Inhospital NEMS for patients with coexisting physical frailty and cognitive imparment during acute exacerbation of COPD: a randomized controlled trial

Introduction: Frailty and cognitive impairments are very prevalent in patients hospitalized by an acute exacerbation of COPD (AECOPD). New approaches that avoid the deterioration during hospitalization in these patients are needed. Objective: To evaluate the effect of a NEMS program in patients with physical frailty, cognitive impairment and AECOPD. Methods: In this randomized clinical trial, patients hospitalized by an AECOPD, with a score <26/30 in the Montreal Cognitive  Assessment Test (MOCA), and with a score ≥3/5 points in the Modified Fried Criteria  were included and randomized into two groups. Patients in the control group received the standard treatment and patients in the experimental group received a daily NEMS program added to the pharmacological treatment. Lower limb strength was evaluated by hand-held dynamometry, Self-Perceived Health Status was evaluated by the EQ-5D questionnaire and physical capacity was evaluated by the 5-times sit to stand test (5STS). Patients were evaluated at baseline and at hospital discharge. Results: Finally, 49 patients were included in this study. There were no differences between groups at baseline in age, BMI, disease severity, hospital stay and main variables. There were significant differences between group at discharge in right lower limb strength and EQ-5D VAS (p<0.001 and p=0.018 respectively). There were not significant differences between groups in 5 STS (p=0.06). Conclusion: This study has evidenced the effectiveness of a NEMS program in patients with coexisting physical frailty and cognitive imparment during acute exacerbation of COPD.