Die Bedeutung der gesundheitsbezogenen Lebensqualität für die Bewertung interventioneller Maßnahmen bei Patienten mit COPD

Zusammenfassung:

Die vorliegende Übersicht bietet einen kritischen Überblick über Methoden und Ergebnisse von Studien zur Effektivität der Rehabilitation bei chronisch-obstruktiven Lungenerkrankungen (COPD) hinsichtlich der gesundheitsbezogenen Lebensqualität (HRQOL). In 14 (45 %) der 31 analysierten Studien wurde ein krankheitsspezifisches und in 12 (39 %) Studien ein krankheitsübergreifendes (generelles) Verfahren zur Messung der HRQOL verwendet. In weiteren 4 der verbleibenden 5 Studien wurde ein generelles und ein krankheitsspezifisches Verfahren eingesetzt. Die generellen Verfahren erwiesen sich als nicht weniger sensitiv für therapieinduzierte Veränderungen im Vergleich zu der krankheitsspezifischen Methodik. Die Analyse der publizierten Studien legt eine kombinierte Verwendung von generellen und spezifischen Verfahren nahe. In 12 (39 %) von 31 Studien zu den Auswirkungen von Rehabilitationsmaßnahmen auf die HRQOL ergaben sich anhaltend positive Effekte einzelner Interventionen wie der operativen Lungenvolumenreduktion, dem Einsatz von Pharmaka, dem Training der Atemmuskulatur und psychologischen Interventionen sowie integrierten Rehabilitationsprogrammen. Stationäre und ambulante Programme unterscheiden sich in der Dauerhaftigkeit ihrer Wirkung. In 2 von 3 Studien zu einem stationären Rehabilitationsprogramm trat nach anfänglicher Verbesserung zum Katamnesezeitpunkt eine Verschlechterung der HRQOL ein. Andererseits hielt die Wirkung von 3 der 4 im ambulanten oder häuslichen Kontext durchgeführten Programme bis zur Katamnese an.

The Significance of Health Related Quality of Life for the Evaluation of Interventional Measures in Patients with COPD:

Health related quality of life (HRQOL) is an important criterion for the evaluation of rehabilitation measures in patients with chronic obstructive pulmonary disease (COPD). The present paper reviews the current literature about the effects of pulmonary rehabilitation on the HRQOL of patients with COPD. The aim is to summarize critically methods, results and unanswered issues of the present research on the effects of pulmonary rehabilitation on HRQOL. The rehabilitation of patients suffering of COPD is mainly based on six types of interventions: 1. long-term oxygen therapy (LTO), 2. pharmacological management, 3. surgical therapy (bilateral reduction of lung volume), 4. physical therapy, 5. nutritional therapy (special diets), and 6. psycho-social interventions (e.g. psychotherapy, training and education). Thirty-one studies could be included in which HRQOL served as an outcome criterion for the rehabilitation of COPD patients. In 14 (45 %) studies exclusively a disease-specific measure for the assessment of HRQOL was employed, while in 12 (39 %) studies a generic instrument was applied. In the remaining five (16 %) studies two ore more measures were used, whereas four of them combined a generic and a disease-specific method. The St. Georges Respiratory Questionnnaire (SGRQ) und the Chronic Respiratory Disease Questionnaire (CRDQ) belonged to the group of the specific instruments, while among the generic measures the Sickness Impact Profile (SIP), the Nottingham Health Profile (NHP), the SF-36 and the Quality of Well-Being Scale (QWB) were most frequently used in COPD patients. The surgical bilateral reduction of lung volume, pharmacological therapy, upper extremities muscle training and psychological measures as single interventions proved to have persistent positive effects on the HRQOL. Several rehabilitation programs, composed of a wide variety of different interventions were effective in terms of HRQOL. On the other hand, at follow-up, the short-term positive effects had decreased in two of the three studies, where the rehabilitation took place exclusively in an inpatient setting. However, in three of four programs implemented in an outpatient setting, a persistent positive effect on HRQOL could be demonstrated. In conclusion from the as of yet available findings, we suggest for future studies to use only such measures of HRQOL which have been tested psychometrically in patients with COPD and to combine disease-specific and generic measures. In order to achieve lasting positive effects of rehabilitation on HRQOL, outpatient settings or ambulatory refreshment sessions following rehabilitation on an inpatient basis should be preferred.

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