The effectiveness of a structured education pulmonary rehabilitation programme for improving the health status of people with moderate and severe chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial

Abstract

ObjectiveTo evaluate the effectiveness of a structured education pulmonary rehabilitation programme on the health status of people with chronic obstructive pulmonary disease (COPD).DesignTwo-arm, cluster randomised controlled trial.Setting32 general practices in the Republic of Ireland.Participants350 participants with a diagnosis of moderate or severe COPD.InterventionExperimental group received a structured education pulmonary rehabilitation programme, delivered by the practice nurse and physiotherapist. Control group received usual care.Main outcome measureHealth status as measured by the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12–14 weeks postcompletion of the programme.ResultsParticipants allocated to the intervention group had statistically significant higher mean change total CRQ scores (adjusted mean difference (MD) 1.11, 95% CI 0.35 to 1.87). However, the CI does not exclude a smaller difference than the one that was prespecified as clinically important. Participants allocated to the intervention group also had statistically significant higher mean CRQ Dyspnoea scores after intervention (adjusted MD 0.49, 95% CI 0.20 to 0.78) and CRQ Physical scores (adjusted MD 0.37, 95% CI 0.14 to 0.60). However, CIs for both the CRQ Dyspnoea and CRQ Physical subscales do not exclude smaller differences as prespecified as clinically important. No other statistically significant differences between groups were seen.ConclusionsA primary care based structured education pulmonary rehabilitation programme is feasible and may increase local accessibility to people with moderate and severe COPD.Trial registrationISRCTN52403063.

Programas educativos en pacientes con Enfermedad Pulmonar Obstructiva Crónica. Revisión integradora

“…Protocolos de investigación sin resultados (n=7) (15)(16)(17)(18)(19)(20)(21) incluían a pacientes con EPOC y pacientes sanos (n=3) (22)(23)(24) los pacientes asignados al grupo control no tenían una atención convencional (n=7) (25)(26)(27)(28)(29)(30)(31) estudio repetido (n=5) (32)(33)(34)(35)(36) la intervención era un programa de canto (n=1) (37) , no tenía una intervención educativa (n=2) (38,39) se centraba principalmente en un programa de rehabilitación pulmonar basado en ejercicios físicos (n=3) (40)(41)(42) , se basaba en un abstract de un congreso (n=1) (43) u otros cuyo objetivo era validar un cuestionario para la tos (n=1) (44) . Se realizó una búsqueda manual de las referencias de los 28 artículos que cumplían los criterios de selección (5,45-71) con la obtención de 4 artículos (72)(73)(74)(75) …”

The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial

“…Two patients in the intervention group and six patients in the control group died over the course of the trial and are excluded from the analysis, leaving 342 (98%) for the statistical analysis 9. The primary outcome in the clinical analysis was change in disease-specific health status from baseline to follow-up, as measured using the CRQ 8.…”

“…The SEPRP consisted of a 2 hour group-based session each week for 8 weeks delivered jointly by practice nurses and physiotherapists and was compared in the trial to usual practice in primary care. The primary outcome in the clinical analysis was change in disease-specific health status from baseline to follow-up, as measured using the Chronic Respiratory Questionnaire (CRQ) instrument,8 with results indicating a significant improvement in health status for patients who received the intervention relative to the control of usual care 9…”

Clinical highlights from the 2013 ERS Congress in Barcelona

“…Patients allocated to the intervention had a significantly higher mean change in total Chronic Respiratory Questionnaire scores and the programme was feasible in primary care [95].…”