Journal Article

An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial

Chaplin, Emma J, Chimera, Rudo, Bankart, M John, Singh, Sally J, Williams, Johanna E A, Hussain, Syed F, Harvey-Dunstan, Theresa C, Morgan, Mike D, Greening, Neil J, Vincent, Emma E, Steiner, Michael C

2014

Overview

Objective To investigate whether an early rehabilitation intervention initiated during acute admission for exacerbations of chronic respiratory disease reduces the risk of readmission over 12 months and ameliorates the negative effects of the episode on physical performance and health status.Design Prospective, randomised controlled trial.Setting An acute cardiorespiratory unit in a teaching hospital and an acute medical unit in an affiliated teaching district general hospital, United Kingdom.Participants 389 patients aged between 45 and 93 who within 48 hours of admission to hospital with an exacerbation of chronic respiratory disease were randomised to an early rehabilitation intervention (n=196) or to usual care (n=193).Main outcome measures The primary outcome was readmission rate at 12 months. Secondary outcomes included number of hospital days, mortality, physical performance, and health status. The primary analysis was by intention to treat, with prespecified per protocol analysis as a secondary outcome.Interventions Participants in the early rehabilitation group received a six week intervention, started within 48 hours of admission. The intervention comprised prescribed, progressive aerobic, resistance, and neuromuscular electrical stimulation training. Patients also received a self management and education package.Results Of the 389 participants, 320 (82%) had a primary diagnosis of chronic obstructive pulmonary disease. 233 (60%) were readmitted at least once in the following year (62% in the intervention group and 58% in the control group). No significant difference between groups was found (hazard ratio 1.1, 95% confidence interval 0.86 to 1.43, P=0.4). An increase in mortality was seen in the intervention group at one year (odds ratio 1.74, 95% confidence interval 1.05 to 2.88, P=0.03). Significant recovery in physical performance and health status was seen after discharge in both groups, with no significant difference between groups at one year.Conclusion Early rehabilitation during hospital admission for chronic respiratory disease did not reduce the risk of subsequent readmission or enhance recovery of physical function following the event over 12 months. Mortality at 12 months was higher in the intervention group. The results suggest that beyond current standard physiotherapy practice, progressive exercise rehabilitation should not be started during the early stages of the acute illness.Trial registration Current Controlled Trials ISRCTN05557928.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group Ltd
• Subject: Aged / Aged, 80 and over / Asthma / Asthma - mortality / Asthma - rehabilitation / Bronchiectasis - mortality / Bronchiectasis - rehabilitation / Chronic Disease / Chronic obstructive pulmonary disease / Clinical trials / Disease Progression / Exercise / Female / Follow-Up Studies / Health Status / Hospitalization / Hospitals / Humans / Intention to Treat Analysis / Intervention / Length of Stay - statistics & numerical data / Lung diseases / Lung Diseases, Interstitial - mortality / Lung Diseases, Interstitial - rehabilitation / Male / Middle Aged / Mortality / Patient Compliance - statistics & numerical data / Patient Education as Topic / Patient Readmission - statistics & numerical data / Physical fitness / Physical Therapy Modalities / Prospective Studies / Pulmonary Disease, Chronic Obstructive - mortality / Pulmonary Disease, Chronic Obstructive - rehabilitation / Recovery of Function / Rehabilitation / Respiratory diseases / Self Care / Single-Blind Method / Sports training / Treatment Outcome / Walking