Pulmonary rehabilitation reduces fatigue in COPD: a responder analysis

Abstract

<b>Background:</b> Only few studies have investigated the effects of pulmonary rehabilitation (PR) on fatigue in COPD. To date, it remains unknown which patients have a clinically relevant improvement in fatigue following PR. Purpose of this study was to identify these responders. <b>Methods:</b> Demographics, lung function, mood status (SCL90-A and BDI-PC), exercise tolerance (6MWD), and health status (NCSI) were assessed before and after a 12-week PR program at Dekkerswald Radboudumc (Nijmegen, The Netherlands). Fatigue was assessed using the Checklist Individual Strength (CIS)-Fatigue. Patients with a decline ≥10 points (MCID) were defined as responders. <b>Results:</b> 446 COPD patients (61±9 years, 53% male, FEV1 43±18 %pred, 75% severe fatigue) completed the PR. 53% were identified as responders. Mean change in fatigue after PR (10±12 points, p&lt;0.01) exceeded the MCID. Baseline CIS-Fatigue (45±7 vs 38±9 points, respectively) and health-related quality-of-life (HRQoL) were significantly different between responders and non-responders. No significant differences between responders and non-responders were found in demographics, baseline mood status, lung function, 6MWD, and dyspnea. Responders reported a significantly greater improvement in mood status, 6MWD, dyspnea and health status (Table). <b>Conclusions:</b> PR reduces fatigue in COPD. Responders on fatigue have worse fatigue and HRQoL scores at baseline, and are likely to be responders on other outcomes in PR.