title: Comparable improvements achieved in chronic obstructive pulmonary disease through pulmonary rehabilitation with and without a structured educational intervention: a randomized controlled trial.
abstract: OBJECTIVE
  Pulmonary rehabilitation is beneficial for people with chronic obstructive pulmonary disease (COPD) and typically includes exercise and disease-specific education components. However, the benefits directly attributable to the education component remain unclear. This trial sought to determine whether the addition of education to exercise training resulted in greater improvements in health outcomes than pulmonary rehabilitation where education has been omitted.
  
  
  METHODS
  A randomized trial with allocation concealment, assessor blinded to group allocation and intention-to-treat analysis was conducted. Two hundred and sixty-seven people with COPD (mean age 72(9) years, forced expiratory volume in 1 s, 59(23)% predicted) were allocated to receive either 8 weeks of twice weekly group exercise training plus education or exercise training alone. Education was disease specific with a self-management focus. Primary outcome measures included 6-min walk distance and Chronic Respiratory Questionnaire. Secondary outcomes included dyspnoea, health behaviours, generic health-related quality of life, self-efficacy and healthcare usage with measurements taken immediately following completion and at 6 and 12 months.
  
  
  RESULTS
  There were no significant differences that indicated greater improvement in any health outcome with the addition of education. The two intervention groups had similar significant improvements immediately following intervention, and these were maintained comparably in the subsequent 12 months.
  
  
  CONCLUSIONS
  The results of this investigation suggest that disease-specific group education is not an essential component of pulmonary rehabilitation. Pulmonary rehabilitation based on exercise training is an effective option in the management of patients with COPD if multidisciplinary education cannot be offered.
authors.affiliation: Department of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Felicity C
authors.initials: FC
authors.lastname: Blackstock
authors.affiliation: Department of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Australia.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Webster
authors.affiliation: Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.|Institute for Breathing and Sleep, Heidelberg, Australia.
authors.forename: Christine F
authors.initials: CF
authors.lastname: McDonald
authors.affiliation: Department of Physiotherapy, Austin Health, Heidelberg, Australia.|Institute for Breathing and Sleep, Heidelberg, Australia.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Hill
mesh_terms: D000368:Aged; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D026741:Physical Therapy Modalities; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: chronic obstructive pulmonary disease; education; exercise; randomized controlled trial; rehabilitation