Journal Article

Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial

Mahal, Ajay, Burge, Angela T, Nicolson, Caroline, McDonald, Christine F, Gillies, Rebecca, Hill, Catherine J, Cox, Narelle S, Lee, Annemarie L, Moore, Rosemary, Holland, Anne E, O'Halloran, Paul, Lahham, Aroub

2017

Overview

BackgroundPulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor. We assessed whether home-based pulmonary rehabilitation, delivered using minimal resources, had equivalent outcomes to centre-based pulmonary rehabilitation.MethodsA randomised controlled equivalence trial with 12 months follow-up. Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist. The primary outcome was change in 6 min walk distance (6MWD).ResultsWe enrolled 166 participants to receive centre-based rehabilitation (n=86) or home-based rehabilitation (n=80). Intention-to-treat analysis confirmed non-inferiority of home-based rehabilitation for 6MWD at end-rehabilitation and the confidence interval (CI) did not rule out superiority (mean difference favouring home group 18.6 m, 95% CI −3.3 to 40.7). At 12 months the CI did not exclude inferiority (−5.1 m, −29.2 to 18.9). Between-group differences for dyspnoea-related quality of life did not rule out superiority of home-based rehabilitation at programme completion (1.6 points, −0.3 to 3.5) and groups were equivalent at 12 months (0.05 points, −2.0 to 2.1). The per-protocol analysis showed the same pattern of findings. Neither group maintained postrehabilitation gains at 12 months.ConclusionsThis home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation. Neither model was effective in maintaining gains at 12 months. Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation.Trial registration numberNCT01423227, clinicaltrials.gov.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Aerobics / Aged / Aged, 80 and over / Clinical outcomes / Dyspnea - etiology / Early intervention / Exercise / Female / Fitness training programs / Goal setting / Home Care Services / House Calls / Humans / Intention to Treat Analysis / Male / Management training / Middle Aged / Patients / Physical fitness / Pulmonary Disease, Chronic Obstructive - complications / Pulmonary Disease, Chronic Obstructive - economics / Pulmonary Disease, Chronic Obstructive - physiopathology / Pulmonary Disease, Chronic Obstructive - rehabilitation / Quality of Life / Rehabilitation / Rehabilitation Centers / Single-Blind Method / Telephone / Therapeutic Equivalency / Walk Test / Walking