LONG-TERM OUTCOME OF PULMONARY REHABILITATION IN PATIENTS WITH COPD

Background: This study investigates the long-term benefits of pulmonar y rehabilitation in terms of health-related quality of life (HRQL). Su ch information is of particular importance in developing strategies fo r aftercare at home which aim to maintain the initial improvements see n after rehabilitation. Methods: Criteria for inclusion were diagnosis of COPD, age 40 to 80 years, and completion of an inpatient pulmonary rehabilitation program. HRQL was assessed by the St. George Respirato ry Questionnaire, and the component ''well-being'' from the Medical Ps ychological Questionnaire for Lung Diseases. Patient characteristics i ncluded lung function parameters such as FEV1, the diffusion capacity for carbon monoxide and maximal inspiratory mouth pressure, age, socio economic variables, and exercise tolerance evaluated by a 12-min walki ng test. To define patients in whom long-term benefits were sustained 9 months postdischarge, cases were clustered using hierarchical cluste r analysis, based on the HRQL scores at discharge. Results: Complete d ata sets were obtained from 77 patients. Two groups of cases were clus tered. Patient characteristics were essentially the same in both group s. HRQL differed significantly between groups on admission, at dischar ge, and at follow-up. Within-group analysis revealed that patients in group 1 (n=44) had. ''moderate'' scores on HRQL on admission, a signif icant improvement between admission and discharge, followed by a signi ficant deterioration of HRQL at follow-up. Group 2 (n=33) had ''severe ly'' impaired HRQL on admission, little improvement after rehabilitati on, and remained in fairly stable condition 9 months postdischarge. Co nclusions: Results suggest that patients with COPD require a different iated aftercare program of postdischarge pulmonary rehabilitation.