Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD

Abstract

IntroductionPersonalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR.MethodsHome-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28).ResultsNo incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months.ConclusionHome-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed.

A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

“…Our data support the conclusions of the latter authors that this is due to participants not exercising at sufficient intensity and, as our results indicate, not walking at a sufficient frequency. In contrast, in a recent cohort study of home-based PR with once weekly supervision, participants exercised for at least 5 days per week, for 30 to 45 minutes, and at a higher intensity than our participants did, resulting in a statistically and clinically significant increase in physical capacity 38. Thus, a more demanding program, if enforceable, could have produced better outcomes.…”

“…Second, the tele-rehab intervention may have been better delivered by health professionals, such as physiotherapists who are skilled in the management of exercise, movement, and function for people with COPD. Additionally, individuals may require prior experience of structured exercise as well as integrating this into daily activities 38. Future research may indicate how many supervised sessions are initially required.…”

Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients

“… 8 – 11 Furthermore, a significant increase in the number of steps on the 6MST (from 488 to 570) was observed not only after outpatient PR (in agreement with previously published results in 30 COPD patients), 16 but also after home PR in a population of patients with idiopathic pulmonary fibrosis, 43 unselected patients with more severe chronic lung disease (80% on long term oxygen therapy and/or noninvasive ventilation), 17 and in COPD patients. 18 The mean improvement of 79 steps on the 6MST in this study is superior to the 40-step MCID proposed by Pichon et al 44 based on the analysis of the results of 62 COPD patients managed by inpatient PR. The performances on the two clinical exercise tolerance tests were significantly improved after PR: 79 steps on the 6MST and 42 m on the 6MWT, and these improvements were significantly correlated with each other.…”

“… 15 , 16 The 6MST has been used to assess exercise tolerance in the context of PR. 17 , 18 However, the correlation between the 6MST and validated indices used to measure exercise capacity (6MWT and CPET) has not yet been established.…”

Physical therapy in chronic obstructive pulmonary disease (analysis of the evidence-based medicine)

“…All studies found that pulmonary rehabilitation programs or individual physical therapy programs were effective in improving the quality of life [12][13][14][15][16][17], physical endurance [12][13][14][15][16][18][19][20][21][22][23], respiratory muscle strength [13,18,23], reducing symptoms of CoPd [14,16,19,23], improving the function of external breathing [16,[24][25][26], blood parameters [22,27], cognitive functions [21], functional state of muscles [28], survival rates [29,30], and reducing the number of hospital days [31]. The main part of investigations was devoted to the comparison of therapeutic rehabilitation programs that included several components and referred to stable patients with CoPd.…”