Chest
Clinical InvestigationsThe Effectiveness of Different Combinations of Pulmonary Rehabilitation Program Components: A Randomized Controlled Trial
Section snippets
Materials and Methods
The research design consisted of one between-subjects factor (treatment group) and one within-subjects factor (time). The treatment group had three levels: exercise training alone (ETA) [standard, usual care], exercise training plus activity training (ETAT), and exercise training plus a lecture series (ETLS). Patients were randomized to one of the three treatment groups. Five quality-of-life and functional status data points were collected for each participant: baseline (preintervention), and
Results
The recruitment period of the study was from January 2001 to March 2002. Sixty-four percent (n = 43) of invited patients were recruited for the study (Fig 2). This sample size was chosen based on the number of participants that could feasibly be recruited within a 15-month period.A prioripower analysis was difficult because of limited literature available to estimate means and SDs, size of interaction, and main treatment group effects, and covariance effects of different treatment combinations.
Functional Status
Age was found to have a linear effect and to predict ETAT treatment effectiveness for functional status. Participants of older age in the ETAT group experienced the greatest improvements in functional status as compared to the other two groups at 12 weeks. The ETAT treatment appeared to have no greater effect on functional status for participants of comparatively young age.
The finding that age predicts functional status treatment effectiveness is consistent with the theoretical information of
Conclusion
A strength of this study was the inclusion of two experimental treatment groups that allowed for comparison of treatment combination effects, including teaching methods and content, and increased control of the placebo effect of attention.42 An important focus was on the effect of dyspnea management strategies directed toward daily activity performance in contrast to most other pulmonary outcome studies that have primarily investigated the effect of dyspnea management on exercise performance.
It
Acknowledgments
The authors thank Dr. Deborah Labovitz (New York University, Department of Occupational Therapy) for research guidance, Dr. Jeremy Weedon (SUNY, Downstate Medical Center, Scientific Computing Center) for data analysis; the New York State Occupational Therapy Association for a research committee grant; and Nellcor Mallinckrodt Inc. for the loan of pulse oximeters.
References (42)
- et al.
The components of a respiratory rehabilitation program: a systematic overview
Chest
(1997) - et al.
Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M)
Heart Lung
(1998) - et al.
The COPD self-efficacy scale
Chest
(1991) - et al.
Treatment of dyspnea in COPD: a controlled clinical trial of dyspnea management strategies
Chest
(1995) - et al.
Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial
Lancet
(2000) - et al.
A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD: a follow-up of 18 months
Chest
(1996) - et al.
Long-term effects of outpatient rehabilitation of COPD: a randomized trial
Chest
(2000) - et al.
Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease
Lancet
(1996) - et al.
Rehabilitation of patients with chronic obstructive pulmonary disease: exercise twice a week is not sufficient
Respir Med
(2000) - et al.
Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease
Patient Educ Couns
(1996)
American Thoracic Society Pulmonary rehabilitation
Am J Respir Crit Care Med
Pulmonary rehabilitation: improves quality of life in chronic lung disease, but evaluation must continue
BMJ
Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency
Eur Respir J
ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines
J Cardiopulm Rehabil
Learning and patient satisfaction outcomes of two methods for providing instruction in pulmonary rehabilitation
J Rehabil Outcomes Meas
The CES-D scale: a new self-report depression scale for research in the general population
Appl Psychol Meas
Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients
Psychol Med
A measure of quality of life for clinical trials in chronic lung disease
Thorax
Twelve-minute walking test for assessing disability in chronic bronchitis
BMJ
Functional status in pulmonary rehabilitation participants
J Cardiopulm Rehabil
Forcing a sequential experiment to be balanced
Biometrika
Cited by (67)
Pulmonary Rehabilitation for COPD
2021, Encyclopedia of Respiratory Medicine, Second EditionThe added value of therapist communication on the effect of physical therapy treatment in older adults; a systematic review and meta-analysis
2019, Patient Education and CounselingCitation Excerpt :It might be argued that the primary factor could be therapist time and not the specific behavior technique. There were four studies identified in which a therapist spent equal time with the intervention and control group [27,39,43,46]. Merging evidence of these four studies showed comparable results.
Effects of short pulmonary rehabilitation in patients with COPD
2015, FisioterapiaOccupational Therapy for Improving Occupational Performance in COPD Patients: A Scoping Review
2023, Canadian Journal of Occupational TherapyOccupational therapy in adults with chronic respiratory conditions: A scoping review
2023, Australian Occupational Therapy Journal
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)