PT Critically Appraised Topics

Document Type

Critically Appraised Topic

Publication Date


Clinical Scenario

The patient who led me to pursue this question is a 60 year old male with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Medical treatment to date has included physical therapy in both inpatient and outpatient settings, home-based personal exercise and pharmacological interventions. Problems identified (or PT diagnosis) include dyspnea, inability to perform activities of daily living (ADL's), overall muscular weakness and decreased aerobic capacity.

Clinical Question

Does early skilled therapeutic exercise following acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) help reduce readmission to hospitals by increasing exercise capacity?

Clinical Bottom Line

Based on the results of the outcomes from Eaton et al. and Seymour et al. there appears to be sufficient data to support the use of early skilled therapeutic exercise in reducing the rate of hospital readmission following acute exacerbation of COPD. The only outcome measure related to the clinical question was hospital readmission within three months following discharge from acute care services. Neither of the studies found any reason as to why a patient should not participate in early skilled therapeutic exercise. Both studies had a relatively low NNT supporting the treatment; however, the confidence interval of Eaton et al. reached the negative range in the upper boundary meaning that, to decrease the readmission of one participant to the hospital, an infinite amount of participants may need to be treated with early skilled therapeutic exercise. Chi-square analysis (0.89) of data reported by Eaton et al. failed to achieve statistical significance. Additionally, Eaton et al. lacked an appropriate power of subjects and had a major lack of participant protocol (only 40%) adherence in the treatment group. Had these threats been eliminated, the study might have different findings. The internal validity of the studies ranged from fair to good (PEDro scores 7/10). The external validity was not compromised and the results may be easily generalized to other patients with COPD. Although the studies were conducted in England and New Zealand, the subjects' demographics appear to reflect characteristics of COPD patients who are treated in the United States.