PMID- 35176055 OWN - NLM STAT- MEDLINE DCOM- 20220228 LR - 20220228 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 17 IP - 2 DP - 2022 TI - Multidimensional outcome assessment of pulmonary rehabilitation in traits-based clusters of COPD patients. PG - e0263657 LID - 10.1371/journal.pone.0263657 [doi] LID - e0263657 AB - BACKGROUND: Clusters of COPD patients have been reported in order to individualize the treatment program. Neither co-morbidity clusters, nor integrated respiratory physiomics clusters contributed to a better prediction of outcomes. Based on a thoroughly assessed set of pulmonary and extra-pulmonary traits at the start of a pulmonary rehabilitation (PR) program, we recently described seven clusters of COPD patients. The aims of this study are to confirm multidimensional differential response and to assess the potential of pulmonary and extra-pulmonary traits-based clusters to predict this multidimensional response to PR pulmonary in COPD patients. METHODS: Outcomes of a 40-session PR program for COPD patients, referred by a chest physician, were evaluated based on the minimal clinically important difference (MCID) for 6-minute walk distance (6MWD), cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression scores, MRC dyspnea grade and St George's Respiratory Questionnaire. The aforementioned response indicators were used to calculate the overall multidimensional response and patients were grouped in very good, good, moderate and poor responders. In the same way, responses to pulmonary rehabilitation were compared based on seven previously identified pulmonary and extra-pulmonary traits-based clusters. RESULTS: Of the whole sample, drop out was 19% and 419 patients (55.4% males, age: 64.3 +/- 8.8, FEV1% of predicted: 48.9 +/- 20) completed the pulmonary rehabilitation program. Very good responders had significantly worse baseline characteristics with a higher burden of disease, a higher proportion of rollator-users, higher body mass index (BMI), more limitations of activities in daily life, emotional dysfunction, higher symptoms of dyspnea and worse quality of life. Of the seven pre-identified clusters, 'the overall best functioning cluster' and 'the low disease burden cluster' both including the best 6MWD, the lowest dyspnea score and the overall best health status, demonstrated attenuated outcomes, while in 'the cluster of disabled patients', 76% of the patients improved health status with at least 2 times MCID. This 'cluster of disabled patients' as well as 'the multimorbid cluster', 'the emotionally dysfunctioning cluster', 'the overall worst-functioning cluster' and 'the physically dysfunctioning cluster' all demonstrated improvements in performance and satisfaction for occupational activities (more than 65% of patients improved with > 1MCID), emotional functioning (more than 50% of patients improved with > 1 MCID) and overall health status (more than 58%). CONCLUSION: The current study confirms the differential response to pulmonary rehabilitation based on multidimensional response profiling. Cluster analysis of baseline traits illustrates that non-linear, clinically important differences can be achieved in the most functionally and emotionally impaired clusters and that 'the overall best functional cluster' as well as 'the low disease burden cluster' had an attenuated outcome. FAU - Augustin, Ingrid M L AU - Augustin IML AUID- ORCID: 0000-0003-0312-1265 AD - Ciro, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. AD - NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. FAU - Franssen, Frits M E AU - Franssen FME AD - Ciro, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. AD - NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. AD - Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands. FAU - Houben-Wilke, Sarah AU - Houben-Wilke S AUID- ORCID: 0000-0001-6214-0365 AD - Ciro, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. FAU - Janssen, Daisy J A AU - Janssen DJA AUID- ORCID: 0000-0002-1827-9869 AD - Ciro, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. AD - Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands. FAU - Gaffron, Swetlana AU - Gaffron S AUID- ORCID: 0000-0002-4540-0732 AD - Viscovery Software GmbH, Vienna, Austria. FAU - Pennings, Herman-Jan AU - Pennings HJ AD - Department of Respiratory Medicine, Laurentius Hospital, Roermond, The Netherlands. FAU - Smeenk, Frank W J M AU - Smeenk FWJM AD - Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands. FAU - Pieters, Willem R AU - Pieters WR AD - Department of Respiratory Medicine, Elkerliek Hospital, Helmond, The Netherlands. FAU - Hoogerwerf, Amber AU - Hoogerwerf A AD - Department of Respiratory Medicine, St. Jans Gasthuis, Weert, The Netherlands. FAU - Michels, Arent-Jan AU - Michels AJ AD - Department of Respiratory Medicine, St. Anna Hospital, Geldrop, The Netherlands. FAU - van Merode, Frits AU - van Merode F AD - School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands. FAU - Wouters, Emiel F M AU - Wouters EFM AD - Ciro, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. AD - NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. AD - Ludwig Boltzmann Institute for Lung Health, Vienna, Austria. FAU - Spruit, Martijn A AU - Spruit MA AUID- ORCID: 0000-0003-3822-7430 AD - Ciro, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. AD - NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. AD - Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands. LA - eng PT - Clinical Trial PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20220217 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Canada/epidemiology MH - Dyspnea/epidemiology/*rehabilitation MH - *Exercise Tolerance MH - Female MH - *Forced Expiratory Volume MH - Health Status MH - Humans MH - Male MH - Middle Aged MH - Outcome Assessment, Health Care MH - Prospective Studies MH - Pulmonary Disease, Chronic Obstructive/epidemiology/*rehabilitation MH - *Quality of Life MH - Surveys and Questionnaires PMC - PMC8853536 COIS- The following authors are affiliated with CIRO+: Ingrid Augustin, Frits Franssen, Sarah Houben-Wilke, Daisy Janssen, Martijn Spruit. The following author is an employee of Viscovery Software GmbH: Swetlana Gaffron. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials. EDAT- 2022/02/18 06:00 MHDA- 2022/03/01 06:00 PMCR- 2022/02/17 CRDT- 2022/02/17 17:14 PHST- 2021/05/19 00:00 [received] PHST- 2022/01/25 00:00 [accepted] PHST- 2022/02/17 17:14 [entrez] PHST- 2022/02/18 06:00 [pubmed] PHST- 2022/03/01 06:00 [medline] PHST- 2022/02/17 00:00 [pmc-release] AID - PONE-D-21-16014 [pii] AID - 10.1371/journal.pone.0263657 [doi] PST - epublish SO - PLoS One. 2022 Feb 17;17(2):e0263657. doi: 10.1371/journal.pone.0263657. eCollection 2022.