Improved health-related quality of life after lung volume reduction surgery and pulmonary rehabilitation.
OBJECTIVE
It has been hypothesized that lung volume reduction surgery (LVRS) and pulmonary rehabilitation improve health-related quality of life (HRQOL). The purpose of this study was to test the hypothesis by examining the long-term functional consequences and general health status of patients with emphysema who have undergone LVRS and pulmonary rehabilitation.


METHODS
Forty-nine subjects with severe emphysema, aged 51 to 84 years old, post-LVRS and pulmonary rehabilitation participated in this study. Subjects reported changes in physical and mental domains on the Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36) over 3 time periods: prior to surgery, 6 months postsurgery, and 18 months postsurgery. The population as a whole was studied and both gender and age were analyzed as subsets. Subjects participated in an intensive 2-week (10 daily sessions) pulmonary rehabilitation program following LVRS.


RESULTS
Subjects showed significant improvements in both the physical and mental component summaries at Time 2 (3 months post-LVRS through 6 months post-LVRS) and Time 3 (12 months post-LVRS through 18 months post-LVRS) when compared to Time 1 (pre-LVRS). On the mental component summary scale, subjects younger than 65 years old had significant improvement compared to subjects 65 years and older at Time 3 (P < .05). Women significantly improved more than men at Time 3 on the physical component summary scale (P < .05).


CONCLUSIONS
Lung volume reduction surgery and 2 weeks (10 daily sessions) of intensive pulmonary rehabilitation appears to improve HRQOL in people with emphysema up to at least 18 months postsurgery. What these data further suggest is that even after declines in health, women can improve HRQOL later in life, and that greater focus should be given to the emotional needs of our older patients.
Beling
Janna
J
California State University, Northridge, Department of Physical Therapy, Northridge, CA.
N Engl J Med. 2003 May 22;348(21):2059-73
12759479
Ann Thorac Surg. 2006 Jan;81(1):314-20; discussion 320-1
16368389
Chest. 2004 Sep;126(3):781-9
15364757
Proc Am Thorac Soc. 2008 May 1;5(4):461-7
18453356
Chest. 2007 May;131(5 Suppl):4S-42S
17494825
Eur Respir J. 2004 Jun;23(6):932-46
15219010
Ann Thorac Surg. 2000 Sep;70(3):948-53; discussion 954
11016339
Respir Med. 2006 Oct;100(10):1843-9
16516455
Am J Respir Crit Care Med. 1999 Dec;160(6):2018-27
10588623
Med Care. 1992 Jun;30(6):473-83
1593914
Lancet. 1996 Oct 26;348(9035):1115-9
8888163
N Engl J Med. 2000 Jul 27;343(4):239-45
10911005
Chest. 2005 Oct;128(4):2653-63
16236939
J Cardiopulm Rehabil. 2000 Jan;20(1):24-36
10680095
Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 2):S1-40
10194189
J Clin Epidemiol. 1998 Sep;51(9):755-62
9731924
Ann Intern Med. 1980 Sep;93(3):391-8
6776858
Spine (Phila Pa 1976). 2000 Jun 15;25(12):1509-14
10851099
J Psychosom Res. 2005 Dec;59(6):429-43
16310027
Respir Med. 2006 Oct;100(10):1767-74
16531031
Chest. 1999 Dec;116(6):1750-61
10593802
JAMA. 1989 Aug 18;262(7):907-13
2754790
Chest. 2005 Apr;127(4):1166-77
15821191
Soc Sci Med. 2001 Sep;53(5):569-78
11478537
Eur Respir J Suppl. 2003 Jun;41:36s-45s
12795330
Med Care. 1993 Mar;31(3):247-63
8450681
Ann Intern Med. 2005 Feb 15;142(4):233-9
15710956
Natl Vital Stat Rep. 2008 Apr 24;56(10):1-120
18512336
Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
17507545
MMWR Surveill Summ. 2002 Aug 2;51(6):1-16
12198919
Lancet. 1981 Mar 28;1(8222):681-6
6110912
Respir Med. 2005 May;99(5):638-44
15823463
Respir Med. 1991 Sep;85 Suppl B:25-31; discussion 33-7
1759018
Chest. 2004 Jul;126(1):81-9
15249446
JAMA. 1994 Nov 16;272(19):1497-505
7966841
Am J Respir Crit Care Med. 2006 Jun 15;173(12):1326-34
16543549
Am J Respir Crit Care Med. 2006 Jun 15;173(12):1390-413
16760357
Chest. 2003 Apr;123(4):1026-37
12684290
Chest. 1995 Jun;107(6):1585-9
7781351
COPD. 2008 Apr;5(2):133-8
18415812
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003793
17054186
Chest. 1999 Feb;115(2):383-9
10027436
Am J Public Health. 2008 Nov;98(11):2085-91
18511734
J Clin Epidemiol. 1999 Mar;52(3):187-92
10210235
Chest. 1998 Mar;113(3):619-24
9515834
Eur Respir J. 2002 Jan;19(1):54-60
11843327
J Thorac Cardiovasc Surg. 1995 Jan;109(1):106-16; discussion 116-9
7815786
Health Qual Life Outcomes. 2005 Sep 09;3:56
16153294