Longevity of pulmonary rehabilitation benefit for chronic obstructive pulmonary disease-health care utilisation in the subsequent 2 years.

Background: The primary aim was to determine the healthcare utilisation benefits including respiratory-related hospital admissions, hospital admission days and emergency department presentations in the 0-12 and 12-24 months postpulmonary rehabilitation compared with the 12 months preprogramme. Methods: An observational, data-linkage design of 11 standardised pulmonary rehabilitation programmes were used. All programmes were 8 weeks in duration with two supervised exercise sessions per week and were required to use the national pulmonary rehabilitation recommendations with regard to programme organisation, exercise training guidelines and multidisciplinary education. For each participant with chronic obstructive pulmonary disease (COPD), healthcare utilisation data were collected for the 12 months preprogramme and 24 months postprogramme. Results: 426 participants (231 males, FEV149.3 (19.6) % predicted) were studied. The number of respiratory admissions/participant/year decreased from 0.7 (1.1) in the 12 months preprogramme to 0.5 (1.9) in the 12 months postprogramme, p=0.083; but increased in the 12-24 months postprogramme to 1.0 (2.3), p<0.001. The hospital days/participant/year improved from 4.0 (7.8) days in the 12 months preprogramme to 2.5 (8.5) days in the 12 months postprogramme, p<0.001; but increased in the 12-24 months postprogramme to 6.1 (16.6) days, p=0.004. The emergency department presentations/participant/year improved from 1.15 (1.75) in the 12 months preprogramme to 0.9 (1.8) in the 12 months postprogramme, p=0.003; but increased in the 12-24 months postprogramme to 2.0 (3.3), p<0.001. Conclusion: Pulmonary rehabilitation significantly improves hospital days and emergency department presentations in the first 12 months postprogramme. Healthcare utilisation benefits in the second 12 months are less clear.

A simple clinical measure of quadriceps muscle strength identifies responders to pulmonary rehabilitation.

The aim was to determine if baseline measures can predict response to pulmonary rehabilitation in terms of six-minute walk distance (6MWD) or quality of life. Participants with COPD who attended pulmonary rehabilitation between 2010 and 2012 were recruited. Baseline measures evaluated included physical activity, quadriceps strength, comorbidities, inflammatory markers, and self-efficacy. Participants were classified as a responder with improvement in 6MWD (criteria of ≥25 m or ≥2SD) and Chronic Respiratory Questionnaire (CRQ; ≥0.5 points/question). Eighty-five participants with a mean (SD) age of 67(9) years and a mean forced expiratory volume in one second of 55(22)% were studied. Forty-nine and 19 participants were responders when using the 6MWD criteria of ≥25 m and ≥61.9 m, respectively, with forty-four participants improving in CRQ. In a regression model, responders in 6MWD (≥25 m criteria) had lower baseline quadriceps strength (P = 0.028) and higher baseline self-efficacy scores (P = 0.045). Independent predictors of 6MWD response (≥61.9 m criteria) were participants with metabolic disease (P = 0.007) and lower baseline quadriceps strength (P = 0.016). Lower baseline CRQ was the only independent predictor of CRQ response. A participant with relatively lower baseline quadriceps strength was the strongest independent predictor of 6MWD response. Metabolic disease may predict 6MWD response, but predictors of CRQ response remain unclear.

Metabolic disease and participant age are independent predictors of response to pulmonary rehabilitation.

PURPOSE: The study aims were (1) to determine whether baseline measures-including the Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) index; Age, Dyspnea, and Airflow Obstruction (ADO) index; physical activity; comorbidities (cardiac, metabolic, or musculoskeletal disease); and the number of hospitalizations over the previous 12 months-can predict responders in 6-minute walk distance (6MWD) following pulmonary rehabilitation (PR) and (2) to determine whether different methods in defining improvement in 6MWD affected identifying responders to PR. METHODS: All participants with chronic obstructive pulmonary disease who attended PR at our institution between 2004 and 2009 were evaluated. A participant was classified as a responder with improvement in 6MWD (≥25 m or ≥2 SD of this dataset coefficient of repeatability). RESULTS: A total of 203 participants (mean age, 68.2 ± 8.7 years; mean predicted forced expiratory volume in 1 second, 52.5 ± 22.4%) were analyzed. One hundred twenty participants (59.1%) had a comorbidity categorized as cardiac, metabolic, or musculoskeletal disease. The binary logistic regression models showed that younger participants (P ≤ .015) and, when using the coefficient of repeatability method (≥60.9 m), participants with metabolic disease (P = .040) were the only independent predictors of response. No other measure, including participant BODE or ADO index scores, contributed to either model. CONCLUSION: Identifying responders in exercise capacity following PR remains difficult, with only age and participants with metabolic disease identified as independent predictors.

Performance-based criteria are used in participant selection for pulmonary rehabilitation programs.

OBJECTIVE: To determine the participant entry criteria used by Australian-based pulmonary rehabilitation programs and the factors that influence selection. METHODS: This cross-sectional observational study invited all program coordinators listed on the Australian Lung Foundation's pulmonary rehabilitation database in November 2009. RESULTS: The response rate was 40.5% (79/195), with 58% of respondents reporting a waiting list. Forty respondents reported prioritising referrals due to: disease severity (75%), requirement for medical procedure (70%), upon medical request (60%) or participant's likelihood to benefit (55%). Fifty-eight respondents reported using entry criteria to select participants, which was mainly for safety reasons and performance-based expectations. All 58 respondents used at least one exclusion criterion in selecting their participants, compared with only 25 programs using inclusion criteria. Increased demand on individual programs was related to prioritising referrals (P<0.001) and was reported by 12 programs as a reason for using participant entry criteria. CONCLUSIONS: Program coordinators commonly prioritise referrals and use participant entry criteria to manage clinical demand with performance-based expectations an important consideration. The inclusion criteria that identify participants more likely to benefit from pulmonary rehabilitation are less commonly used in the performance-based selections. What is known about the topic? Pulmonary rehabilitation is an essential component of chronic lung disease management due to the high-quality evidence demonstrating that these programs can improve participants' exercise capacity, dyspnea and quality of life. However, access to pulmonary rehabilitation is severely limited in Australia with <1% of individuals with moderate to severe chronic obstructive pulmonary disease able to participate in these programs each year. Prior to the present study it was unknown how Australian pulmonary rehabilitation coordinators manage this demand on their programs. What does this paper add? Program coordinators commonly prioritise referrals and use participant entry criteria to select participants, with performance-based expectations an important consideration. Although higher demand and waiting list pressure appear to influence these performance-based considerations, programs do not report using the existing evidence identifying responders to pulmonary rehabilitation in selecting participants for program inclusion. This finding is a reflection of the inadequate evidence identifying which individuals are more likely to benefit from pulmonary rehabilitation. What are the implications for practitioners? With the current healthcare resources in Australia, pulmonary rehabilitation programs cannot meet the burden of all people with chronic obstructive pulmonary disease. Therefore the selection of participants considered most likely to benefit from pulmonary rehabilitation programs will continue to occur. Better criteria are needed to improve participant selection to ensure timely access to individuals that are most likely to benefit from pulmonary rehabilitation.