Evaluation of an Enhanced Pulmonary Rehabilitation Program: A Randomised Controlled Trial.

Abstract

RATIONALE\nPulmonary rehabilitation (PR) is the most effective strategy to improve health outcomes in people with 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.\n\n\nOBJECTIVE\nTo compare a newly developed enhanced pulmonary rehabilitation program (EPR) to a traditional PR program on outcome achievement.\n\n\nMETHODS\nIn this randomized parallel-group controlled trial, PR classes were block randomized to EPR or traditional PR, which were delivered over 16 sessions each. The EPR 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 following PR. Healthcare visits were collected 2 years before PR and 1 year after. Mortality was recorded 1 year after PR.\n\n\nRESULTS\nOf the 207 COPD patients enrolled, 108 received the EPR and 99 traditional PR. Physical activity (steps) and self-efficacy improved from pre- to post-PR in both programs, with no differences between groups. These effects were not sustained at 6 months. Exercise tolerance and HRQoL improved from pre- to post-PR with no between group differences, which were maintained at 6 months. Visits to primary care providers and respiratory specialists decreased in the EPR program relative to traditional PR. EPR was delivered as intended and there was no meaningful cross-contamination between the two programs.\n\n\nCONCLUSIONS\nEnhancing 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 to traditional PR except for reduced resource utilization from primary and specialist physician visits in the EPR program. Clinical trial registered with ClinicalTrials.gov (NCT02917915).