Sewell L, Singh SJ, Williams JE, Collier R, Morgan M

Thorax. Jan 31, 2006 [Epub ahead of print].

Glenfield Hospital, University Hospitals of Leicester NHS Trust, United Kingdom

Background:

The evidence of benefit for pulmonary rehabilitation (PR) programmes is established. However the optimal duration of a PR programme is not known. We completed a randomised controlled trial with patients with COPD to assess whether a four-week PR programme was equivalent to our conventional seven-week PR programme at equivalent time points of seven weeks and six months.

Methods:

100 patients (56 men) with stable COPD of mean (SD) age 70 (8) years, forced expiratory volume in one second (FEV1) 1.13 (0.50) litres were randomised to either a seven-week (n = 50) or four-week (n = 50) supervised PR programme. Patients were assessed at baseline, completion of the supervised PR programme and six months later. Patients randomised to the four-week group were also assessed at the seven-week time point. Outcome measures were: Incremental Shuttle Walking Test, Endurance Shuttle Walk Test (ESWT) Chronic Respiratory Questionnaire-Self Reported and the Breathing Problems Questionnaire.

Results:

41 patients in each group completed the PR programme. Patients in the four-week group attained higher ESWT times (mean difference (95% CI) 124 seconds (17.00 to 232.16), p = 0.024) at the seven-week time point. There were no other statistically significant between group differences for any other measure at the seven-week or six month time points. Patients in both groups made statistically significant improvements in all outcome measures at seven weeks.

Conclusions:

A shortened four-week supervised pulmonary rehabilitation programme is equivalent to a seven-week supervised pulmonary rehabilitation programme at the comparable time points of seven weeks and six months.

PMID: 16449270 [PubMed-as supplied by publisher]

Commentary:

The optimal duration of outpatient pulmonary rehabilitation remains controversial and is dictated often by several factors including, severity of patient functional limitation, ongoing identification of reasonable goals of rehabilitation, country and existing type of healthcare system, and PR programs available. In some countries, PR is limited by third party payors to the minimal number of sessions needed to achieve stated goals, whereas elsewhere, a more liberal total duration of rehabilitation is routine. In nearly every country, however, resources for PR remain limited, and it is usually difficult to provide comprehensive PR to the large number of patients who could benefit from it. Therefore, it is important to know how clinical outcomes of shorter (eg, 4 week) outpatient programs compare with those of conventional 7- to 12-week programs. In this article, the investigators have demonstrated nicely that patients who undergo 4 weeks of outpatient PR achieve comparable gains in exercise tolerance, dyspnea, and health status with those who undergo the 7-week program. Such shortened duration of programs has the potential to decrease PR costs for individual persons ^and to enable provision of PR services to a larger number of patients overall. It remains unclear whether the present results regarding program duration can be generalized to outpatient PR programs conducted in different countries with varying program structure and content.

CR