Chest
Volume 120, Issue 5, November 2001, Pages 1500-1505
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Clinical Investigations
COPD
In-Hospital Short-term Training Program for Patients With Chronic Airway Obstruction

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Objective

To compare the functional benefits and relative costs of administering an intense short-term inpatient vs a longer outpatient pulmonary rehabilitation program (PRP) for patients with chronic airway obstruction (CAO).

Design

Retrospective case-control study.

Setting

Pulmonary ward and outpatient clinic of a rehabilitation center.

Patients

Forty-three patients (case subjects) selected on the basis of selection criteria were compared with control subjects matched to them for age, sex, FEV1, and diagnosis of either COPD or asthma. Case subjects performed 10 to 12 daily sessions (5 sessions a week) of inpatient PRP; control subjects performed 20 to 24 sessions (3 sessions a week) of outpatient PRP.

Measurements

At baseline and after the PRP, an incremental exercise test was performed, including evaluation of dyspnea and leg fatigue by Borg scale (D and F, respectively) at each workload step. The cost of PRP was also evaluated.

Results

Both PRPs resulted in similar significant improvements in cycloergometry peak workload (from 68 ± 18 to 82 ± 22 and from 75 ± 17 to 87 ± 27 W in case subjects and control subjects, respectively), isoload D (from 6.4 ± 1.6 to 4.2 ± 1.8 for case subjects and from 8.5 ± 1.9 to 6.3 ± 2.4 for control subjects) and isoload F (from 6.6 ± 1.8 to 4.2 ± 1.8 for case subjects and from 8.9 ± 1.9 to 7.0 ± 1.8 for control subjects). Although the single daily session was less expensive, the outpatient PRP total costs were greater because of the higher number of sessions and the cost of daily transportation.

Conclusions

In patients with CAO, a shorter inpatient PRP may result in improvement in exercise tolerance similar to a longer outpatient PRP but with lower costs. Whether a shorter outpatient PRP may get physiologic and clinical benefits, while further reducing costs, must be evaluated by future controlled, randomized, prospective studies.

Section snippets

Materials and Methods

Patients gave their informed consent to the study, which was approved by the Ethical Committee of Salvatore Maugeri Foundation

Results

Of 395 CAO patients admitted to the hospital and 96 patients admitted to the day-hospital–based outpatient PRP between July 1, 1998 and June 30, 1999, 43 pairs of patients met the inclusion criteria of matching and were therefore included in our study.

Discussion

This retrospective case-control study has demonstrated that in CAO patients, an inpatient PRP, delivered during a shorter time interval, can provide the same improvement in exercise tolerance and reduction in dyspnea as a longer outpatient PRP while reducing the health-care costs of providing the program.

The role of PRP in improving the health status of these patients has been widely recognized, and guidelines for rehabilitation have been published.919 Our study confirms the positive effects of

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  • Cited by (0)

    Received December 12, 2000; revision accepted May 15, 2001.

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