Effects of community-based pulmonary rehabilitation in 33 municipalities in Denmark - results from the KOALA project

Background: The positive impact of pulmonary rehabilitation (PR) in patients with COPD is well documented. However, little is known regarding the effect of this treatment in community-based settings. Since 2007, all Danish municipalities have been offering PR to patients with moderate to severe COPD, whereas patients with very severe disease or those suffering from many comorbidities were referred to outpatient hospital-based PR. Objective: To analyze the effect of a standardized PR program conducted in a community-based setting on exercise capacity and health-related quality of life (HRQoL). Methods: This is a real-life study including data from patients attending PR at one of the 33 healthcare centers in Denmark during the period 2011-2012. For the purpose of registration and for quality assurance, the KOALA database was established and this web-based registration instrument was offered free of charge to every municipality. Measures included sociodemo-graphic and health-related variables and outcomes were exercise capacity and HRQoL assessed by 6-minute walking distance (6MWD) and the 15D questionnaire, respectively, at the beginning (baseline) and after completion of PR. Relative improvements in 6MWD and 15D were analyzed with multivariable linear models in patients who attended >50% of the sessions. Results: A total of 581 patients completed the PR (72% of those included). We found statistically significant and clinically meaningful differences between baseline and end of rehabilitation values for both main outcomes with a mean change in 6MWD of 45 m, and the magnitude of improvement corresponds to other findings. Furthermore, relative improvements in 6MWD and 15D were correlated, as was the relative change in 15D and baseline Medical Research Council scores. Conclusion: Standardized, multidisciplinary PR conducted in a community-based setting showed good adherence to the program and produced effects on exercise capacity and HRQoL that were clinically meaningful and comparable in size to hospital-based PR.