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      Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

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          Abstract

          Objective

          The aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF).

          Design

          A prospective study.

          Patients

          Seventeen patients diagnosed with IPF.

          Methods

          A home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale), pulmonary function (pulmonary function test), exercise capacity (6-minute walking test, 6MWD), and general health related quality of life (Medical Outcomes Short Form-36) were evaluated.

          Results

          A significant decrease in perceived dyspnea (p = 0.003) and leg fatigue (p < 0.05) severities, and an increase in the 6MWD (p = 0.04) and general health related quality of life scores (health perception, physical role, and emotional status subscores) were found after the program (p < 0.05).

          Conclusion

          Home-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.

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          Most cited references15

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          Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial.

          Pulmonary rehabilitation is beneficial for patients with chronic lung disease. However, long-term maintenance has been difficult to achieve after short-term treatment. We evaluated a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates. Subjects were randomly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions (n = 87) or standard care (n = 85) and followed for 24 months. Except for a slight imbalance between sexes, experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation. During the 12-month intervention, exercise tolerance (maximum treadmill workload and 6-minute walk distance) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days. There were no group differences for other measures of pulmonary function, dyspnea, self-efficacy, generic and disease-specific quality of life, and health care use. By 24 months, there were no significant group differences. Patients returned to levels close to but above prerehabilitation measures. We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation.
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            Assessment of health-related quality of life in patients with interstitial lung disease.

            Health-related quality of life associated with interstitial lung disease has received little attention in clinical studies because there have been no validated methods for directly measuring it. We have assessed the validity of several generic and respiratory-specific quality-of-life instruments in patients with interstitial lung disease. Cross-sectional study. Outpatient pulmonary clinic at a university referral center. Fifty patients with interstitial disease such as idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis, and asbestosis. Patients were administered four quality-of-life questionnaires, the Medical Outcomes Study Short Form 36 (SF-36), the Quality of Well-being scale (QWB), the Chronic Respiratory Questionnaire (CRQ), and the St. George's Respiratory Questionnaire (SGRQ). Patients concomitantly underwent pulmonary function testing and performed a 6-min walk. Validation of these instruments was based on testing an a priori hypothesis that worse quality-of-life scores should correlate with more severe physiologic impairment demonstrated by pulmonary function tests, exercise tolerance on the 6-min walk, and dyspnea scores. Our patients, on average, had a moderate degree of physiologic impairment and demonstrated moderately decreased quality-of-life scores. Scores from all four quality-of-life questionnaires correlated significantly with 6-min walk distance and dyspnea score. Scores from the SF-36, QWB, and SGRQ showed significant correlation with FVC, FEV(1), and diffusing capacity as well. The SF-36 and SGRQ consistently showed the strongest correlation with physical impairment. Our findings indicate that preexisting quality-of-life instruments can be applied to patients with interstitial lung disease and suggest that the SF-36 and the SGRQ, in particular, are sensitive tools for assessing quality of life in these patients. Future intervention studies of patients with interstitial lung disease should consider using these measures.
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              Pulmonary rehabilitation in interstitial lung disease: benefits and predictors of response.

              Data examining the role of pulmonary rehabilitation (PR) in interstitial lung disease (ILD) are limited. We tested the hypothesis that PR can improve functional status and dyspnea in a large group of patients with ILD, and that certain baseline patient variables can predict this improvement. Data from patients who were referred to PR with a diagnosis of ILD were included. Baseline and post-PR variables were recorded, and changes in 6-min walk test (6MWT) distance and dyspnea were evaluated. The impact of baseline variables on change in 6MWT distance and dyspnea were analyzed. A statistically significant difference was seen in both the change in Borg score and 6MWT distance after PR (p < 0.0001). These changes were consistent with previously established clinically significant differences. Baseline 6MWT distance was a significant predictor of change in 6MWT distance (p < 0.0001), with increasing baseline 6MWT distance predicting a smaller improvement after PR. These results suggest that PR should be considered as a standard of care for patients with ILD.
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                Author and article information

                Journal
                Multidiscip Respir Med
                Multidiscip Respir Med
                Multidisciplinary Respiratory Medicine
                BioMed Central
                1828-695X
                2049-6958
                2010
                28 February 2010
                : 5
                : 1
                : 31-37
                Affiliations
                [1 ]School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balcova, Izmir, Turkey
                [2 ]Department of Chest Diseases, Dokuz Eylul University, Balcova, Izmir, Turkey
                Article
                2049-6958-5-1-31
                10.1186/2049-6958-5-1-31
                3463037
                22958625
                b6ec4fa3-37b7-452e-91a6-1dd9a6efd639
                Copyright ©2010 Novamedia srl
                History
                : 12 November 2009
                : 9 December 2009
                Categories
                Original Article

                Respiratory medicine
                home-based pulmonary rehabilitation,quality of life,idiopathic pulmonary fibrosis,exercise capacity

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