Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed.MethodsPatients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks.ResultsThere was a significant difference in the distance covered on the six-minute walk test (p < 0.05) and BODE index (p < 0.001) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline.ConclusionA home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.

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

“…We defined HCPR as a PR program developed in a non-specialized community health service, in a community center, or at the patient's home. Other RCTs that compared standard OPR to home or community-based PR show similar results and greater effectiveness of HCPR for some outcomes such as exercise capacity and sensation of dyspnea 20,21,22 . Some systematic reviews 23,24,25 compare OPR to controls (no exercise), but none compare OPR and HCPR.…”

Australian and New Zealand Pulmonary Rehabilitation Guidelines

“…One additional RCT from Australia, comparing home‐based rehabilitation to a standard hospital‐based programme, was published after the search was conducted and was included because of its direct relevance to this question. Of the included studies, six made a direct comparison of home‐based with hospital‐based PR . Two studies were powered for equivalence .…”

“…Two studies were powered for equivalence . In one study, every session of home‐based exercise was directly supervised by a physiotherapist; the other five home‐based programmes included supervision of the initial session only and/or telephone contact. Three of the studies, including the two largest trials, reported regular weekly contact with participants in the home‐based intervention but frequency of contact was unreported in the other three studies …”

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

“…A similar approach was adopted by Guell et al,108 with group education before allocating exercise training to either home or hospital; again there were no important differences between the groups after 9 weeks in this small RCT but this was unlikely to be powered for equivalence. Two studies adopted a broadly similar approach to that delivered in the UK; one over 8 weeks and one over 12 weeks 109 110. Puente-Maestu et al 109 showed differences in the physiological response to the two environments but performance was similar.…”