Chest
Volume 128, Issue 2, August 2005, Pages 673-683
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Clinical Investigations
The Effects of Short-term and Long-term Pulmonary Rehabilitation on Functional Capacity, Perceived Dyspnea, and Quality of Life

https://doi.org/10.1378/chest.128.2.673Get rights and content

Study objectives

The purposes of this study were as follows: (1) to determine whether physical performance, quality of life, and dyspnea with activities of daily living improved following both short-term and long-term pulmonary rehabilitation (PR) across multiple hospital outpatient programs; (2) to examine the differences in these parameters between men and women; and (3) to determine what relationships existed between the psychosocial parameters and the results of the 6-min walk (6MW) test performance across programs

Design

Nonexperimental, prospective, and comparative

Setting

Seven outpatient hospital PR programs from urban and rural settings across North Carolina

Participants

Three hundred nine women and 281 men who were 20 to 93 years of age (mean [± SD] age, 66.7 ± 11.1 years) with chronic lung disease

Interventions

All 6MW tests and health surveys were administered prior to and immediately following 12 and 24 weeks of supervised PR participation. Scores from the 6MW tests, the Ferrans and Powers quality of life index-pulmonary version III (QLI), the Medical Outcomes Study 36-item short form (SF-36), and the University of California at San Diego shortness of breath questionnaire (SOBQ) were compared at PR entry, at 12 weeks, and at 24 weeks for differences by gender with repeated-measures analysis of variance. The study entry and follow-up SF-36 physical and mental component summary scores, the QLI health/function and overall scores, and the SOBQ scores were also compared to the 6MW test scores with Pearson correlation coefficient analysis

Results

The mean summary scores on the SF-36 and the QLI increased after 12 weeks of PR (p < 0.05), and improvements were maintained by 24 weeks of PR participation (p < 0.05). Scores on the SOBQ improved after 12 weeks (p < 0.001) among the short-term participants, but not until after 24 weeks among the long-term participants (p = 0.009). The 6MW test performance improved after 12 weeks (p < 0.001) and again from 12 to 24 weeks (p = 0.002) in the long-term participants. No relevant correlational relationships were found between 6MW scores and the summary scores of the administered surveys (r= −0.43 to 0.36)

Conclusions

Physical performance, as measured by the 6MW test, continued to improve with up to 24 weeks of PR participation. Quality-of-life measures and the perception of dyspnea improved after 12 weeks of PR participation, with improvements maintained by 24 weeks of PR participation. It is recommended that PR patients participate in supervised PR for at least 24 weeks to gain and maintain optimal health benefits

Section snippets

Participants

The subjects for this investigation consisted of 309 women and 281 men aged 20 to 93 years (mean [± SD] age, 66.7 ± 11.1 years) from seven North Carolina PR programs. The greatest number of subjects in this study came from hospitals in the greater Charlotte and Greensboro metropolitan areas. All patients had some form of restrictive, obstructive, or mixed lung disease. A majority of patients had COPD (92%), consisting primarily of emphysema, asthma, chronic bronchitis, or combinations of the

6MW Test

The 6MW distance (in feet) increased in men and women across programs (p < 0.001) following 12 weeks of PR (Table 1). While men walked further than women on both the initial and 12-week follow-up tests (p < 0.05), there were no interaction effects (p = 0.304) between genders as both improved similarly. The effect sizes for men and women were 0.47 and 0.54, respectively, indicating moderate clinical improvements in 6MW test performance after 12 weeks (men, 15%; women, 18%)

In the patients who

Discussion

This multiple-site study was designed to evaluate functional status and health-related QOL relationships in patients with chronic lung disease following both short-term and long-term supervised PR intervention. While the participating PR programs may have differed in staff and structure, their assessment measures were standardized for uniform outcome data tracking. Analyzing data in this fashion from several hospital outpatient facilities may offer a better look at the “real-life” benefits of

Conclusions

The process of measuring outcomes, benchmarking results, and using this information to verify the importance of PR intervention will be critical for the success of PR programs in the 21st century.60, 61, 62 This study from the NCCRA adds to the growing body of literature showing successful health outcomes following both short-term and long-term supervised PR. Based on data from this study and previous investigations,5, 6, 10, 50, 51, 52 it appears that supervised PR of up to at least 24 weeks

Acknowledgments

The authors thank the staff of the following North Carolina programs for taking the time and effort to measure, quantify, and submit data to the NCCRA Pulmonary Rehabilitation Registry for this ongoing investigation: Presbyterian Pulmonary Rehabilitation Program (Charlotte); Moses Cone Pulmonary Rehabilitation Program (Greensboro); Mercy South Pulmonary Rehabilitation Program (Pineville); Transylvania Community Hospital Pulmonary Rehabilitation Program (Brevard), Wake Forest/Baptist Hospital

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