Authors (including presenting author) :
Tsui AYY (1), Ling SO (2), Ng PK (2), Poon YL (2), Yim CW (2), Kwan HY (2), Yau A (2), Man LS (2), Fong SY (2), Chan RWY (1), Chan BSC (1), Kong ISY (1), Cheung EYY (1), Chau RMW (1)
Affiliation :
(1) Physiotherapy Department, Kowloon Hospital (2) Department of Respiratory Medicine, Kowloon Hospital
Introduction :
COPD exacerbation is common cause of hospitalization, resulting in poor rehabilitation outcomes. Collaborative goal-setting with COPD patients cultivates realistic positivity in outcomes and rehabilitation process. To formulate a pragmatic goal with the patients to attain in rehabilitation program is of key importance to enhance engagement for a more positive outcome in reducing hospitalization due to exacerbation.
Objectives :
The aim of the study was to explore the threshold in functional exercise capacity improvement for COPD patients in serving as achievable goal driving to enhance rehabilitation outcome with alleviation of exacerbation and hospitalization.
Methodology :
A retrospective data mining from COPD patients of Respiratory Medicine Department of Kowloon Hospital attending PRP from May 2014 to Jan 2019 was analysed. The patient’s demographic data, 6-minute Walk Distance(6MWD), episodes and days of hospitalization due to acute exacerbation within one year before and after pulmonary rehabilitation were analysed.
Result & Outcome :
A total of 89 records of COPD patients receiving PRP were retrieved. Majority was male(93%) and age ranged from 37-89. Most of the patients were in severe to very severe airflow obstruction (COPD GOLD Stage-II(21.3%), Stage-III(48.3%), Stage-IV(30.3%)).
Patients demonstrated significant improvement in 6MWD(63.65m±78.71;p=0.000) after PRP. There was no statistically significant difference in hospitalization due to acute exacerbation in term of number of admission(0.25±2.61; p=0.37) and hospital stay(3.40days±43.15;p=0.46). Nonetheless, a total reduction in 22 hospital admissions and 168 days of hospitalization impacted clinical significance in decrease burden to patients and healthcare cost.
The threshold of improvement of 6MWD of more than 30m(Minimal clinical important difference of COPD population) yielded a significant decreased risk(0.728;95% confidence interval0.54–0.98;p< 0.05) for hospitalization due to acute exacerbation after Pulmonary Rehabilitation Program. This served as achievable pragmatic goal for the COPD patients driving to impactful improvement in functional exercise capacity and reduced acute exacerbation of COPD hospitalizations. Moreover, the significant reduction in frequent readmission is imperative to enhance positivity in rehabilitation outcomes and process with reduced disease burden in healthcare utilization.
