title: Differential response to pulmonary rehabilitation in COPD: multidimensional profiling.
abstract: The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD.
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands martijnspruit@ciro-horn.nl.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Ingrid M L
authors.initials: IM
authors.lastname: Augustin
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Lowie E
authors.initials: LE
authors.lastname: Vanfleteren
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
authors.affiliation: Viscovery Software GmbH, Vienna, Austria.
authors.forename: Swetlana
authors.initials: S
authors.lastname: Gaffron
authors.affiliation: Dept of Respiratory Medicine, St. Laurentius Hospital, Roermond, The Netherlands.
authors.forename: Herman-Jan
authors.initials: HJ
authors.lastname: Pennings
authors.affiliation: Dept of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Smeenk
authors.affiliation: Dept of Respiratory Medicine, Elkerliek Hospital, Helmond, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Pieters
authors.affiliation: Dept of Respiratory Medicine, St. Jans Gasthuis, Weert, The Netherlands.
authors.forename: Jan J A M
authors.initials: JJ
authors.lastname: van den Bergh
authors.affiliation: Dept of Respiratory Medicine, St Anna Hospital, Geldrop, The Netherlands.
authors.forename: Arent-Jan
authors.initials: AJ
authors.lastname: Michels
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Miriam T J
authors.initials: MT
authors.lastname: Groenen
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Erica P A
authors.initials: EP
authors.lastname: Rutten
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), The Netherlands.
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Frits M E
authors.initials: FM
authors.lastname: Franssen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D004417:Dyspnea / Q000503:physiopathology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D012044:Regression Analysis; D012138:Respiratory Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome