Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

Abstract

BackgroundStandardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD.MethodsA total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units.ResultsThere was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks.ConclusionsThe standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.Trial registration numberISRCTN81189044.

Rehabilitation in chronic respiratory diseases: Live your life to the max

“…Lack of awareness regarding access and benefits and insufficient funding and availability of PR programmes are important issues related to this underuse . Motivated by the lack of resources and poor uptake of traditional centre‐based PR, alternative models, including home‐based PR with minimal resources, have been studied . The clinical outcomes of these programmes were positive, but they have instigated an international debate about the definition of PR and its minimal core components.…”

Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases

“…This approach, applying some of the core components of pulmonary rehabilitation, confers short‐term improvements in the level of breathlessness, exercise tolerance and disease‐specific quality of life, with no significant difference compared to outpatient pulmonary rehabilitation . To date, however, it is not possible to exclude non‐inferiority …”

The past, present and future of pulmonary rehabilitation

“…All these interventions, particularly if they show effects, may have a place in the care of patients with chronic respiratory conditions, but it is not helpful to move the field forward if they are branded as ‘rehabilitation’ or proposed as alternatives for pulmonary rehabilitation . In the past few years, internet‐based self‐management programmes, home‐based minimally supervised rehabilitation, tai chi exercises and yoga have all been proposed as alternatives for pulmonary rehabilitation. While these interventions may have a place in the management of some patients with chronic respiratory diseases, or may be the only alternatives in specific regions, it should be clear that these interventions are no substitute for pulmonary rehabilitation.…”