Würtemberger G, Hütter B O
Abteilung für Innere Medizin, Pneumologie, Reha-Zentrum Reichshof, Reichshof-Eckenhagen.
Pneumologie. 2001 Feb;55(2):91-9. doi: 10.1055/s-2001-11284.
Health related quality of life (HRQOL) is an important criterion for the evaluation of rehabilitation measures in patients with chronic obstructive pulmonary disease (COPD). The present paper reviews the current literature about the effects of pulmonary rehabilitation on the HRQOL of patients with COPD. The aim is to summarize critically methods, results and unanswered issues of the present research on the effects of pulmonary rehabilitation on HRQOL. The rehabilitation of patients suffering of COPD is mainly based on six types of interventions: 1. long-term oxygen therapy (LTO), 2. pharmacological management, 3. surgical therapy (bilateral reduction of lung volume), 4. physical therapy, 5. nutritional therapy (special diets), and 6. psycho-social interventions (e.g. psychotherapy, training and education). Thirty-one studies could be included in which HRQOL served as an outcome criterion for the rehabilitation of COPD patients. In 14 (45%) studies exclusively a disease-specific measure for the assessment of HRQOL was employed, while in 12 (39%) studies a generic instrument was applied. In the remaining five (16%) studies two ore more measures were used, whereas four of them combined a generic and a disease-specific method. The St. Georges Respiratory Questionnaire (SGRQ) und the Chronic Respiratory Disease Questionnaire (CRDQ) belonged to the group of the specific instruments, while among the generic measures the Sickness Impact Profile (SIP), the Nottingham Health Profile (NHP), the SF-36 and the Quality of Well-Being Scale (QWB) were most frequently used in COPD patients. The surgical bilateral reduction of lung volume, pharmacological therapy, upper extremities muscle training and psychological measures as single interventions proved to have persistent positive effects on the HRQOL. Several rehabilitation programs, composed of a wide variety of different interventions were effective in terms of HRQOL. On the other hand, at follow-up, the short-term positive effects had decreased in two of the three studies, where the rehabilitation took place exclusively in an inpatient setting. However, in three of four programs implemented in an outpatient setting, a persistent positive effect on HRQOL could be demonstrated. In conclusion from the as of yet available findings, we suggest for future studies to use only such measures of HRQOL which have been tested psychometrically in patients with COPD and to combine disease-specific and generic measures. In order to achieve lasting positive effects of rehabilitation on HRQOL, outpatient settings or ambulatory refreshment sessions following rehabilitation on an inpatient basis should be preferred.
健康相关生活质量（HRQOL）是评估慢性阻塞性肺疾病（COPD）患者康复措施的一项重要标准。本文综述了当前有关肺康复对COPD患者HRQOL影响的文献。目的是批判性地总结目前关于肺康复对HRQOL影响的研究方法、结果及未解决的问题。COPD患者的康复主要基于六种干预措施：1. 长期氧疗（LTO）；2. 药物治疗；3. 手术治疗（双侧肺减容）；4. 物理治疗；5. 营养治疗（特殊饮食）；6. 心理社会干预（如心理治疗、培训和教育）。有31项研究纳入其中，这些研究将HRQOL作为COPD患者康复的一项结果标准。在14项（45%）研究中仅采用了一种针对HRQOL评估的疾病特异性测量方法，而在12项（39%）研究中应用了一种通用工具。在其余5项（16%）研究中使用了两种或更多种测量方法，其中4项将通用方法与疾病特异性方法相结合。圣乔治呼吸问卷（SGRQ）和慢性呼吸系统疾病问卷（CRDQ）属于特异性测量工具组，而在通用测量方法中，疾病影响量表（SIP）、诺丁汉健康量表（NHP）、SF-36和幸福感量表（QWB）在COPD患者中使用最为频繁。手术双侧肺减容、药物治疗、上肢肌肉训练和心理措施作为单一干预措施已证明对HRQOL有持续的积极影响。由多种不同干预措施组成的几个康复项目在HRQOL方面是有效的。另一方面，在随访时，三项研究中有两项的短期积极影响有所下降，这两项研究的康复仅在住院环境中进行。然而，在四项门诊实施的项目中有三项对HRQOL有持续的积极影响。根据目前已有的研究结果，我们建议未来的研究仅使用在COPD患者中经过心理测量测试的HRQOL测量方法，并将疾病特异性测量方法与通用测量方法相结合。为了使康复对HRQOL产生持久的积极影响，应优先选择门诊环境或住院康复后的门诊强化治疗。
