Outcomes from a Nurse - Managed COPD Rehabilitation Program

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States, causing 105,000 deaths annually. The health care system is affected because approximately 13.5 million people have COPD, which is progressive and incurable, and costs about $23.9 billion per year. Although the literature endorses the role of exercise as part of pulmonary rehabilitation, no randomized trials exist comparing a nurse-managed comprehensive pulmonary rehabilitation program to education only and routine follow-up. Most COPD studies that do exist have small sample sizes and took place outside the United States.

The purpose of this study is to compare a nurse-managed comprehensive pulmonary rehabilitation program to education only and follow-up by the patient's routine healthcare provider. A prospective, intervention-based, two group, longitudinal design will be used. The independent variables in this study will be a nurse-managed comprehensive pulmonary rehabilitation program and an education-only program with COPD management from the patient's routine healthcare provider. The dependent variables will be pulmonary function, exercise tolerance, activity and rest patterns, quality of life, and exacerbations, which will include healthcare utilization and costs.

Outcome variables will be analyzed with analysis of covariance techniques. These analyses will compare both the short-term and the long-term effectiveness of the two COPD programs. They will include an evaluation of differences across three COPD stage cohorts, while holding constant demographic, treatment, and comorbidity variables. Multiple regression analysis will be used to develop a profile of patients who are most likely to benefit from a comprehensive program. Multiple regression analysis will also be used to evaluate the appropriateness of the Roy Adaptation Model.

This study will be the basis for a series of future studies investigating the long-term role of rehabilitation interventions for military beneficiaries with COPD.