Primary Care Majorca Department, Son Pisà Primary Health Centre, C/ Vicenç Joan Perello Ribes, 65, Palma de Mallorca, Baleares, Spain.
BMC Fam Pract. 2013 Feb 11;14:21. doi: 10.1186/1471-2296-14-21.
Pulmonary Rehabilitation for moderate Chronic Obstructive Pulmonary Disease in primary care could improve patients' quality of life.
This study aimed to assess the efficacy of a 3-month Pulmonary Rehabilitation (PR) program with a further 9 months of maintenance (RHBM group) compared with both PR for 3 months without further maintenance (RHB group) and usual care in improving the quality of life of patients with moderate COPD.We conducted a parallel-group, randomized clinical trial in Majorca primary health care in which 97 patients with moderate COPD were assigned to the 3 groups. Health outcomes were quality of life, exercise capacity, pulmonary function and exacerbations.
We found statistically and clinically significant differences in the three groups at 3 months in the emotion dimension (0.53; 95%CI0.06-1.01) in the usual care group, (0.72; 95%CI0.26-1.18) the RHB group (0.87; 95%CI 0.44-1.30) and the RHBM group as well as in fatigue (0.47; 95%CI 0.17-0.78) in the RHBM group. After 1 year, these differences favored the long-term rehabilitation group in the domains of fatigue (0.56; 95%CI 0.22-0.91), mastery (0.79; 95%CI 0.03-1.55) and emotion (0.75; 95%CI 0.17-1.33). Between-group analysis only showed statistically and clinically significant differences between the RHB group and control group in the dyspnea dimension (0.79 95%CI 0.05-1.52). No differences were found for exacerbations, pulmonary function or exercise capacity.
We found that patients with moderate COPD and low level of impairment did not show meaningful changes in QoL, exercise tolerance, pulmonary function or exacerbation after a one-year, community based rehabilitation program. However, long-term improvements in the emotional, fatigue and mastery dimensions (within intervention groups) were identified.
ISRCTN94514482.
在初级保健中，针对中度慢性阻塞性肺疾病（COPD）的肺康复治疗可以改善患者的生活质量。
本研究旨在评估为期 3 个月的肺康复（PR）计划加 9 个月维持治疗（RHBM 组）与仅进行 3 个月 PR 治疗而无进一步维持治疗（RHB 组）以及常规护理相比，对中度 COPD 患者生活质量的改善效果。我们在马略卡岛的初级卫生保健机构中进行了一项平行组随机临床试验，其中 97 例中度 COPD 患者被分配到 3 组。健康结局为生活质量、运动能力、肺功能和加重。
我们发现，在常规护理组，情绪维度（0.53；95%CI0.06-1.01）、RHB 组（0.72；95%CI0.26-1.18）和 RHBM 组（0.87；95%CI 0.44-1.30）在 3 个月时以及在 RHBM 组的疲劳维度（0.47；95%CI 0.17-0.78）均存在统计学和临床意义上的显著差异。1 年后，这些差异有利于长期康复组在疲劳（0.56；95%CI 0.22-0.91）、掌握（0.79；95%CI 0.03-1.55）和情绪（0.75；95%CI 0.17-1.33）方面的领域。组间分析仅显示 RHB 组与对照组在呼吸困难维度（0.79 95%CI 0.05-1.52）上存在统计学和临床意义上的显著差异。在加重、肺功能或运动能力方面没有发现差异。
我们发现，在基于社区的康复计划进行 1 年后，患有中度 COPD 且功能损害程度较低的患者在生活质量、运动耐量、肺功能或加重方面没有出现有意义的变化。然而，在干预组内发现了情绪、疲劳和掌握维度的长期改善。
ISRCTN94514482。
