Jervan Øyvind, Haukeland-Parker Stacey, Gleditsch Jostein, Tavoly Mazdak, Klok Frederikus A, Steine Kjetil, Johannessen Hege Hølmo, Spruit Martijn A, Atar Dan, Holst René, Astrup Dahm Anders Erik, Sirnes Per Anton, Stavem Knut, Ghanima Waleed
Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Physical Medicine and Rehabilitation, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Chest. 2023 Oct;164(4):981-991. doi: 10.1016/j.chest.2023.04.042. Epub 2023 May 5.
Persistent dyspnea, functional limitations, and reduced quality of life (QoL) are common following pulmonary embolism (PE). Rehabilitation is a potential treatment option, but the scientific evidence is limited.
Does an exercise-based rehabilitation program improve exercise capacity in PE survivors with persistent dyspnea?
This randomized controlled trial was conducted at two hospitals. Patients with persistent dyspnea following PE diagnosed 6 to 72 months earlier, without cardiopulmonary comorbidities, were randomized 1:1 to either the rehabilitation or the control group. The rehabilitation program consisted of two weekly sessions of physical exercise for 8 weeks and one educational session. The control group received usual care. The primary end point was the difference in Incremental Shuttle Walk Test between groups at follow-up. Secondary end points included differences in the Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D and Pulmonary Embolism-QoL questionnaires) and dyspnea (Shortness of Breath questionnaire).
A total of 211 subjects were included: 108 (51%) were randomized to the rehabilitation group and 103 (49%) to the control group. At follow-up, participants allocated to the rehabilitation group performed better on the ISWT compared with the control group (mean difference, 53.0 m; 95% CI, 17.7-88.3; P = .0035). The rehabilitation group reported better scores on the Pulmonary Embolism-QoL questionnaire (mean difference, -4%; 95% CI, -0.09 to 0.00; P = .041) at follow-up, but there were no differences in generic QoL, dyspnea scores, or the ESWT. No adverse events occurred during the intervention.
In patients with persistent dyspnea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care. Rehabilitation should be considered in patients with persistent dyspnea following PE. Further research is needed, however, to assess the optimal patient selection, timing, mode, and duration of rehabilitation.
ClinicalTrials.gov; No.: NCT03405480; URL: www.
gov.
肺栓塞（PE）后持续存在呼吸困难、功能受限及生活质量（QoL）下降很常见。康复治疗是一种潜在的治疗选择，但科学证据有限。
基于运动的康复计划能否改善有持续呼吸困难的PE幸存者的运动能力？
这项随机对照试验在两家医院进行。6至72个月前被诊断为PE后有持续呼吸困难且无心肺合并症的患者，按1:1随机分为康复组或对照组。康复计划包括为期8周的每周两次体育锻炼课程和一次教育课程。对照组接受常规护理。主要终点是随访时两组间递增穿梭步行试验的差异。次要终点包括耐力穿梭步行试验（ESWT）、QoL（EQ-5D和肺栓塞-QoL问卷）及呼吸困难（气短问卷）的差异。
共纳入211名受试者：108名（51%）被随机分配至康复组，103名（49%）被分配至对照组。随访时，与对照组相比，分配至康复组的参与者在递增穿梭步行试验中的表现更好（平均差异，53.0米；95%CI，17.7 - 88.3；P = 0.0035）。随访时，康复组在肺栓塞-QoL问卷上的得分更高（平均差异，-4%；95%CI，-0.09至0.00；P = 0.041），但在一般QoL、呼吸困难评分或ESWT方面无差异。干预期间未发生不良事件。
在PE后有持续呼吸困难的患者中，接受康复治疗的患者在随访时的运动能力优于接受常规护理的患者。对于PE后有持续呼吸困难的患者应考虑康复治疗。然而，需要进一步研究以评估康复治疗的最佳患者选择、时机、方式及持续时间。
ClinicalTrials.gov；编号：NCT03405480；网址：www.CLINICALTRIALS.gov
