyspnoea scale in patients with COPD.
  
  
  METHODS
  This is a retrospective, observational study of data collected from 450 consecutive patients with COPD attending outpatient PR: 247 male, mean (SD) age 69.5 (8.9) yrs and FEV(1) 44.6 (19.7)% predicted. The Incremental Shuttle Walk Test (ISWT) was performed before and after the seven-week course
  
  
  RESULTS
  395 patients (88%) completed the programme. The mean (SD) baseline ISWT performance was 167 (113)m. The distribution of baseline MRC grades was 2 - 15.4%, 3 - 24.9%, 4 - 27.3% and 5 - 32.4%. The mean (95% CI) improvement in ISWT after PR for each MRC scale grade was highly significant (p<0.0005); 2 - 66 (50-83)m, 3 - 63 (50-75)m, 4 - 59 (49-70)m, and 5 - 54 (43-64)m.
  
  
  CONCLUSIONS
  Patients with COPD, of all MRC dyspnoea grades, benefit comparably from pulmonary rehabilitation achieving both statistically and clinically meaningful improvements in exercise performance. MRC grade should therefore not be used to exclude patients from pulmonary rehabilitation.
authors.affiliation: Dept of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester, Glenfield Hospital, Leicester LE3 9QP, United Kingdom. rachael.evans@uhl-tr.nhs.uk
authors.forename: R A
authors.initials: RA
authors.lastname: Evans
authors.forename: S J
authors.initials: SJ
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: Collier
authors.forename: J E
authors.initials: JE
authors.lastname: Williams
authors.forename: M D L
authors.initials: MD
authors.lastname: Morgan
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome