A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease

Background-Pulmonary rehabilitation programmes have been shown to improve b oth exercise tolerance and health status in patients with chronic obstructi ve pulmonary disease (COPD). The optimal duration for a pulmonary rehabilit ation programme is, however, unknown. To assess whether the current pulmona ry rehabilitation programme could be shortened a randomised controlled tria l was conducted in 44 patients with COPD who were allocated to either a sev en week or a four week course. Methods-Patients were randomised to either our standard seven week twice we ekly outpatient based programme or a comparable but shortened four week cou rse. They were assessed at baseline and at completion by the Chronic Respir atory Questionnaire (CRQ), the Breathing Problems Questionnaire (BPQ), the incremental shuttle walking test (SWT), and the treadmill endurance test (T ET). Results-Twenty one patients (61% men) of mean (SD) age 68 (9.2) years and forced expiratory volume in one second ( FEV,) 1.08 (0.4)1 completed a conventional seven week course and 23 (67% men) of mean (SD) age 69 (8.8) y ears and FEV, 1.03 (0.3)1 completed a shortened four week course. Patients who completed the seven week rehabilitation programme had greater improveme nts in all outcome measures than those undertaking the four week course. Th ese differences reached clinical and statistical significance for the total CRQ score, which was the primary outcome variable (mean difference (95% co nfidence intervals (CI) of difference) -0.61(-0.15 to -1.08), p<0.05), and the CRQ domains of dyspnoea (-0.80 (95% CI -0.13 to -1.48), p<0.05), emotio n (-0.89 (95% CI -0.33 to -1.45), p<0.005), and mastery (-0.84 (95% CI -0.1 0 to -1.58), p<0.05). There were also trends towards greater improvements i n exercise assessments in the seven week group but the differences did not reach statistical significance (SWT: mean difference -16.9 (95% CI 24.8 to -58.6), p=0.41; TET: geometric mean difference -1.21 (95% CI -0.60 to -2.47 ), p=0.56). Conclusions-A seven week course of pulmonary rehabilitation provides greate r benefits to patients than a four week course in terms of improvements in health status. Larger prospective studies are required to determine the opt imal duration of a pulmonary rehabilitation programme. (Thorax 2001;56:143- 145).