***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: This study tested the hypothesis that severity of respiratory disability may affect the outcome of pulmonary rehabilitation . In this r and omized , controlled study , 126 patients with chronic obstructive pulmonary disease ( COPD ) were stratified for dyspnoea using the Medical Research Council ( MRC ) dyspnoea score into MRC3/4 ( Moderate ) ( n=66 ) and MRC 5 ( Severe ) dyspnoeic ( n=60 ) groups . The patients were r and omly assigned to an eight week programme of either exercise plus education ( Exercise group ) or education ( Control group ) . Education and exercise programmes for the moderately dyspnoeic patients were carried out in a hospital outpatient setting . Severely dyspnoeic patients were all treated at home . Those in the Exercise group received an individualized training programme . There was a significant improvement in shuttle walking distance in the moderate dyspnoeic group , who received exercise training ; baseline ( mean+/-SEM ) 191+/-22 m , post-rehabilitation 279+/-22 m ( p<0.001 ) . There was no improvement in exercise performance in the severely dyspnoeic patients receiving exercise . Neither group of control patients improved . Health status , assessed by the Total Chronic Respiratory Disease Question naire score , increased in the moderately dyspnoeic patients receiving exercise from 80+/-18 to 95+/-17 ( p<0.0001 ) after rehabilitation . Much smaller changes were seen in the other three groups . Improvement in exercise performance and health status in patients with chronic obstructive pulmonary disease after an exercise programme depends on the initial degree of dyspnoea It was postulated that home hospitalisation ( HH ) of selected chronic obstructive pulmonary disease ( COPD ) exacerbations admitted at the emergency room ( ER ) could facilitate a better outcome than conventional hospitalisation . To this end , 222 COPD patients ( 3.2 % female ; 71±10 yrs ( mean±sd ) ) were r and omly assigned to HH ( n=121 ) or conventional care ( n=101 ) . During HH , integrated care was delivered by a specialised nurse with the patient 's free-phone access to the nurse ensured for an 8‐week follow-up period . Mortality ( HH : 4.1 % ; controls : 6.9 % ) and hospital readmissions ( HH : 0.24±0.57 ; controls : 0.38±0.70 ) were similar in both groups . However , at the end of the follow-up period , HH patients showed : 1 ) a lower rate of ER visits ( 0.13±0.43 versus 0.31±0.62 ) ; and 2 ) a noticeable improvement of quality of life ( Δ St George 's Respiratory Question naire ( SGRQ ) , −6.9 versus −2.4 ) . Furthermore , a higher percentage of patients had a better knowledge of the disease ( 58 % versus 27 % ) , a better self-management of their condition ( 81 % versus 48 % ) , and the patient 's satisfaction was greater . The average overall direct cost per HH patient was 62 % of the costs of conventional care , essentially due to fewer days of inpatient hospitalisation ( 1.7±2.3 versus 4.2±4.1 days ) . A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective . The home hospitalisation intervention  generates better outcomes at lower costs than conventional care BACKGROUND Chronic obstructive pulmomary disease ( COPD ) is associated with substantial mortality , morbidity , and costs to the health care system . With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services , for conditions such as COPD . AIM To determine the effectiveness of an outreach respiratory nurse in a shared care approach , with collaboration between general practitioners and hospital services , in the management of patients with severe COPD . METHODS Patients with severe COPD attending The Queen Elizabeth Hospital , Adelaide participated in a r and omised controlled trial of a home based nursing intervention ( HBNI ) over 12 months with outcome measures including mortality rate , hospital service utilisation , FEV1 and health related quality of life ( HRQL ) using a modified Dartmouth Primary Care Co-operative Quality of Life question naire . RESULTS There were 48 subjects in each study arm , with no differences in mortality rate ( eight deaths in the HBNI group and seven in the control group ) , hospital admissions , length of stay , number of outpatient and Emergency Service visits . The study had inadequate follow-up of FEV1 and HRQL within the control group . Within the HBNI group , a small improvement in HRQL ( in three of ten indices measured ) was demonstrated , despite a deterioration in FEV1 ( 11 % reduction , p=0.04 ) compared to baseline . Quality of life of HBNI subjects ' carers did not change . CONCLUSION An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation Seventy five patients with chronic respiratory disability were r and omised to a group visited by a respiratory health worker ( 42 ) or control group  ( 33 ) . The first group was visited monthly by a respiratory nurse , who gave education and support . The effect of the intervention was assessed in terms of quality of life ( by question naires ) , the number and duration of admissions to hospital , and the number of deaths . The question naires on quality of life showed no changes in either group during the study , but nearly all of the group visited by a respiratory health worker said that they valued the visits and wished them to continue . Their knowledge about their condition also improved compared with that of the controls . The duration of stay in hospital for respiratory reasons in the group visited by a respiratory health worker was longer than that of control patients . This was explained by their being scored as more ill than the controls on admission . Fewer patients died in the group visited by a respiratory health worker than in the control group ( p = 0.11 ) . The patients in the group visited by respiratory health workers may have survived longer because they sought help rather than dying at home . If confirmed this could have implication s for the cost of their care The purpose of this study was to examine the effects of a home-based pulmonary rehabilitation program on lung function , dyspnea , exercise tolerance , and quality of life in 23 Koreans with moderate to severe chronic lung disease . The outcome measures were forced expiratory volume in 1s ( FEV1 , % predicted ) , Borg score , 6 min walking distance ( 6MWD ) , and chronic respiratory disease question naire ( CRDQ ) . Experimental group ( n=15 ) performed the 8-week home-based pulmonary rehabilitation program , composed of inspiratory muscle training , upper and lower extremity exercise , relaxation , and telephone visit . Patients in control group ( n=8 ) were only given educational advice . The experimental group showed a lower level of exertional dyspnea , more exercise tolerance , and greater improvement in health-related quality of life than the control group ( p<0.05 ) . Lung function was not statistically different . This study yielded evidence for the beneficial effects of home-based pulmonary rehabilitation program PURPOSE Pulmonary rehabilitation programs often show beneficial effects in patients with chronic obstructive pulmonary disease ( COPD ) . These programs are usually hospital-based . This study assesses the feasibility and application of a 12-week Home-Care Rehabilitation Program ( HCRP ) , carried out by general practitioners , physiotherapists , and home-care nurses . METHODS Effects of the HCRP are assessed in 15 COPD patients with moderate to severe airflow limitation ( inspiratory vital capacity [ IVC ] : mean , 75.4 [ SD , 13.7 ] percent predicted , mean FEV1 : 45.5 [ 6.9 ] percent predicted ) and are compared with a stratified and r and omized control group ( n = 15 ) . RESULTS All participating disciplines judged the program to be useful and feasible . Patient compliance with the rehabilitation exercises was high . No major problems concerning the rehabilitation program were reported . After the HCRP , 4-minute walking distance improved significantly from 274 m [ 61 ] to 301 m [ 72 ] and maximal work load ( W max ) , as measured during an incremental cycle test , increased from 75.3 W [ 24 ] to 85.3 W [ 28 ] . At equal work levels ( W submax ) during the cycle test both Borg dyspnea and leg effort scores decreased significantly after the HCRP ( 6.7 [ 1.3 ] versus 4.9 [ 1.7 ] and 4.2 [ 2.0 ] versus 1.7 [ 2.5 ] , respectively ) . Changes in walking distance , dyspnea , and leg effort scores at W submax were significantly different between the two groups . IVC and FEV1 did not change significantly . In the control group , no significant changes in any parameter were observed . CONCLUSION It was possible to design and perform successfully a home-care rehabilitation program , providing both objective and subjective improvements in a group of patients with COPD . A home-care rehabilitation program appears to be a valuable component in the management of COPD patients with a moderate to severe airflow limitation BACKGROUND For chronically ill patients , readmission to the hospital can be frequent and costly . We studied the effect of an intervention design ed to increase access to primary care after discharge from the hospital , with the goals of reducing readmissions and emergency department visits and increasing patients ' quality of life and satisfaction with care . METHODS In a multicenter r and omized , controlled trial at nine Veterans Affairs Medical Centers , we r and omly assigned 1396 veterans hospitalized with diabetes , chronic obstructive pulmonary disease , or congestive heart failure to receive either usual care or an intensive primary care intervention . The intervention involved close follow-up by a nurse and a primary care physician , beginning before discharge and continuing for the next six months . RESULTS The patients were severely ill . Half of those with congestive heart failure ( 504 patients ) had disease in New York Heart Association class III or IV ; 30 percent of those with diabetes ( 751 patients ) had end-organ damage ; and a quarter of those with chronic obstructive pulmonary disease ( 583 patients ) required home oxygen treatment or oral corticosteroids  . The patients had extremely poor quality -of-life scores . Although they received more intensive primary care than the controls , the patients in the intervention group had significantly higher rates of readmission ( 0.19 vs 0.14 per month , P = 0.005 ) and more days of rehospitalization ( 10.2 vs 8.8 , P = 0.041 ) . The patients in the intervention group were more satisfied with their care ( P < 0.001 ) , but there was no difference between the study groups in quality -of-life scores , which remained very low ( P = 0.53 ) . CONCLUSIONS For veterans discharged from Veterans Affairs hospitals , the primary care intervention we studied increased rather than decreased the rate of rehospitalization , although patients in the intervention group were more satisfied with their care In a controlled trial of exercise retraining in patients with severe chronic bronchitis , 33 subjects were followed for a mean period of 10.3 months . The exercise programme was supervised once a week , and daily training comprised a 12-minute walk and simple stair climbing exercises . The subjects in the exercise group showed a highly significant improvement in their walking distance , attaining a maximum increase of 24 % after eight to 12 months . There was also considerable subjective improvement . The control group did not improve . No significant changes in cardiorespiratory function or muscle strength were seen . Simple exercise rehabilitation is of benefit to patients with disabling obstructive lung disease BACKGROUND --Pulmonary rehabilitation has been shown to have short term subjective and objective benefits for patients with chronic obstructive pulmonary disease ( COPD ) . However , appropriately controlled studies have not previously been performed , nor have the benefits of different types of continuation programme for rehabilitation been investigated . Both these problems have been addressed in a single study of the long term effects of once monthly physiotherapy versus once weekly physiotherapy at home after a comprehensive home rehabilitation programme on quality of life and exercise tolerance in patients with COPD . METHODS --Thirty six patients with severe airways obstruction ( mean SD ) forced expiratory volume in one second ( FEV1 ) 1.3(0.4 ) 1 , FEV1/inspiratory vital capacity ( IVC ) 37.2(7.9)% ) were studied . Twenty three patients followed a rehabilitation programme at home for 18 months consisting of physiotherapy and supervision by a nurse and general practitioner . During the first three months all 23 patients visited the physiotherapist twice a week for a 0.5 hour session . Thereafter , 11 patients ( group A ) received a session of physiotherapy once weekly while 12 patients ( group B ) received a session of physiotherapy once a month . The control group C ( 13 patients ) received no rehabilitation at all .  Quality of life was assessed by the Chronic Respiratory Question naire , exercise tolerance by the six minute walking distance , and lung function by FEV1 and IVC . Outcome measures were assessed at baseline and at three , six , 12 , and 18 months . RESULTS --Long term improvements in quality of life were found in patients in groups A and B , but not in those in group C compared with baseline , but these only reached significance in group B at all time points . Patients in group B had a higher quality of life than those in group C only at three and 12 months . There was a decrease in both six minute walking distance ( at 12 and 18 months ) and IVC ( at three , 12 , 
    Output:
    
Post hoc subgroup analysis suggested that mortality was reduced by the outreach nursing programme in patients with less severe disease .
REVIEW ER 'S CONCLUSIONS Patients with moderate COPD may have mortality and health related quality of life gains from a nursing outreach programme , but there are no data about reductions in hospital utilisation .
Patients with severe COPD do not appear to have benefit from such programmes and one large study found no reduction in hospital admissions in such patients