title: Effect of early pulmonary rehabilitation on health care utilization and health status in patients hospitalized with acute exacerbations of COPD.
abstract: OBJECTIVE
  Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) incur heavy utilization of health-care resources for patients who require hospitalization. We evaluated whether an early outpatient pulmonary rehabilitation programme (PRP) after hospitalization for AECOPD could reduce acute health-care utilization over the succeeding year.
  
  
  METHODS
  Sixty patients admitted with AECOPD were randomized to either PRP or usual care (UC). The PRP group received 8weeks of outpatient rehabilitation programme 2-3weeks after discharge from hospital. Lung function, 6min walk test and dyspnoea score were assessed at baseline, 3, 6, 9 and 12months, while St George's respiratory questionnaire and cardiopulmonary exercise test were assessed at baseline, 3, 6 and 12months.
  
  
  RESULTS
  The PRP and UC groups demonstrated a 53.3% and 43.3% risk of readmissions at 12months (incident risk ratio 0.97 (95% CI: 0.57-1.60), P=0.90). The mean readmission rates were 1.00±1.20 and 1.03±1.87 (P=0.47) for the PRP versus UC groups respectively. The rates of AECOPD and emergency department visits were similar between the two groups. The St George's respiratory questionnaire total score was lower in the PRP group (40.15±19.10 vs 46.91±18.21, P=0.01 and 42.3±20.06 vs 51.44±18.98 P=0.01 at 3 and 6months respectively). There were no statistically significant differences in the FEV(1) % predicted, dyspnoea score, 6min walk test and maximal oxygen consumption during exercise test between PRP and UC at different time points.
  
  
  CONCLUSIONS
  An early rehabilitation programme following AECOPD led to improvement in quality of life up to 6months, but did not reduce health-care utilization at 1year.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Fanny W S
authors.initials: FW
authors.lastname: Ko
authors.forename: David L K
authors.initials: DL
authors.lastname: Dai
authors.forename: Jenny
authors.initials: J
authors.lastname: Ngai
authors.forename: Alvin
authors.initials: A
authors.lastname: Tung
authors.forename: Susanna
authors.initials: S
authors.lastname: Ng
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lai
authors.forename: Ricky
authors.initials: R
authors.lastname: Fong
authors.forename: Herman
authors.initials: H
authors.lastname: Lau
authors.forename: Wilson
authors.initials: W
authors.lastname: Tam
authors.forename: David S C
authors.initials: DS
authors.lastname: Hui
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D018450:Disease Progression; D004417:Dyspnea / Q000534:rehabilitation; D005260:Female; D006304:Health Status; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires; D016896:Treatment Outcome