Effets d’un programme de réhabilitation respiratoire selon la sévérité de la BPCO

Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review

BACKGROUND

The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures.

OBJECTIVES

This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD).

METHODS

The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel.

RESULTS

We included 267 studies (43153 individuals with COPD). A broad range of domains (n=22), outcomes (n=163) and measures (n=217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n=218) assessed with the 6-min walk test (n=140), health-related quality of life (n=204) assessed with the Saint George's respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified Medical Research Council dyspnea scale (n=56). The least reported outcomes were comorbidities, adverse events and knowledge.

CONCLUSIONS

This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders.

PROSPERO ID

CRD42017079935.

Simulation-Based Estimates of the Effectiveness and Cost-Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease in France

BACKGROUND

The medico-economic impact of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is poorly documented.

OBJECTIVE

To estimate the effectiveness and cost-effectiveness of pulmonary rehabilitation in a hypothetical cohort of COPD patients.

METHODS

We used a multi-state Markov model, adopting society's perspective. Simulated cohorts of French GOLD stage 2 to 4 COPD patients with and without pulmonary rehabilitation were compared in terms of life expectancy, quality-adjusted life years (QALY), disease-related costs, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses included variations of key model parameters.

PRINCIPAL FINDINGS

At the horizon of a COPD patient's remaining lifetime, pulmonary rehabilitation would result in mean gain of 0.8 QALY, with an over disease-related costs of 14 102 € per patient. The ICER was 17 583 €/QALY. Sensitivity analysis showed that pulmonary rehabilitation was cost-effective in every scenario (ICER <50 000 €/QALY).

CONCLUSIONS

These results should provide a useful basis for COPD pulmonary rehabilitation programs.

[Home-based exercise training and physical activity level over one year in COPD patients]

INTRODUCTION

The aim of our study was to investigate whether exclusive home-based training was feasible and effective in COPD patients and if patients have a persistent improvement in their level of physical activity after this intervention.

METHODS

One hundred COPD patients (FEV1=42.6% predicted) first underwent 25 weekly sessions of supervised cycle ergometry training, followed by one year of monthly supervised follow-up. Six minutes walking test, endurance test, BODE index and activity monitoring were performed before, after and one year after inclusion.

RESULTS

About 80% of the patients completed the program. They improved their exercise tolerance and their daily physical activity level, even one year after inclusion. However, more severe patients did not maintain these benefits. Daily physical activity quantity was also decreased in these patients one year after inclusion.

CONCLUSION

This home-based exercise training program is feasible and effective. Improvements are sustainable for the majority of patients. However, severe patients were not able to maintain these benefits. Other exercise training strategies may have to be considered in these patients.

[A comparison of pulmonary rehabilitation delivered in the home or at a centre for patients with COPD]

AIM

There are few data showing how pulmonary rehabilitation (PR) for COPD patients carried out at home impacts on health-related quality of life (HRQL). The aim of this study was to determine if PR conducted at home improves quality of life.

METHODS

We compared the results of home-based PR versus PR performed in an outpatient center. The outcomes were the HRQL measured by the Saint-George's Hospital questionnaire and the 6-minute walk test distance (6MWT). Fifty-six COPD patients were included for PR either at home (n=27) or in the outpatient center (n=29) depending on distance from the center and patients preference. The two groups were similar for sex, age, BMI, lung function, and initial peak oxygen uptake.

RESULTS

6MWT showed a similar non-significant improvement in both groups after PR (+12±46m in home-based PR,+13±34m in outpatient center). HRQL was significantly improved in the home-based group in 2 domains : "Activity" (-8.6±6.4 vs -0.7±17.7, P<0.05), "Impact" (-8.4±6.5 vs 1.6±11.7, P<0.001) and total score (-8.2±4.0 vs 0.0±8.8, P<0.001).

CONCLUSION

Pulmonary rehabilitation at home is associated with improvements in health-related quality of life, and thus can be considered where availability of treatment in specialized centers is limited.

[Outcomes of a pulmonary rehabilitation program including singing training]

INTRODUCTION

Respiratory education by singing may be considered in the course of pulmonary rehabilitation to help control breathing and reduce dyspnoea.

METHODS

We have undertaken singing training during pulmonary rehabilitation in 45 patients, mean age 60.1 ± 10.0 years, suffering from COPD (n=37) or other chronic respiratory disorders (n=8). The parameters measured at the beginning and end of course of rehabilitation were: forced vital capacity, FEV1, total lung capacity, residual volume, 6 min walking distance, VO2max, maximum pressure, MRC dyspnoea score, Cincinnati questionnaires and VSRQ (simplified visual respiratory questionnaire).

RESULTS

The following were the principal significant variations observed (initial value, % variation, significance): 6 minutes walk (326 ± 114 m, +13.8%, P=0.006); VO2max (18,1 ± 6.1 ml/kg/min, +8.3%, P=0.01); P max (75 ± 31 W, +14.7%, P=0.001); MRC score (2.3 ± 0.6, -21.7%, P<10(-4)); VSRQ score (34 ± 13, +50.0%, P<10(-6)). There was no significant change in the level of dyspnoea evaluated by the Cincinnati score.

CONCLUSION

These results are in favor of a beneficial effect of singing during pulmonary rehabilitation.