Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial

Abstract

BackgroundPulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor. We assessed whether home-based pulmonary rehabilitation, delivered using minimal resources, had equivalent outcomes to centre-based pulmonary rehabilitation.MethodsA randomised controlled equivalence trial with 12 months follow-up. Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist. The primary outcome was change in 6 min walk distance (6MWD).ResultsWe enrolled 166 participants to receive centre-based rehabilitation (n=86) or home-based rehabilitation (n=80). Intention-to-treat analysis confirmed non-inferiority of home-based rehabilitation for 6MWD at end-rehabilitation and the confidence interval (CI) did not rule out superiority (mean difference favouring home group 18.6 m, 95% CI −3.3 to 40.7). At 12 months the CI did not exclude inferiority (−5.1 m, −29.2 to 18.9). Between-group differences for dyspnoea-related quality of life did not rule out superiority of home-based rehabilitation at programme completion (1.6 points, −0.3 to 3.5) and groups were equivalent at 12 months (0.05 points, −2.0 to 2.1). The per-protocol analysis showed the same pattern of findings. Neither group maintained postrehabilitation gains at 12 months.ConclusionsThis home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation. Neither model was effective in maintaining gains at 12 months. Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation.Trial registration numberNCT01423227, clinicaltrials.gov.

There’s no place like home: Integrating pulmonary rehabilitation into the home setting

“…There is no universal agreement of just what comprises home-based pulmonary rehabilitation, other than that a substantial portion (but not necessarily all) of the intervention is provided in the home setting. Table 1 lists various conceptions of home-based pulmonary rehabilitation, provided for stable COPD patients or in the periexacerbation period [3,7,8,28,[29][30][31][32][33][34][35][36][37][38]. It is important to note that the pulmonary rehabilitation intervention in these studies is exceedingly heterogeneous, underscoring the lack of consensus of what this intervention encompasses.…”

“…The home exercise centered on training using portable cycle ergometers (supplied to the patients, but taken away after study completion), initiated in the home by an exercise specialist, with a target intensity of 60% maximal work rate, a duration of 40 min, and a frequency of three times weekly, and follow-up with weekly telephone calls. In contrast, in a study by Holland and colleagues conducted in Australia [8], the home-based intervention included one home visit by a physiotherapist to establish exercise goals and supervise the first exercise session, 30-min of twice-weekly walking exercise supported by pedometer feedback, light resistance training, and low intensity calisthenics (such as sit-to-stand exercises). Once-weekly telephone calls from the physiotherapist, using motivational interviewing techniques were given; and selected self-management education and goal setting were incorporated into these weekly discussions.…”

“…Offering pulmonary rehabilitation in the home or community setting might increase referrals and patient participation, thereby reducing the effect of under-utilization. Adding to this argument, randomized trials comparing center-based to home-based interventions show equivalence across several patientcentered outcome areas, including dyspnea-relief and improvements in health status and exercise capacity [7][8]. The effect of home-based pulmonary rehabilitation in the post-exacerbation period for COPD has not been adequately tested.…”

Recent Advances in Pulmonary Rehabilitation for Patients with COPD

“…9,10 This PR program differs from the recent home-based PR programs. 11,12 in the point of low-intensity exercise program including such as respiratory muscle stretching calisthenics and low intensity IMT.…”

Providing heart failure rehabilitation in the home via telerehabilitation

“…In particular, telerehabilitation is at least as effective as traditional centre-based rehabilitation programs for patients with cardiopulmonary diseases, in terms of exercise capacity as measured by the 6 minute walk test (6MWT) and peak oxygen consumption (Frederix et al, 2015a;Tsai et al, 2017), quality of life (Holland et al, 2016;Piotrowicz et al, 2010), and adverse events (Arthur et al, 2002;Piotrowicz et al, 2015b). Telerehabilitation has higher adherence rates (Piotrowicz et al, 2010;Varnfield et al, 2014), higher patient satisfaction levels and appears to be more cost-effective compared with centre-based programs Kraal et al, 2017).…”