title: Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.
abstract: OBJECTIVE
  In COPD, hospital admissions and readmissions account for the majority of health-care costs. The aim of this prospective randomized controlled study was to determine if early pulmonary rehabilitation, commenced as an inpatient and continued after discharge, reduced acute health-care utilization.
  
  
  METHODS
  Consecutive COPD patients (n = 397), admitted with an exacerbation, were screened: 228 satisfied the eligibility criteria, of whom 97 consented to randomization to rehabilitation or usual care. Both intention-to-treat and per-protocol analyses are reported with adherence being defined a priori as participation in at least 75% of rehabilitation sessions.
  
  
  RESULTS
  The participants were elderly with severe impairment of pulmonary function, poor health-related quality of life and high COPD-related morbidity. The rehabilitation group demonstrated a 23% (95% CI: 11-36%) risk of readmission at 3 months, with attendees having a 16% (95% CI: 0-32%) risk compared with 32% (95% CI: 19-45%) for usual care. These differences were not significant. There were a total of 79 COPD-related readmission days (1.7 per patient, 95% CI: 0.6-2.7, P = 0.19) in the rehabilitation group, compared with 25 (1.3 per patient, 95% CI: 0-3.1, P = 0.17) for the attendees and 209 (4.2 per patient, 95% CI: 1.7-6.7) for usual care. The BMI, airflow obstruction, dyspnoea and exercise capacity index showed a non-significant trend to greater improvement among attendees compared with those receiving usual care (5.5 (2.3) and 5.6 (2.7) at baseline, improving to 3.7 (1.9) and 4.5 (2.5), respectively, at 3 months). No adverse effects were identified.
  
  
  CONCLUSIONS
  Early inpatient-outpatient rehabilitation for COPD patients admitted with an exacerbation was feasible and safe, and was associated with a non-significant trend towards reduced acute health-care utilization.
authors.affiliation: Respiratory Services, Auckland City Hospital, Auckland, New Zealand. teaton@adhb.govt.nz
authors.forename: Tam
authors.initials: T
authors.lastname: Eaton
authors.forename: Pam
authors.initials: P
authors.lastname: Young
authors.forename: Wendy
authors.initials: W
authors.lastname: Fergusson
authors.forename: Lisa
authors.initials: L
authors.lastname: Moodie
authors.forename: Irene
authors.initials: I
authors.lastname: Zeng
authors.forename: Fiona
authors.initials: F
authors.lastname: O'Kane
authors.forename: Nichola
authors.initials: N
authors.lastname: Good
authors.forename: Leanne
authors.initials: L
authors.lastname: Rhodes
authors.forename: Phillippa
authors.initials: P
authors.lastname: Poole
authors.forename: John
authors.initials: J
authors.lastname: Kolbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000534:rehabilitation*; D011788:Quality of Life