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Güell-Rous MR, Morante-Vélez F, Flotats-Farré G, Paz-Del Río LD, Closa-Rusinés C, Ouchi-Vernet D, Segura-Medina M, Bolíbar-Ribas I. Timing of Pulmonary Rehabilitation in Readmitted Patients with Severe Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. COPD 2020; 18:26-34. [PMID: 33287581 DOI: 10.1080/15412555.2020.1856059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Early pulmonary rehabilitation (PR), started during hospitalization or within the first month after discharge, has been shown to reduce exacerbations and improve health-related-quality of life (HRQoL) and exercise capacity. However, no randomized clinical trials (RCT) have compared the efficacy of PR started during hospitalization (DHPR) to PR initiated one month post-hospitalization (PHPR). We conducted an RCT to compare DHPR to PHPR in severe patients with COPD readmitted for exacerbations in a tertiary hospital setting. Patients were randomized to receive three months of DHPR or PHPR. Outcomes were assessed at completion of the PR programme and at months 3 and 9. A total of 53 patients (26 DHPR and 27 PHPR) were included. There were no between-group differences in the number of exacerbations (mean, 3.62 vs. 3.04 in the DHPR and PHPR groups, respectively; p = 0.403). Dyspnea in activities of daily living, exercise capacity, and all HRQoL parameters improved in the PHPR group. In the DHPR group, improvement was observed only for some HRQoL parameters. All gains in both groups were lost during follow-up. More adverse events were observed in the DHPR group (20 vs 5, p = 0.023), although none of these were clinically significant. In this sample of patients with severe COPD readmitted to the hospital for exacerbations, both approaches to PR were safe, but PHPR yielded better outcomes overall. These findings suggest that, PR should be initiated in patients with severe COPD only after hospital discharge when the patients' clinical condition has stabilized.
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Affiliation(s)
- Maria-Rosa Güell-Rous
- Department of Pneumology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Pulmonary Rehabilitation Area, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Fatima Morante-Vélez
- Department of Pneumology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Gemma Flotats-Farré
- Home Pulmonary Rehabilitation Department, Corporación Fisiogestión, Barcelona, Catalonia, Spain
| | - Luis-Daniel Paz-Del Río
- Department of Pneumology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Pulmonary Rehabilitation Area, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Conxita Closa-Rusinés
- Home Pulmonary Rehabilitation Department, Corporación Fisiogestión, Barcelona, Catalonia, Spain
| | - Dan Ouchi-Vernet
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Macarena Segura-Medina
- Department of Pneumology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Pulmonary Rehabilitation Area, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Ignasi Bolíbar-Ribas
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain.,Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Siemieniuk RAC, Chu DK, Kim LHY, Güell-Rous MR, Alhazzani W, Soccal PM, Karanicolas PJ, Farhoumand PD, Siemieniuk JLK, Satia I, Irusen EM, Refaat MM, Mikita JS, Smith M, Cohen DN, Vandvik PO, Agoritsas T, Lytvyn L, Guyatt GH. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ 2018; 363:k4169. [PMID: 30355567 DOI: 10.1136/bmj.k4169] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Reed A C Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S 4K1, Canada
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton L8S 4K1, Canada
| | - Lisa Ha-Yeon Kim
- Department of Medicine, McMaster University, Hamilton L8S 4K1, Canada
| | - Maria-Rosa Güell-Rous
- Departament de Pneumologia, Hospital de la Santa Creu I Sant Pau. Barcelona, Catalonia 08041, Spain
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S 4K1, Canada
- Department of Medicine, McMaster University, Hamilton L8S 4K1, Canada
| | - Paola M Soccal
- Division of Pulmonary Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Paul J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Pauline D Farhoumand
- Division General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | | | - Imran Satia
- Department of Medicine, McMaster University, Hamilton L8S 4K1, Canada
| | - Elvis M Irusen
- Divisions of Pulmonology and Medical Intensive Care, Stellenbosch University, Cape Town 7505, South Africa
| | - Marwan M Refaat
- Departments of Internal Medicine and Biochemistry & Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, Beirut 1107 2020, Lebanon
| | | | | | | | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S 4K1, Canada
- Division General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
- Division Clinical Epidemiology, University Hospitals of Geneva, 1205 Geneva, 1205, Switzerland
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S 4K1, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S 4K1, Canada
- Department of Medicine, McMaster University, Hamilton L8S 4K1, Canada
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