title: An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial.
abstract: OBJECTIVE
  To investigate whether an early rehabilitation intervention initiated during acute admission for exacerbations of chronic respiratory disease reduces the risk of readmission over 12 months and ameliorates the negative effects of the episode on physical performance and health status.
  
  
  METHODS
  Prospective, randomised controlled trial.
  
  
  METHODS
  An acute cardiorespiratory unit in a teaching hospital and an acute medical unit in an affiliated teaching district general hospital, United Kingdom.
  
  
  METHODS
  389 patients aged between 45 and 93 who within 48 hours of admission to hospital with an exacerbation of chronic respiratory disease were randomised to an early rehabilitation intervention (n=196) or to usual care (n=193).
  
  
  METHODS
  The primary outcome was readmission rate at 12 months. Secondary outcomes included number of hospital days, mortality, physical performance, and health status. The primary analysis was by intention to treat, with prespecified per protocol analysis as a secondary outcome.
  
  
  METHODS
  Participants in the early rehabilitation group received a six week intervention, started within 48 hours of admission. The intervention comprised prescribed, progressive aerobic, resistance, and neuromuscular electrical stimulation training. Patients also received a self management and education package.
  
  
  RESULTS
  Of the 389 participants, 320 (82%) had a primary diagnosis of chronic obstructive pulmonary disease. 233 (60%) were readmitted at least once in the following year (62% in the intervention group and 58% in the control group). No significant difference between groups was found (hazard ratio 1.1, 95% confidence interval 0.86 to 1.43, P=0.4). An increase in mortality was seen in the intervention group at one year (odds ratio 1.74, 95% confidence interval 1.05 to 2.88, P=0.03). Significant recovery in physical performance and health status was seen after discharge in both groups, with no significant difference between groups at one year.
  
  
  CONCLUSIONS
  Early rehabilitation during hospital admission for chronic respiratory disease did not reduce the risk of subsequent readmission or enhance recovery of physical function following the event over 12 months. Mortality at 12 months was higher in the intervention group. The results suggest that beyond current standard physiotherapy practice, progressive exercise rehabilitation should not be started during the early stages of the acute illness.Trial registration Current Controlled Trials ISRCTN05557928.
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK njg27@le.ac.uk.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Greening
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK.
authors.forename: Johanna E A
authors.initials: JE
authors.lastname: Williams
authors.affiliation: Kettering General Hospital NHS Foundation Trust, Kettering, UK.
authors.forename: Syed F
authors.initials: SF
authors.lastname: Hussain
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK.
authors.forename: Theresa C
authors.initials: TC
authors.lastname: Harvey-Dunstan
authors.affiliation: Department of Primary Care and Health Sciences, Keele University, Keele, UK.
authors.forename: M John
authors.initials: MJ
authors.lastname: Bankart
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Chaplin
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK.
authors.forename: Emma E
authors.initials: EE
authors.lastname: Vincent
authors.affiliation: Kettering General Hospital NHS Foundation Trust, Kettering, UK.
authors.forename: Rudo
authors.initials: R
authors.lastname: Chimera
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK.
authors.forename: Mike D
authors.initials: MD
authors.lastname: Morgan
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Singh
authors.affiliation: Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester, Leicester LE3 9QP UK School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Steiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000401:mortality / Q000534:rehabilitation*; D001987:Bronchiectasis / Q000401:mortality / Q000534:rehabilitation*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D017563:Lung Diseases, Interstitial / Q000401:mortality / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000534:rehabilitation*; D020127:Recovery of Function; D012648:Self Care; D016037:Single-Blind Method; D016896:Treatment Outcome