Grosbois Jean Marie, Gicquello Alice, Langlois Carole, Le Rouzic Olivier, Bart Frédéric, Wallaert Benoit, Chenivesse Cécile
FormAction Santé, rue Pietralunga, Pérenchies, France ; Service de Pneumologie, CH Béthune, France.
Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille, France.
Int J Chron Obstruct Pulmon Dis. 2015 Sep 25;10:2037-44. doi: 10.2147/COPD.S90534. eCollection 2015.
Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR.
Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient's home from the PR center and the patient's preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient's exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28).
No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months.
Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed.
慢性阻塞性肺疾病（COPD）患者的个性化全球肺康复（PR）管理是有效的，无论康复在何处进行。这项回顾性观察研究的目的是研究在家进行肺康复治疗的COPD患者在管理期间运动能力和生活质量的长期结果。
对211例COPD患者（平均年龄62.3±11.1岁；平均一秒用力呼气量41.5%±17.7%）进行居家肺康复治疗。选择居家肺康复治疗是因为患者家离肺康复中心较远以及患者的偏好。每位患者由一名团队成员每周单独管理一次，共8周，其余时间根据个人行动计划在无监督的情况下继续进行体育锻炼。肺康复计划包括运动训练、治疗性患者教育和自我管理。居家评估包括通过6分钟踏阶试验、计时起立行走试验、十次坐立试验、医院焦虑抑郁评分以及生活质量（视觉简化呼吸问卷，VQ11，毛杰里呼吸衰竭28）来评估患者的运动能力。
在居家肺康复治疗过程中未观察到任何事件或事故。在完成该计划后、6个月和12个月时，6分钟踏阶试验有显著改善，而计时起立行走试验和十次坐立试验在肺康复治疗后和6个月时有改善，但在12个月时没有改善。医院焦虑抑郁评分和生活质量评分在肺康复治疗后有所改善，并且这种改善在6个月和12个月时持续存在。
对未经选择的COPD患者进行居家肺康复治疗在短期内是有效的，并且这种有效性在中期（6个月）和长期（12个月）得以维持。如果能进行所有活动，如运动训练、治疗性教育和自我管理，居家肺康复治疗是门诊管理的一种替代方案。
