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Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study

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Maddocks 2016 Thorax Frailty and PR in COPD.pdfAccepted version805.29 kBUnknownView/Open
Thorax-2016-Maddocks-988-95.pdfPublished version910.72 kBAdobe PDFView/Open
Title: Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study
Authors: Maddocks, M
Kon, SS
Canavan, JL
Jones, SE
Nolan, CM
Labey, A
Polkey, MI
Man, WD
Item Type: Journal Article
Abstract: BACKGROUND: Frailty is an important clinical syndrome that is consistently associated with adverse outcomes in older people. The relevance of frailty to chronic respiratory disease and its management is unknown. OBJECTIVES: To determine the prevalence of frailty among patients with stable COPD and examine whether frailty affects completion and outcomes of pulmonary rehabilitation. METHODS: 816 outpatients with COPD (mean (SD) age 70 (10) years, FEV1% predicted 48.9 (21.0)) were recruited between November 2011 and January 2015. Frailty was assessed using the Fried criteria (weight loss, exhaustion, low physical activity, slowness and weakness) before and after pulmonary rehabilitation. Predictors of programme non-completion were identified using multivariate logistic regression, and outcomes were compared using analysis of covariance, adjusting for age and sex. RESULTS: 209/816 patients (25.6%, 95% CI 22.7 to 28.7) were frail. Prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score and age-adjusted comorbidity burden (all p≤0.01). Patients who were frail had double the odds of programme non-completion (adjusted OR 2.20, 95% CI 1.39 to 3.46, p=0.001), often due to exacerbation and/or hospital admission. However, rehabilitation outcomes favoured frail completers, with consistently better responses in MRC score, exercise performance, physical activity level and health status (all p<0.001). After rehabilitation, 71/115 (61.3%) previously frail patients no longer met case criteria for frailty. CONCLUSIONS: Frailty affects one in four patients with COPD referred for pulmonary rehabilitation and is an independent predictor of programme non-completion. However, patients who are frail respond favourably to rehabilitation and their frailty can be reversed in the short term.
Issue Date: 12-Jun-2016
Date of Acceptance: 6-May-2016
URI: http://hdl.handle.net/10044/1/34161
DOI: https://dx.doi.org/10.1136/thoraxjnl-2016-208460
ISSN: 1468-3296
Publisher: BMJ Publishing Group
Start Page: 988
End Page: 995
Journal / Book Title: Thorax
Volume: 71
Copyright Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Keywords: COPD epidemiology
Exercise
Pulmonary Rehabilitation
Respiratory System
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute