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Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
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2005 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 128, no 5, 3489-3499 p.Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVES: In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements.

DESIGN: After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year.

SETTING: All seven thoracic surgery centers in Sweden.

PATIENTS: All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS.

INTERVENTIONS: Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively.

MEASUREMENTS AND RESULTS: Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months.

CONCLUSIONS: In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.

Place, publisher, year, edition, pages
2005. Vol. 128, no 5, 3489-3499 p.
Keyword [en]
emphysema, health status, lung function, Medical Outcomes Study Short-Form General Health Survey, St. George Respiratory Questionnaire
National Category
Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-22852DOI: 10.1378/chest.128.5.3489ISI: 000233508400060PubMedID: 16304304OAI: oai:DiVA.org:umu-22852DiVA: diva2:218272
Available from: 2009-05-19 Created: 2009-05-19 Last updated: 2015-09-07Bibliographically approved

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