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A Prospective Cohort Study on the Effects of Geriatric Rehabilitation Following Acute Exacerbations of COPD
hospitalized for an acute exacerbation, often do not receive recommended
post-acute pulmonary rehabilitation. This underuse might be related to the
impaired clinical and functional status of these patients, who are more likely to
present with frailty, comorbidities, and disability. Having developed and
implemented a geriatric rehabilitation program for these patients (GR_COPD), the
primary aim of this study was to investigate the effectiveness of this program.
DESIGN AND INTERVENTION: A prospective cohort study with a 3-month follow-up
period. Patients who declined the GR_COPD program were considered as controls.
SETTING AND PARTICIPANTS: The study was conducted at the pulmonary department of
2 hospitals. Patients were eligible when hospitalized as a result of an acute
exacerbation of COPD and indicated for the GR_COPD program based on standardized
criteria.
Show moreOBJECTIVES: Older patients with chronic obstructive pulmonary disease (COPD),
hospitalized for an acute exacerbation, often do not receive recommended
post-acute pulmonary rehabilitation. This underuse might be related to the
impaired clinical and functional status of these patients, who are more likely to
present with frailty, comorbidities, and disability. Having developed and
implemented a geriatric rehabilitation program for these patients (GR_COPD), the
primary aim of this study was to investigate the effectiveness of this program.
DESIGN AND INTERVENTION: A prospective cohort study with a 3-month follow-up
period. Patients who declined the GR_COPD program were considered as controls.
SETTING AND PARTICIPANTS: The study was conducted at the pulmonary department of
2 hospitals. Patients were eligible when hospitalized as a result of an acute
exacerbation of COPD and indicated for the GR_COPD program based on standardized
criteria.
METHODS: Primary outcome was defined as change in disease-specific health status
measured with the clinical COPD questionnaire (CCQ), secondary outcome as the
exacerbation rate ratio during follow-up. To balance potential confounders
between the intervention and control group, propensity score-based weighted
linear regression analyses were performed.
RESULTS: Of the 158 included patients [78 (49.4%) male, mean age 70.8 (±8.1)
years, mean forced expiratory volume in 1 second: 35.5 (±12.8) as % of
predicted], 78 received the GR_COPD program. The results of the CCQ showed a
significant and clinically relevant treatment effect of -0.56 points [95%
confidence interval (CI) -0.89, -0.23; P = .001). Patients in the control group
had 2.77 times more exacerbations compared with the intervention group (95% CI
2.13, 3.58; P < .001).
CONCLUSIONS/IMPLICATIONS: This study shows a clinically relevant effect of the
GR_COPD program on disease-specific health status and exacerbation rate.
Implementation of the program for older patients with severe COPD hospitalized
for an acute exacerbation is recommended.
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- All authors
- Isselt, E.F.V. van; Eijk, M. van; Geloven, N. van; Groenewegen-Sipkema, K.H.; Berg, J.W.K. van den; Nieuwenhuys, C.M.A.; Chavannes, N.H.; Achterberg, W.P.
- Date
- 2019-07-31
- Volume
- 20
- Issue
- 7
- Pages
- 850 - +