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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 LU ; Strom, K; Skoogh, B E; Jorfeldt, L; Nilsson, F; Forslund-Stiby, D; Ranstam, Jonas LU and Gyllstedt, Erik LU (2005) In Chest 128(5). p.3489-3499
Abstract
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
health status, emphysema, lung function, Short-Form General Health Survey, Medical Outcomes Study, St. George Respiratory Questionnaire
in
Chest
volume
128
issue
5
pages
3489 - 3499
publisher
American College of Chest Physicians
external identifiers
  • pmid:16304304
  • wos:000233508400060
  • scopus:28144446423
ISSN
1931-3543
DOI
10.1378/chest.128.5.3489
language
English
LU publication?
yes
id
0236abd1-61bd-4081-8d70-bb483511ab03 (old id 211860)
date added to LUP
2007-08-07 14:18:34
date last changed
2017-02-12 04:15:02
@article{0236abd1-61bd-4081-8d70-bb483511ab03,
  abstract     = {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.},
  author       = {Hillerdal, G and Löfdahl, Claes-Göran and Strom, K and Skoogh, B E and Jorfeldt, L and Nilsson, F and Forslund-Stiby, D and Ranstam, Jonas and Gyllstedt, Erik},
  issn         = {1931-3543},
  keyword      = {health status,emphysema,lung function,Short-Form General Health Survey,Medical Outcomes Study,St. George Respiratory Questionnaire},
  language     = {eng},
  number       = {5},
  pages        = {3489--3499},
  publisher    = {American College of Chest Physicians},
  series       = {Chest},
  title        = {Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes - A randomized controlled clinical trial},
  url          = {http://dx.doi.org/10.1378/chest.128.5.3489},
  volume       = {128},
  year         = {2005},
}