Short-Term Effects of Comprehensive Pulmonary Rehabilitation and its Maintenance in Patients with Idiopathic Pulmonary Fibrosis: A Randomized Controlled Trial

Abstract

The recommendation for pulmonary rehabilitation (PR) in idiopathic pulmonary fibrosis (IPF) is weak with low-quality evidence. Therefore, the aim of this study is to investigate short-term PR effects and their maintenance after a 3-month follow-up. Fifty-four IPF patients were randomized into a group receiving a 3-week comprehensive, inpatient PR (n = 34, FVC: 74 ± 19% pred.) or usual care (UC) (n = 17, FVC: 72 ± 20%pred.). Outcomes were measured at baseline (T1), after intervention (T2), and 3 months after T2 (T3). A 6-min walk distance (6MWD) was used as the primary outcome and chronic respiratory disease questionnaire (CRQ) scores as the secondary outcome. Change in 6MWD from T1 to T2 (Δ = 61 m, 95% CI (18.5–102.4), p = 0.006) but not from T1 to T3 (∆ = 26 m, 95% CI (8.0–61.5), p = 0.16) differed significantly between groups. Higher baseline FVC and higher anxiety symptoms were significant predictors of better short-term 6MWD improvements. For the change in CRQ total score, a significant between-group difference from T1 to T2 (∆ = 3.0 pts, 95% CI (0.7–5.3), p = 0.01) and from T1 to T3 (∆ = 3.5 pts, 95% CI (1.5–5.4), p = 0.001) was found in favour of the PR group. To conclude, in addition to the short-term benefits, inpatient PR is effective at inducing medium-term quality of life improvements in IPF. PR in the early stages of the disease seems to provoke the best benefits.

Effectiveness of Pulmonary Rehabilitation in Interstitial Lung Disease, Including Coronavirus Diseases: A Systematic Review and Meta-analysis

“…The literature search retrieved 12,214 articles, which were reviewed based on the title and abstract after discarding duplicates. Finally, 11 RCTs 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 met the inclusion criteria and were selected for this systematic review and meta-analysis ( fig 1 ), including a total sample of 637 participants. Excluded studies with reasons for exclusion are available in supplementary table S1 (available online only at http://www.archives-pmr.org/ ).…”

“…As evaluated by Cochrane Collab ' f R T 18.2 % of the studies showed a high risk of bias, 31,37 72.7 % some concerns 21, 32-36, 38, 39 and 9,1 % a low risk of bias. 30 When studies were analysed by individual domains, 91% of them had shortcomings in the selection of the reported results domain 21,[31][32][33][34][35][36][37][38][39] (Supplementary Figure S1).…”

Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study

“…Currently, there is some evidence that suggests that the development of a fibrotic lung disease as an outcome of COIVD-19 is also a serious concern [33,34]. Since our study was not randomized and does not contain a COVID-19 control group without PR we would like to draw an indirect comparison by using a group of idiopathic pulmonary fibrosis (IPF) patients from a former study of our working group where the same outcome measures were assessed [35]. [36].…”

Protocol for long-term effect of pulmonary rehabilitation under nintedanib in idiopathic pulmonary fibrosis

“…Previous studies on PR in patients with IPF demonstrated a short-term effect on exercise capacity, dyspnea, and health-related quality of life [28]. However, few studies have evaluated the long-term effects of PR with inconsistent results [13][14][15][16]. Disease progression of IPF and acute respiratory events during and after PR might interfere with the long-term effect of PR [15].…”

“…Pulmonary rehabilitation (PR) is a comprehensive intervention, which mainly includes structured and supervised exercise training and education that has been clearly demonstrated to reduce dyspnea, increase exercise capacity, and improve health-related quality of life in individuals with chronic obstructive pulmonary disease (COPD) [10]. The effect of PR has been shown in patients with IPF [11][12][13]; however, these benefits are reportedly moderate and transient [14]. Although some long-term benefits have been reported [15,16], biases such as a low number of patients and intermingling of interstitial lung disease other than IPF could not be excluded.…”