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Effectiviteit van een revalidatieprogramma voor patienten met astma en COPD uitgevoerd in de eerstelijnsgezondheidsszorg [Dutch]
Cambach W, Chadwick-Straver RVM, Wagenaar RC, van Keimpema ARJ
Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 1998;108(2):26-36
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIM: To evaluate differences in efficacy between a 3-month course of rehabilitation plus medication and medication alone in patients with asthma and chronic obstructive pulmonary disease (COPD). SETTING: Eight community-based physiotherapy practives. SUBJECTS: Sixty-six subjects aged between 18 and 75 years with complaints of diminished capacity for activities of daily living and breathless caused by airway obstruction, and a PaO2 higher than 65 mmHg and a pCO2 lower than 45 mmHg at rest of after exercise were included. Subjects were screened and selected by chest physicians. METHOD: The rehabilitation programme consisted of exercise training, patient education, breathing retraining, mucus evacuation techniques, relaxation techniques, and recreational activities. Subjects were divided into a COPD group and an asthma group. In a randomized controlled trial with a crossover design, the effects of the rehabilitation programme were evaluated 3 months and 6 months after baseline measurements in terms of exercise tolerance and quality of life. Exercise tolerance was assessed by means of an endurance bicycle ergometer test, a submaximal bicycle ergometer test, and a 6-minute walking test. Quality of life was evaluated by means of the Chronic Respiratory Disease Questionnaire (CRQ). Specialized community nurses took part in the education programme. RESULTS: The subjects who started with rehabilitation showed significant improvements in endurance time (421s), heart rate (6 beats/min), walking distance (39m), and total CRQ score (17 points) compared to the control group after 3 months. A within-group analysis showed that these improvements were still significant after 6 months, indicating follow-up effects. The improvements were similar in subjects with asthma or COPD, with the exception of the greater improvements in walking distance seen in subjects with asthma. The improvements in exercise tolerance were not significantly correlated with improvements in quality of life. CONCLUSION: Rehabilitation of subjects with asthma and COPD in community-based physiotherapy practices improves exercise tolerance and quality of life.

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