Major Stephen, Moreno Marcella, Shelton John, Panos Ralph J
Pulmonary, Critical Care, and Sleep Medicine Division, Cincinnati Veterans Affairs Medical Center (Drs Major and Panos), Pulmonary, Critical Care, and Sleep Medicine Division, University of Cincinnati College of Medicine (Drs Major and Panos), and Pulmonary Rehabilitation Program, Cincinnati Veterans Affairs Medical Center (Ms Moreno, Mr Shelton, and Dr Panos), Cincinnati, Ohio.
J Cardiopulm Rehabil Prev. 2014 Nov-Dec;34(6):420-9. doi: 10.1097/HCR.0000000000000079.
To measure respiratory health and respiratory-related (RR) health care utilization in veterans with chronic obstructive pulmonary disease referred to pulmonary rehabilitation (PR) at the Cincinnati Veterans Administration (VA) Medical Center.
We reviewed the records of 430 patients referred for PR from 2008 to 2010: 78 met inclusion criteria and completed PR (PR group); 92 qualified for PR but declined participation (referral group). All PR participants completed the St. George's Respiratory Questionnaire (SGRQ), BODE index, 6-minute walk test (6MWT), UCSD Shortness of Breath Questionnaire (UCSDSOBQ), Pulmonary Disease Knowledge Test, and self-reported use of short-acting bronchodilators before and after PR. All VA health care encounters during the 12 months before and after PR (PR group) or referral (referral group) were reviewed.
Respiratory health improved after PR: SGRQ (60.6 ± 15.1, 51.1 ± 16.7), BODE (4.65 ± 1.93, 3.41 ± 1.84), 6MWT (497 ± 367 m, 572 ± 397 m), UCSDSOBQ (68.3 ± 21.1, 61.0 ± 20.9), Pulmonary Disease Knowledge Test (75.9 ± 12.4%, 85.9 ± 11.1%), short-acting bronchodilator (22.5 ± 25.3, 12.8 ± 15.6 inhalations per week) (before, after PR; P < .001 for all comparisons). The RR emergency department (ED) visits (0.71 ± 1.44, 0.44 ± 0.86; P = .04) and RR hospitalizations (0.41 ± 0.73, 0.23 ± 0.51; P = .03) (visits/patient/year; pre-PR, post-PR) decreased following PR. RR ED visits and hospitalizations were the same for the PR and referral groups prior to PR but declined post-PR (0.44 ± 0.86, 0.78 ± 1.36 ED visits/patient/year; P = .05) and (0.23 ± 0.51, 0.59 ± 1.20 hospitalizations/patient/year; P = .01). Ninety-four percent of PR participants achieved the minimal clinically important difference in at least 1 univariate scale (Modified Medical Research Council, UCSDSOBQ, SGRQ, and 6MWT); 82%, 2 scales; 59%, 3 scales; and 24%, all 4 scales.
Pulmonary rehabilitation improves respiratory health in veterans with chronic obstructive pulmonary disease and decreases RR health care utilization.
测量在辛辛那提退伍军人事务部（VA）医疗中心接受肺康复（PR）治疗的慢性阻塞性肺疾病退伍军人的呼吸健康状况以及与呼吸相关（RR）的医疗保健利用率。
我们回顾了2008年至2010年被转诊接受PR治疗的430例患者的记录：78例符合纳入标准并完成了PR治疗（PR组）；92例符合PR治疗条件但拒绝参与（转诊组）。所有PR参与者在PR治疗前后均完成了圣乔治呼吸问卷（SGRQ）、BODE指数、6分钟步行试验（6MWT）、加州大学圣地亚哥分校呼吸急促问卷（UCSDSOBQ）、肺病知识测试以及自我报告的短效支气管扩张剂使用情况。对PR组PR治疗前后以及转诊组转诊前后12个月内所有VA医疗保健就诊情况进行了回顾。
PR治疗后呼吸健康状况得到改善：SGRQ（60.6±15.1，51.1±16.7）、BODE（4.65±1.93，3.41±1.84）、6MWT（497±367米，572±397米）、UCSDSOBQ（68.3±21.1，61.0±20.9）、肺病知识测试（75.9±12.4%，85.9±11.1%）、短效支气管扩张剂（22.5±25.3，12.8±15.6次/周）（PR治疗前、后；所有比较P<.001）。PR治疗后RR急诊室（ED）就诊次数（0.71±1.44，0.44±0.86；P=.04）和RR住院次数（0.41±0.73，0.23±0.51；P=.03）（就诊次数/患者/年；PR治疗前、后）减少。PR组和转诊组在PR治疗前RR急诊室就诊次数和住院次数相同，但PR治疗后减少（0.44±0.86，0.78±1.36次急诊室就诊次数/患者/年；P=.05）以及（0.23±0.51，0.59±1.20次住院次数/患者/年；P=.01）。94%的PR参与者在至少1个单变量量表（改良医学研究委员会、UCSDSOBQ、SGRQ和6MWT）上达到了最小临床重要差异；82%在2个量表上达到；59%在3个量表上达到；24%在所有4个量表上达到。
肺康复可改善慢性阻塞性肺疾病退伍军人的呼吸健康状况，并降低RR医疗保健利用率。
