Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations after COPD Admission
Lindenauer 2021 trial design and results
Design
Observational cohort study of Medicare beneficiaries
Treatment
Pulmonary rehabilitation initiated within 90 days of discharge
Control
No pulmonary rehabilitation within 90 days
Population
Medicare beneficiaries hospitalised for chronic obstructive pulmonary disease
Follow-up
1 year
Primary endpoint
Rehospitalisation within one year of initiating rehabilitation
Result
Initiation within 90 days was associated with a lower risk of readmission over the following year (hazard ratio 0.83, 95% CI 0.77 to 0.90). Mean cumulative rehospitalisations at one year were 0.95 for those starting within 90 days versus 1.15 for those who did not (p<0.001).
Secondary endpoints
Cumulative rehospitalisations, mortality
After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.
The trial authors, in the published abstract
How it has aged
Observational, so confounding by indication is the obvious objection — patients well enough to attend rehabilitation are patients likely to do better anyway. Its value is scale and real-world setting, and it confirms what randomised trials found in far smaller samples. See also Bourne 2023 on how to widen access.
Publications
Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease
Stefan MS, Pekow PS, Priya A, et al. Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021 Nov 1;204(9):1015-1023.
17% lower hazard of readmission over one year
Observational design with likely confounding by indication
Very few eligible patients actually initiated rehabilitation