Evaluation of inpatient rehabilitation regarding pulmonary diseases in the clinics Falkenstein and Bad Reichenhall (Clinics of institutions for social accident insurance)

Status:

completed 02/2011

Aims:

There is sufficient evidence that pulmonary rehabilitation leads to following positive effects: Increase of physical performance, improvement of psychosocial state and reduction of dyspnea. In comparison to the evidence-based short-term effects of pulmonary rehabilitation, long-lasting improvements are documented less well. Current knowledge is based on evaluations of patients with chronic obstructive lung pulmonary disease, up to date only few trials concerning the efficacy of pulmonary rehabilitation in non-COPD patients have been published.

Activities/Methods:

The prospective intervention study carried out in the two rehabilitation clinics Falkenstein/Vogtland and Bad Reichenhall included 263 insured persons of different social accident insurance institutions in total, i. e. 121 patients suffering from occupational asthma, 42 patients with silicosis, 66 patients with asbestosis and 34 patients with miners' COPD. According to inclusion criteria all patients were required to have a reduction of earning capacity between 20 and 50 percent caused by occupational lung disease. Exercise capacity had to be 40 watts minimum and they should not be older than 70 years. A previous rehabilitation had to date back at least two years. The comprehensive evaluations consisted of patient's medical history, measurement of lung function, maximal exercise capacity, a six-minute-walk and muscle strength as well as by answering different questionnaires about quality of life, dyspnea, anxiety and depression. Each evaluation was carried out at four different dates in the clinic where the rehabilitation had taken place: prior to rehabilitation, directly after as well as three and twelf months after rehabilitation.

Results:

After describing the applied methods and questionnaires, the results are presented. The most important improvements achieved by the rehabilitation are summarized as follows:

- Inpatient pulmonary rehabilitation in patients with occupational lung diseases is an appropriate method to improve course of disease.

- Measurement of muscle strength and maximal work capacity showed a sustainable improvement of physical functioning up to one year after rehabilitation.

- Achievements were independent of grade of impairment at baseline, so less trained patients benefit more in relation to their initial results.

- In patients with obstructive impairment of lung function more accentuated effects were stated compared to patients with asbestosis causing restrictive lung disease.

- Regardless of underlying diseases a significant reduction of respiratory infections in the year after the rehabilitation could be observed. A reduction of respiratory infections does not only reflect a consolidation of course of disease but also has indirect effects on costs as well as use of the health care system.

- Benefits were independent of age, smoking habits, body weight and comorbidities.

- Despite a long-known diagnosis, some patients didn't receive any antiobstructive medication before rehabilitation. An adequate medication could be given to 20 patients during rehabilitation.

- Success rate of smoking cessation started during rehabilitation exceeded 70 %.

- Very low loss rate of participants indicated a high commitment of both clinics and a good acceptance of this study.

Perspective: Inpatient pulmonary rehabilitation with varied and individual training as well as education programs can be considered an applicable method to improve the course of disease in patients with occupational respiratory diseases. A combination of inpatient rehabilitation and maintenance programs like sport groups aiming at improving chronic lung diseases is advisable to integrate and prolong the achieved improvements of physical activity in patients' daily routine.

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