Research compares pulmonary rehabilitation in community with hospital settings
News release from NETSCC, HTA
17 February 2010
The provision of group based pulmonary rehabilitation in a community setting, for chronic obstructive pulmonary disease, is as effective as hospital rehabilitation suggests research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme.
Pulmonary rehabilitation is a well established treatment programme of supervised exercises and education to improve the function and quality of life of patients with chronic lung disease, predominantly caused by smoking. Currently treatment is usually carried out in a hospital setting. However, the benefits of this treatment are progressively lost once the course terminates. This has led to a search for ways to prolong its benefit, including intensive strategies such as repeated courses of rehabilitation and weekly supervised rehabilitation.
“Whilst these have shown promise, they are expensive and there is no evidence on the cost-effectiveness of such approaches,” says lead researcher Dr Rod Lawson. “A community based programme could potentially produce a change in lifestyle and more sustained benefits, but it’s only sensible to check whether this really works before making wholesale changes.”
The clinical trial conducted by researchers at the Royal Hallamshire Hospital in Sheffield, compared community versus hospital rehabilitation for chronic obstructive pulmonary disease to see if one is superior to the other. Over an 18 month period 240 patients were randomised to receive either community or hospital rehabilitation. The researchers measured exercise capacity, quality of life and the use of healthcare resources. These groups were then split further and received routine, standard care or additional telephone calls for encouragement and advice to assess whether the improvements from rehabilitation could be prolonged.
They found that there was no significant difference in improvement between the groups. Telephone follow up did not significantly alter continuation of exercise, but disease related quality of life was better maintained after telephone follow up compared to standard care. The economic analysis did not favour either hospital or community settings, but did find follow up with telephone encouragement might be cost-effective, and suggests further research into this could be undertaken.
“Our research did not show that either intervention was superior, but was able to establish that the level of cost effectiveness was similar and so optimum provisions will be dependent on local factors,” says Dr Lawson. “What was highlighted was that whilst group pulmonary rehabilitation was effective in either setting, there were many people who could have benefitted but were unwilling to take up the treatment, for a variety of reasons. Increasing uptake has a large potential for improving public health, and is likely to be more important than minor changes in the rehabilitation programme itself."
To view the full details of this project visit www.hta.ac.uk/1316
Notes for editors
1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme commissions research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 530 issues published to date. The journal’s 2009 Impact Factor (6.91) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk
2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
Contact details
Naomi Williams, Programme Manager (Communications)
Telephone: 02380 595 646, Email: N.E.Williams@southampton.ac.uk
Kelly Waterman, Assistant Programme Manager (Communications)
Telephone: 02380 597 376, Email: k.waterman@southampton.ac.uk
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