Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients
Received 12 July 2019
Accepted for publication 21 November 2019
Published 27 December 2019 Volume 2019:14 Pages 3017—3023
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Stefania Costi,1 Ernesto Crisafulli,2 Ludovico Trianni,3 Bianca Beghè,4 Silvia Faverzani,5 Giuseppe Scopelliti,5 Alfredo Chetta,5 Enrico Clini4
1Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplants Oncology and Regenerative Medicine-University of Modena and Reggio Emilia and Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy; 2Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; 3Rehabilitation Unit-Hospital Villa Pineta, Pavullo Nel Frignano, Modena, Italy; 4Department of Medical and Surgical Sciences-University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy; 5Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
Correspondence: Ernesto Crisafulli
Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
Background: The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR).
Methods: We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes.
Results: Compared to the category of individuals with 6MWD >350 meters, those patients with 201–350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased.
Conclusion: This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.
Keywords: chronic obstructive pulmonary disease, pulmonary rehabilitation, patient selection, minimal clinically important difference, exercise tolerance, dyspnea
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