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Rehabilitation
Original Article
Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial
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  1. Elizabeth J Horton1,
  2. Katy E Mitchell2,
  3. Vicki Johnson-Warrington2,
  4. Lindsay D Apps2,
  5. Louise Sewell2,
  6. Mike Morgan2,
  7. Rod S Taylor3,
  8. Sally J Singh2,4
  1. 1 Faculty of Health and Life Sciences, Coventry University, Coventry, UK
  2. 2 Centre for Exercise and Rehabilitation Science, University Hospitals Leicester NHS Trust, Leicester, UK
  3. 3 University of Exeter Medical School, St Luke’s Campus, Exeter, UK
  4. 4 National Centre for Sport and Exercise Medicine, Loughborough University, Leicester, UK
  1. Correspondence to Elizabeth J Horton, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK; e.horton{at}coventry.ac.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.

  • pulmonary rehabilitation
  • exercise

https://doi.org/10.1136/thoraxjnl-2016-208506

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    Footnotes

    • Contributors Study design: EJH, LS, MM and SJS. Data collection and management: EJH, KEM, VJW, LDA and LS. Data analysis: EJH and RST. Writing and editing of manuscript: all authors.

    • Funding GSK provided an unrestricted monetary grant to part fund the this study.

    • Competing interests None declared.

    • Ethics approval Leicestershire Northamptonshire and Rutland Regional Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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