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Length and Clinical Effectiveness of Pulmonary Rehabilitation in Outpatients With Chronic Airway Obstruction^*

^* From the Fondazione Villa Pineta and University of Modena-Reggio Emilia, Division of Pneumology & Pulmonary Rehabilitation, Pavullo (MO), Italy.

Correspondence to: Enrico Clini, MD, FCCP, Ospedale e Fondazione Villa Pineta, Division of Pneumology & Pulmonary Rehabilitation, Via Gaiato 127, 41010 Pavullo (MO), Italy; e-mail: eclini{at}qubisoft.it

Study objective: To assess the clinical effectiveness of pulmonary rehabilitation (PR) after 10 or 20 consecutive sessions in outpatients with chronic airway obstruction (CAO).

Design: Observational prospective cohort trial.

Setting: Outpatient clinic of a rehabilitation center.

Patients and interventions: Twenty-five outpatients (mean age, 65 ± 9 years [± SD]; FEV₁, 64 ± 12% predicted) admitted to a comprehensive PR program, including exercise training.

Measurements and results: The load reached on a cycloergometer (maximal achieved load [W-max]), the maximal and isoload dyspnea and leg fatigue on a Borg scale, 6-min walk distance (6MWD), and the health-related quality of life as assessed using the St. George’s Respiratory Questionnaire (SGRQ) [total and components score] have been recorded as outcome measures at baseline, after 10 sessions (T10), and after 20 sessions (T20). The predefined criteria of the clinically significant improvement were as follows: + 15% W-max, + 54 m at 6MWD, – 1 point at isoload dyspnea and leg fatigue, and – 4% at SGRQ scores. There was a mean significant difference between changes at T20 and T10 for 6MWD (– 42.96 m; 95% confidence interval [CI], – 57.79 to – 28.12 m; p = 0.001), total SGRQ (4.80; 95% CI, 2.29 to 7.31; p = 0.001), activity SGRQ (3.60; 95% CI, 0.48 to 6.71; p = 0.025), and symptoms SGRQ (5.96; 95% CI, 2.72 to 9.2; p = 0.001). The percentage of patients who improved was different at T20 as compared with T10 for W-max (68% and 48%, respectively; p = 0.025), 6MWD (76% and 20%, p = 0.001), and total SGRQ (64% and 36%, p = 0.008).

Conclusions: A 10-session course of PR provides only limited clinically significant changes of outcome measures when compared with a 20-session course in outpatients with CAO of mild-to-moderate severity.

Key Words: exercise • COPD • outcome measures • quality of life

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