Wijkstra P J, Ten Vergert E M, van Altena R, Otten V, Kraan J, Postma D S, Koëter G H
Rehabilitation Centre Beatrixoord, Haren, The Netherlands.
Thorax. 1995 Aug;50(8):824-8. doi: 10.1136/thx.50.8.824.
BACKGROUND--Pulmonary rehabilitation has been shown to have short term subjective and objective benefits for patients with chronic obstructive pulmonary disease (COPD). However, appropriately controlled studies have not previously been performed, nor have the benefits of different types of continuation programme for rehabilitation been investigated. Both these problems have been addressed in a single study of the long term effects of once monthly physiotherapy versus once weekly physiotherapy at home after a comprehensive home rehabilitation programme on quality of life and exercise tolerance in patients with COPD. METHODS--Thirty six patients with severe airways obstruction (mean SD) forced expiratory volume in one second (FEV1) 1.3(0.4) 1, FEV1/inspiratory vital capacity (IVC) 37.2(7.9)%) were studied. Twenty three patients followed a rehabilitation programme at home for 18 months consisting of physiotherapy and supervision by a nurse and general practitioner. During the first three months all 23 patients visited the physiotherapist twice a week for a 0.5 hour session. Thereafter, 11 patients (group A) received a session of physiotherapy once weekly while 12 patients (group B) received a session of physiotherapy once a month. The control group C (13 patients) received no rehabilitation at all. Quality of life was assessed by the Chronic Respiratory Questionnaire, exercise tolerance by the six minute walking distance, and lung function by FEV1 and IVC. Outcome measures were assessed at baseline and at three, six, 12, and 18 months. RESULTS--Long term improvements in quality of life were found in patients in groups A and B, but not in those in group C compared with baseline, but these only reached significance in group B at all time points. Patients in group B had a higher quality of life than those in group C only at three and 12 months. There was a decrease in both six minute walking distance (at 12 and 18 months) and IVC (at three, 12, and 18 months) in patients in group C compared with the baseline measurement. Between groups analysis showed no differences for six minute walking distance, FEV1, and IVC. CONCLUSIONS--This study is the first to show that rehabilitation at home for three months followed by once monthly physiotherapy sessions improves quality of life over 18 months. The change in quality of life was not associated with a change in exercise tolerance.
背景——肺康复已被证明对慢性阻塞性肺疾病（COPD）患者有短期主观和客观益处。然而，此前尚未进行过适当对照的研究，也未对不同类型的康复延续计划的益处进行调查。在一项关于COPD患者在家接受全面康复计划后，每月一次物理治疗与每周一次物理治疗对生活质量和运动耐量的长期影响的单一研究中，上述两个问题均得到了解决。
方法——研究了36例严重气道阻塞患者（一秒用力呼气容积（FEV1）均值±标准差为1.3(0.4)L，FEV1/吸气肺活量（IVC）为37.2(7.9)%）。23例患者在家接受了为期18个月的康复计划，包括物理治疗以及护士和全科医生的监督。在最初三个月里，所有23例患者每周两次拜访物理治疗师，每次治疗0.5小时。此后，11例患者（A组）每周接受一次物理治疗，12例患者（B组）每月接受一次物理治疗。对照组C（13例患者）未接受任何康复治疗。通过慢性呼吸问卷评估生活质量，通过6分钟步行距离评估运动耐量，通过FEV1和IVC评估肺功能。在基线以及3、6、12和18个月时评估结果指标。
结果——与基线相比，A组和B组患者的生活质量有长期改善，而C组患者没有，但这些改善仅在B组所有时间点均达到显著水平。B组患者仅在3个月和12个月时生活质量高于C组患者。与基线测量相比，C组患者的6分钟步行距离（在12个月和18个月时）和IVC（在3、12和18个月时）均有所下降。组间分析显示，6分钟步行距离、FEV1和IVC无差异。
结论——本研究首次表明，在家进行三个月的康复治疗，随后每月进行一次物理治疗，可在18个月内改善生活质量。生活质量的变化与运动耐量的变化无关。
