***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 Background Recently , there has been a surge of international interest in combining qualitative and quantitative methods in a single study – often called mixed methods research . It is timely to consider why and how mixed methods research is used in health services research ( HSR ) . Methods Documentary analysis of proposals and reports of 75 mixed methods studies funded by a research commissioner of HSR in Engl and between 1994 and 2004 .  Face-to-face semi-structured interviews with 20 research ers sample d from these studies . Results 18 % ( 119/647 ) of HSR studies were classified as mixed methods research . In the documentation , comprehensiveness was the main driver for using mixed methods research , with research ers wanting to address a wider range of questions than quantitative methods alone would allow . Interviewees elaborated on this , identifying the need for qualitative research to engage with the complexity of health , health care interventions , and the environment in which studies took place . Motivations for adopting a mixed methods approach were not always based on the intrinsic value of mixed methods research for addressing the research question ; they could be strategic , for example , to obtain funding . Mixed methods research was used in the context of evaluation , including r and omised and non-r and omised design s ; survey and fieldwork exploratory studies ; and instrument development . Studies drew on a limited number of methods – particularly surveys and individual interviews – but used methods in a wide range of roles . Conclusion Mixed methods research is common in HSR in the UK . Its use is driven by pragmatism rather than principle , motivated by the perceived deficit of quantitative methods alone to address the complexity of research in health care , as well as other more strategic gains . Methods are combined in a range of context s , yet the emerging method ological contributions from HSR to the field of mixed methods research are currently limited to the single context of combining qualitative methods and r and omised controlled trials . Health services research ers could further contribute to the development of mixed methods research in the context s of instrument development , survey and fieldwork , and non-r and omised evaluations Background Pulmonary rehabilitation ( PR ) is recognized as an evidence -based treatment in improving dyspnea and quality of life in patients with COPD . We evaluated the number needed to treat ( NNT ) to achieve an increase in physical capacity , as defined by a significant improvement in the six-minute walk test ( 6MWT ) in patients with COPD undergoing PR . Methods The study enrolled 284 patients aged 41 to 86 years ( mean age 69.4 years ) divided into two groups : a  study group ( 222 patients ) undergoing a PR program  , and a control group ( 62 patients ) treated only with drugs .  The study group included patients with COPD divided in four subgroups according to GOLD stages . Results In the study group , 142 out of 222 patients ( 64 % ) had an increase of at least 54 m in the 6MWT following PR versus 8 out of 62 patients ( 13 % ) in the control group after the same time interval . The NNT in the overall study group was 2 ; the same NNT was obtained in GOLD stages 2 , 3 , and 4 , but was 8 in stage 1 . Conclusions PR is highly effective in improving the exercise capacity of patients with COPD , as demonstrated by a valuable NNT , with better results in patients with a more severe disease BACKGROUND : A key component in the management of chronic obstructive pulmonary disease ( COPD ) patients is pulmonary rehabilitation ( PR ) , the corner stone of which is exercise training . AIM : This study aims to evaluate the effect of a two-months , home-based PR program with outpatient supervision every two weeks , on exercise tolerance and health-related quality of life ( HRQL ) using Arabic-translated st and ardized generic and specific question naires in COPD patients recently recovered from acute exacerbation , DESIGN : R and omized clinical trial . SETTING AND SUBJECTS : A total of 39 COPD patients who recovered from acute exacerbation were r and omly allocated either a two-month home-based PR program in addition to st and ard medical therapy or st and ard medical therapy alone in the period between July 2008 and March 2009 . METHODS : Pulmonary function tests ( PFTs ) , six-minute walk distance ( 6-MWD ) test , Arabic-translated chronic respiratory disease question naire-self administered st and ardized format ( CRQ-SAS ) and quality of life scale Short Form ( SF-36 ) were compared between 25 patients with moderate to severe COPD who underwent a two-month PR program ( group 1 ) and 14 COPD patients who did not ( group 2 ) . RESULTS : Group 1 showed significant improvement in the 6-MWD , and HRQL scores at two months compared with the usual care patients in group 2 ( P less than 0.05 ) . Improvement in both CRQ-SAS and SF-36 scores were statistically significant and comparable in group 1 . CONCLUSION : The supervised , post discharge , two-month home-based PR program is an effective non pharmacological intervention in the management of stable patients with COPD . The 6-MWD is a simple , inexpensive and safe test to assess physical and functional capabilities among COPD patients . HRQL can be measured in patients with COPD either by disease-specific tools that have been specifically design ed for use in patients with respiratory system disorders or by generic HRQL tools that can be used across population s with a variety of medical conditions . The Arabic-translated CRQ-SAS is a new tool for assessment of Arabic-speaking patients with chronic respiratory diseases OBJECTIVE To examine the effect of an  inpatient pulmonary rehabilitation program  on functional outcome , supplemental oxygen use , quality of life ( QOL ) , and rehospitalization . DESIGN A prospect i ve study . SETTING Inpatient pulmonary rehabilitation unit . PATIENTS One hundred fifty-seven patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) admitted to an inpatient pulmonary rehabilitation program over a 3-year period . INTERVENTION Comprehensive interdisciplinary inpatient pulmonary rehabilitation program with an average length of stay of 21 days . MAIN OUTCOME MEASURES Improvements in QOL question naire scores , COPD knowledge question naire scores , 6-minute walking test ( with 3 ambulation categories : bed-bound , household ambulators , community ambulators ) , and supplemental oxygen use . Rehospitalization 1 year after completion of the program was also assessed and compared with hospital days for the year before the program . RESULTS On discharge from the program , 88 % of individuals walked farther ( p < .0001 ) , and community ambulators doubled their walking distance , whereas bed-bound patients decreased 10-fold ; supplemental oxygen use dropped 33 % during the day ( p < .0001 ) and 57 % during the night ( p < .0001 ) ; 82 % showed improved QOL ( p < .0001 ) ; 67 % showed improved knowledge of COPD ( p < .0001 ) ; and 67 % of the sample spent less time in the hospital during the 12 months after program completion compared with the 12 months before admission ( p < .001 ) . CONCLUSIONS An inpatient pulmonary rehabilitation program leads to improved endurance and functional ambulation , decreased supplemental oxygen use , and fewer hospitalizations 1 year after discharge for patients with COPD 
    Output:
    
The psychosocial support of PR contributes to the patients ’ strength and desire for participation and the health education leads to illness-perception learning .
Both psychosocial support and health education develop patients ’ empowerment , while PR promotes opportunities to health transitions .
The empowerment experienced by the patients in taking advantage of these opportunities leads to positive impacts over time .
If they do not exploit these occasions , negative impacts arise in their life , which make the treatment assistance or follow-up more difficult .
The COPD patients ’ feedback revealed that PR promotes a better ‘ way of life ’ , well-being and important behavioural changes towards health promotion