Long-term outcome of pulmonary rehabilitation in patients with COPD

Background: This study investigates the long-term benefits of pulmonary rehabilitation in terms of health-related quality of life (HRQL). Such information is of particular importance in developing strategies for aftercare at home which aim to maintain the initial improvements seen 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 Respiratory Questionnaire, and the component ''well-being'' from the Medical Psychological Questionnaire for Lung Diseases. Patient characteristics included lung function parameters such as FEV1, the diffusion capacity for carbon monoxide and maximal inspiratory mouth pressure, age, socioeconomic variables, and exercise tolerance evaluated by a 12-min walking test. To define patients in whom long-term benefits were sustained 9 months postdischarge, cases were clustered using hierarchical cluster analysis, based on the HRQL scores at discharge. Results: Complete data sets were obtained from 77 patients. Two groups of cases were clustered. Patient characteristics were essentially the same in both groups. HRQL differed significantly between groups on admission, at discharge, and at follow-up. Within-group analysis revealed that patients in group 1 (n=44) had. ''moderate'' scores on HRQL on admission, a significant improvement between admission and discharge, followed by a significant deterioration of HRQL at follow-up. Group 2 (n=33) had ''severely'' impaired HRQL on admission, little improvement after rehabilitation, and remained in fairly stable condition 9 months postdischarge. Conclusions: Results suggest that patients with COPD require a differentiated aftercare program of postdischarge pulmonary rehabilitation.