Survival following pulmonary rehabilitation in patients with COPD: the effect of program completion and change in incremental shuttle walking test distance
Authors Houchen-Wolloff L, Williams JEA, Green RH, Woltmann G, Steiner MC, Sewell L, Morgan MD, Singh SJ
Received 2 June 2017
Accepted for publication 13 July 2017
Published 20 December 2017 Volume 2018:13 Pages 37—44
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Linzy Houchen-Wolloff,1 Johanna EA Williams,1 Ruth H Green,2 Gerrit Woltmann,2 Michael C Steiner,1,2 Louise Sewell,1 Michael DL Morgan,1,2 Sally J Singh1
1NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, 2Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
Rationale: Pulmonary rehabilitation (PR) in patients with COPD has consistently been shown to produce benefits in exercise capacity, symptoms, and health status. The data surrounding survival following PR are less clear. Our aims were to compare the long-term survival in two cohorts of patients referred for PR; those who successfully completed PR, and a comparator group constructed from patients who either did not complete PR or did not start the program. Additionally, we compared survival between those people who were able to achieve a clinically meaningful improvement in exercise capacity (incremental shuttle walking test) following PR with those who were not.
Methods: A retrospective longitudinal analysis of clinical service outcomes was conducted to compare the long-term survival in “completers” and “non-completers” of rehabilitation at two hospitals within the University Hospitals of Leicester NHS Trust from January 1, 2000 to February 23, 2012. For “completers”, we also analyzed survival in those meeting (and not meeting) the desired level of change in the incremental shuttle walking test (≥50 m vs <50 m).
Results: We present to you the largest dataset on this topic (n=1,515). Survival data were ascertained for 823 (54.3%) patients with COPD who had completed a course of PR and for 692 (45.7%) patients who dropped out. Survival time was significantly greater in “completers” compared to “non-completers” of PR (p<0.001). In addition, PR success (≥50 m change in walking distance) was also associated with improved survival (p<0.05).
Conclusion: The data show an association between completion of PR and survival. In addition, PR success (>50 m change in walking distance) was also associated with improved survival.
Keywords: survival, COPD, exercise
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