Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study

Sabina Anna Guler, Seo Am Hur, Michael K. Stickland, Patrick Brun, Luc Bovet, Anne E. Holland, Janet Bondarenko, Nathan Hambly, Joshua Wald, Nima Makhdami, Michael Kreuter, Rainer Gloeckl, Inga Jarosch, Benjamin Tan, Kerri A. Johannson, S. Ainslie McBride, Kaissa De Boer, Jacqueline S. Sandoz, Kelly Sun, Deborah AssayagSurya P. Bhatt, Julie Morisset, Vincent Ferraro, Chris Garvey, Pat G. Camp, Christopher J. Ryerson

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21 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)589-595
Number of pages7
JournalThorax
Volume77
Issue number6
DOIs
Publication statusPublished - Jun 2022

Keywords

  • exercise
  • idiopathic pulmonary fibrosis
  • interstitial fibrosis
  • pulmonary rehabilitation

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