Enhanced Pulmonary Rehabilitation Program May Reduce Physician Visits in COPD

In patients with chronic obstructive pulmonary disease (COPD), an enhanced pulmonary rehabilitation program that emphasizes chronic disease self-management may help to reduce physician visits, according to the results of a randomized parallel-group study published in the Annals of the American Thoracic Society.

Pulmonary rehabilitation is the most effective strategy to improve health outcomes in people with COPD. However, rehabilitation with a strong focus on disease self-management may be better for facilitating long-term behavior change. Researchers sought to compare a newly developed enhanced pulmonary rehabilitation with a traditional pulmonary rehabilitation program on outcome achievement in a randomized controlled trial (ClinicalTrials.gov Identifier: NCT02917915).

In this study, pulmonary rehabilitation classes were block randomized to enhanced pulmonary rehabilitation or traditional pulmonary rehabilitation, which were delivered over the course of 16 sessions. The enhanced pulmonary rehabilitation incorporated education modules which had a stronger focus on chronic disease self-management. Fidelity of the intervention for content and delivery was assessed, and data on physical activity, self-efficacy, exercise tolerance, and health-related quality of life (HRQoL) were collected before, after, and 6 months following pulmonary rehabilitation. Health care visits were collected 2 years before pulmonary rehabilitation and 1 year after, and mortality was recorded 1 year after pulmonary rehabilitation.

Of the 207 patients with COPD enrolled, 108 received enhanced pulmonary rehabilitation and 99 traditional pulmonary rehabilitation. Physical activity and self-efficacy improved from before and after pulmonary rehabilitation in both programs, with no differences between groups, but these effects were not sustained at 6 months. Exercise tolerance and HRQoL improved from before to after pulmonary rehabilitation with no between-group differences, which were maintained at 6 months. Visits to primary care providers and respiratory specialists decreased among individuals in the enhanced pulmonary rehabilitation program relative to traditional pulmonary rehabilitation.

The authors concluded, “The [enhanced pulmonary rehabilitation] program compared to traditional [pulmonary rehabilitation] did not result in a superior improvement of physical activity and health outcomes selected for this study but had an added benefit of reducing physician visits.”

Disclosure: This research was supported by AstraZeneca Canada, Covenant Hospital Foundation, and RESPIPLUS. Please see the original reference for a full list of disclosures.

Reference

Selzler A-M, Jourdain T, Wald J, et al. Evaluation of an enhanced pulmonary rehabilitation program: a randomised controlled trial. Ann Am Thorac Soc. Published online May 18, 2021. doi:10.1513/AnnalsATS.202009-1160OC