Incorporating Comprehensive Assessment Parameters to Better Characterize and Plan Rehabilitation for Persons with Chronic Obstructive Pulmonary Disease

Objectives: The current management of chronic obstructive pulmonary disease (COPD) largely ignores its heterogeneous pulmonary and extrapulmonary manifestations in the individual patient. This study aimed to identify clusters of patients with COPD based on a thorough traits assessment. Design: An observational, prospective, single-center study. Setting and Participants: Patients with COPD referred by chest physicians for a comprehensive pulmonary rehabilitation program to CIRO (Horn, the Netherlands) were eligible to participate. CIRO is a specialized pulmonary rehabilitation center in the southern part of the Netherlands for patients with complex underlying respiratory diseases. Methods: Clinically stable patients with COPD underwent a comprehensive assessment, including pulmonary traits (airflow limitation, static hyperinflation, gas transfer, respiratory pressures, and arterial blood gases), extrapulmonary functional traits, and health status (quadriceps muscle strength, physical functioning, body composition, comorbidities, symptoms perception, and social and emotional functioning). Clusters were generated using the SOM-Ward Cluster algorithm, a hybrid algorithm that applies the classical hierarchical method of Ward on top of the self-organizing map topology. Results: Based on the abovementioned attributes of 518 patients with mild to very severe COPD (44% women, age 64.1 +/- 9.1 years, forced expiratory volume in the first second 48.6% +/- 20.0% of predicted), 7 clusters were identified. Clusters had unique patterns differing in demographics, pulmonary, extrapulmonary functional, and behavioral traits and/or health status. Conclusion and Implications: The tremendous heterogeneity in pulmonary, extrapulmonary functional and behavioral traits, and health status in patients with COPD supports the need for an individual comprehensive assessment and a goal-directed personalized management strategy. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.