Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home.

University of Groningen, Groningen, Groningen, Netherlands
European Respiratory Journal (Impact Factor: 7.13). 03/1994; 7(2):269-73. DOI: 10.1183/09031936.94.07020269
Source: PubMed

ABSTRACT We have developed a rehabilitation programme at home and have investigated its effects on quality of life (QOL), lung function, and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). We studied 43 patients with severe airflow obstruction: forced expiratory volume in one second (FEV1) 1.3 +/- 0.4 l (mean +/- SD), FEV1/inspiratory vital capacity (IVC) 37 +/- 7.9%. After stratification, 28 patients were randomly allocated in a home rehabilitation programme for 12 weeks. Fifteen patients in a control group received no rehabilitation. The rehabilitation group received physiotherapy by the local physiotherapist, and supervision by a nurse and a general practitioner. Quality of life was assessed by the four dimensions of the Chronic Respiratory Questionnaire (CRQ). We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea, emotion, and mastery. Lung function showed no changes in the rehabilitation group. The exercise tolerance improved significantly in the rehabilitation group compared to the control group. The improvement in quality of life was not correlated with the improvement in exercise tolerance. Rehabilitation of COPD patients at home may improve quality of life; this improvement is not correlated with an improvement in lung function and exercise tolerance.

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Available from: Peter J Wijkstra, Aug 01, 2015
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    • "Figure 6 Change in 6-minute walking distance after ~1-month, 8-week, and 12-week interventions. (PEmax) (Akinci & Olgun, 2011; Fernandez et al., 2009; Ghanem et al., 2010; Hernandez et al., 2000; Koppers et al., 2006; Larson et al., 1999; du Moulin et al., 2009; Oh, 2003; Singh et al., 2003; Wijkstra et al., 1994, 1996; Xie et al., 2003). One of the trials reported a significant difference in PaCO 2 from baseline for the intervention group (Akinci & Olgun, 2011). "
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    ABSTRACT: PURPOSE: The pulmonary rehabilitation program has become a cornerstone in the management of patients with chronic obstructive pulmonary disease (COPD). Programs based in hospital and treatment facilities, however, are inconvenient and underutilized. A home-based program is a promising alternative, but studies of its effectiveness have yielded inconsistent results. The purpose of this study is to evaluate the impact of home-based pulmonary rehabilitation programs on health-related quality of life (HRQoL) and other health outcomes in patients with COPD. METHODS: Randomized controlled trials (RCTs) of home-based pulmonary rehabilitation programs published between February 1991 and February 2012 were retrieved from electronic databases (PubMed, Cochrane Library, Science Direct, China National Knowledge Infrastructure [CNKI], and Wanfang Database). Two reviewers independently assessed topical relevance and trial quality, extracted data for meta-analysis using the Review Manager v5.1 software, and contacted the original studies' authors for additional information. FINDINGS: Eighteen trials, comprising 733 randomized patients, were included in the meta-analysis. COPD patients experienced significant relief in dyspnea status, measured by the Borg score (Fixed effects model, WMD = -0.92, 95% CI: -1.61~-0.23, p = .009) and baseline dyspnea index (BDI) (Fixed effects model, WMD = -1.77, 95% CI: -2.65~-0.89, p < .0001) after 12 weeks of home-based intervention. Home-based intervention also improved patients' HRQoL scores, measured by the Chronic Respiratory Questionnaire (CRQ) and St. George's Respiratory Questionnaire (SGRQ) (Fixed effects model, WMD = -11.33, 95% CI: -16.37~-6.29, p < .0001, SGRQ total scores after 12 weeks of intervention); exercise capacity (measured by the 6-minute walking distance test (6MWD) (Fixed effects model, WMD = 35.88, 95% CI: 9.38~62.38, p = .008, after 12 weeks of intervention); and pulmonary functions (measured by forced expiratory volume in one-second/forced vital capacity (FEV1 /FVC) [Random effects model, WMD = -10.72, 95% CI: -15.86~-5.58, p < .0001, after 12 weeks of intervention), as compared with the nonintervention control group; however, no statistically significant changes were seen in maximal workload, hospital admission, cost of care, or mortality between the two groups. CONCLUSIONS AND CLINICAL RELEVANCE: Home-based pulmonary rehabilitation programs represent effective therapeutic intervention approaches for relieving COPD-associated respiratory symptoms and improving HRQoL and exercise capacity. Rigorously designed, large-scale RCTs are still needed to identify an optimal standard home-based pulmonary rehabilitation program.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 01/2014; 39(1). DOI:10.1002/rnj.112 · 0.85 Impact Factor
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    • "It is therefore of great importance that therapy for COPD should treat the multicomponent nature of the disease (Agusti 2005). Pulmonary rehabilitation programmes for COPD patients improve the physical performance and the quality of life and are nowadays a cornerstone in the treatment of patients with COPD (Wijkstra et al 1994; Donner and Muir 1997). "
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    ABSTRACT: Patients with chronic obstructive pulmonary disease (COPD) have low exercise capacity and low content of high energetic phosphates in their skeletal muscles. The aim of the present study was to investigate whether creatine supplementation together with exercise training may increase physical performance compared with exercise training in patients with COPD. In a randomized, double-blind, placebo-controlled study, 23 patients with COPD (forced expiratory volume in one second [FEV1] < 70% of predicted) were randomized to oral creatine (n = 13) or placebo (n = 10) supplementation during an 8-week rehabilitation programme including exercise training. Physical performance was assessed by Endurance Shuttle Walking Test (ESWT), dyspnea and leg fatigue with Borg CR- 10, quality of life with St George's Respiratory Questionnaire (SGRQ). In addition, lung function test, artery blood gases, grip strength test, muscle strength and fatigue in knee extensors were measured. COPD patients receiving creatine supplementation increased their average walking time by 61% (ESWT) (p < 0.05) after the training period compared with 48% (p = 0.07) in the placebo group. Rated dyspnea directly after the ESWT decreased significantly from 7 to 5 (p < 0.05) in the creatine group. However, the difference between the groups was not statistically significant neither in walking time nor in rated dyspnea. Creatine supplementation did not increase the health related quality of life, lung function, artery blood gases, grip strength and knee extensor strength/fatigue. Oral creatine supplementation in combination with exercise training showed no significant improvement in physical performance, measured as ESWT, in patients with COPD compared with exercise training alone.
    International Journal of COPD 02/2006; 1(4):445-53. DOI:10.2147/copd.2006.1.4.445 · 2.73 Impact Factor
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    • "FUNGSI PARU-PARU Hasil kajian mendapati pesakit COPD yang menjalani program rehabilitasi pulmonari di hospital dan di rumah tidak menunjukkan peningkatan fungsi paruparu yang bererti walaupun setelah menjalani intervensi selama lapan minggu. Ini menyerupai kajian Wijkstra et al. (1994) yang tidak menunjukan peningkatan dalam fungsi paru-paru bagi kumpulan program rehabilitasi yang dijalankan di rumah selama 12 minggu. Malah kumpulan kawalan yang langsung tidak menerima rehabilitasi mengalami kemerosotan yang bererti. "
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