Integrated Multimodal Rehabilitation in an Elderly Patient with Pulmonary Fibrosis: A 24-Month CARE-Compliant Case Report

Abstract

Pulmonary fibrosis is a progressive interstitial lung disease characterized by exertional dyspnea, impaired exercise tolerance, hypoxemia, and functional decline. Elderly individuals with pulmonary fibrosis frequently experience additional musculoskeletal, cognitive, and balance-related impairments that further compromise independence and quality of life. While pulmonary rehabilitation is recommended as an adjunctive therapy, evidence regarding long-term multidisciplinary rehabilitation approaches remains limited.
We report the case of a 69-year-old female with pulmonary fibrosis complicated by osteoporosis, bilateral hip hairline fractures, obstructive sleep apnoea, and mild cognitive impairment who underwent a structured multimodal rehabilitation program over 24 months. Baseline evaluation demonstrated severe functional limitation with resting oxygen saturation (SpO2) of 86% on room air, mMRC dyspnea grade 3, impaired mobility, high fall risk, disturbed sleep, and prior dependence on supplemental oxygen and BiPAP support.
The rehabilitation program combined graded physiotherapy, breathing retraining/pranayama, and cognitive rehabilitation delivered in phased progression according to symptom tolerance and functional capacity. Over the 24-month follow-up period, the patient demonstrated clinically meaningful improvements in resting oxygen saturation (86% to 98%), six-minute walk distance (120 m to 280 m), dyspnea severity (mMRC grade 3 to grade 1), balance, mobility, sleep quality, and functional independence. Supplemental oxygen and BiPAP support were discontinued during follow-up. No intervention-related adverse events were observed.
This case highlights the potential role of long-term integrated rehabilitation as a safe and effective adjunct to standard medical management in pulmonary fibrosis, particularly in elderly patients with multisystem functional decline. Further controlled studies are required to evaluate the reproducibility and efficacy of multimodal rehabilitation approaches in interstitial lung disease.