Benefits of an Inpatient Pulmonary Rehabilitation Program: A Prospective Analysis.

Benefits of an Inpatient Pulmonary Rehabilitation Program: A Prospective Analysis Stewart DG, Drake DF, Robertson C, et al (Brooks Health System, Jacksonville, Fla; Virginia Commonwealth University, Medical College of Virginia Campus; Health-South Rehabilitation Hospital of Virginia, Richmond, Va), Arch Phys Med Rehabil. 2001;82:347-352.

The objective of this study was to examine the effects of an inpatient pulmonary rehabilitation program on measures of lung disease, lung function, and hospitalization rates. The subjects were 157 patients (66% women, 34% men; mean age=72.5 [+ or -] 8.8 years) admitted to an acute rehabilitation hospital for pulmonary rehabilitation between February 1995 and June 1998. Most of the subjects (90%) were admitted directly from an acute care hospital. All subjects had moderate to severe chronic obstructive pulmonary disease (COPD), which was characterized by measurements of forced expiratory volume in 1 second of less than 40% of predicted volume. Many subjects had comorbidities of cancer (15.3%) or pneumonia (18.6%).

The dependent measures were total distance and longest distance walked without rest on the Six-Minute Walk Test, supplemental oxygen use, a quality-of-life scale, a test of pulmonary rehabilitation knowledge, discharge disposition, and days hospitalized. The rehabilitation program consisted of hallway walking, treadmill walking, upper- and lower-extremity cycling, training on activities of daily living, and recreational activities performed for 3 hours per day, 5 days per week. The average length of stay was 21 days.

Following the program, 88% of the subjects increased their 6-minute walk distance, and the mean distance walked was 67% greater than at admission (342.3 ft [102.7 m] to 570.8 ft [162.2 m]), which was considered to be significantly greater. In 84% of the subjects, the longest distance walked without rest increased from 268.9 ft (80.6 m) to 485.7 ft (145.7 m). The percentage of patients requiring supplemental oxygen decreased significantly from 76% during the day and 79% at night at baseline to 33% during the day and 57% at night at the conclusion of the study. Quality-of-life measures and knowledge of pulmonary rehabilitation increased significantly. The vast majority (98.8%) of subjects were discharged to their home following the program, and 66% enrolled in follow-up outpatient pulmonary rehabilitation programs.

Hospitalization days decreased significantly following the program, with 67% spending fewer days in the hospital in the 12 months following the program than in the 12 months preceding the program. The mean decrease in hospital days was 11.7, which the researchers calculated as saving $3,000 per subject.

According to the researchers, this study demonstrated that an intensive, inpatient pulmonary rehabilitation program can positively affect exercise ability, quality of life, oxygen use, and hospitalization in patients with COPD.

Anne K Swisher, PT West Virginia University Morgantown, WVa