Patient Education Peer educator vs. respiratory therapist support: Which form of support better maintains health and functional outcomes following pulmonary rehabilitation? Eric Y. Wong a,b , Cally A. Jennings c, *, Wendy M. Rodgers c , Anne-Marie Selzler c , Lindsay G. Simmonds b , Rashida Hamir b , Michael K. Stickland a,b a Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada b Centre for Lung Health (Covenant Health), Edmonton General Continuing Care Centre, Edmonton, Alberta, Canada c Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada 1. Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability worldwide [1]. Pulmonary rehabilitation (PR) is an evidence-based multi-disciplinary approach to COPD management that aims to restore patients to the highest possible levels of independent function. Research has shown that PR effectively reduces COPD symptoms, improves functional exercise capacity and health related quality of life (HRQOL), while reducing hospitalizations, exacerbations and health care costs [2]. However, the longer-term benefits are not clear, as outcomes often return to baseline in the months following PR [2]. Ongoing support to COPD patients following completion of the PR program has been identified as a potential strategy to maintain these health outcomes [3]. Previous studies looking at ongoing support have mainly focused on regular supervised exercise sessions following PR [4–8], however these extended programs require significant resources and there is minimal evidence that they are effective. Furthermore, due to space, funding, and staffing constraints, PR programs are not designed to provide patients with ongoing access following PR. In addition PR programs are not often conveniently located for patients to attend. Therefore, it is not feasible for many patients to continue their exercise programs at a treatment facility. One of the primary goals of PR is to produce enduring behavior patterns that patients can maintain themselves. Recent research identified the Patient Education and Counseling 95 (2014) 118–125 A R T I C L E I N F O Article history: Received 12 February 2013 Received in revised form 24 October 2013 Accepted 9 December 2013 Keywords: COPD Exercise Pulmonary rehabilitation A B S T R A C T Objective: This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes. Methods: Phase one (n = 79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n = 168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. George’s Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR. Results: Six-month follow-up data for phase one was collected for 66 COPD patients (n = 35 peer support, n = 31 UC) and 142 for phase two (n = 42 peer support, n = 52 RT support, n = 48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT. Conclusion: Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes. Practice implications: There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide. ß 2013 Elsevier Ireland Ltd. All rights reserved. Abbreviations: ANOVA, analysis of variance; BMI, body mass index; BOCF, baseline observation carried forward; COPD, chronic obstructive pulmonary disease; FEV 1 , force expiratory volume in the first second; HRQOL, health related quality of life; ITT, intention to treat; MRC, medical research council dyspnea scale; PR, pulmonary rehabilitation; PS, peer support group; RMANOVA, repeated measures analysis of variance; RS, respiratory therapist support group; SD, standard deviation; SGRQ, St. George’s respiratory questionnaire; UC, usual care group; 6MWT, six minute walk test. * Corresponding author at: Van Vliet Centre, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada. Tel.: +1 780 492 0618. E-mail address: cally1@ualberta.ca (C.A. Jennings). Contents lists available at ScienceDirect Patient Education and Counseling jo ur n al h o mep ag e: w ww .elsevier .co m /loc ate/p ated u co u 0738-3991/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2013.12.008