S25 The Effects of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Abstract

Background There is good evidence that pulmonaryrehabilitation (PR) provides benefit for patients with chronicobstructive pulmonary disease (COPD) in terms of quality of life anddaily functioning. However it is generally accepted that thebenefits diminish over time. Methods We conducted a randomisedcontrolled parallel study of a maintenance programme, followingstandard PR, consisting of a two hour session of education andstrength and endurance training every 3 months versus standard care.Measurements were made, at baseline (prior to a standard PRprogramme), at randomisation (after successful completion of a PRprogramme) and after 12 months, of the chronic respiratoryquestionnaire (CRQ), endurance shuttle walk test (ESWT), EuroQol(EQ5D), hospital anxiety and depression score (HADS) and activityquestionnaires. CRQ was also completed every 3 months by post.Results 250 (139 male) patients, mean (SD) age of 69.2 (9.2) years,FEV1 41 (16)% predicted, provided informed consent to participate inthe study. The mean (95% CI) improvement in CRQ following theinitial PR was 0.76 (0.59, 0.93) units. 148 patients entered therandomised part of the study. There remained a significantimprovement in CRQ dyspnoea at 12 months compared to baseline forthe group as a whole. However, there was no statisticallysignificant differences detected between the intervention andcontrol groups for the CRQ dyspnoea score, which amounted to 0.19(-0.26, 0.64) units, or other domains of the CRQ. There was nodifference in the ESTW distance between the two groups (109.1(-100.1 to 318.2) metres) or HADS (-0.2 (-2.41,2) units). There wasa higher level of self-reported activity, according to the visualanalogue score of 16.2/100, in the maintenance group but not thereported metabolic equivalent (MET)-minutes per week. There was nodifference in any of the CRQ measures at any of 3 monthlymeasurements between the intervention and control groups ConclusionA maintenance programme of 3monthly 2 hour sessions does not improveoutcomes in patients with COPD after 12 months. We cannot recommendthat our maintenance programme is adopted. It is likely that amaintenance programme should commence earlier than 3 months andpossibly be more intensive.