Predictors of success for pulmonary rehabilitation in patients awaiting lung transplantation.
BACKGROUND
Numerous studies have shown the effectiveness of comprehensive pulmonary rehabilitation (PR) programs in chronic obstructive pulmonary disease (COPD). At present, it is uncertain whether PR is also effective in the management of patients with various diseases awaiting lung transplantation (LTx).


METHODS
In a retrospective clinical preanalysis and postanalysis, we investigated the effects of a 5-week inpatient PR in LTx candidates. We compared data of patients with COPD, α-1-antitrypsin deficiency, interstitial lung disease, or cystic fibrosis before and after PR with regard to exercise capacity (6-min walking distance [6MWD]) and health-related quality of life (HRQL; SF36). Multivariate stepwise regression analysis was performed to detect predictors of PR outcome.


RESULTS
Eight hundred eleven data sets from consecutive patients referred to our PR center before LTx could be analysed (COPD, 360; α-1-antitrypsin deficiency, 127; interstitial lung disease, 195; cystic fibrosis, 69; other, 60). After PR 6MWD increased by 56 ± 58 m (P < 0.001), the physical summary component of SF36 (0-100) improved by 1.9 ± 8.5 points (P < 0.001), the mental summary component of SF36 by 8.7 ± 13.5 points (P < 0.001). Stepwise regression analysis yielded no relevant predictors of success or nonsuccess of PR with regard to age, sex, disease, body mass index, 6MWD, and HRQL on admission.


CONCLUSIONS
Short-term comprehensive PR can significantly improve exercise capacity and HRQL in LTx candidates to a clinically relevant extent independent of the underlying lung disease. No relevant predictor influencing PR outcome could be detected. Further research is needed to evaluate the relevance of PR before LTx and its impact on clinical outcome after transplantation.
1 Department of Respiratory Medicine, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, Schoenau, Germany. 2 Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Germany. 3 Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.
Klaus
K
Kenn
Rainer
R
Gloeckl
Andreas
A
Soennichsen
Bernd
B
Sczepanski
Sandra
S
Winterkamp
M
M
Boensch
Tobias
T
Welte
D000328:Adult; D000368:Aged; D003550:Cystic Fibrosis / Q000534:rehabilitation; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000534:rehabilitation*; D017563:Lung Diseases, Interstitial / Q000534:rehabilitation; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation; D011788:Quality of Life; D012189:Retrospective Studies; D019896:alpha 1-Antitrypsin Deficiency / Q000534:rehabilitation