Although one purpose of pulmonary rehabilitation is to enhance patients' performance, perceived difficulty in assessing functional status has discouraged its measurement as an outcome event in efficacy studies of pulmonary rehabilitation. METHODS: We sought to address this shortcoming by evaluating the efficacy of a 12-session, 6-week, comprehensive rehabilitation program in 16 patients with severe lung disease (FEV1 = 0.94±0.42 L [mean ± standard deviation]), assessing changes in spirometry, oxygen saturation, 6-minute walk distance, and functional performance as measured by three scales (Medical Research Council Index, Modified Pneumoconiosis Research Unit Score, and the Modified Dyspnea Index). RESULTS: Although no improvement in airflow or oxygen saturation occurred, mean 6-minute walk distance increased by 27%, and the rehabilitation program did confer functional benefits, as reflected by significant improvement in all three functional status scores. CONCLUSION: Pulmonary rehabilitation of patients with chronic lung disease can enhance their walking capacity and functional status as measured by the three scales. Our comparison of the scores on the three functional scales suggests that the Modified Dyspnea Index may be the most sensitive measure of changes in patients' functional status.
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References
1.
MoserKM, BokinskyGE, SavageRT, ArchibaldCJ, HansenPR. Results of a comprehensive rehabilitation program. Arch Intern Med1980;140:1596–1601.
2.
ChristieD.Physical training in chronic obstructive lung disease. Br Med J1968;2:150–151.
3.
BelmanMJ, KrendreganBA. Physical training fails to improve ventilatory muscle endurance in patients with chronic obstructive pulmonary disease. Chest1982;81:440–443.
4.
NicholasJJ, GilbertR, GabeR, AuchinclossJH. Evaluation of an exercise therapy program for patients with chronic obstructive pulmonary disease. Am Rev Respir Dis1970;102:1–9.
5.
VyasMN, BanisterEW, MortonJW, GrzybowskiS.Response to exercise in patients with chronic airway obstruction. Am Rev Respir Dis1971;103:390–400.
6.
PaezPN, PhillipsonEA, MasangkayM, SprouleBJ. The physiologic basis of training patients with emphysema. Am Rev Respir Dis1967;95:944–953.
7.
MungallIPF, HainsworthR.An objective assessment of the value of exercise training to patients with chronic obstructive airways disease. Q J Med1980;193:77–85.
8.
SinclairDJM, IngramCG. Controlled trial of supervised exercise training in chronic bronchitis. Br Med J1980;1:519–521.
9.
CockcroftAE, SaundersMJ, BerryG.Randomized controlled trial of rehabilitation in chronic respiratory disability. Thorax1981;36:200–203.
10.
McGavinCR, GuptaSP, LloydEL, McHardyGJR. Physical rehabilitation for the chronic bronchitic: Results of a controlled trial of exercises in the home. Thorax1977;32:307–311.
11.
GuyattGH, BermanLB, TownsendM.Long-term outcome after respiratory rehabilitation. Can Med Assoc J1987;137:1089–1095.
12.
GuyattGH, BermanLB, TownsendM, PugsleySO, ChambersLW. A measure of quality of life for clinical trials in chronic lung disease. Thorax1987;42:773–778.
13.
HolleRHO, WilliamsDV, VandreeJC, StarksGL, SchoeneRB. Increased muscle efficiency and sustained benefits in an outpatient community hospital-based pulmonary rehabilitation program. Chest1988;94:1161–1168.
14.
DegreS, SergtselsR, MessinR, . Hemodynamic responses to physical training in patients with chronic lung disease. Am Rev Respir Dis1974;110:395–402.
15.
Medical Research Council. Committee on research into chronic bronchitis. Instructions for the use of the questionnaire on respiratory symptoms. Devon, England: WJ Holman, 1966.
16.
StollerJK, FerrantiR, FeinsteinAR. Further specification and evaluation of a new clinical index for dyspnea. Am Rev Respir Dis1986;134:1129–1134.
17.
MahlerDA, WeinbergDH, WellsCK, FeinsteinAR. The measurement of dyspnea: Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest1984;85:751–758.
18.
American Thoracic Society. Recommended respiratory disease questionnaires for use with adults and children in epidemiologic research. Am Rev Respir Dis1978;118 (Suppl):7–52.
19.
KramerMS, FeinsteinAR. Clinical biostatistics: LIV. The biostatistics of concordance. Clin Pharm Ther1981;29:111–123.
20.
FeinsteinAR, JosephyBR, WellsCK. Scientific and clinical problems in indexes of functional disability. Ann Intern Med1986;105:413–420.
21.
MahlerDA, MatthayRA, SnyderPE, WellsCK, LokeJ.Sustained-release theophylline reduces dyspnea in irreversible obliterative airways disease. Am Rev Respir Dis1985;131:22–25.
22.
GuyattGH, TownsendM, PugsleySO, . Bronchodilators in chronic air flow limitation. Effects on airway function, exercise capacity, and quality of life. Am Rev Respir Dis1987;135:1069–1074.
23.
McGavinCR, ArtvinliM, NaoeH, McHardyGJR. Dyspnea, disability, and distance walked: Comparison of estimates of exercise performance in respiratory disease. Br Med J1978;2:241–243.
24.
CampbellEJM, HowellJBL. The sensation of breathlessness. Br Med Bull1963;19:36–40.
25.
GuyattGH. The use of the six-minute walk test as an outcome measure in clinical trials in chronic heart failure. Heart Failure1987;Oct/Nov:211–217.
26.
GuyattGH, PugsleySO, SullivanMJ, . Effect of encouragement on walking test performance. Thorax1984;39:818–822.
