Impact of Respiratory Muscle Strength Training Program on Hospital Readmissions in Patients With Chronic Obstructive Pulmonary Disease: A Retrospective Pilot Study.

چکیده اصلی

PURPOSE: Chronic obstructive pulmonary disease (COPD) is associated with high 30-day hospital readmission rates and significant health care costs. Respiratory muscle weakness and dysphagia are common in this population and may contribute to adverse outcomes. Respiratory muscle strength training (RMST) has demonstrated benefits in outpatient settings; however, evidence supporting its initiation during acute hospitalization is limited. The purpose of this study was to evaluate the impact and feasibility of a speech-language pathologist (SLP)-led RMST program initiated during acute hospitalization on 30-day hospital readmission rates among adults with COPD. METHOD: A retrospective analysis was conducted of a year-long RMST pilot program implemented in 2022 at a rural acute care hospital. Adults admitted with COPD exacerbations who received combined inspiratory and expiratory RMST were included. Readmission rates from the implementation year were compared with a historical pre-intervention year (2019). A comparable hospital within the same health system that did not implement RMST served as a control site. Two-proportion z tests and effect size calculations were used to assess differences. Feasibility and cost outcomes were analyzed descriptively. RESULTS: A total of 66 patients completed in-hospital RMST training. No adverse events were reported, and the intervention was well tolerated. The 30-day readmission rate at the intervention hospital decreased from 14.4% in 2019 to 7.3% in 2022, representing a 7.1-percentage-point absolute risk reduction and a 49.3% relative risk reduction. While the within-site comparison did not reach statistical significance, readmission rates in 2022 were significantly lower than those at the control hospital. CONCLUSIONS: Initiation of SLP-led RMST during acute hospitalization for COPD appears feasible, cost-effective, and is associated with a promising reduction in 30-day readmission rates. However, given the retrospective design and nonsignificant within-site comparison, causal conclusions cannot be drawn. These preliminary findings support further prospective investigation of RMST as an interdisciplinary intervention to improve outcomes in hospitalized COPD patients, particularly in rural settings.

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