Outpatient Pulmonary Rehabilitation

Abstract

We read with great interest the article by Finnerty et al (June 2001).1Finnerty JP Keeping I Bullough I et al.The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial.Chest. 2001; : 1705-1710Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar This large, randomized, controlled trial showed that, in patients with COPD, outpatient rehabilitation can improve walking distance and health-related quality of life for 12 weeks. These results were obtained in a nonteaching hospital, so the authors suggested that the results of previous studies could now be extrapolated beyond centers dedicated to these regimens. Still, several earlier studies have shown comparable positive results even after rehabilitation in the home setting.2Wijkstra PJ van Altena R Kraan J et al.Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home.Eur Respir J. 1994; 7: 269-273Crossref PubMed Scopus (264) Google Scholar3Cambach W Chadwick-Straver RV Wagenaar RC et al.The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial.Eur Respir J. 1997; 10: 104-113Crossref PubMed Scopus (233) Google Scholar4Strijbos JH Postma DS van Altena R et al.A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD: a follow-up of 18 months.Chest. 1996; 109: 366-372Abstract Full Text Full Text PDF PubMed Scopus (281) Google Scholar5Hernandez MT Rubio TM Ruiz FO et al.Results of a home-based training program for patients with COPD.Chest. 2000; 118: 106-114Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar In the present paper, the studies by Wijkstra et al2Wijkstra PJ van Altena R Kraan J et al.Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home.Eur Respir J. 1994; 7: 269-273Crossref PubMed Scopus (264) Google Scholar and Cambach et al3Cambach W Chadwick-Straver RV Wagenaar RC et al.The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial.Eur Respir J. 1997; 10: 104-113Crossref PubMed Scopus (233) Google Scholar were both cited as outpatient rehabilitation programs. However, the patients in these studies received their training from a local physical therapist in the community and were not supervised by hospital staff. Studies with a comparable design, like Strijbos et al4Strijbos JH Postma DS van Altena R et al.A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD: a follow-up of 18 months.Chest. 1996; 109: 366-372Abstract Full Text Full Text PDF PubMed Scopus (281) Google Scholar and Hernandez et al5Hernandez MT Rubio TM Ruiz FO et al.Results of a home-based training program for patients with COPD.Chest. 2000; 118: 106-114Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar also showed that rehabilitation programs carried out in a home setting were beneficial. Thus, rehabilitation programs can be very effective in specific groups of patients with COPD in different settings. If these patients receive adequate training, it can be beneficial not only in an outpatient setting beyond a teaching hospital but even in a setting in the community, with no direct supervision from the hospital. Outpatient Pulmonary RehabilitationCHESTVol. 121Issue 6PreviewI agree that two of the studies cited in our paper as outpatient-based were, in fact, not supervised by hospital staff but were entirely community-based.1,2 I am entirely in agreement that rehabilitation programs can be very effective in the community, and indeed, while the professional input remains similar to before, our current pulmonary rehabilitation program is conducted entirely in the community, in co-operation with general practitioners. Full-Text PDF