Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes - A randomized controlled clinical trial

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Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes - A randomized controlled clinical trial. / Hillerdal, G; Löfdahl, Claes-Göran; Strom, K; Skoogh, B E; Jorfeldt, L; Nilsson, F; Forslund-Stiby, D; Ranstam, Jonas; Gyllstedt, Erik.

I: Chest, Vol. 128, Nr. 5, 2005, s. 3489-3499.

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Hillerdal, G ; Löfdahl, Claes-Göran ; Strom, K ; Skoogh, B E ; Jorfeldt, L ; Nilsson, F ; Forslund-Stiby, D ; Ranstam, Jonas ; Gyllstedt, Erik. / Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes - A randomized controlled clinical trial. I: Chest. 2005 ; Vol. 128, Nr. 5. s. 3489-3499.

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TY - JOUR

T1 - Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes - A randomized controlled clinical trial

AU - Hillerdal, G

AU - Löfdahl, Claes-Göran

AU - Strom, K

AU - Skoogh, B E

AU - Jorfeldt, L

AU - Nilsson, F

AU - Forslund-Stiby, D

AU - Ranstam, Jonas

AU - Gyllstedt, Erik

PY - 2005

Y1 - 2005

N2 - 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. FEV1, 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, LVES can improve health status in survivors but is associated with mortality risk. The effects are stable for at least I year. Physical training alone failed to achieve a similar improvement.

AB - 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. FEV1, 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, LVES can improve health status in survivors but is associated with mortality risk. The effects are stable for at least I year. Physical training alone failed to achieve a similar improvement.

KW - health status

KW - emphysema

KW - lung function

KW - Short-Form General Health Survey

KW - Medical Outcomes Study

KW - St. George Respiratory Questionnaire

U2 - 10.1378/chest.128.5.3489

DO - 10.1378/chest.128.5.3489

M3 - Article

VL - 128

SP - 3489

EP - 3499

JO - Chest

T2 - Chest

JF - Chest

SN - 1931-3543

IS - 5

ER -