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European Journal of Physical and Rehabilitation Medicine 2021 Apr 16

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 a cohort of patients with severe and very 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 Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre, Rio de Janeiro, Brazil; 2 Rehabilitation Center, Military Police of the State of Rio de Janeiro, Rio de Janeiro, Brazil; 3 Physical Therapy Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 4 Postgraduate Programme in Medical Sciences, Rio de Janeiro State University Faculty of Medical Sciences, Rio de Janeiro, Brazil; 5 Oswaldo Cruz Foundation, Scientific Computing Program, Rio de Janeiro, Brazil; 6 Internal Medicine, Institute of Thoracic Diseases School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil


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BACKGROUD: 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.
MATERIALS AND METHODS: This was a prospective study where cohorts of 195 patients undergoing a PR program were followed up for 5 years. They were divided into 3 groups: control (PR = 0 or < 3 months), partial adherence (PR > 6 and ≤ 18 months) and adherence (PR = 24 months). All patients were evaluated every 6 months (D0, D6, D12, D18 and D24, and mapped annually concerning hospitalizations and mortality). Data were analysed by medians and interquartile ranges, and Kruskal-Wallis nonparametric 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 favourable clinical effects, thus reducing the frequency of hospitalizations and mortality in this population.


KEY WORDS: Long-term pulmonary rehabilitation; Chronic obstructive pulmonary disease; Hospitalizations; Mortality

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