Garrod Rachel, Ford Katie, Daly Cecilia, Hoareau Clare, Howard Michael, Simmonds Claire
School of Physiotherapy, Kingston University, London, UK.
Physiother Res Int. 2004;9(3):111-20. doi: 10.1002/pri.311.
There is significant research supporting the role of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD). However, less is known about real-life clinical rehabilitation services. Data were analysed from a clinical pulmonary rehabilitation service provided in the UK, consisting of seven weeks' twice-weekly training and education.
A retrospective study. Baseline measures consisted of activity of daily living, mood state, spirometry, exercise tolerance using the Incremental Shuttle Walk Test (ISWT) and health status using the St George's Hospital Respiratory Questionnaire (SGRQ). Responders to pulmonary rehabilitation were defined as those with a mean reduction of four points on the SGRQ and a mean increase of 48 metres on the ISWT.
One hundred and eight patients entered the programme and 91 completed it. All outcomes showed statistically and clinically significant change after the rehabilitation programme. Responder analysis showed that 37% of patients achieved benefits for both the SGRQ and the ISWT. Twenty-eight per cent of patients were non-responders for both; 17% benefited for the SGRO only and 14% improved their exercise tolerance. Patients with restrictive disease (n = 11) showed large mean ISWT score of 98.2 m (Standard deviation (SD) 69.4 m) (p < 0.01), as did patients with moderate COPD (n = 30), who scored a mean ISWT change of 77.3 m (SD 92.0 m) (p < 0.01) and a SGRQ score of -7.6 (SD 13.7) (p < 0.01), and those with mild COPD (n = 12), who scored a mean ISWT change of 62.5 m (SD 87.4 m) (p < 0.01) and a mean SGRQ change of -3. 7 (SD 8.1) (p < 0.01). Patients with severe COPD (n = 23) showed a smaller mean change in ISWT of 32.6 m (SD 79.4 m) and in SGRQ of -2.8 (SD 7.1). However, analysis of variance (ANOVA) showed no statistical differences between the groups (p = 0.13).
Clinical pulmonary rehabilitation programmes are effective for most patients. However for patients with more severe impairment, maximal gains may be harder, or take longer, to achieve. Patients with restrictive disease appear to do well, although future trials will be needed to test this supposition.
有大量研究支持肺康复在慢性阻塞性肺疾病（COPD）中的作用。然而，对于实际临床康复服务的了解较少。对英国提供的一项临床肺康复服务数据进行了分析，该服务包括为期七周、每周两次的训练和教育。
一项回顾性研究。基线测量包括日常生活活动、情绪状态、肺量计检查、使用递增往返步行试验（ISWT）评估运动耐力以及使用圣乔治医院呼吸问卷（SGRQ）评估健康状况。肺康复的应答者定义为SGRQ平均降低4分且ISWT平均增加48米的患者。
108名患者进入该项目，91名完成。康复项目后所有结果均显示出统计学和临床意义上的变化。应答者分析表明，37%的患者在SGRQ和ISWT方面均取得了改善。28%的患者在两者上均无应答；17%的患者仅在SGRQ上受益，14%的患者运动耐力得到改善。限制性疾病患者（n = 11）的ISWT平均得分较高，为98.2米（标准差（SD）69.4米）（p < 0.01），中度COPD患者（n = 30）也是如此，他们的ISWT平均变化为77.3米（SD 92.0米）（p < 0.01），SGRQ得分为 -7.6（SD 13.7）（p < 0.01），轻度COPD患者（n = 12）也是如此，他们的ISWT平均变化为62.5米（SD 87.4米）（p < 0.01），SGRQ平均变化为 -3.7（SD 8.1）（p < 0.01）。重度COPD患者（n = 23）的ISWT平均变化较小，为32.6米（SD 79.4米），SGRQ平均变化为 -2.8（SD 7.1）。然而，方差分析（ANOVA）显示各组之间无统计学差异（p = 0.13）。
临床肺康复项目对大多数患者有效。然而，对于损伤更严重的患者，可能更难或需要更长时间才能实现最大程度的改善。限制性疾病患者似乎效果良好，尽管需要未来的试验来验证这一假设。
