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Early Rehab Doesn't Reduce Readmission Rates in Chronic Respiratory Disease — Physician’s First Watch

Medical News |
July 10, 2014

Early Rehab Doesn't Reduce Readmission Rates in Chronic Respiratory Disease

By Kelly Young

Edited by Susan Sadoughi, MD, and Lorenzo Di Francesco, MD, FACP, FHM

Progressive rehabilitation soon after hospital admission for chronic respiratory disease did not reduce the readmission rate. In fact, it was associated with increased mortality risk, researchers report in The BMJ.

Nearly 400 patients admitted with an acute exacerbation of a chronic respiratory disease (roughly 80% had chronic obstructive pulmonary disease) were randomized either to 6 weeks of usual care or daily rehabilitation consisting of progressive strength and aerobic training and neuromuscular electrical stimulation first in the hospital, then at home.

There was no significant difference in 1-year hospital readmission rates between the groups, at roughly 60%. However, the mortality rate was higher in the intervention group (25% vs. 16% in usual care). Fewer intervention patients agreed to participate in pulmonary rehabilitation at 3 months (14% vs. 22%). The authors write: "It is possible that this reduced uptake was one of the mediating factors explaining the lack of reduction in the rate of admission to hospital and the increased mortality in the intervention group."

They conclude: "Beyond current standard physiotherapy practice, progressive exercise rehabilitation should not be started during the early stages of the acute illness."

Reader Comments (2)

Nicholas Hopkinson MA PhD FRCP Physician, Pulmonary Medicine, Royal Brompton Hospital, London UK

Pulmonary rehabilitation started early post-discharge has an established evidence base witha number needed to treat of 4 to prevent 1 readmission [Puhan - Cochrane library]. It involves exercise supervised by health professionals in a supportive group environment.
The intervention in this study was an unsupervised home walking program and compliance with it was poor. The authors of this paper state clearly; "“we did not provide pulmonary rehabilitation as defined in recent guidelines" and it is vital that this message is not lost.
The study in fact highlights the need to provide proper pulmonary rehabilitation programmes, as defined in evidence-based guidelines and that cutting corners may be ineffective or even harmful.

TIM BEVIN Physician, Family Medicine/General Practice

useful summary. COPD is a difficult condition to improve longterm?

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