title: The effectiveness of a structured education pulmonary rehabilitation programme for improving the health status of people with moderate and severe chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of a structured education pulmonary rehabilitation programme on the health status of people with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Two-arm, cluster randomised controlled trial.
  
  
  METHODS
  32 general practices in the Republic of Ireland.
  
  
  METHODS
  350 participants with a diagnosis of moderate or severe COPD.
  
  
  METHODS
  Experimental group received a structured education pulmonary rehabilitation programme, delivered by the practice nurse and physiotherapist. Control group received usual care.
  
  
  METHODS
  Health status as measured by the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12-14 weeks postcompletion of the programme.
  
  
  RESULTS
  Participants allocated to the intervention group had statistically significant higher mean change total CRQ scores (adjusted mean difference (MD) 1.11, 95% CI 0.35 to 1.87). However, the CI does not exclude a smaller difference than the one that was prespecified as clinically important. Participants allocated to the intervention group also had statistically significant higher mean CRQ Dyspnoea scores after intervention (adjusted MD 0.49, 95% CI 0.20 to 0.78) and CRQ Physical scores (adjusted MD 0.37, 95% CI 0.14 to 0.60). However, CIs for both the CRQ Dyspnoea and CRQ Physical subscales do not exclude smaller differences as prespecified as clinically important. No other statistically significant differences between groups were seen.
  
  
  CONCLUSIONS
  A primary care based structured education pulmonary rehabilitation programme is feasible and may increase local accessibility to people with moderate and severe COPD.
  
  
  BACKGROUND
  ISRCTN52403063.
authors.affiliation: School of Nursing and Midwifery, National University of Ireland, , Galway, Ireland.
authors.forename: Dympna
authors.initials: D
authors.lastname: Casey
authors.forename: Kathy
authors.initials: K
authors.lastname: Murphy
authors.forename: Declan
authors.initials: D
authors.lastname: Devane
authors.forename: Adeline
authors.initials: A
authors.lastname: Cooney
authors.forename: Bernard
authors.initials: B
authors.lastname: McCarthy
authors.forename: Lorraine
authors.initials: L
authors.lastname: Mee
authors.forename: John
authors.initials: J
authors.lastname: Newell
authors.forename: Eamon
authors.initials: E
authors.lastname: O'Shea
authors.forename: Carl
authors.initials: C
authors.lastname: Scarrott
authors.forename: Paddy
authors.initials: P
authors.lastname: Gillespie
authors.forename: Collette
authors.initials: C
authors.lastname: Kirwan
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D007494:Ireland; D008297:Male; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Exercise; Pulmonary Rehabilitation