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Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial
  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. 1Faculty of Health and Life Sciences, Coventry University, Coventry, UK
  2. 2Centre for Exercise and Rehabilitation Science, University Hospitals Leicester NHS Trust, Leicester, UK
  3. 3University of Exeter Medical School, St Luke's Campus, Exeter, UK
  4. 4National 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

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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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