| Authors | Holland, A. Mahal, A. Hill, CJ. Lee, AL. Burge, AT. Cox, NS. Moore, R. Nicolson, C. O'Halloran, P. Lahham, A. Gillies, R. McDonald, CF. |
|---|---|
| Type | Journal Article (Original Research) |
| Journal | Thorax |
| PubMed ID | 27672116 |
| Year of Publication | 2017 |
| URL | https://www.ncbi.nlm.nih.gov/pubmed/27672116 |
| DOI | http://dx.doi.org/10.1136/thoraxjnl-2016-208514 |
| Download |  Thorax-2017-Holland-57-65.pdf (788.6 KB) |
| Abstract | BACKGROUND: Pulmonary 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. METHODS: A 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). RESULTS: We 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. CONCLUSIONS: This 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. |
http://www.ibas.org.au/what-we-do/publications/3872868
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