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Title: | Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and COPD: A Propensity-Matched Real-World Study |
Authors: | Nolan, CM Polgar, O Schofield, SJ Patel, S Barker, RE Walsh, JA Ingram, KA George, PM Molyneaux, PL Maher, TM Man, WDC |
Keywords: | COPD;idiopathic pulmonary fibrosis;prognosis;pulmonary rehabilitation |
Issue Date: | 23-Oct-2021 |
Publisher: | Elsevier Inc under license from the American College of Chest Physicians. |
Citation: | Nolan, C.M. et al. (2022) 'Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and COPD: A Propensity-Matched Real-World Study', Chest, 161 (3), pp. 728 - 737. doi: 10.1016/j.chest.2021.10.021. |
Abstract: | Cpyright © 2021 The Author(s). Background: The adherence to and clinical efficacy of pulmonary rehabilitation in idiopathic pulmonary fibrosis (IPF), particularly in comparison with COPD, remains uncertain. The objectives of this real-world study were to compare the responses of patients with IPF with a matched group of patients with COPD undergoing the same supervised, outpatient pulmonary rehabilitation program and to determine whether pulmonary rehabilitation is associated with survival in IPF. Research Question: Do people with IPF improve to the same extent with pulmonary rehabilitation as a matched group of individuals with COPD, and are noncompletion of or nonresponse to pulmonary rehabilitation, or both, associated with 1-year all-cause mortality in IPF? Study Design and Methods: Using propensity score matching, 163 patients with IPF were matched 1:1 with a control group of 163 patients with COPD referred for pulmonary rehabilitation. We compared between-group pulmonary rehabilitation completion rates and response. Survival status in the IPF cohort was recorded over 1 year after pulmonary rehabilitation discharge. Cox proportional hazards regression explored the association between pulmonary rehabilitation status and all-cause mortality. Results: Similar pulmonary rehabilitation completion rates (IPF, 69%; COPD, 63%; P = .24) and improvements in exercise response were observed in both groups with no significant mean between-group differences in incremental shuttle walk test (ISWT) change (mean, 2 m [95% CI, –18 to 22 m]). Pulmonary rehabilitation noncompletion (hazard ratio [HR], 5.62 [95% CI, 2.24-14.08]) and nonresponse (HR, 3.91 [95% CI, 1.54-9.93]) were associated independently with increased 1-year all-cause mortality in IPF. Interpretation: This real-word study demonstrated that patients with IPF have similar completion rates and magnitude of response to pulmonary rehabilitation compared with a matched group of patients with COPD. In IPF, noncompletion of and nonresponse to pulmonary rehabilitation were associated with increased all-cause mortality. These data reinforce the benefits of pulmonary rehabilitation in patients with IPF. |
Description: | Supplementary data available at: https://journal.chestnet.org/cms/10.1016/j.chest.2021.10.021/attachment/814ea172-99e4-4122-8fd1-15c25422db75/mmc1.pdf (21MB). |
URI: | https://bura.brunel.ac.uk/handle/2438/25550 |
DOI: | https://doi.org/10.1016/j.chest.2021.10.021 |
ISSN: | 0012-3692 |
Appears in Collections: | Dept of Health Sciences Research Papers |
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FullText.pdf | Copyright © 2021 The Author(s). Published by Elsevier Inc under license from the American College of Chest Physicians. User License: Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0). | 517.17 kB | Adobe PDF | View/Open |
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