Short-course Out-patient Pulmonary Rehabilitation and COPD Exacerbations

Effect of Short Course Out-patient Pulmonary Rehabilitation on the Activity and Frequency of Exacerbations of Patients With Chronic Obstructive Pulmonary Disease.

This study assessed whether a short course pulmonary rehabilitation programme with periodic reinforcement exercise training and phone call reminders would help to increase physical activity in COPD patients and also decrease readmissions for AECOPD.

Objectives: Chronic obstructive pulmonary disease (COPD) is a disease with significant morbidity and incurs heavy utilization of healthcare resources. The direct cost of hospital admissions related to COPD is the single largest source of expenditure in the public hospital system. This study assessed whether a short course pulmonary rehabilitation programme with periodic reinforcement exercise training and phone call reminders would help to increase physical activity in COPD patients and also decrease readmissions for AECOPD. Hypothesis: The above programme can reduce readmissions for AECOPD Design: Randomised control trial. Patients will be randomised to the intervention or usual care group Subjects: Patients discharged from hospital after an episode of acute exacerbation of COPD Study instruments: Activity monitor, quality of life questionnaire Interventions: The Intervention group will receive a short course pulmonary rehabilitation training as out-patient in the physiotherapy department for 4-8 sessions, 2 hours each time, 1-2 times weekly. The training is scheduled in the way that each subject would have at least 4-8 weeks supervised training by trained physiotherapist. Home exercise will be taught and the case manager will give phone calls to the subject every 2 weeks to provide support and reinforcement for having continuous exercise at home for one year. Patients will be invited to attend reinforcement out-patient physiotherapy training once very month or every 2 months if they are willing to attend.

The physiotherapist will provide every patient an individualized physical training programme that fits their cardiopulmonary status. Patients will have the training as out-patient in the physiotherapy department for 4-8 sessions, 2 hours each time, 1-2 times weekly. Home exercise will be taught. Our case manager will give phone calls to the subject every 2 weeks to provide support and reinforcement for having continuous exercise at home for one year. Patients will be invited to attend reinforcement out-patient physiotherapy training once very month or every 2 months if they are willing to attend.

The control group will receive no physiotherapy training by physiotherapist and no phone calls from case manager for reinforcement of home exercise. .

Inclusion Criteria: Patients with COPD exacerbations Exclusion Criteria: History of asthma, lung resection or other significant pulmonary disease like pulmonary fibrosis. Active infection like pulmonary tuberculosis Unable to complete assessment due to physical and/or cognitive impairment Completed a pulmonary rehabilitation program in the previous 24 months. Having short life expectancy like subjects with terminal malignancy or intractable heart failure

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