title: A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study.
abstract: OBJECTIVE
  To investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over three years among patients with Chronic Obstructive Pulmonary Disease.
  
  
  BACKGROUND
  Although Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established.
  
  
  METHODS
  A quasi-experimental design.
  
  
  METHODS
  Primary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after one year and three years. Exacerbation frequency was calculated from one year before to three years after the programme.
  
  
  RESULTS
  No significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after one year and three years. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p = 0·091) but increased again in both groups after three years.
  
  
  CONCLUSIONS
  There was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after one year. There is a need for support and coaching at regular follow-ups in primary health care.
  
  
  CONCLUSIONS
  There is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow-ups.
authors.affiliation: University Healthcare Research Centre, Faculty of Health and Medicine, Örebro University, Örebro, Sweden.|Centre for Assessment of Medical Technology, Örebro University, Örebro, Sweden.
authors.forename: Ann-Britt
authors.initials: AB
authors.lastname: Zakrisson
authors.affiliation: Clinical Epidemiology and Biostatistics, Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
authors.forename: Ayako
authors.initials: A
authors.lastname: Hiyoshi
authors.affiliation: Head of Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.|Department of Nursing, Karlstad University, Karlstad, Sweden.
authors.forename: Kersti
authors.initials: K
authors.lastname: Theander
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing* / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chronic Obstructive Pulmonary Disease; exacerbations; long-term effects; primary health care; pulmonary rehabilitation; quality of life