Evaluation of an Enhanced Pulmonary Rehabilitation Program: A Randomized Controlled Trial

Anne-Marie Selzler; Tina Jourdain; Joshua Wald; Maria Sedeno; Tania Janaudis-Ferreira; Roger Goldstein; Jean Bourbeau; Michael K Stickland

doi:10.1513/AnnalsATS.202009-1160OC

Evaluation of an Enhanced Pulmonary Rehabilitation Program: A Randomized Controlled Trial

Ann Am Thorac Soc. 2021 Oct;18(10):1650-1660. doi: 10.1513/AnnalsATS.202009-1160OC.

Authors

Anne-Marie Selzler^{1

2}, Tina Jourdain², Joshua Wald³, Maria Sedeno^{3

4}, Tania Janaudis-Ferreira^{3

5

6}, Roger Goldstein^{7

8}, Jean Bourbeau^{3

5}, Michael K Stickland^{1

2}

Affiliations

¹ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
² G.F. MacDonald Centre for Lung Health-Covenant Health, Edmonton, Alberta, Canada.
³ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre.
⁴ RESPIPLUS, Montreal, Québec, Canada.
⁵ Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, and.
⁶ School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada.
⁷ Department of Medicine and Physical Therapy, University of Toronto, Toronto, Ontario, Canada; and.
⁸ Respiratory Medicine West Park Healthcare Centre, Toronto, Ontario, Canada.

PMID: 34004123
DOI: 10.1513/AnnalsATS.202009-1160OC

Abstract

Rationale: Pulmonary rehabilitation (PR) is the most effective strategy to improve health outcomes in people with chronic obstructive pulmonary disease (COPD), although it has had limited success in promoting sustained physical activity. PR with a strong focus on disease self-management may better facilitate long-term behavior change. Objectives: To compare a newly developed enhanced PR (EPR) program with a traditional PR program on outcome achievement. Methods: In this randomized parallel-group controlled trial, PR classes were block-randomized to EPR or traditional PR and were delivered over 16 sessions each. The EPR program incorporated new and updated "Living Well with COPD" education modules, which had a stronger focus on chronic disease self-management. Fidelity of the intervention for content and delivery was assessed. Physical activity, self-efficacy, exercise tolerance, and health-related quality of life (HRQoL) were collected before, after, and 6 months after PR. Healthcare visits were collected 2 years before PR and 1 year after. Mortality was recorded 1 year after PR. Results: Of the 207 patients with COPD enrolled, 108 received EPR and 99 received traditional PR. Physical activity (steps) and self-efficacy improved from before to after PR in both programs, with no differences between groups. These effects were not sustained at 6 months. Exercise tolerance and HRQoL improved from before to after PR with no between-group differences and were maintained at 6 months. Visits to primary care providers and respiratory specialists decreased in the EPR program relative to the traditional PR program. EPR was delivered as intended, and there was no meaningful cross-contamination between the two programs. Conclusions: Enhancing PR to have a greater emphasis on chronic disease self-management did not result in a superior improvement of physical activity and health outcomes compared with traditional PR except for reduced resource usage from primary and specialist physician visits in the EPR program.Clinical trial registered with ClinicalTrials.gov (NCT02917915).

Keywords: COPD; healthcare use; physical activity; pulmonary rehabilitation; self-management education.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Exercise
Exercise Tolerance
Humans
Pulmonary Disease, Chronic Obstructive*
Quality of Life*
Self Efficacy

Associated data

ClinicalTrials.gov/NCT02917915