Real-life feasibility and effectiveness of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease requiring medical equipment

Abstract

BackgroundPulmonary rehabilitation (PR) is a key treatment of chronic obstructive pulmonary disease (COPD) but studies are still needed to identify the most pertinent criteria to personalize this intervention and improve its efficacy.ObjectiveThis real-life retrospective study compared the effects of home-based PR on exercise tolerance, anxiety, depression, and health-related quality of life (HRQoL) in COPD patients, according to their medical equipment.MethodsExercise tolerance, anxiety, depression, and HRQoL were evaluated in 109 patients equipped with long-term oxygen therapy (LTOT), 84 patients with noninvasive ventilation (NIV), 25 patients with continuous positive airway pressure (CPAP), and 80 patients with no equipment (NE), before, just after, and 6 and 12 months after PR.ResultsAt baseline, the body mass index in the CPAP and NIV groups was higher (p<0.05) than in the other two groups, and the forced expiratory volume in 1 second was lower in the LTOT and NIV groups (p<0.001). All parameters improved after PR in the four groups (p<0.05), but for exercise tolerance, only the 6-minute stepper test showed maintained improvement after 6 and 12 months, whereas the 10 times sit-to-stand and timed up-and-go tests were only improved just after PR. At every time point, exercise tolerance was lower in the LTOT group (p<0.05), with a similar trend in the NIV group.ConclusionDespite differences in the medical equipment to treat COPD, home-based PR showed comparable feasibility, safety, and efficacy in all equipment-based groups. Medical equipment should therefore not be a barrier to home-based PR.

Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review

“…This included five studies examining the 6MWT, 7-11 39 studies examining STS tests, 35 studies examining step tests 19,24, and 17 studies examining the Timed Up and Go (TUG). 17,19,24,33,42,49,50,[83][84][85][86][87][88][89][90][91][92] Ten studies examined more than one test, including four that examined STS and TUG, 17,42,48,49 four that examined two kinds of STS test, 29,32,44,45 and two studies (in three reports) that examined STS, TUG and step tests. 18,23,50 The PRISMA diagram is in Figure 1 and study characteristics are in Supplementary Tables S2-S5.…”

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

“…However, exacerbation frequency and mortality were not significantly different between groups. COQUART et al [107] found that home-based PR in patients with NIV is feasible. They compared PR in patients on nocturnal CPAP, nocturnal NIV, LTOT or no additional equipment.…”

Nonadherence to treatment and quality of life among patients with chronic obstructive pulmonary disease

“…Adherence to treatment can be broadly defined as “the extent to which a person's behavior corresponds with the agreed recommendations from a health-care provider.”[ 6 ] COPD is a chronic disease that typically necessitates the regular use of pharmacotherapies. [ 7 8 ] Nonadherence rate in COPD has been estimated to be more than 50%. [ 9 ] Poor adherence in COPD is influenced by many factors related to the patients, the illness, the prescribed medications, the society, and the health system.…”