An evaluation of factors associated with completion and benefit from pulmonary rehabilitation in COPD
An evaluation of factors associated with completion and benefit from pulmonary rehabilitation in COPD
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DOI：
10.1136/bmjresp-2014-000051
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发表时间：
2013-08-01
影响因子：
4.1
通讯作者：
Hopkinson, Nicholas S.
中科院分区：
文献类型：
--
作者：
Boutou, Afroditi K.;Tanner, Rebecca J.;Hopkinson, Nicholas S.
背景：肺康复（PR）是慢性阻塞性肺疾病（COPD）患者的重要治疗方法，但目前尚不清楚是否有任何基线参数可以预测疗效或依从性。目的：确定基线测量是否可以预测谁将完成该计划，以及谁将从最小临床重要差异（MCID）中获得临床显着获益，这涉及到运动能力和健康相关生活质量（HRQoL）。方法：在伦敦8个中心之一的门诊PR项目中，前瞻性地收集COPD患者的基线评估数据。“完成”定义为参加至少75%的指定公关访问并返回进行后续评估。结果测量的MCID基于已发表的数据。结果：共纳入门诊COPD患者787例（年龄68.1±10.5岁，男性49.6%）。完成PR的患者（n=449, 57.1%）明显年龄较大，气流阻塞较轻，焦虑和抑郁评分较低，呼吸困难较少，HRQoL较好。多因素分析仅保留基线CAT评分（OR=0.925; 95% CI 0.879 ~ 0.974; p=0.003）。基线步行距离最低的患者最有可能达到运动能力的MCID。没有基线变量可以独立预测HRQoL中MCID的实现。结论：HRQoL较好的患者更有可能完成PR，而基线运动表现较差的患者更有可能实现运动能力的MCID阳性。然而，没有基线参数可以预测谁在HRQoL方面受益最大。
Background: Pulmonary Rehabilitation (PR) is an important treatment for patients with chronic obstructive pulmonary disease (COPD) but it is not established whether any baseline parameter can predict response or compliance.Aim: To identify whether baseline measures can predict who will complete the programme and who will achieve a clinically significant benefit from a Minimum Clinical Important Difference (MCID) in terms of exercise capacity and health-related quality of life (HRQoL).Methods: Data were collected prospectively from patients with COPD at their baseline assessment for an outpatient PR programme in one of eight centres across London. 'Completion' was defined as attending at least 75% of the designated PR visits and return for the follow-up evaluation. The MCID for outcome measures was based on published data.Results: 787 outpatients with COPD (68.1 +/- 10.5 years old; 49.6% males) were included. Patients who completed PR (n=449, 57.1%) were significantly older with less severe airflow obstruction, lower anxiety and depression scores, less dyspnoea and better HRQoL. Only baseline CAT score (OR=0.925; 95% CI 0.879 to 0.974; p=0.003) was retained in multivariate analysis. Patients with the lowest baseline walking distance were most likely to achieve the MCID for exercise capacity. No baseline variable could independently predict achievement of an MCID in HRQoL.Conclusions: Patients with better HRQoL are more likely to complete PR while worse baseline exercise performance makes the achievement of a positive MCID in exercise capacity more likely. However, no baseline parameter could predict who would benefit the most in terms of HRQoL.