Outpatient pulmonary rehabilitation for ph patients: A different perspective.
Small BL, Cajigas H, Neumann S, and Awdish R. Outpatient pulmonary rehabilitation for ph patients: A different perspective. Am J Respir Crit Care Med 2015; 191.
Am J Respir Crit Care Med
Pulmonary Rehabilitation (PR) is considered a class IA treatment indication in patients with WHO group I Pulmonary Arterial Hypertension (PAH). PR is also commonly prescribed in other WHO PH groups. Prior studies in inpatient and outpatient settings have demonstrated a reduction in dyspnea scores, improvement in QOL and increments in six-minute walk distances (6MWT). Our aim is to understand the effect of PR, as typically designed in the care of general pulmonary patients, in an urban outpatient setting within a mixed group of patients with PH. METHODS: We performed a retrospective chart review of patients referred by our specialized PH clinic (NYHA FC I-IV, WHO Groups I to IV, N = 13, F = 100%) before and after attendance to the PR program. Individualized treatment plans were designed for each patient including counseling, exercises performed to a BORG scale of 3-4/10, and psychosocial interventions, with an average of 22 sessions completed per patient, over 13 weeks. Completion of the program was considered if the patient reached a number of pre-determined sessions or if they attained a plateau in exercise capacity determined by the rehabilitation team. RESULTS: Compared to baseline data, completion of PR revealed no significant change in NYHA FC (p=0.87), 6MWT (p = 0.75), BNP (p = 0.76), or any hemodynamic or echocardiographic variable. A decrease in BORG dyspnea scores, however, was associated with a faster treadmill speed used by patients. Though exercises were closely monitored, two patients suffered adverse events (dizziness, chest pain and diaphoresis). CONCLUSION: Though discrepant with other investigations of PR in PH, our results suggest that not all traditional ambulatory pulmonary rehabilitation models may be of equal benefit to PH patients. This study suggests the need for the development of a PH-specific and standardized protocol in order to reach the desired outcomes in this population in all PR centers.