Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients

Abstract

BACKGROUND:A key component in the management of chronic obstructive pulmonary disease (COPD) patients is pulmonary rehabilitation (PR), the corner stone of which is exercise training.AIM:This study aims to evaluate the effect of a two-months, home-based PR program with outpatient supervision every two weeks, on exercise tolerance and health-related quality of life (HRQL) using Arabic-translated standardized generic and specific questionnaires in COPD patients recently recovered from acute exacerbation,DESIGN:Randomized clinical trial.SETTING AND SUBJECTS:A total of 39 COPD patients who recovered from acute exacerbation were randomly allocated either a two-month home-based PR program in addition to standard medical therapy or standard medical therapy alone in the period between July 2008 and March 2009.METHODS:Pulmonary function tests (PFTs), six-minute walk distance (6-MWD) test, Arabic-translated chronic respiratory disease questionnaire-self administered standardized format (CRQ-SAS) and quality of life scale Short Form (SF-36) were compared between 25 patients with moderate to severe COPD who underwent a two-month PR program (group 1) and 14 COPD patients who did not (group 2).RESULTS:Group 1 showed significant improvement in the 6-MWD, and HRQL scores at two months compared with the usual care patients in group 2 (P less than 0.05). Improvement in both CRQ-SAS and SF-36 scores were statistically significant and comparable in group 1.CONCLUSION:The supervised, post discharge, two-month home-based PR program is an effective non pharmacological intervention in the management of stable patients with COPD. The 6-MWD is a simple, inexpensive and safe test to assess physical and functional capabilities among COPD patients. HRQL can be measured in patients with COPD either by disease-specific tools that have been specifically designed for use in patients with respiratory system disorders or by generic HRQL tools that can be used across populations with a variety of medical conditions. The Arabic-translated CRQ-SAS is a new tool for assessment of Arabic-speaking patients with chronic respiratory diseases.

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…Of these, 58 were considered potentially relevant and 23 studies 17,18,19,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50 met the eligibility criteria and were included in this review. One of the selected studies appeared in two distinct publications 49,50 in which the same intervention was applied to the same patients but describing different outcomes.…”

“…Finally, there was a significant decrease in sensation of dyspnea assessed by MRC in HCPR compared to controls (-0.21, 95%CI: -0.42 to -0.00, I 2 = 0%) ( Figure 6). (b) Quality of Life: Thirteen studies 17,18,19,31,33,34,36,38,42,44,46,47,49 (n = 521) assessed quality of life with CRQ and four 18,30,39,48 (n = 281) with SGRQ. The meta-analysis showed that participants who received the intervention showed significant improvement in the four quality of life domains as- Figure 3 Graph on risk of bias for each selected study.…”

“…Thirteen studies were done in Europe 17,19,21,31,33,38,42,43,45,46,48,49,50 , six in Asia 30,36,39,40,44,47 , two in Australasia 34,35 , one in North America 41 , and one in South America 32 . Among the studies included in the review, 19 17,18,19,30,31,32,33,34,36,38,39,40,42,43,44,46,47,48,49,50 compared HCPR to control group (n = total 893; n HCPR = 485), while four 35,37,41,45 compared HCPR to OPR (n total = 375; n HCPR = 178). No studies reported harmful effects related to HCPR during interventions.…”

“…• Analysis 1: HCPR vs. control group (a) Functional Capacity and Dyspnea: Ten studies 30,31,33,36,40,44,46,47,48,50 (n = 461) assessed functional capacity with the 6MWT and seven used the ISWT 18,32,34,38,39,42,43 (n = 321). Four studies 19,38,43,48 (n = 280) evaluated dyspnea using the MRC.…”

“…• Analysis 2: HCPR vs. OPR (a) Functional Capacity: Three studies 36,37,41 (n = 334) assessed functional capacity using the 6MWT. When considered jointly, the interventions did not differ significantly in the distance walked in the 6MWT (8.70m, 95%CI: -6.67 to 24.08, I 2 = 0%) ( Figure 9).…”