Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Respirology. 2011 Nov;16(8):1196-202. doi: 10.1111/j.1440-1843.2011.02029.x.
It is unclear whether the severity of functional limitation resulting from IPF affects the response to pulmonary rehabilitation. The aim of this study was to compare the outcomes of rehabilitation in patients with IPF, who were grouped according to the Medical Research Council (MRC) dyspnoea scale.
Sixty-five subjects (46, 71% men) with stable IPF were enrolled in an 8-week pulmonary rehabilitation programme. Subjects with MRC dyspnoea grades 2, 3 and 4 undertook a supervised outpatient programme, whereas subjects with MRC dyspnoea grade 5 participated in an unsupervised, home-based programme, with review every 2 weeks. The outcome measures included functional exercise capacity (6MWD), health status (Medical Outcomes Study Short Form 36 (SF-36)) and dyspnoea (transition dyspnoea index), which were measured at baseline and immediately after the programme. Hospitalizations for respiratory exacerbations were compared for the 12 months preceding and following the programme.
The number of subjects with MRC dyspnoea grades 2, 3, 4 and 5 were 16 (25%), 17 (26%), 17 (26%) and 15 (23%), respectively. There were differences between these groups in the magnitude of change in 6MWD, SF-36 and transition dyspnoea index (all P < 0.05). Specifically, subjects with MRC dyspnoea grade 2 or 3 demonstrated clinically and statistically significant improvements in 6MWD and SF-36 following rehabilitation (all P < 0.05). In contrast, for all measures, subjects with MRC dyspnoea grade 4 or 5 showed little or no improvement, or deteriorated following rehabilitation. Hospitalizations were reduced following rehabilitation only in subjects with MRC dyspnoea grade 2, 3 or 4 (P<0.05).
The response to pulmonary rehabilitation in subjects with IPF varies depending on the MRC grade of dyspnoea, with little benefit being observed in subjects with severe functional limitation.
特发性肺纤维化（IPF）所致功能受限严重程度对肺康复反应的影响尚不清楚。本研究旨在比较 IPF 患者根据英国医学研究理事会（MRC）呼吸困难量表分组后的康复结局。
纳入 65 例（46 例，71%为男性）稳定期 IPF 患者，参加 8 周肺康复计划。MRC 呼吸困难分级 2、3 和 4 级患者接受门诊监督康复，MRC 呼吸困难分级 5 级患者接受非监督家庭康复，每 2 周复查。主要终点是功能运动能力（6 分钟步行距离，6MWD）、健康状况（健康调查简表 36 项，SF-36）和呼吸困难（过渡呼吸困难指数），于基线和康复计划结束后即刻测量。比较康复前后 12 个月内因呼吸恶化住院的情况。
MRC 呼吸困难分级 2、3、4 和 5 级患者分别有 16 例（25%）、17 例（26%）、17 例（26%）和 15 例（23%）。6MWD、SF-36 和过渡呼吸困难指数的变化程度在这些组之间存在差异（均 P<0.05）。具体而言，MRC 呼吸困难分级 2 或 3 级患者康复后 6MWD 和 SF-36 均有临床和统计学意义上的改善（均 P<0.05）。相比之下，MRC 呼吸困难分级 4 或 5 级患者的所有指标改善甚微或无改善，甚至恶化。仅 MRC 呼吸困难分级 2、3 或 4 级患者的住院率在康复后降低（P<0.05）。
IPF 患者对肺康复的反应因 MRC 呼吸困难分级而异，严重功能受限患者获益甚微。
