***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE Acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) impair health-related quality of life ( HRQL ) . We evaluated the effect of an abbreviated repeat pulmonary rehabilitation ( PR ) program on HRQL after an AE COPD . METHODS Patients who had completed PR were followed for up to 12 months to identify an AE COPD and then placed in r and omized groups to receive a 3-week repeat-PR intervention or usual care .  Measures of HRQL ( Chronic Respiratory Disease Question naire , CRQ ) and functional exercise capacity ( 6-minute walk distance , 6MWD ) were collected at 2 ( T1 ) , 5 ( T2 ) , and 12 weeks ( T3 ) post-AE COPD . The repeat-PR program was undertaken between T1 and T2 . Between-group differences were examined using repeated- measures analysis of variance or covariance . RESULTS Of the 60 patients ( 30 men , age 69±8 years , forced expiratory volume in 1 second 0.86±0.40 L , 6MWD 367±99 m ) followed , 41 experienced an AE COPD 14 ± 11 weeks after completion of the initial PR program and 33 completed the study . Of these , 16 and 17 were r and omized to the intervention and control groups , respectively . No between-group differences were demonstrated at T2 or T3 . With the exclusion of 5 subjects who experienced a second AE COPD between T1 and T3 , the participants in the intervention group demonstrated greater reduction in dyspnea when compared to those in the control group at T3 ( 0.8±1.6 vs −0.4±1.3 points per item , P = .04 ) . CONCLUSIONS The reduction in dyspnea in those who did not experience a second AE COPD provides preliminary evidence for the role of repeat programs . The application of repeat PR should be refined in larger trials Background : The evidence of benefit for pulmonary rehabilitation ( PR ) programmes is established . However , the optimal duration of a PR programme is not known . A r and omised controlled trial was undertaken in patients with chronic obstructive pulmonary disease ( COPD ) to assess whether a 4 week PR programme was equivalent to our conventional 7 week PR programme at equivalent time points of 7 weeks and 6 months . Methods : One hundred patients ( 56 men ) with stable COPD of mean ( SD ) age 70 ( 8) years and forced expiratory volume in 1 second ( FEV1 ) 1.13 ( 0.50 ) litres were r and omised to either a 7 week ( n = 50 ) or 4 week ( n = 50 ) supervised PR programme . Patients were assessed at baseline , at completion of the supervised PR programme , and 6 months later . Patients r and omised to the 4 week group were also assessed at the 7 week time point . Outcome measures were the Incremental Shuttle Walk Test , Endurance Shuttle Walk Test ( ESWT ) , Chronic Respiratory Question naire-Self Reported , and the Breathing Problems Question naire . Results : Forty one patients in each group completed the PR programme . Patients made significant within group improvements after supervised rehabilitation . There were no statistically significant differences between the groups for any other measure at the 7 week or 6 month time points , except that patients in the 4 week group attained higher ESWT times ( mean difference 124 seconds ( 95 % CI 17.00 to 232.16 ) , p = 0.024 ) at the 7 week time point . Conclusions : A shortened 4 week supervised PR programme is equivalent to a 7 week supervised PR programme at the comparable time points of 7 weeks and 6 months OBJECTIVES To compare the effectiveness of a once-weekly supervised pulmonary rehabilitation programme with a st and ard twice-weekly format . DESIGN R and omised trial of equivalency . SETTING Pulmonary rehabilitation service of a primary care trust delivered at two physiotherapy outpatient departments . PARTICIPANTS Thirty patients with chronic obstructive pulmonary disease . OUTCOME MEASURES Primary outcomes were the Incremental Shuttle Walking Test ( ISWT ) , Endurance Shuttle Walking Test ( ESWT ) and St George 's Respiratory Question naire ( SGRQ ) , assessed at baseline and at completion of the supervised programme . Secondary outcomes were home-exercise activity , attendance levels and patient satisfaction with the programme . INTERVENTIONS The once-weekly group ( n=15 ) received one supervised rehabilitation session per week , and the twice-weekly group ( n=15 ) received two sessions per week , both for 8 weeks , together with a home-exercise plan . RESULTS After pulmonary rehabilitation , the groups showed similar improvements in exercise tolerance ( median values : ISWT once-weekly 60metres , twice-weekly 50metres ; ESWT once-weekly 226seconds , twice-weekly 109seconds ) . However , for health-related quality -of-life , the once-weekly group 's score did not change ( SGRQ 0 ) , whereas an improvement was seen for the twice-weekly group ( SGRQ 3.7 ) . The number of home-exercise sessions and attendance levels were similar between the groups . Patient satisfaction with both formats was high and almost identical between the groups . CONCLUSIONS This pilot provides data to inform a larger study and shows that the methodology is feasible . The findings suggest that once-weekly supervision may be capable of producing equivalent improvements in exercise tolerance as a twice-weekly programme , but the health-related quality -of-life outcome appeared to be poorer for once-weekly supervision OBJECTIVE To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease ( COPD ) . METHODS A r and omized control trial was undertaken during which an experimental group received 2h of education delivered by a certified COPD educator and a control group received usual care . The Bristol COPD Knowledge Question naire ( BCKQ ) was self-administered at the time of r and omization and approximately three months later . RESULTS Of the 93 individuals that completed the study , 50 ( forced expiratory volume in 1s [FEV(1)]=60.0+/-14.3 % predicted ; 22 males ) and 43 ( FEV(1)=58.2+/-14.4 % predicted ; 20 males ) participants were r and omized to the experimental and control groups , respectively . The BCKQ increased from 27.6+/-8.7 to 36.5+/-7.7 points ( p<0.001 ) in the experimental group , which was greater than any seen in the control group ( between-group difference 8.3 , 95 % confidence interval 5.5 - 11.2 points ) . CONCLUSION As little as 2h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge . PRACTICE IMPLICATION S A program of brief education delivered in the primary care setting , represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation Objective To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD , using St . George ’s Respiratory question naire ( SGRQ ) , the 6-minutes walking test ( 6-MWT ) and BODE index as the primary outcome measures . Methods A prospect i ve , parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD ( 67 men and 13 women ; mean age 64.8 ± 10.6 years ; FEV1 , 42.8 % ± 7.6 % of the predicted value . The active group ( n = 40 ) took part in a 14-week rehabilitation program [ 3 h/wk , 1.5 h of education and exercise and 1.5 h of cycling ] . The control group ( n = 40 ) was review ed routinely as medical out patients . The following evaluations were carried out at study entry and after14 weeks : ( 1 ) pulmonary function studies ; ( 2 ) 6-minutes walking test 6MWT ; ( 3 ) quality of life ; and ( 4 ) BODE index . Results The following patients completed the study : 35 patients ( 87.5 % ) from the active group ( mean age , 63.7 ± 11.9 years ; mean forced expiratory volume in one second ( FEV1 ) , 41.9 ± 2.6 % of the predicted value ) ; and 36 patients ( 88 % ) from the control group ( mean age , 65.9 ± 10.3 years ; mean FEV1 , 43.33 ± 3.6 % of the predicted value ) . We found no changes in pulmonary function parameters in the active group and the control one at 14weeks . On the other h and , there were significant changes within the components of the SGRQ ( 12.3 for the score total ) for the patients of the active group but not for the patients of the control one ( only 1.5 for the score total ) , we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one , and finally a decrease of two points ( from 6 to 4 ) was noted in the score of the active group ’s BODE index without any change in the control group ’s one . Conclusion An outpatient-based of 14-week rehabilitation program  significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD , and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index OBJECTIVE The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease ( COPD ) are uncertain . We aim ed to assess the short- and medium-term efficacy of such a program in this clinical setting . PATIENTS AND METHODS Patients with severe COPD ( stages III-IV , classification of the Global Initiative for Chronic Obstructive Lung Disease ) and incapacitating dyspnea ( scores 3 - 5 , Medical Research Council [ MRC ] scale ) were r and omized to a control or domiciliary rehabilitation group . The 9-week supervised pulmonary rehabilitation program included educational sessions , respiratory physiotherapy , and muscle training in weekly sessions in the patient 's home . We assessed the following variables at baseline , 9 weeks , and 6 months : lung function , exercise tolerance ( 3-minute walk test ) , dyspnea ( MRC score ) , and health-related quality of life with the Chronic Respiratory Question naire ( CRQ ) . RESULTS Thirty-eight patients with a mean ( SD ) age of 68 ( 6 ) years were enrolled . The mean MRC score was 4 ( 0.8 ) and mean forced expiratory volume in 1 second was 29 % of reference . Twenty-nine patients completed the study ( 6 months ) . Distance covered on the walk test increased significantly in the rehabilitation group ( P=.001 ) and the difference was maintained at 6 months . Dyspnea also improved significantly with rehabilitation ( P<.05 ) , but the reduction was not evident at 6 months . Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks : dyspnea ( 3.1 [ 0.8 ] vs 3.6 [ 0.7 ] ; P=.02 ) and fatigue ( 3.7 [ 0.8 ] vs 4.2 [ 0.9 ] ; P=.002 ) . A clinical ly relevant but not statistically significant change in mastery over disease was detected ( from 4.3 to 4.9 ) . All improvements were maintained at 6 months . CONCLUSIONS Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months BACKGROUND Self-management interventions improve various outcomes for many chronic diseases . The definite place of self-management in the care of chronic obstructive pulmonary disease ( COPD ) has not been established . We evaluated the effect of a continuum of self-management , specific to COPD , on the use of hospital services and health status among patients with moderate to severe disease . METHODS A multicenter , r and omized clinical trial was carried out in 7 hospitals from February 1998 to July 1999 . All patients had advanced COPD with at least 1 hospitalization for exacerbation in the previous year . Patients were assigned to a self-management program or to usual care . The intervention consisted of a comprehensive patient education program administered through weekly visits by trained health professionals over a 2-month period with monthly telephone follow-up . Over 12 months , data were collected regarding the primary outcome and number of hospitalizations ; secondary outcomes included emergency visits and patient health status . RESULTS Hospital admissions for exacerbation of COPD were reduced by 39.8 % in the intervention group compared with the usual care group ( P = .01 ) , and admissions for other health problems were reduced by 57.1 % ( P = .01 ) . Emergency department visits were reduced by 41.0 % ( P = .02 ) and unscheduled physician visits by 58.9 % ( P = .003 ) . Greater improvements in the impact subscale and total quality -of-life scores were observed in the intervention group at 4 months , although some of the benefits were maintained only for the impact score at 12 months . CONCLUSIONS A continuum of self-management for COPD patients provided by a trained health professional can significantly reduce the utilization of health care services and improve health status . This approach of care can be implemented within normal practice This study tested the hypothesis that severity of respiratory 
    Output:
    
Conclusion Unlike previous reports , we found high participation and low dropout rates in studies of PR or SM support for COPD .