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Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial
  1. Anne E Holland1,2,3,
  2. Ajay Mahal4,
  3. Catherine J Hill3,5,
  4. Annemarie L Lee1,2,3,
  5. Angela T Burge1,2,3,
  6. Narelle S Cox1,3,
  7. Rosemary Moore3,
  8. Caroline Nicolson1,2,
  9. Paul O'Halloran6,
  10. Aroub Lahham1,3,
  11. Rebecca Gillies1,5,
  12. Christine F McDonald3,7,8
  1. 1Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
  2. 2Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
  3. 3Institute for Breathing and Sleep, Melbourne, Victoria, Australia
  4. 4The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
  6. 6Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
  7. 7Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
  8. 8Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Anne E Holland, La Trobe University Clinical School, Alfred Health, 99 Commercial Rd, Melbourne, VIC 3004, Australia; a.holland{at}alfred.org.au

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.

Trial registration number NCT01423227, clinicaltrials.gov.

  • Pulmonary Rehabilitation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors Conception and design: AEH, AM, CFM. Data acquisition: AEH, CJH, ALL, ATB, NSC, RM, CN, PO, AL, RG. Data analysis: AEH, AM, ATB, NSC, AL, ALL. Drafting and critically revising the manuscript, and final approval for publication: all authors.

  • Funding This study was funded by a Lung Foundation Australia / Boehringer Ingelheim COPD Research Fellowship and a National Health and Medical Research Council (Australia), project grant 1046353.

  • Competing interests None declared.

  • Ethics approval Alfred Hospital HREC, Austin Health HREC, La Trobe University HEC.

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

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