The effects of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomised controlled trial

Andrew M Wilson, Paula Browne, Sandra Olive, Allan Clark, Penny Galey, Emma Dix, Helene Woodhouse, Sue Robinson, Edward C F Wilson, Lindi Staunton, Andrew M Wilson, Paula Browne, Sandra Olive, Allan Clark, Penny Galey, Emma Dix, Helene Woodhouse, Sue Robinson, Edward C F Wilson, Lindi Staunton

Abstract

Objectives: Pulmonary rehabilitation (PR) provides benefit for patients with chronic obstructive pulmonary disease (COPD) in terms of quality of life (QoL) and exercise capacity; however, the effects diminish over time. Our aim was to evaluate a maintenance programme for patients who had completed PR.

Setting: Primary and secondary care PR programmes in Norfolk.

Participants: 148 patients with COPD who had completed at least 60% of a standard PR programme were randomised and data are available for 110 patients. Patients had greater than 20 pack year smoking history and less than 80% predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection.

Interventions: Patients were randomised to receive a maintenance programme or standard care. The maintenance programme consisted of 2 h (1 h individually tailored exercise training and 1 h education programme) every 3 months for 1 year.

Primary and secondary outcome measures: The Chronic Respiratory Questionnaire (CRQ) (primary outcome), endurance shuttle walk test (ESWT), EuroQol (EQ5D), hospital anxiety and depression score (HADS), body mass index (BMI), body fat, activity levels (overall score and activity diary) and exacerbations were assessed before and after 12 months.

Results: There was no statistically significant difference between the groups for the change in CRQ dyspnoea score (primary end point) at 12 months which amounted to 0.19 (-0.26 to 0.64) units or other domains of the CRQ. There was no difference in the ESWT duration (-10.06 (-191.16 to 171.03) seconds), BMI, body fat, EQ5D, MET-minutes, activity rating, HADS, exacerbations or admissions.

Conclusions: A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months. We do not recommend that our maintenance programme is adopted. Other methods of sustaining the benefits of PR are required.

Trial registration number: NCT00925171.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Disposition of patients. Although the majority (237 (94.8%) patients) started the standard pulmonary rehabilitation (PR) programme, there was a large withdrawal rate prior to randomisation mainly due to inability to complete the standard PR programme (56 (23.6%) patients). n=number of patients.
Figure 2
Figure 2
Change in components of the Chronic Respiratory Questionnaire (CRQ) at 3−month intervals. There was no difference in any of the CRQ measures at any of three monthly measurements between the intervention and control groups. The control is the solid line and the intervention is dashed line. The bars represent the 95% CIs. PR, pulmonary rehabilitation.

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