Journal of Gerontological Nursing

Feature Article 

Inpatient Pulmonary Rehabilitation Program in a Long-Term Care Facility: Short-Term Outcomes and Patient Satisfaction

George M. Kiongera, DNP, GNP-BC, NP-C; Susan Crocker Houde, PhD, ANP-C

Abstract

The purpose of the current study was to evaluate short-term outcomes of inpatient pulmonary rehabilitation (IPR) programs for older patients with chronic obstructive pulmonary disease (COPD). IPR comprises medical management, exercise, nutrition counseling, and coping skills education programs, among other interventions. The current study used a pretest–posttest design with 21 participants evenly split by gender between the ages of 46 and 95. Effects of IPR on functional tolerance exercise capacity and perceived dyspnea on exertion level had a statistically significant difference by the end of the program. Scores for health-related quality of life and subscales of symptoms, impact, and activity in participants younger than 65 were not statistically significant, whereas St. George’s Respiratory Questionnaire scores for participants older than 65 showed a statistically significant improvement. Results showed that early IPR is an effective intervention for the management of symptoms of COPD in older adults recovering from a COPD exacerbation. [Journal of Gerontological Nursing, 41(8), 44–52.]

Dr. Kiongera is President and Chief Executive Officer, Maestro-Connections Health Systems, Lawrence; and Dr. Crocker Houde is Associate Dean, Director of Division of Public Health, Director Regional Consortium of Community-Engaged Gerontology Researchers, University of Massachusetts–Lowell, Lowell, Massachusetts.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank DiJon Fasoli, PhD, MS, MBA, RN, for facilitating the initial development of this study; Gail Baratta, BSN, RN-C, for facilitating this study at the long-term care facility; and Ramraj Gautam, PhD, for editorial and technical assistance.

Address correspondence to George M. Kiongera, DNP, GNP-BC, NP-C, President and Chief Executive Officer, Maestro-Connections Health Systems, 439 S. Union Street, Suite 107, Lawrence, MA 01843; e-mail: georgekiongera@hotmail.com.

Received: May 02, 2013
Accepted: June 10, 2015

Abstract

The purpose of the current study was to evaluate short-term outcomes of inpatient pulmonary rehabilitation (IPR) programs for older patients with chronic obstructive pulmonary disease (COPD). IPR comprises medical management, exercise, nutrition counseling, and coping skills education programs, among other interventions. The current study used a pretest–posttest design with 21 participants evenly split by gender between the ages of 46 and 95. Effects of IPR on functional tolerance exercise capacity and perceived dyspnea on exertion level had a statistically significant difference by the end of the program. Scores for health-related quality of life and subscales of symptoms, impact, and activity in participants younger than 65 were not statistically significant, whereas St. George’s Respiratory Questionnaire scores for participants older than 65 showed a statistically significant improvement. Results showed that early IPR is an effective intervention for the management of symptoms of COPD in older adults recovering from a COPD exacerbation. [Journal of Gerontological Nursing, 41(8), 44–52.]

Dr. Kiongera is President and Chief Executive Officer, Maestro-Connections Health Systems, Lawrence; and Dr. Crocker Houde is Associate Dean, Director of Division of Public Health, Director Regional Consortium of Community-Engaged Gerontology Researchers, University of Massachusetts–Lowell, Lowell, Massachusetts.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank DiJon Fasoli, PhD, MS, MBA, RN, for facilitating the initial development of this study; Gail Baratta, BSN, RN-C, for facilitating this study at the long-term care facility; and Ramraj Gautam, PhD, for editorial and technical assistance.

Address correspondence to George M. Kiongera, DNP, GNP-BC, NP-C, President and Chief Executive Officer, Maestro-Connections Health Systems, 439 S. Union Street, Suite 107, Lawrence, MA 01843; e-mail: georgekiongera@hotmail.com.

Received: May 02, 2013
Accepted: June 10, 2015

Chronic obstructive pulmonary disease (COPD) is currently the third leading cause of death and twelfth leading cause of morbidity in the United States (Qaseem et al., 2011). COPD is more prevalent than other major chronic diseases, such as Alzheimer’s disease and chronic renal failure. More than 5% of the adult population in the United States is affected by COPD and the attributed economic cost in 2010 was estimated to be $49.9 billion. The direct cost of medical care is estimated to be $29.9 billion per year (Qaseem et al., 2011). Ries et al. (2007) also ranked COPD second to coronary heart disease as the reason for Social Security disability payments.

Diagnosis and Symptoms of COPD

The Global Initiative for Chronic Obstructive Lung Disease (GOLD; 2013) guidelines define COPD as a relatively common progressive disease causing persistent airflow limitations. It is generally associated with chronic and enhanced inflammatory response in the lungs and airways (GOLD, 2013). Although COPD may be prevented and treated, it cannot be cured with medical treatments. Progression of the disease is characterized by a cascade of systemic effects that lead to deteriorating respiratory function, resulting in compromised exercise tolerance capacity, perceived dyspnea on exertion, chronic cough with or without sputum production, wheezing, and respiratory failure (Qaseem et al., 2011), and decreased health-related quality of life (HRQoL) (Pasqua et al., 2009).

Pulmonary Rehabilitation Programs for Patients with COPD

Kyung and Chin (2007) reported that older adults with COPD have physical limitations that make normal function and activity impossible. Pulmonary rehabilitation programs are aimed at reducing debilitating and disabling symptoms experienced by patients experiencing COPD by incorporating the following components: (a) patient assessment, (b) education, (c) exercise training, (d) nutrition counseling, (e) psychosocial support, (f) behavior modification techniques, and (g) self-management skills (Qaseem et al., 2011).

Pulmonary rehabilitation programs have been incorporated in all major guidelines as a standard practice of care for the management of patients with COPD (Ries et al., 2007). Puhan et al. (2011) reported that a majority of existing studies focus on outpatient pulmonary rehabilitation for patients with stable pulmonary status; few focus on inpatient pulmonary rehabilitation (IPR) after COPD exacerbation. In an electronic literature search by Puhan et al. (2011) using MEDLINE, EMBASE, PEDro, and the Cochrane central registry of controlled trials databases, only nine studies involving 432 inpatients were found. Puhan et al. (2011) reported that searches were conducted using these databases from their inception until March 2010.

About Inpatient Pulmonary Rehabilitation Programs

Puhan et al. (2011) described IPR as being designed for more fragile patients as compared to out-patient pulmonary rehabilitation programs, which are designed for stable patients who are not at risk for frequent hospitalization due to respiratory failure. IPR programs are also more expensive and referred patients must be justified by physicians for the purpose of insurance coverage. IPR programs integrate rehabilitation components, such as medical management, exercise, and coping skills (Puhan et al., 2011).

A study involving 22 patients (ages 68 to 72) with respiratory failure due to COPD showed that IPR provided over a 4-week period improved neuromotor disability, dyspnea, exercise tolerance, and quality of life (Pasqua et al., 2009). This finding was consistent with the findings of the study by Votto, Bowen, Scalise, Wollschlager, and Zuwallack (1996) on short-stay comprehensive IPR for patients (mean age = 71) with advanced COPD, which indicated improvement in outcome measures of timed distance walking, dyspnea, functional activities, and psychological status after 10 days of pulmonary rehabilitation.

Objective

The objective of the current study was to evaluate the effectiveness of a 24-session, 6- to 8-week IPR program for patients with COPD of two distinct age groups (younger and older than 65) in a long-term care facility on the following outcome measures: (a) functional tolerance exercise capacity, (b) perceived dyspnea on exertion level, (c) HRQoL, and (d) a satisfaction survey questionnaire using a 5-point Likert scale.

Method

Design

The current study was a pre-test–posttest design adopted to assess the effectiveness of an IPR program for patients with COPD in a 26-bed unit in a long-term care facility in New England. The study was conducted in English. No incentives were offered for participation. The study was approved by the university’s institutional review board.

Participants

Twenty-three participants, including 11 females and 12 males, were recruited. All participants had referrals for the program from their attending physician. Of the 23 participants recruited, 21 completed the required IPR programs and two did not (one died and one signed out of the facility against medical advice).

Participants were recruited to IPR by the research coordinator on admission to the facility. The purpose of the study was explained to participants who signed informed consent, agreeing to participate. For the duration of the study, they were short-term residents in the long-term care facility.

Inclusion criteria were a diagnosis of COPD as defined by the American Thoracic Society (ATS) and a post-bronchodilator–forced expiratory volume in 1 second between 50% and 80% predicted. Exclusion criteria were ischemic heart disease, musculoskeletal disorder, active tuberculosis, acute myocardial infarction, or being mentally challenged to the extent that a questionnaire could not be completed with assistance.

Characteristics of the 23 participants recruited for IPR are provided in Table 1. Participants consisted of middle-aged and older adults, with a mean age of 69.27 (SD = 13.39 years, range = 46 to 95 years). Eight participants were younger and 15 were older than 65. The mean body mass index for the sample was 29.15. Comorbidities of the younger and older than 65 groups are found in Table 1.

Demographic Characteristics of Participants (N = 23)a

Table 1:

Demographic Characteristics of Participants (N = 23)

Measures

IPR is a multidisciplinary program that involves a pulmonary physician, physical therapists, occupational therapists, RNs, a nutritionist, a psychiatrist, and a medical social worker. Functional exercise capacity, perceived dyspnea on exertion, and general quality of life were measured through the course of IPR using various methods.

6-Minute Walk Distance Test. Functional exercise capacity was measured by the 6-Minute Walk Distance (6MWD) test on admission and after IPR. The 6MWD test requires participants to walk for 6 minutes on a flat, hard surface in a hallway approximately 25 m long, according to ATS guidelines (Salzman, 2009). Participants were encouraged to cover the longest distance as fast as they could within 6 minutes.

Borg CR10 Rating of Perceived Dyspnea Scale. The Borg CR10 Scale is a 10-item self-assessment rating scale used by patients with COPD during exercise training to determine the level of physical activity-induced–perceived dyspnea on exertion, according to the ATS (2012). The Borg CR10 modified version rating scale has values ranging from 0 = nothing at all to 10 = very, very severe. Cronbach’s alpha was 0.85. The scale was administered by the same IPR staff before and after rehabilitation to assess changes in perceived dyspnea on exertion levels.

Health-Related Quality of Life. HRQoL is a self-reported assessment of an individual’s perceived quality of daily life on a social, emotional, and physical level. The program measures HRQoL as it is impacted by COPD. HRQoL was measured by the St. George’s Respiratory Questionnaire (SGRQ; Jones & Forde, 2008) on admission and after the IPR program. Part 1 of the SGRQ measures frequency of respiratory symptoms and participants’ perceptions of their most recent respiratory symptoms. Part 2 measures participants’ current state in relation to disturbances to physical activity and psychosocial functioning. Cronbach’s alpha reliability of the SGRQ score was 0.76, 0.84 for the symptoms score, 0.76 for the activity score, and 0.64 for the impact score.

Satisfaction Survey Questionnaire. Participants’ feedback was measured by a satisfaction survey questionnaire administered at the end of the IPR program. The questionnaire was a 5-point Likert-scaled response satisfaction survey. The scale was adopted from the Australian Lung Foundation pulmonary rehabilitation toolkit (Alison et al., 2009). The six-item measure asks participants to rate the effectiveness of the IPR components on a scale of 1 = strongly disagree to 5 = strongly agree. Cronbach’s alpha of the scale was 0.86.

Data Analysis

Functional tolerance exercise capacity, perceived dyspnea on exertion level, and HRQoL were analyzed using paired t tests. Pre and post outcome measures were the independent variables for each test. Means were reported with standard deviations. The significance level was set at p < 0.05 for each outcome measure. Statistical analyses were performed using SPSS for Windows version 20.

Intervention

Inpatient Pulmonary Rehabilitation Program Components

IPR equipment included 25 m of a flat, straight walking corridor; pulse oximeters; hand weights; TheraBand™ resistive exercise bands; a Stairmaster®; stethoscopes; a sphygmomanometer; oxygen and flow regulators; nasal prongs; the Borg CR10 Scale; a tape measure; a stationary bicycle; weight machines; an arm crank ergometer; a rowing machine; an Omnicycle™; and an electric stimulator. The IPR program was designed to provide 24-hour per day nursing care as well as medical evaluations to inpatients during IPR program activities. Participants completed three or four sessions each week for 3 hours of supervised exercise activity depending on whether the approved length of stay by their respective insurance carriers was 6 or 8 weeks. The goal was to ensure each participant received a total of 24 sessions of IPR program activities.

Functional Exercise Tolerance Capacity. An individualized exercise program focusing on lower and upper limb endurance and strengthening was designed for each participant. The program was tailored to match each participant’s level of tolerance depending on his/her condition at the point of acceptance to the IPR program. Exercise training progressed slowly toward participant goals each week. Exercise activities included walking distance training on the facility’s triangular flat surface while supervised by a physical or occupational therapist. This training was set at 75% to 80% of the average 6-minute distance walked during trials on admission.

Cycling intensity training on the ergometer was titrated during exercise based on achieving a perceived exertion score of 3 to 4 on the Borg CR10 rating of perceived dyspnea. This training entailed cycling 60 rotations per minute on an electronically braked cycle ergometer. Participants cycled the unloaded ergometer for 3 minutes and then the load was gradually increased by 20 watts every 5 minutes until they no longer felt able to continue. Participants’ maximum work rate during exercise endurance was compared with the predicted maximum work rate within 10 minutes of exercise.

An electric stimulator was also used for exercise training sessions for neuromuscular electrical stimulation during quadriceps muscle strengthening. Other equipment used during exercise training activities included TheraBands, hand weights, and an Omnicycle. Special consideration was paid to helping patients learn to stay active doing daily activities, as discharge was also a focus of the program. To achieve this goal, pacing and energy conservation techniques were incorporated into bathing, dressing, grooming, dining, and home management during IPR program instructions on exercise activities by occupational therapists.

Perceived Dyspnea on Exertion. Educational activities and exercise training interventions were provided to every participant and used in the management of perceived dyspnea on exertion. During educational lectures by respiratory, physical, and occupational therapists, participants were provided with information on the relationship between physical activity avoidance and perceived dyspnea on exertion and its association with impaired quality of life (Janssens et al., 2011). Educational training programs about dyspnea on exertion focused on major breathing techniques, energy conservation, relaxation, breathing retraining, nutrition, managing secretions, inhaler use and disease management, and warning signs. Other instructional educational activities included pursed-lip breathing to relieve dyspnea and thereby inhibit expiratory airway collapse; posture technique of leaning forward to relieve dyspnea by reducing breathing effort; and diaphragmatic breathing, which entails only emptying the diaphragm during inspiration (ATS, 2012). These educational and self-management program components were offered two times per week for 6 weeks.

Exercise training was also a major IPR component in helping patients manage perceived dyspnea on exertion. Upper limb endurance interval exercise training was provided based on weight repetitions and dyspnea score. Participants started by performing 15 repetitions with their hands as a starting weight. The weights progressed by increments of 0.5 kg, with a goal of performing 1 kg. An upper limb endurance exercise was prescribed to fall within a dyspnea score of 2 = slight to 3 = slight to moderate on the Borg CR10 Scale (ATS, 2012). Three to four sessions per week of supervised exercise activity were offered to participants. All 21 participants who completed the IPR program participated in the educational training sessions and supervised exercise activities.

Results

Outcome Performance Variables

The outcome measures of functional tolerance exercise capacity, perceived dyspnea on exertion, and HRQoL can be found in Table 2.

Pre and Post Outcome Measures after 8 Weeks of Inpatient Pulmonary Rehabilitation (N = 21)a

Table 2:

Pre and Post Outcome Measures after 8 Weeks of Inpatient Pulmonary Rehabilitation (N = 21)

At the end of the 24 sessions, participants’ results on the 6MWD test for functional tolerance exercise capacity increased significantly; results for perceived dyspnea on exertion measured by the Borg CR10 Scale at 6 minutes decreased and SGRQ scores for HRQoL improved measurably.

The paired t tests for all pre-IPR compared to post-IPR scores based on age group are shown in Table 3 (for participants younger than 65) and Table 4 (for participants older than 65). Results of the 6MWD test for functional tolerance exercise for those older (p < 0.001) and younger (p = 0.002) than 65 were statistically significant. T statistic and df for these results were set within standard ranges.

Pre and Post Outcome Measures for the Younger than 65 Group After 8 Weeks of Inpatient Pulmonary Rehabilitation (n = 8)

Table 3:

Pre and Post Outcome Measures for the Younger than 65 Group After 8 Weeks of Inpatient Pulmonary Rehabilitation (n = 8)

Pre and Post Outcome Measures for the Older than 65 Group after 8 Weeks of Inpatient Pulmonary Rehabilitation (n = 13)

Table 4:

Pre and Post Outcome Measures for the Older than 65 Group after 8 Weeks of Inpatient Pulmonary Rehabilitation (n = 13)

The younger than 65 group showed a statistically significant difference in overall Borg CR10 scores (p = 0.019). The SGRQ scores for HRQoL (p = 0.059) and domains of symptoms (p = 0.067), impact (p = 0.100), and activity (p = 0.219) were not statistically significant.

The older than 65 group’s paired t test scores showed no statistically significant difference in Borg CR10 scores (p = 0.150). However, this age group showed a statistically significant difference in the SGRQ scores for HRQoL (p = 0.048) and the activity domain (p = 0.050). The symptoms and impact domains showed no statistically significant differences at the completion of IPR for the group.

Participants used a six-item, 5-point Likert scale to rate the aspects of the IPR program in managing their symptoms. The outcome of participants’ feedback is shown in Table 5. Results indicated participants agreed that the IPR components helped them meet their objectives.

5-Point Likert Scale Satisfaction Survey Questionnaire after 8 Weeks of Inpatient Pulmonary Rehabilitation (N = 22)a

Table 5:

5-Point Likert Scale Satisfaction Survey Questionnaire after 8 Weeks of Inpatient Pulmonary Rehabilitation (N = 22)

Discussion

Significant improvements were seen in the scores of all outcome measures at the end of the 8-week IPR program. However, outcomes differed by age group. Significant improvements were seen in functional exercise tolerance capacity, perceived dyspnea on exertion, and HRQoL. Improvement in pre-IPR scores following the IPR program supports the importance of IPR in the management of COPD symptoms (Gonzi et al., 2011).

Participants improved on the 6MWD test across age groups. These findings are consistent with a study by Enfield et al. (2010) that compared the changes of a 6MWD test before and after IPR for patients with severe end-stage COPD. The outcome of that study showed a significant change in pre- and post-6MWD test scores after IPR. Enfield et al. (2010) maintains that the changes in these outcome measures are uniquely related to IPR as compared to outpatient pulmonary rehabilitation that deals with patients in stable pulmonary states. Most patients who join IPR from acute care hospitals have impaired muscle function (Spruit et al., 2003) due to physical inactivity (Pitta et al., 2006) and respond well to exercise training that decreases symptoms associated with COPD.

Participants showed substantial improvement in perceived dyspnea on exertion at the end of IPR. However, when the outcome measure was analyzed on the basis of age, the younger than 65 group showed a statistically significant difference, whereas the older than 65 group did not. This finding may be due to a higher likelihood of increased severity of the disease in individuals older than 65; as a result, IPR may have had a more measurable impact on perceived dyspnea for the younger group. However, no data are available regarding severity of COPD as related to age, so it is ultimately unclear why these results occurred.

The SGRQ total and subscale scores of activity showed a statistically significant difference in HRQoL for the older than 65 group. This is an important outcome measure as it is associated with an individual’s physiological functioning and perception of overall improvement in health (ATS, 2012). The outcome measure is also important for quantifying the benefits of a health program. However, there was no statistically significant difference in HRQoL for the younger than 65 group as measured by the SGRQ and its subscales. HRQoL is associated with an individual’s satisfaction or happiness with life (ATS, 2012) and positive changes in this outcome measure in the older than 65 group is an important finding.

The older than 65 group had a higher incidence of participants with depression and anxiety. Depression and anxiety tend to affect patients’ self-care management and emotional and social levels of physical functioning. This finding is consistent with a study by Cleland, Lee, and Hall (2007) that linked a strong association between depressive disorder, anxiety, and poor HRQoL in patients with COPD. Providing education and tools for self-care management of issues related to comorbidities affecting participants’ physical functioning may have contributed to the remarkable improvement in the older than 65 group in HRQoL during IPR.

Strengths and Limitations

Strengths of the current study include the scales used, which showed a reliability by producing an acceptable Cronbach’s alpha of more than 0.70 (except for the SGRQ impact subscale, which had a Cronbach’s alpha of 0.64). The current study is one of a few related to IPR outcomes conducted in a long-term care facility for older adults. Analyses of IPR scores showed the effect of IPR on older adults based on age following COPD exacerbations. The number of participants who completed the program (n = 21, 91.3%) was another factor considered to contribute to the strengths of the study. Another strength was the qualities of the intervention itself, which offered comprehensive inpatient care practice in a long-term care facility. The study measured improvements in symptoms and functional capacity, which likely contributed to improved HRQoL.

The main limitation of the current study was the relatively small sample. Small samples tend to overestimate (Behnke, Jörres, Kirsten, & Magnussen, 2003) the effect of interventions compared to large samples. Another limitation was the difficulty in recruitment of participants from acute care. This proved to be challenging because not all patients wanted to be involved in exercise training after hospitalization following a COPD exacerbation. Activity avoidance due to fear of breathlessness (Boot, van Exel, & van der Gulden, 2009) affected the recruitment process due to participants’ avoidance of dyspnea-inducing physical activity.

Another limitation was the lack of a control group, which would have received the standard outpatient care to treat COPD. Use of a control group could have allowed a comparison of what specific benefits arose from the IPR versus general outpatient care.

Implications for Nurses

The results suggest that IPR may be a useful therapy for older adults in the management of COPD following an exacerbation. Because all participants had been hospitalized for COPD exacerbation prior to IPR, the significant improvement in all outcome measures, particularly HRQoL for the older than 65 group, suggests there may have been a lack of training in managing symptoms in this age group. Problems encountered during initiation of IPR among the older than 65 group were severe deconditioning and muscle wasting determined by a physical examination; depression; anxiety; uncontrolled type 2 diabetes; and difficulty walking compared to the younger group. Cleland et al. (2007) reported that physical problems combined with emotional factors of anxiety and depression lead older adults with COPD to become withdrawn from active and satisfying lifestyles.

Gerontological nurses should address education and self-care management issues associated with COPD exacerbation. Depressive and anxiety disorder symptoms are not specific to patients with COPD and may be undiagnosed. Studies have shown that proper management of these mood disorders during COPD exacerbation recovery time has positive outcomes in HRQoL, improves functioning capacity, and prevents hospital readmissions (Coventry & Hind, 2007).

Implications for Future Research

Studies with large samples should be conducted to provide more precise and valid results for the effects of IPR in long-term care facilities for older adults. Cost-effective analysis should also be factored in such studies to analyze financial benefit from IPR after a COPD exacerbation as related to increased cost of care. Research into ways in which patients with COPD may be able to maintain exercise behavior long-term to improve HRQoL may be beneficial, as would research into management of mood disorders, such as depression and anxiety. Research using a control group could provide more precision regarding how IPR programs benefited the sample as compared to typical outpatient COPD care.

Conclusion

The current study showed that early IPR is an effective intervention for the management of symptoms of COPD in both middle-age and older adults recovering from a COPD exacerbation. Post-exacerbation management of COPD by an IPR program has short-term benefits of increased functional exercise tolerance capacity and perceived dyspnea on exertion level. HRQoL showed a statistically significant difference only in adults older than 65.

Participants agreed in a satisfaction survey questionnaire provided at the end of the IPR program that individualized exercise training was effective and beneficial in symptom management following a COPD exacerbation.

References

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Demographic Characteristics of Participants (N = 23)a

Variable Total, n (%) Younger Than 65 Group (n = 8) Older Than 65 Group (n = 15)
Gender
  Male 12 (52.2) 5 7
  Female 11 (47.8) 3 8
Race
  White 22 (95.7) 7 15
  Hispanic 1 (4.3) 1 0
Weight
  Underweight 2 (8.7) 1 1
  Normal weight 8 (34.8) 2 6
  Overweight 13 (56.5) 5 8
Comorbidities
  Difficulty walking 17 (73.9) 5 12
  Type 2 diabetes mellitus 10 (43.5) 6 4
  Hypertension 9 (39.1) 3 6
  Depression 7 (30.4) 4 3
  Congestive heart failure 6 (26.1) 2 4
  Pneumonia 4 (17.4) 3 1
  Obesity 4 (17.4) 3 1
  Anxiety 3 (13) 0 3
  Tobacco use 1 (4.3) 1 0

Pre and Post Outcome Measures after 8 Weeks of Inpatient Pulmonary Rehabilitation (N = 21)a

Scale Pre Mean (SD) Post Mean (SD)b p Valuec % Change
6MWD test (m) 104.68 (40.92) 179.18 (57.9) 0.05* 71.16
Borg CR10 5.12 (1.86) 4.19 (2.27) 0.011* −18.16
SGRQ 45.81 (16.79) 36 (16.37) 0.005* −22.20
  Symptoms 53.57 (27.85) 41.76 (28.98) 0.017* −22.04
  Impact 39.29 (17.85) 31.13 (15.07) 0.035* −21.96
  Activity 52.32 (23.38) 40.87 (23.78) 0.017* −22.88

Pre and Post Outcome Measures for the Younger than 65 Group After 8 Weeks of Inpatient Pulmonary Rehabilitation (n = 8)

Scale Pre, Mean (SD) Post, Mean (SD)a p Valueb
6MWD test (m) 121.32 (39.91) 226.61 (32.32) 0.002*
Borg CR10 5.12 (1.96) 3.88 (2.64) 0.019*
SGRQ 50.33 (15.87) 37.91 (7.49) 0.059
  Symptoms 51.56 (24.34) 43.54 (27.51) 0.067
  Impact 46.91 (16.87) 30.59 (10.19) 0.100
  Activity 56.58 (22.33) 46.98 (17.94) 0.219

Pre and Post Outcome Measures for the Older than 65 Group after 8 Weeks of Inpatient Pulmonary Rehabilitation (n = 13)

Scale Pre, Mean (SD) Post, Mean (SD)a p Valueb
6MWD test (m) 94.45 (39.54) 149.98 (50.55) 0.001*
Borg CR10 5.11 (1.87) 4.38 (2.10) 0.150
SGRQ 43.23 (17.64) 34.90 (19.98) 0.048*
  Symptoms 54.73 (30.50) 40.74 (30.77) 0.064
  Impact 35.33 (17.76) 31.43 (17.63) 0.200
  Activity 49.90 (24.43) 37.38 (26.53) 0.050

5-Point Likert Scale Satisfaction Survey Questionnaire after 8 Weeks of Inpatient Pulmonary Rehabilitation (N = 22)a

Statement Mean (Range)
The program has helped me manage my lung condition more effectively. 3.91 (2 to 5)
The information was pitched at an appropriate level. 4.05 (3 to 5)
The program met my expectations. 3.73 (2 to 5)
I found the program was worthwhile. 3.82 (2 to 5)
The exercise program has been helpful. 4.27 (2 to 5)
I would recommend this program to others with a lung condition. 4.05 (3 to 5)

Keypoints

Kiongera, G.M. & Crocker Houde, S. (2015). Inpatient Pulmonary Rehabilitation Program in a Long-Term Care Facility: Short-Term Outcomes and Patient Satisfaction. Journal of Gerontological Nursing, 41(8), 44–52.

  1. Chronic obstructive pulmonary disease (COPD) is irreversible and is currently the third leading cause of death and twelfth leading cause of morbidity in the United States.

  2. The inpatient pulmonary rehabilitation (IPR) program comprises medical management, exercise, nutrition counseling, and coping skills, among other interventions.

  3. Early IPR is an effective intervention for the management of symptoms of COPD in older adults recovering from COPD exacerbations.

10.3928/00989134-20150622-01

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