A Prospective Cohort Study on the Effects of Geriatric Rehabilitation Following Acute Exacerbations of COPD.
OBJECTIVES
Older patients with chronic obstructive pulmonary disease (COPD), hospitalized for an acute exacerbation, often do not receive recommended post-acute pulmonary rehabilitation. This underuse might be related to the impaired clinical and functional status of these patients, who are more likely to present with frailty, comorbidities, and disability. Having developed and implemented a geriatric rehabilitation program for these patients (GR_COPD), the primary aim of this study was to investigate the effectiveness of this program.


DESIGN AND INTERVENTION
A prospective cohort study with a 3-month follow-up period. Patients who declined the GR_COPD program were considered as controls.


SETTING AND PARTICIPANTS
The study was conducted at the pulmonary department of 2 hospitals. Patients were eligible when hospitalized as a result of an acute exacerbation of COPD and indicated for the GR_COPD program based on standardized criteria.


METHODS
Primary outcome was defined as change in disease-specific health status measured with the clinical COPD questionnaire (CCQ), secondary outcome as the exacerbation rate ratio during follow-up. To balance potential confounders between the intervention and control group, propensity score-based weighted linear regression analyses were performed.


RESULTS
Of the 158 included patients [78 (49.4%) male, mean age 70.8 (±8.1) years, mean forced expiratory volume in 1 second: 35.5 (±12.8) as % of predicted], 78 received the GR_COPD program. The results of the CCQ showed a significant and clinically relevant treatment effect of -0.56 points [95% confidence interval (CI) -0.89, -0.23; P = .001). Patients in the control group had 2.77 times more exacerbations compared with the intervention group (95% CI 2.13, 3.58; P < .001).


CONCLUSIONS/IMPLICATIONS
This study shows a clinically relevant effect of the GR_COPD program on disease-specific health status and exacerbation rate. Implementation of the program for older patients with severe COPD hospitalized for an acute exacerbation is recommended.
['van Dam van Isselt|Eléonore F|EF|', 'van Eijk|Monica|M|', 'van Geloven|Nan|N|', 'Groenewegen-Sipkema|Karin H|KH|', 'van den Berg|Jan-Willem K|JK|', 'Nieuwenhuys|Cécile M A|CMA|', 'Chavannes|Niels H|NH|', 'Achterberg|Wilco P|WP|']
D000208:Acute Disease D000368:Aged D000369:Aged, 80 and over D016000:Cluster Analysis D005260:Female D005851:Geriatric Nursing D006801:Humans D008297:Male D008875:Middle Aged D017063:Outcome Assessment, Health Care D011446:Prospective Studies D029424:Pulmonary Disease, Chronic Obstructive
Geriatric rehabilitation COPD health status post-acute PR propensity score