TY - JOUR
T1 - Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease
T2 - a multicentre retrospective cohort study
AU - Guler, Sabina Anna
AU - Hur, Seo Am
AU - Stickland, Michael K.
AU - Brun, Patrick
AU - Bovet, Luc
AU - Holland, Anne E.
AU - Bondarenko, Janet
AU - Hambly, Nathan
AU - Wald, Joshua
AU - Makhdami, Nima
AU - Kreuter, Michael
AU - Gloeckl, Rainer
AU - Jarosch, Inga
AU - Tan, Benjamin
AU - Johannson, Kerri A.
AU - McBride, S. Ainslie
AU - De Boer, Kaissa
AU - Sandoz, Jacqueline S.
AU - Sun, Kelly
AU - Assayag, Deborah
AU - Bhatt, Surya P.
AU - Morisset, Julie
AU - Ferraro, Vincent
AU - Garvey, Chris
AU - Camp, Pat G.
AU - Ryerson, Christopher J.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/6
Y1 - 2022/6
N2 - BACKGROUND: The impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival. METHODS: This retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders. RESULTS: 701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%). CONCLUSIONS: Patients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.
AB - BACKGROUND: The impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival. METHODS: This retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders. RESULTS: 701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%). CONCLUSIONS: Patients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.
KW - exercise
KW - idiopathic pulmonary fibrosis
KW - interstitial fibrosis
KW - pulmonary rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85122750907&partnerID=8YFLogxK
U2 - 10.1136/thoraxjnl-2021-217361
DO - 10.1136/thoraxjnl-2021-217361
M3 - Article
C2 - 34462346
AN - SCOPUS:85122750907
SN - 0040-6376
VL - 77
SP - 589
EP - 595
JO - Thorax
JF - Thorax
IS - 6
ER -