1. Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study
- Author
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Surya P. Bhatt, Anne E Holland, Janet Bondarenko, Christopher J. Ryerson, Kaïssa de Boer, Deborah Assayag, Rainer Gloeckl, Seo Am Hur, Benjamin Tan, Nathan Hambly, Pat G. Camp, Chris Garvey, Nima Makhdami, Vincent Ferraro, Michael Kreuter, Michael K. Stickland, Julie Morisset, Jacqueline S Sandoz, Luc Bovet, Sabina A. Guler, Patrick Brun, Inga Jarosch, S Ainslie McBride, Joshua Wald, Kerri A. Johannson, and Kelly Sun
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,law.invention ,Cohort Studies ,Idiopathic pulmonary fibrosis ,Randomized controlled trial ,law ,Internal medicine ,Outpatients ,Humans ,Medicine ,Lung transplantation ,Pulmonary rehabilitation ,610 Medicine & health ,Retrospective Studies ,Inpatients ,Exercise Tolerance ,Lung ,business.industry ,Interstitial lung disease ,Retrospective cohort study ,medicine.disease ,medicine.anatomical_structure ,Female ,Lung Diseases, Interstitial ,business ,Cohort study - Abstract
BackgroundThe 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.MethodsThis 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.Results701 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, pConclusionsPatients 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.
- Published
- 2021