Journal of the American Medical Directors Association
Original StudyIncorporating Comprehensive Assessment Parameters to Better Characterize and Plan Rehabilitation for Persons with Chronic Obstructive Pulmonary Disease
Section snippets
Study Design
The current analyses are based on data from the Chance Study: an observational, prospective, single-center study about COPD, health status, and cardiovascular comorbidities in relation to the outcomes of pulmonary rehabilitation.16 This study was approved by the Medical Ethical Committee of the Maastricht University Medical Centre (METC 11-3-070) and is registered at http://www.trialregister.nl (NTR 3416).
Study Sample
Patients with COPD referred by chest physicians from general and academic hospitals for a
Patient Characteristics
A total of 518 patients were analyzed (Table 1). The majority of patients had COPD GOLD D (72%). Patients had a substantial smoking history, and a high disease burden and medical resource use reflected by the mean number of exacerbations as well as hospitalizations in the last year (2.2 and 0.9, respectively). A quarter of them used LTOT. On average, patients had an impaired physical fitness, 1 or more comorbidities, and experienced a high impact on activities in daily life.
Patient Profiles of the 7 Clusters
Seven clusters were
Discussion
In a sample of patients with moderate to very severe COPD referred for pulmonary rehabilitation, clustering based on a thorough assessment of a broad set of pulmonary and extrapulmonary (functional, behavioral) traits and health status resulted in 7 distinct clusters. However, heterogeneity within clusters and overlap regarding individual traits between clusters remain large. Our data suggest that a broad assessment of treatable traits might be useful in individual patients in order to offer
Conclusion and Implications
Based on respiratory, functional, and emotional treatable traits, patients with COPD were divided into 7 clusters: the overall best-functioning cluster, the ADL-limited cluster, the multimorbid cluster, the low-burden cluster, the emotionally dysfunctioning cluster, the overall worst-functioning cluster, and the physically dysfunctioning cluster. Our data clearly illustrate the tremendous heterogeneity in manifested pulmonary, extrapulmonary functional, and behavioral traits in patients with
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The CHANCE study was supported by the Lung Foundation Netherlands (3.4.10.015) and GlaxoSmithKline (SCO115406). These funding organizations provided only financial support, not playing a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors declare no conflicts of interest.