Pulmonary rehabilitation in clinical routine: a follow-up study

The effect of rehabilitation for chronic obstructive pulmonary disease has been well-documented in randomized controlled trials. Evidence-based guidelines support rehabilitation programmes for chronic obstructive pulmonary disease, but knowledge of their outcome in clinical practice is limited. The aim of this study was to assess the outcome of a clinical routine rehabilitation programme for chronic obstructive pulmonary disease implemented by a Danish regional hospital.

Changes in walk-distance (6-min walk-distance test; 6MWD), dyspnoea (Medical Research Council dyspnoea scale; MRC) and health-related quality of life (Short-Form 36; SF-36) were compared between and within completers and non-completers from baseline to the end of clinical routine rehabilitation, and at 6 and 12 months. The 8-week clinical routine rehabilitation comprised bi-weekly 90-min sessions of patient education and physical training.

The hospital treated 521 patients during the study period. Of these, 175 were invited to join the study, 148 participated at baseline, and 98 at the 12-month follow-up. Completers' 6MWD was sustained from baseline to the end of clinical routine rehabilitation, but had declined by 12 months. Dyspnoea and health-related quality of life did not change. Seventy-five percent of completers felt better or much better after rehabilitation.

The failure of completers to achieve expected outcomes shows a need for a stronger implementation effort and continuous quality control. Successful implementation in clinical routine requires targeted recruitment and overall programme improvement in general, and a stronger focus on physical training and staff competences.