Effect of a Physiotherapist-Guided Home-Based Exercise Intervention on Physical Capacity and Patient-Reported Outcomes Among Patients With Acute Pulmonary Embolism
Authors: Nanna Rolving, Barbara C. Brocki, Jannie R. Bloch-Nielsen, Torben B. Larsen, Frank L. Jensen, Hanne R. Mikkelsen, Pernille Ravn, Lars Frost
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Survivors of acute pulmonary embolism (PE) experience long-term negative physical and mental consequences, but the effects of rehabilitation on outcomes among these patients have not been investigated. <h3>Objective</h3> To investigate the effect of a rehabilitation intervention, comprising an 8-week home-based exercise program and nurse consultations, on physical capacity and patient-reported outcomes among patients with acute PE. <h3>Design, Setting, and Participants</h3> This multicenter randomized clinical superiority trial was conducted at 4 regional hospitals and 1 university hospital in Denmark. The 140 consecutively included participants had been diagnosed with an acute PE between April 2016 and February 2018 and had 6 months of follow-up. An intention-to-treat analysis was conducted. <h3>Intervention</h3> Patients in the control group received a brief nurse consultation, while patients in the exercise group participated in an 8-week home-based exercise program in addition to receiving nurse consultations. <h3>Main Outcomes and Measures</h3> The primary outcome was the Incremental Shuttle Walk Test, and secondary outcomes were the Pulmonary Embolism Quality of Life and the EuroQol–5 Dimensions–3 Levels questionnaires, self-reported number of sick-leave days, and self-reported use of psychotropic drugs. <h3>Results</h3> A total of 140 patients (90 [64.3%] men) were included, with a mean (SD) age of 61 (11) years. Of 70 participants (50.0%) randomized to each group, 69 participants (49.3%) received the intervention and 68 (48.6%) received the control intervention. Both groups achieved improvements in all outcomes (eg, mean [SD] improvement on Incremental Shuttle Walk Test: control group, 78 (127) m; intervention group, 104 [106] m; median [interquartile range] improvement on Pulmonary Embolism Quality of Life: control group, −17 [−22 to −11] points; intervention group, −20 [−24 to −15] points). Between-group differences were nonsignificant. The mean differences between the intervention group and the control group were 25 m (95% CI, −20 to 70 m;<i>P</i> = .27) on the Incremental Shuttle Walk Test, 3.0 points (95% CI, −3.7 to 9.9 points;<i>P</i> = .39) on the Pulmonary Embolism Quality of Life questionnaire, and 0.017 point (95% CI, −0.032 to 0.065 point;<i>P</i> = .50) on the EuroQol–5 Dimensions–3 Levels questionnaire. Of the 27 patients in the intervention group on sick leave at baseline, 24 (88.9%) reported fit-for-duty at the 6-month follow-up, and of 18 patients in the control group on sick leave, 17 (94.4%) reported fit-for-duty at the 6-month follow up. The between-group risk difference was not significant (5.5 points;<i>P</i> = .49). <h3>Conclusions and Relevance</h3> An 8-week rehabilitation intervention with exercise added to nurse consultations did not show significantly better outcomes than nurse consultations alone. However, because of a ceiling effect on the primary outcome of physical capacity and an inclusion of patients with a low comorbidity burden and low PE disease severity, definitive conclusions could not be drawn. Initiating an exercise intervention shortly after pulmonary embolism was safe and without adverse events. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02684721