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Thorax. 2018 Jan;73(1):29-36. doi: 10.1136/thoraxjnl-2016-208506. Epub 2017 Jul 29.

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial.

Author information

1
Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
2
Centre for Exercise and Rehabilitation Science, University Hospitals Leicester NHS Trust, Leicester, UK.
3
University of Exeter Medical School, St Luke's Campus, Exeter, UK.
4
National Centre for Sport and Exercise Medicine, Loughborough University, Leicester, UK.

Abstract

BACKGROUND:

Standardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD.

METHODS:

A total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units.

RESULTS:

There was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: -0.24, 95% CI -0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks.

CONCLUSIONS:

The standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.

TRIAL REGISTRATION NUMBER:

ISRCTN81189044.

KEYWORDS:

exercise; pulmonary rehabilitation

PMID:
28756402
DOI:
10.1136/thoraxjnl-2016-208506
[Indexed for MEDLINE]

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