Early hospital-initiated rehab for chronic respiratory disease shows no benefit versus usual care

Patients hospitalized for chronic respiratory disease did not appear to benefit from early rehab started during their hospital stay versus usual care, according to a new study.

Researchers at 2 affiliated teaching hospitals in the United Kingdom performed a randomized, controlled trial to determine whether early rehab during acute admission for chronic respiratory disease exacerbations would improve outcomes and reduce risk for readmission. Patients with an exacerbation of chronic respiratory disease were assigned within 48 hours of hospital admission to receive early rehab or usual care. Early rehab involved a 6-week intervention that included prescribed aerobic, resistance, and neuromuscular electrical stimulation training, along with information on self-management and education. Usual care included physiotherapy (airway clearance, mobility assessment and supervision, and smoking cessation advice) and nutritional status assessment, along with outpatient pulmonary rehab offered 3 months after hospital discharge. The study's primary outcome measure was readmission rate at 12 months; secondary outcome measures were number of hospital days, mortality rate, physical performance, and health status. The study results were published online by The BMJ on July 8.

One hundred ninety-six patients were assigned to the early rehab group, and 193 were assigned to the usual care group. Mean age was approximately 71 years, and 44% and 45% of patients in each group, respectively, were men. Most of the patients (82%) had chronic obstructive pulmonary disease as their primary diagnosis. A total of 233 patients (60%) had at least 1 readmission in the year after their index admission, 62% of the early rehab group (122 of 196 patients) and 58% of the usual care group (111 of 193 patients), with no significant between-group difference (hazard ratio, 1.1; 95% CI, 0.86 to 1.43; P=0.4). Mortality rate appeared to increase in the intervention group at 1 year (odds ratio, 1.74; 95% CI, 1.05 to 2.88; P=0.03). Both groups demonstrated significant improvement in physical performance and health status after hospital discharge, and no significant between-group difference in these outcomes was noted at 1 year.

The authors noted that they included patients with various chronic respiratory diseases and that their results apply only to patients with fewer than 5 hospital admissions in the previous 12 months. However, they concluded that early rehab during hospital admission for acute exacerbation of chronic respiratory disease does not reduce readmission risk or improve physical outcomes over the next year compared with usual care. “The lack of impact on physical function and readmissions and the observation of an increased mortality at 12 months in the intervention group indicate caution before implementing such programmes during the immediate recovery from acute illness,” the authors wrote.