Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial

Background Pulmonary rehabilitation seems to be an effective intervention i n patients with chronic obstructive pulmonary disease. We undertook a rando mised controlled trial to assess the effect of outpatient pulmonary rehabil itation on use of health care and patients' wellbeing over 1 year. Methods 200 patients with disabling chronic lung disease (the majority with chronic obstructive pulmonary disease) were randomly assigned a 6-week mul tidisciplinary rehabilitation programme (18 visits) or standard medical man agement. Use of health services was assessed from hospital and general-prac tice records. Analysis was by intention to treat. Findings There was no difference between the rehabilitation (n=99) and cont rol (n=101) groups in the number of patients admitted to hospital (40 vs 41 ) but the number of days these patients spent in hospital differed signific antly (mean 10.4 [SD 9.7] vs 21.0 [20.7], p=0.022). The rehabilitation grou p had more primary-care consultations at the general-practitioner's premise s than did the control group (8.6 [6.8] vs 7.3 [8.3], p=0.033) but fewer pr imary-care home visits (1.5 [2.8] vs 2.8 [4.6], p=0.037). Compared with con trol, the rehabilitation group also showed greater improvements in walking ability and in general and disease-specific health status. Interpretation For patients chronically disabled by obstructive pulmonary d isease, an intensive, multidisciplinary, outpatient programme of rehabilita tion is an effective intervention, in the short term and the long term, tha t decreases use of health services.