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(Chest. 2002;121:2082-2083.)
© 2002 American College of Chest Physicians

Outpatient Pulmonary Rehabilitation

P.J. Wijkstra, MD, PhD and G.H. Koeter, MD, PhD

University Hospital Gröningen, The Netherlands

Correspondence to: P.J. Wijkstra, MD, PhD, University of Hospital, Department of Pulmonary Diseases, P.O. Box 30.001, 9700 RB Gröningen, The Netherlands

To the Editor:

We read with great interest the article by Finnerty et al (June 2001).1 This large, randomized, controlled trial showed that, in patients with COPD, outpatient rehabilitation can improve walking distance and health-related quality of life for 12 weeks. These results were obtained in a nonteaching hospital, so the authors suggested that the results of previous studies could now be extrapolated beyond centers dedicated to these regimens. Still, several earlier studies have shown comparable positive results even after rehabilitation in the home setting.2 3 4 5 In the present paper, the studies by Wijkstra et al2 and Cambach et al3 were both cited as outpatient rehabilitation programs. However, the patients in these studies received their training from a local physical therapist in the community and were not supervised by hospital staff. Studies with a comparable design, like Strijbos et al4 and Hernandez et al5 also showed that rehabilitation programs carried out in a home setting were beneficial. Thus, rehabilitation programs can be very effective in specific groups of patients with COPD in different settings. If these patients receive adequate training, it can be beneficial not only in an outpatient setting beyond a teaching hospital but even in a setting in the community, with no direct supervision from the hospital.

References

  1. Finnerty, JP, Keeping, I, Bullough, I, et al (2001) The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest 119,1705-1710[Abstract/Free Full Text]
  2. Wijkstra, PJ, van Altena, R, Kraan, J, et al (1994) Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. Eur Respir J 7,269-273[Abstract]
  3. Cambach, W, Chadwick-Straver, RV, Wagenaar, RC, et al (1997) The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J 10,104-113[Abstract]
  4. Strijbos, JH, Postma, DS, van Altena, R, et al (1996) A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD: a follow-up of 18 months. Chest 109,366-372[Abstract/Free Full Text]
  5. Hernandez, MT, Rubio, TM, Ruiz, FO, et al (2000) Results of a home-based training program for patients with COPD. Chest 118,106-114[Abstract/Free Full Text]

James P Finnerty, MD

Countess of Chester Hospital, Chester, United Kingdom

Correspondence to: James P. Finnerty, MD, Department of Medicine, Countess of Chester Hospital, Liverpool Rd, Chester CH2 1UL, United Kingdom Back

To the Editor:

I agree that two of the studies cited in our paper as outpatient-based were, in fact, not supervised by hospital staff but were entirely community-based.1 2 I am entirely in agreement that rehabilitation programs can be very effective in the community, and indeed, while the professional input remains similar to before, our current pulmonary rehabilitation program is conducted entirely in the community, in co-operation with general practitioners.

References

  1. Wijkstra, PJ, van Altena, R, Kraan, J, et al (1994) Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. Eur Respir J 7,269-273
  2. Cambach, W, Chadwick-Straver, RV, Wagenaar, RC, et al (1997) The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J 10,104-113



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