Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis

Abstract

IntroductionDespite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care.Methods and analysisUsing Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence.ResultsWe identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32–1.44; p=0.002) and HRQoL (SMD −0.62, 95% CI −0.88–−0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD −0.10, 95% CI −0.25–0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI −0.15–0.17; p=0.87).ConclusionHome-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.

Cardiovascular and Pulmonary Research: The Year (2022) in Review

“…Despite the proven benefits and numerous guideline recommendation supporting PR as a means of improving physical and psychological wellbeing of people with chronic respiratory disease, PR remains severely underused. 24 Inconvenient timing of programs and geographical distance to PR centers (center-PR) are commonly reported as barriers, in high, low-/middle-income countries. 24 There has been a recent movement to provide PR services remotely in hopes of improving attendance and completion, and the ongoing SARS CoV-2 pandemic has only served to propel this movement.…”

“…Future trials addressing issues of uptake, engagement, completion, and attrition may provide more clarity on which patients would benefit most from home-PR, allowing health care workers to "target" certain patients for home versus center PR. 24…”

Review of the British Thoracic Society Winter Meeting 23 November 2022 23–25 November 2022

“…Digital interventions have shown some promise at increasing completion rates,49 however, improvements in important outcomes such as walking capacity are less convincing. Two systematic reviews have demonstrated broadly equivalent results in unsupervised exercise training and home based PR for those with COPD 50 51. However, all interventions should consider the key components of PR 52…”

Home-Pulmonary Rehabilitation Programme for Patients with Chronic Respiratory Diseases in Malaysia: A Mixed Method Feasibility Study

“…It is important, however, for patients with CRDs to have continued access to PR despite lockdown periods 8 and there is now strong evidence suggesting Home-PR programme provides outcomes comparable to Centre-based PR 9,10,11,12 . Compared to usual care, our recent meta-analysis showed that Home-PR programme signi cantly improved exercise capacity [standardised mean difference (SMD) 0.88; 95% con dence interval (CI) 0.32 to 1.44; p = 0.002) and HRQoL (SMD − 0.62; 95% CI -0.88 to -0.36; p = 0.001)] 13 . Hence a Home-PR programme enables people with CRDs to continue receiving rehabilitation even if they are unable to attend the PR centre for whatever reason.…”