ABS63: Pulmonary rehabilitation in the community is effective, but benefits may be distorted by methods of analysis

Abstract

Introduction:

Pulmonary rehabilitation (PR) programmes are increasingly community based, being run by health professionals who may have limited experience of reporting outcomes. The way patient outcome data is analysed and presented can distort the benefits of PR. PR programme reports are increasingly used to justify investment. It is important that they are accurate.

Aims:

To assess the benefits of community based PR, and compare the impact of two methods of analysis on the magnitude of observed improvements.

Subjects and methods:

COPD patients seen by the Plymouth PR programme: baseline assessment; 7 weekly sessions and follow up. Outcome Assessments: Shuttle walking test distance (SWT), Chronic Respiratory Disease Questionnaire (CRDQ): Breathing Problems Questionnaire (BPQ) at baseline and 7 weeks. Analysis of results of all patients attending at each stage including those who subsequently dropped out (group means) were compared to means of individual changes from baseline.

Results:

183 patients were assessed, 151 completed the programme. Mean FEV₁ at baseline: 1.05∓0.4 (n= 117). Mean changes in: SWT (metres) Group 62.8m, individual 51.2 m. Total CRDQ: Group 14.1, individual 13.2; HADS Anxiety: Group −1.3, individual −1.3 Depression: Group −0.8, individual −0.6. SBPQ: Group −1.1, individual −0.7. The mean baseline scores in those who dropped out were lower than means for those who completed the programme, for instance mean SWT of completers was 183m, but drop outs was 124m (p = 0.009).

Conclusions:

Outcome measures from a once weekly, community PR programme demonstrate changes comparable to those of hospital based programmes. The analysis of outcomes should report mean individual changes rather than mean changes between the group attending at baseline and those completing the programme. The difference reflects that those with severe illness are more likely to drop out. This can lead to improvements in outcome being wrongly attributed to the PR programme.

Conflict of interest and funding

Dr Jones receives educational or research grants from GSK; Astra Zeneca; Boehringer-Ingelheim; Pfizer; Ivax; Altana.