[Group Training of Patients with Chronic Lung Diseases under Outpatient Conditions - Recommendations of the Working Group Lung Sports in Germany and the German Airways League]

[Effects of Supported Aftercare in the Post-Rehabilitation Phase in COPD Patients: A Controlled Study]

BACKGROUND

 C: hronic O: bstructive P: ulmonary D: isease (COPD) is a chronic degenerative disease characterized by an irreversible obstruction of the respiratory system. Medical rehabilitation is of central importance in disease management. Physical training is one of the most important non-drug therapy modules. The effectiveness of inpatient pneumological rehabilitation is considered proven, but the effects are not sustainable.

AIM OF THE STUDY

 Increasing the sustainability of rehabilitation success in patients with COPD through supported aftercare.

METHOD

 Evaluation of the effectiveness of the New Credo in a single-center, controlled longitudinal study with three measurement times (start of rehabilitation, end of rehabilitation, 12-month follow-up). Rehabilitation patients with confirmed COPD were included. The control group (CG) received the guideline-compliant standard care, the intervention group (IG) underwent rehabilitation and follow-up care in accordance with the New Credo. The New Credo is a concept in which aftercare is taken into account at the start of rehabilitation and which emphasizes the personal responsibility and own initiative of the rehabilitation patients. Supporting tools are used for training clinic employees, including a "to do list", checklists for doctors, information for follow-up institutions. A group session is held for the rehabilitation patients assigned to aftercare; they keep different diaries, which they send the rehabilitation clinic at different times after completing rehabilitation. The clinic provides patients feedback that is intended to support them in maintaining physical activity. The primary outcome measure was participation (I: ndex zur M: essung von E: inschränkungen der T: eilhabe, IMET score) in an intra- and intergroup comparison at three measurement times. Secondary outcomes were: C: OPD A: ssessment T: est (CAT), various P: atient R: eported O: utcome M: easures (PROMs) and the extent of physical activity.

RESULTS

 Complete data on 149 IG and 135 CG members were used (complete case analysis). The participants were on average 64 years old, 57 % (IG) and 67 % (KG) were male. Most of the respondents had COPD grade II-III. Twelve months after rehabilitation, the IG showed the same value for primary outcome participation as at the beginning of rehabilitation (M = 30.8; SD = 21.8), the control group showed worse results (M = 41.3; SD = 24.7). The same findings (stability in the IG, deterioration in the CG) was also seen in the secondary outcomes. In the time after rehabilitation, the IG showed in secondary outcomes less deterioration than the CG, but the differences were not significant. With regard to the increase in physical activity, the IG reported significantly more often that they were able to achieve their subjective rehabilitation goals (69 % vs. 34 %, p < 0.01). In addition, they increased the amount of physical activity in the period after rehabilitation to a greater extent than the CG (p = 0.064). They participated in sports at a sports club more often (15 % vs. 5 %, p < 0.01) and did endurance sports significantly more frequently during the follow-up period (46 % vs. 21 %, p < 0.01) CONCLUSION:  Through the intervention with the New Credo, a lasting effect (effect size ES = .40) was expected for the primary outcome participation in the IG as compared to the CG. This assumption was not confirmed: there was neither a time nor a group effect. However, against the background of the particular importance of physical activity in the course of COPD, integration of physical activity permanently into everyday life by the IG can be looked upon as a sort of success of the New Credo.