Léo Blervaque1, Christian Préfaut2, Hélène Forthin3, Francis Maffre3, Marion Bourrelier3, Nelly Héraud4, Matthias Catteau1, Pascal Pomiès1, Dany Jaffuel5, Nicolas Molinari6, Maurice Hayot7, Fares Gouzi8. 1. PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier University, Montpellier, France. 2. Air+R Network, Montpellier University, Montpellier, France. 3. Air+R Network, Montpellier, France. 4. Direction de la recherche clinique et de l'innovation en santé - KORIAN SANTE, 34700, Lodève, France. 5. Department of Pneumology, Montpellier University Hospital, Montpellier, France. 6. IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France. 7. PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France. 8. PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France. f-gouzi@chu-montpellier.fr.
Abstract
BACKGROUND: Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnea in chronic obstructive pulmonary disease (COPD) patients. Maintenance programs can sustain the benefits for 12 to 24 months. Yet, the long-term effects (> 12 months) of pragmatic maintenance programs in real-life settings remain unknown. This prospective cohort study assessed the yearly evolution in the outcomes [6-min walking distance (6MWD), HRQoL, dyspnea] of a supervised self-help PR maintenance program for COPD patients followed for 5 years. The aim was to assess the change in the outcomes and survival probability for 1 to 5 years after PR program discharge in COPD patients following a PR maintenance program supported by supervised self-help associations. METHODS: Data were prospectively collected from 144 COPD patients who followed a pragmatic multidisciplinary PR maintenance program for 1 to 5 years. They were assessed yearly for 6MWD, HRQol (VQ11) and dyspnea (MRC). The 5-year survival probability was compared to that of a control PR group without a maintenance program. A trajectory-based cluster analysis identified the determinants of long-term response. RESULTS: Maintenance program patients showed significant PR benefits at 4 years for 6MWD and VQ11 and 5 years for MRC. The 5-year survival probability was higher than for PR patients without PR maintenance. Two clusters of response to long-term PR were identified, with responders being the less severe COPD patients. CONCLUSIONS: This study provides evidence of the efficacy of a pragmatic PR maintenance program in a real-life setting for more than 3 years. In contrast to short-term PR, long-term PR maintenance appeared more beneficial in less severe COPD patients.
BACKGROUND: Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnea in chronic obstructive pulmonary disease (COPD) patients. Maintenance programs can sustain the benefits for 12 to 24 months. Yet, the long-term effects (> 12 months) of pragmatic maintenance programs in real-life settings remain unknown. This prospective cohort study assessed the yearly evolution in the outcomes [6-min walking distance (6MWD), HRQoL, dyspnea] of a supervised self-help PR maintenance program for COPDpatients followed for 5 years. The aim was to assess the change in the outcomes and survival probability for 1 to 5 years after PR program discharge in COPDpatients following a PR maintenance program supported by supervised self-help associations. METHODS: Data were prospectively collected from 144 COPDpatients who followed a pragmatic multidisciplinary PR maintenance program for 1 to 5 years. They were assessed yearly for 6MWD, HRQol (VQ11) and dyspnea (MRC). The 5-year survival probability was compared to that of a control PR group without a maintenance program. A trajectory-based cluster analysis identified the determinants of long-term response. RESULTS: Maintenance program patients showed significant PR benefits at 4 years for 6MWD and VQ11 and 5 years for MRC. The 5-year survival probability was higher than for PRpatients without PR maintenance. Two clusters of response to long-term PR were identified, with responders being the less severe COPDpatients. CONCLUSIONS: This study provides evidence of the efficacy of a pragmatic PR maintenance program in a real-life setting for more than 3 years. In contrast to short-term PR, long-term PR maintenance appeared more beneficial in less severe COPDpatients.