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Eur Respir J 2006, doi:10.1183/09031936.06.00130605
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ORIGINAL ARTICLE |
Predictors of success and failure in pulmonary rehabilitation
1 School of Physiotherapy, Faculty of Health and Social Care Sciences, St George's, University of London, Cranmer Terrace, Tooting, SW17ORE
2 Cardiac and Vascular Services, St George's, University of London, Cranmer Terrace, Tooting, London, SW17ORE
* To whom correspondence should be addressed. E-mail: rgarrod{at}hscs.sgul.ac.uk.
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Abstract |
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The purpose of this study is to identify prognostic features of COPD associated with success or failure in pulmonary rehabilitation. Patients were stratified according to Medical Research Council Dyspnoea Score (MRC).
74 stable COPD patients, mean age (SD) 68 (10 years), 21 MRC Grade 1/2; 29 Grade 3/4, 24 grade 5. Mean (SD) FEV1 1.10 (0.6) litre attended rehabilitation. Assessments: Quadriceps Torque, 6-Minute Walking Distance (6MWD), Brief Assessment Depression Cards (BASDEC), St George's Respiratory Questionnaire (SGRQ). Predictors of drop out and of response (change SGRQ 4 points or 6MWD 54m) were tested using binary logistic regression.
51 patients completed, of these 39 (77%) showed clinically significant benefit in either 6MWD or SGRQ. Baseline variables were poor predictors of response (p>0.05) in each case. Significant differences were seen between MRC groups for change in 6MWD (p=0.003) and SGRQ Score (p=0.03). Only Grade 1/2, and 3/4 patients improved. Depression was a risk factor for drop out compared with non-depressed (Odds Ratio 8.7, CI 2.8 to 27.1).
Baseline state is a poor predictor of response to rehabilitation, although MRC grade 5 patients showed smaller magnitudes of improvement than patients with less severe MRC grades. Risk of drop -out is significantly greater in depressed patients compared with non-depressed.
Keywords: COPD, prediction, pulmonary rehabilitation, response
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