Give a Little or Give a Lot?

FOR RELATED ARTICLE, SEE PAGE 967Pulmonary rehabilitation is well-established as an effective nonpharmacologic intervention for people with COPD.1McCarthy B. Casey D. Devane Murphy K. E. Lacasse Y. Pulmonary chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2015; 2: CD003793Google Scholar Comprehensive programs that include assessment, exercise training, and self-management education2Spruit M.A. Singh S.J. Garvey C. et al.An official American Thoracic Society/European Respiratory Society statement: key concepts advances in rehabilitation.Am J Respir Crit Care Med. 2013; 188: e13-e64Crossref PubMed Scopus (1697) Google achieve improvements symptoms, quality of life, capacity can reduce hospitalization, which outcome particular importance to patients.3Zhang Morgan R.L. Alonso-Coello P. al.A systematic review how patients value COPD outcomes.Eur J. 2018; 52: 1800222Crossref (24) However, clinical trials have shown the benefits decline once program has ceased frequently return baseline by 1 year.4Spencer L.M. McKeough Z.J. Maintaining following rehabilitation: achievable or not?.Respirology. 2019; 24: 909-915Crossref (18) Maintenance gains made during proved challenging. It well-accepted ongoing participation necessary,4Spencer but this be difficult a group complex health problems, frequent exacerbations, competing demands on their time. A variety strategies been used attempt better maintain over time, outcomes inconsistent. found supervised were delivered monthly less often not maintaining health-related life (HRQL) after rehabilitation, authors unable draw conclusions regarding more supervision.5Alison J.A. Johnston al.Australian New Zealand Rehabilitation guidelines.Respirology. 2017; 22: 800-819Crossref (105) More recently, intensive approach maintenance (fortnightly sessions supportive phone calls intervening weeks) demonstrated at 2 years HRQL.6Guell M.R. Cejudo Ortega F. al.Benefits long-term severe disease. three-year follow-up.Am 195: 622-629Crossref (53) these are clearly superior those achieved “light touch” such telephone support, pedometer biofeedback, 3-month unsupervised training.4Spencer 967 In issue CHEST, Yohannes al7Yohannes A.M. Dryden S. Casaburi R. Hanania N.A. Long-term COPD: 2-year follow-up study..Chest. 2021; 159: 967-974Abstract Full Text PDF (4) report follow up patient-reported measures completion 8-week program. Measures collected typical real-world assessment including HRQL (St George’s Questionnaire), symptoms (modified medical research council dyspnea scale), psychological well-being (Anxiety Inventory Disease Depression Anxiety Stress Scale). Assessment functional (incremental shuttle walk test) was completed end 8 weeks up. At conclusion expected all measures. Of interest that, up, significant improvement from persisted Questionnaire total symptom impact subscales) Disease) without further intervention. worth noting although statistically improved, did regress toward period rehabilitation. The formal strategy This raises question whether there something about under investigation facilitated sustained still evident years. Was component behavior change, overtly identified, within original supported three-quarters participants leisure activity exercise? All had encouraged undertake least 30 minutes walking every day period. Although no data indicate proportion frequency undertaken, early motivation empowerment independently, safely effectively may contributed program’s success participation4Spencer extension HRQL. self-efficacy, particularly exercise, associated positively HRQL.8Selzler Habash Robson L. Lenton Goldstein Brooks Self-efficacy disease: meta-analysis.Patient Educ Couns. 2020; 103: 682-692Crossref (7) included study defined attending 75% sessions. Noncompletion rates provided, previous literature suggests it could high 30% COPD.9Cox N.S. Oliveira C.C. Lahham A. Holland A.E. referral commonly influenced environment, knowledge, beliefs consequences: using Theoretical Domains Framework.J Physiother. 63: 84-93Crossref (76) Scholar,10Keating Lee What prevents disease rehabilitation? review.Chron Dis. 2011; 8: 89-99Crossref (272) results current thus applicable only who attend regularly successfully complete individuals, required benefit, others whom support necessary, both participation. significantly likely depression,10Keating demonstrates clear individuals if achieved; higher depression scores years.7Yohannes If unusually number able because local absence common barriers attendance,9Cox seen cohort represent what locations. lack control group, recruitment single site makes determine benefit solely due other factors come play. Should we give little lot? facing clinicians choose giving (advice continue exercising) similar pedometers11Wootton S.L. Z. Ng C.L.W. al.Effect feedback 12-month programme randomized controlled trial.Respirology. 23: 60-67Crossref (10) programs,6Guell some patients. Identifying need distinguishing them will regardless important challenge researchers. Optimal characteristics intervention, location delivery, use technology vary across patient groups.4Spencer crucial ensuring enhanced COPD-related hospitalization.12Jenkins A.R. Gowler H. Curtis Holden Bridle Jones A.W. Efficacy care use: meta-analysis.Int Chron Obstruct Pulmon 13: 257-273Crossref (21) findings presented here hope provide impetus development targeted future. Long-Term Benefits Patients With 2-Year Follow-Up StudyCHESTVol. 159Issue 3PreviewOver period, PR provides anxiety life. Short-term dyspnea, depression, stress maintained Full-Text