Comparable improvements achieved in chronic obstructive pulmonary disease through pulmonary rehabilitation with and without a structured educational intervention: A randomized controlled trial

Background and objectivePulmonary rehabilitation is beneficial for people with chronic obstructive pulmonary disease (COPD) and typically includes exercise and disease-specific education components. However, the benefits directly attributable to the education component remain unclear. This trial sought to determine whether the addition of education to exercise training resulted in greater improvements in health outcomes than pulmonary rehabilitation where education has been omitted. MethodsA randomized trial with allocation concealment, assessor blinded to group allocation and intention-to-treat analysis was conducted. Two hundred and sixty-seven people with COPD (mean age 72(9) years, forced expiratory volume in 1s, 59(23)% predicted) were allocated to receive either 8 weeks of twice weekly group exercise training plus education or exercise training alone. Education was disease specific with a self-management focus. Primary outcome measures included 6-min walk distance and Chronic Respiratory Questionnaire. Secondary outcomes included dyspnoea, health behaviours, generic health-related quality of life, self-efficacy and healthcare usage with measurements taken immediately following completion and at 6 and 12 months. ResultsThere were no significant differences that indicated greater improvement in any health outcome with the addition of education. The two intervention groups had similar significant improvements immediately following intervention, and these were maintained comparably in the subsequent 12 months. ConclusionsThe results of this investigation suggest that disease-specific group education is not an essential component of pulmonary rehabilitation. Pulmonary rehabilitation based on exercise training is an effective option in the management of patients with COPD if multidisciplinary education cannot be offered. The inclusion of disease-specific group education in pulmonary rehabilitation for COPD was evaluated in a randomized controlled trial. Education incorporating self-management did not result in any additional benefit compared with pulmonary rehabilitation without education. These findings support the delivery of simple exercise-based pulmonary rehabilitation programmes when resources are limited. See Editorial, page 151