Journal de réadaptation cardiaque et pulmonaire

Abstrait

Effectiveness of Institutional Versus Domiciliary Implementation of Standard Pulmonary Rehabilitation Module in Bhopal Gas Exposed Survivors having COPD

Ruma Galgalekar, Devika S, Sindhuprava Rana, Lalit Kumar and Mahesh Rathore

Pulmonary Rehabilitation (PR) is beneficial treatment to decrease symptoms, increase participation and to reduce health costs for COPD patients for improving health quality. Our study compared the impact of pulmonary rehabilitation of gas exposed surviving COPD patients in ameliorating their health status in two operational settings i.e. supervised institutional and unsupervised home based.

The study sample used for PR was 180 gas exposed COPD subjects in age 40-75 yrs. of both gender, satisfying the inclusion (FEV1 of less than 60% and with no active heart disease) and exclusion criteria which was randomized equally into two groups (institutional and domiciliary). Before starting PR program, a 6 Minute Walk Test (MWT), SGRQ score and PFT was done and the same was assessed every 6 months interval. PR program for 1 hr consisted of breathing exercise, pursed lip breathing, huffing and coughing, diaphragmatic and incentive spirometry technique, active range of movements of all upper and lower limb joints and postural drainage.

Descriptive statistics of 6MWT with SpO2, Pulse rate and distance walked by both groups after interval of 6 months and 12 months of PR shows significant improvement in institutional group as compared to domiciliary. There is no significant difference in the FEV1 values at 6 months in both the groups but at 12th month follow up there is a significant reduction of 0.04 units in the FEV1 values in the domiciliary group as compared to baseline. Analysis of quality of life assessment by SGRQ shows decrease in severity of symptoms score, marked improvement in activity score, impact scores and total scores in Institutional Group after 12 months of Pulmonary Rehabilitation. Improvement in Quality of life and functional exercise capacity is significantly higher in Institutional group as compared to domiciliary group.