Effectiveness, Attendance, and Completion of an Integrated, System-Wide Pulmonary Rehabilitation Service for COPD: Prospective Observational Study
Effectiveness, Attendance, and Completion of an Integrated, System-Wide Pulmonary Rehabilitation Service for COPD: Prospective Observational Study
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DOI：
10.3109/15412555.2012.707258
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发表时间：
2012-08-01
影响因子：
2.2
通讯作者：
White, Patrick
中科院分区：
文献类型：
--
作者：
Hogg, Lauren;Garrod, Rachel;White, Patrick
肺康复（PR）是COPD最有效的治疗方法之一，但尚未广泛应用。入学率低，毕业率低。在这项综合公关服务中，我们报告了两个医院和五个社区公关网站每周两次滚动招聘和每周一次队列招聘计划的有效性，出勤率和完成情况。医院和两个社区方案每周两次“滚动”招募，为期8周。三个社区方案每周一次，为期8周。还寻求预测出勤率、完成率和成效的指标。1114例符合条件的COPD患者被转诊。812人（73%）参加了评估，656人（59%）开始，441人（40%）完成。在递增穿梭步行试验（ISWT）中观察到显著改善（平均68.3 m; 95% CI 59.3-77.4），慢性呼吸问卷自我报告呼吸困难量表（CRQ-SR）（0.94; 0.80-1.07），医院焦虑和抑郁量表焦虑（0.9; 0.5-1.2）和抑郁（1.1; 0.8-1.4）组成部分，超过了ISWT和CRQ-SR的最小临床重要差异。每周两次与每周一次的方案相比，显示出类似的改善。如果患者被剥夺了，（剥夺的第四个五分位数为0.56; 0.33-0.94，第五个五分位数为0.57; 0.34-0.85），报告的MRC呼吸困难量表4（0.61; 0.37-0.97）或5（0.39; 0.16-0.93），或由其全科医生转介（0.42; 0.24-0.74）（伪R-2 0.103）。PR在现实世界实践中对COPD有效，达到了与试验相当的结果。尽管参与者人数众多，但人口统计学特征、疾病严重程度、心理发病率和转诊来源无法解释低出勤率和PR完成率。
Pulmonary rehabilitation (PR) is one of the most effective treatments for COPD but not widely available. Uptake is poor and completion rates are low. In this integrated PR service we report on effectiveness, attendance, and completion of twice weekly rolling recruitment and once weekly cohort recruitment programmes in two hospital and five community PR sites. The hospital and two of the community programmes were 'rolling' recruitment twice weekly for 8 weeks. Three community programmes ran in once weekly cohorts for 8 weeks. Predictors of attendance, completion and effectiveness were sought. 1114 eligible COPD patients were referred. 812 (73%) attended assessment, 656 (59%) started and 441 (40%) completed. Significant improvements were seen in incremental shuttle walk test (ISWT) (mean 68.3 m; 95% CI 59.3-77.4), Chronic Respiratory Questionnaire self-report dyspnoea scale (CRQ-SR) (0.94; 0.80-1.07), Hospital Anxiety and Depression Scale anxiety (0.9; 0.5-1.2) and depression (1.1; 0.8-1.4) components, exceeding the minimum clinically important difference for ISWT and CRQ-SR. Twice weekly compared with once weekly programmes showed similar improvement. Patients were less likely to complete if they were deprived (4th quintile of deprivation 0.56; 0.33-0.94, 5th quintile 0.57; 0.34-0.85), reported MRC dyspnoea scale 4 (0.61; 0.37-0.97) or 5 (0.39; 0.16-0.93), or had been referred by their general practitioner (0.42; 0.24-0.74) (pseudo R-2 0.103). PR is effective for COPD in real-world practice achieving results comparable to trials. Low rates of attendance and completion of PR were not explained by demographic characteristics, disease severity, psychological morbidity and source of referral despite the large number of participants.