Pulmonary Rehabilitation Outcomes According to Employment Status in Individuals with COPD: A Prospective Exploratory Study

Background and Purpose: As the workforce ages, facilitating the integration of medical care and occupational activities is a key concern for individuals with chronic obstructive pulmonary disease. Although dyspnea is associated with reduced work productivity, the relationship between employment status and the effects of pulmonary rehabilitation remains unclear. This study examined whether changes in exercise capacity and dyspnea following pulmonary rehabilitation differed according to employment status in individuals with chronic obstructive pulmonary disease. Methods: This exploratory prospective cohort study included 34 individuals with chronic obstructive pulmonary disease who participated in a 3-month outpatient pulmonary rehabilitation program. Participants were classified as employed (n = 6) or unemployed (n = 28). To evaluate changes following pulmonary rehabilitation, a two-way repeated-measures analysis of covariance (ANCOVA) was performed. Time (pre- and post-intervention) was treated as a within-subject factor, while employment status served as a between-subject factor, with age incorporated as a covariate. The primary endpoints were functional exercise capacity, evaluated using the 6 min walk distance, and dyspnea severity, assessed using the modified Medical Research Council scale. Results: For functional exercise capacity, neither the time × employment status interaction nor the main effect of time was statistically significant (p = 0.165 and p = 0.062, respectively). For dyspnea, the time × employment status interaction was not statistically significant (p = 0.567), whereas a significant main effect of time (p = 0.020) and a significant time × age interaction (p = 0.014) were observed. Exploratory within-group comparisons did not detect significant changes in either employment group. Discussion: No statistically significant differences in changes in exercise capacity or dyspnea were detected between employment groups. The significant main effect of time for dyspnea should be interpreted in light of the significant time × age interaction. Given the small and markedly unequal group sizes, particularly the limited number of employed participants, these findings should be regarded as exploratory and hypothesis-generating. Larger prospective studies are required to determine whether employment-related factors modify responses to pulmonary rehabilitation.