Does an 8-week pulmonary rehabilitation (PR) program have equivalent outcomes to a 12-week program in COPD? A randomised controlled trial.

Abstract

<b>Introduction:</b> There is no strong evidence on the optimal duration of pulmonary rehabilitation (PR) programs. <b>Aims:</b> To determine whether an 8-week PR program was equivalent to a 12-week PR program in people with COPD. <b>Methods:</b> A randomised controlled, equivalence trial with assessors blinded to group allocation and intention-to-treat analysis. Participants with COPD were randomised to either an 8-week or 12-week, twice weekly supervised PR program. Between group comparisons were made at completion of each program (8-week or 12-week) and at 12 weeks for both programs. Primary outcome: endurance shuttle walk test (ESWT) with sample size based on excluding a difference in the 95% confidence interval (CI) in ESWT of more than the equivalence limit (EL) of 186 seconds (minimal important difference). Secondary outcomes: St George’s Respiratory Questionnaire (SGRQ), EL -4 points; 6-minute walk distance (6MWD), EL 30m; COPD Assessment Test (CAT), EL -2 points. <b>Results:</b> 66 participants, mean age (SD) 69 yrs (7), FEV₁ 48%pred (17), were randomised (33 per group). At completion of 12-week compared to 8-week PR, mean difference (95%CI): ESWT 71sec (-133 to 276); SGRQ -8 points (-14 to -1); 6MWD 16m (-11 to 44); CAT 0 points (-3 to 3). Comparisons at 12-weeks showed similar findings. <b>Conclusion:</b> At program completion, ESWT, 6MWD and CAT were equivalent between 8 and 12-week PR, though superiority of 12-week PR could not be ruled out for ESWT and 6MWD. 12-week PR was superior to 8-week PR for SGRQ, but equivalence could not be ruled out. When programs were compared at the same timepoint (12 weeks) the outcomes were similar to those shown at program completion.