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Pulmonary rehabilitation in minimal versus high resource settings in COPD

2025-09Artigo científico Acesso aberto
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dc.contributor.authorMarques, Alda
dc.contributor.authorMarques, Alda
dc.contributor.authorAntão, Joana
dc.contributor.authorAntão, Joana
dc.contributor.authorRodrigues, Guilherme
dc.contributor.authorPaixão, Cátia
dc.contributor.authorPaixão, Cátia
dc.contributor.authorRebelo, Patrícia
dc.contributor.authorRebelo, Patrícia Filipa
dc.contributor.authorMachado, Ana
dc.contributor.authorMachado, Ana
dc.contributor.authorSouto-Miranda, Sara
dc.contributor.authorSouto-Miranda, Sara
dc.contributor.authorGrave, Ana Sofia
dc.contributor.authorGrave, Ana
dc.contributor.authorDias, Cíntia
dc.contributor.authorMarinho, Raquel
dc.contributor.authorVilar Marinho , Raquel
dc.contributor.authorMendes, Maria Aurora
dc.contributor.authorOliveira, Ana
dc.contributor.authorAlvarelhão, José Joaquim
dc.contributor.authorAlvarelhão, José
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - pólo NMS
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblElsevier Science B.V., Amsterdam.
dc.date.accessioned2025-07-15T21:16:53Z
dc.date.available2025-07-15T21:16:53Z
dc.date.issued2025-09
dc.descriptionFunding Information: This research was supported by FCT - Funda\u00E7\u00E3o para a Ci\u00EAncia e Tecnologia, I.P. by project reference UID 4501- Instituto de Biomedicina - Universidade de Aveiro. Publisher Copyright: © 2025 The Authors
dc.description.abstractBackground: Comparison of results and associated costs of pulmonary rehabilitation (PR) conducted with minimal resources (MR) versus specialised centres (SC) for people with chronic obstructive pulmonary disease (COPD) remains uncertain. Objectives: We assessed the effects, non-inferiority and associated costs in Portugal of PR with MR compared to PR in SC for COPD. Methods: PR was conducted with MR and in SC. The functional assessment of chronic illness therapy–fatigue scale-FACIT-FS, hospital anxiety and depression scale-HADS, COPD assessment test-CAT, St. George's Respiratory Questionnaire-SGRQ, quadriceps maximum voluntary contraction-QMVC, Brief-Balance Evaluation Systems Test-Brief-BESTest, 6-min walk test-6MWT and 1-min sit-to-stand-test-1minSTS were assessed pre-post PR. Effects were explored with robust/linear mixed effects model. Costs of PR implementation and intervention were estimated. Results: 158 people with COPD (69±8years; 79.7 % male; FEV1 49.0[40.0; 65.8]%predicted) participated, 72 in MR and 86 in SC. No Time∗Group interaction was observed, except for the SGRQ. Improvements were significant for all measures in both settings. Non-inferiority was demonstrated for FACIT-FS, HADS-D, QMVC, Brief-BESTest and 1minSTS but inconclusive for HADS-A, CAT, SGRQ and 6MWT. PR implementation costs were 8384€ with MR vs. 33,123€ in SC. Intervention costs were 5168€ and 9803€/program including non-emergency medical transportation (646€ vs. 1225€/person) in MR and SC, respectively. Conclusion: PR with MR has multiple benefits for people with COPD at a lower cost than in SC. However, its non-inferiority compared to SC remains inconclusive for core outcomes. PR with MR could be an effective alternative to increase access to this essential intervention when SC are unavailable.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent2152472
dc.identifier.doi10.1016/j.rmed.2025.108229
dc.identifier.issn0954-6111
dc.identifier.otherPURE: 121609011
dc.identifier.otherPURE UUID: 99f6447c-ef34-4058-83bb-0531da9bd302
dc.identifier.otherScopus: 105009628105
dc.identifier.urihttp://hdl.handle.net/10362/185192
dc.identifier.urlhttps://www.scopus.com/pages/publications/105009628105
dc.language.isoeng
dc.peerreviewedyes
dc.subjectChronic obstructive pulmonary disease
dc.subjectConstraint settings
dc.subjectLow resources
dc.subjectPulmonary rehabilitation
dc.subjectValue-based healthcare
dc.subjectPulmonary and Respiratory Medicine
dc.titlePulmonary rehabilitation in minimal versus high resource settings in COPDen
dc.title.subtitlea non-inferiority and economic evaluationen
dc.typejournal article
degois.publication.titleRespiratory Medicine
degois.publication.volume246
dspace.entity.typePublication
person.familyNameMarques
person.familyNameAntão
person.familyNamePaixão
person.familyNameRebelo
person.familyNameMachado
person.familyNameSouto-Miranda
person.familyNameGrave
person.familyNameVilar Marinho
person.familyNameAlvarelhão
person.givenNameAlda Sofia Pires
person.givenNameJoana
person.givenNameCátia
person.givenNamePatrícia Filipa
person.givenNameAna
person.givenNameSara
person.givenNameAna
person.givenNameRaquel
person.givenNameJosé
person.identifier1045180
person.identifier2137203
person.identifier2136641
person.identifier.ciencia-idDE15-EFBA-4856
person.identifier.ciencia-idAB1B-A5EA-C43B
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person.identifier.ciencia-idD21D-0290-5C3A
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person.identifier.ciencia-idA11D-4AF2-985C
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person.identifier.orcid0000-0002-4427-2695
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person.identifier.orcid0009-0001-7037-1451
person.identifier.orcid0000-0002-9576-7751
person.identifier.orcid0000-0002-4564-4323
person.identifier.ridK-3150-2013
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person.identifier.scopus-author-id55387623300
rcaap.rightsopenAccess
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