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European Journal of Physical and Rehabilitation Medicine 2021 October;57(5):815-23

DOI: 10.23736/S1973-9087.21.06279-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Long-term pulmonary rehabilitation progressively reduces hospitalizations and mortality in patients with severe COPD: a 5-year follow-up

Luis F. REIS 1, 2 , Fernando S. GUIMARÃES 3, Agnaldo J. LOPES 1, 4, Sara L. MENEZES 3, Antônio G. PACHECO 5, Fernanda C. MELLO 6

1 Augusto Motta University Center, Rio de Janeiro, Brazil; 2 Rehabilitation Center, Military Police of the State of Rio de Janeiro, Rio de Janeiro, Brazil; 3 Department of Physical Therapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 4 Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil; 5 Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 6 Institute of Thoracic Diseases, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil



BACKGROUND: Pulmonary rehabilitation (PR) is recognized as a multidisciplinary intervention designed to reduce symptoms, improve functional status, and prevent acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).
AIM: This study was aimed at evaluating the effects of a long-term PR program on the hospitalization rate and mortality of patients with severe and very severe COPD.
DESIGN: Longitudinal, prospective study.
SETTING: Pulmonary rehabilitation program at our institution.
POPULATION: A cohort of 195 patients undergoing a PR program was followed up for 5 years. They were divided into three groups: control (PR<3 months), partial adherence (PR>6 and ≤18 months) and adherence (PR=24 months).
METHODS: This was a prospective study where All patients were evaluated every 6 months (D0, D6, D12, D18 and D24, and mapped annually concerning hospitalizations and mortality). Data were analyzed by medians and interquartile ranges, and Kruskal-Wallis non-parametric comparative tests were applied. Comparisons of time to first admission and time to death were made using the Kaplan-Meier estimators, and the factors associated with these outcomes were modeled using semi-parametric Cox models.
RESULTS: The results demonstrated a significant reduction in the rate of hospitalization and mortality. The protective effect seems to be dependent on the lengths of stay of patients in the PR program.
CONCLUSIONS: A multi-disciplinary, long-term PR program with individually tailored 96-week supervised interventions, reduces hospitalization rates and mortality in patients with severe and very severe COPD in a 5-year follow-up period. This protective effect on hospitalization and mortality is obtained from at least 18 months of intervention. Patients who stay longer in the PR program appear to experience a longer protective effect at the end of treatment.
CLINICAL REHABILITATION IMPACT: This long-term PR program for patients with severe and very severe COPD produced progressively favorable clinical effects, thus reducing the frequency of hospitalizations and mortality in this population.


KEY WORDS: Rehabilitation; Chronic obstructive pulmonary disease; Hospitalization; Mortality

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