A French study published in December 2009 revealed that COPD patients who continued exercising and receiving education/support through an informal maintenance program after a formal pulmonary rehab program demonstrated significant improvements in exercise tolerance, perceived shortness of breath and self-reported quality of life.
In my mind this study reinforces the need for more proactive efforts by the medical community to educate COPD patients (and pre-COPD patients for that matter) about the power of pulmonary rehab and to provide greater ongoing access for these patients to continue their own "maintenance" program at home, a fitness center or other appropriate venue after graduating from an outpatient program. The more pulmonary rehabilitation access, education and guidance COPD patients receive and the longer they receive this combination, the better they feel and perform. Plain and simple.
It is one of the main reasons I created the Breathe Better for Life guide/CD (click here to learn more) – to put the knowledge of the principles and practices of pulmonary rehabilitation in the hands of people who struggle to breathe so they have a fighting chance of maintaining or improving how they feel throughout their lifetime. It's also why I continue to investigate and develop new pulmonary rehab tools, technology and publishing products - to help the medical community meet this clearly growing need.
In this particular study, the research team led by Gregory Moullec and G. Minot at the University of Montpellier in Montpellier, France, set out to determine whether COPD patients graduating from a typical pulmonary rehab program would maintain or increase conditioning benefits and quality of life survey scores by continuing the practices and principles learned in the pulmonary rehab program (Moullec G, Minot G. An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life. Clin Rehabil Online. December 21, 2009). Full text of the study is available for purchase by clicking here.
In doing so, the researchers first screened moderate to severe COPD patients and yielded 27 subjects who completed the study. All 27 patients went through an intensive 4 week outpatient pulmonary rehab program (20 sessions over the 4 week period). After graduation, they split their study group of 27 COPD patients into two different panels. In one group, 16 graduating COPD patients were provided what the researchers deemed "usual after care". In short, this group received a letter upon graduation outlining a recommended home-based exercise program and sent on their way to self-manage (or not).
The other group of 11 COPD patients joined a regional health network in their local area linked with a self-help association comprised of former pulmonary rehab graduates. With these resources at hand, the second group, denoted by the researchers as the "integrated care group" continued to go to exercise sessions at a local gym supervised by a trainer of sorts with experience in working with people who suffer from chronic disease (referred to in the study as a teacher of adapted physical activities). This second group also received periodic health education visits by representatives of the regional health network and periodic psychologist visits at a local community center.
The researchers evaluated the two groups' physical conditioning and quality of life ratings at 6 months and 12 months after graduation. The results of the two groups are very telling. For example, in one of the prime measures of exercise capacity, the six minute walk test (6MWT), patients from both groups saw their mean six minute walk distances (6MWD) rise at the end of the formal 4 week pulmonary rehab program by 45-52 meters (11-13% improvement) compared to their performance on a 6MWT at the beginning of the program.
However, 6 months and 12 months after graduating the formal rehab program, the "usual after care" group experienced an 8% DROP in 6MWD. In contrast, the "integrated care group" demonstrated an 8% RISE in 6MWD. What's driving the difference? In the researchers view, it is the ongoing commitment of support resources for the "integrated care group". And these same statistically significant differences were demonstrated in nearly all of the measured elements of the study – from perceived shortness of breath to peak exercise load to self-reported quality of life scores, and so on.
The practical reality is that providing these ongoing support resources in today's U.S. health care environment is difficult if not impossible from the standpoints of insurance reimbursement, practitioner capacity and facility capacity.
But what's the alternative? Send people off with a letter to go at it alone? Wait until the patient has a breathing exacerbation event that lands them back in the ER? Forget about them and move on to the next patient?
I don't think so, and I know many pulmonary rehab practitioners don't think so either. But until someone finds a way to dramatically broaden access and/or lower cost of providing pulmonary rehab type services (which, by the way, I'm working on one potential solution currently), graduating COPD patients have nowhere to turn and scant information to use to pursue a maintenance program on their own. My Breathe Better for Life guide/CD is a step in the right direction but it is only a step. Much more is needed if respiratory care professionals truly want to make a noticeable dent in helping people breathe better for the long term.
No comments:
Post a Comment