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Original research
Supervised pulmonary rehabilitation using minimal or specialist exercise equipment in COPD: a propensity-matched analysis
  1. Suhani Patel1,
  2. Melanie D Palmer2,
  3. Claire Marie Nolan1,2,
  4. Ruth Emily Barker1,
  5. Jessica Anne Walsh1,
  6. Stephanie C Wynne1,
  7. Sarah Elizabeth Jones1,
  8. Harriet Shannon3,
  9. Nicholas S Hopkinson4,
  10. Samantha Swee Chin Kon1,5,
  11. Wei Gao6,
  12. Matthew Maddocks6,
  13. William D-C Man1,2,4
  1. 1 Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3 Faculty of Population Health Sciences, University College London, London, UK
  4. 4 National Heart and Lung Institute, Imperial College London, London, UK
  5. 5 The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
  6. 6 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
  1. Correspondence to Suhani Patel, Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK; s.patel1{at}rbht.nhs.uk

Abstract

Background Many trials supporting the benefits of pulmonary rehabilitation (PR) have used specialist exercise equipment, such as treadmills and cycle ergometers. However, access to specialist equipment may not be feasible in some settings. There is growing interest in delivering PR programmes with minimal, low-cost equipment, but uncertainty remains regarding their efficacy compared with programmes using specialist equipment.

Methods Using propensity score matching, 318 consecutive patients with COPD undergoing supervised PR using minimal equipment (PR-min) were compared 1:1 with a control group of 318 patients with COPD who underwent supervised PR using specialist equipment (PR-gym). A non-inferiority analysis was performed for the primary outcome (incremental shuttle walk (ISW)) and secondary outcomes (Chronic Respiratory Disease Questionnaire (CRQ)—domain and total scores).

Results Similar improvements in ISW and CRQ-domains were observed in PR-min and PR-gym groups (mean difference ISW: 3 m (95% CI −16 to 9); CRQ-total: 0.9 (95% CI −2.7 to 4.5)). The 95% CI between group differences for ISW and CRQ-total did not cross the predefined non-inferiority margins. However, completion rates were lower in PR-min compared with PR-gym (64% vs 73%; p=0.014).

Conclusions In patients with COPD, PR delivered using minimal equipment produces clinically significant benefits in exercise capacity and health-related quality of life that are non-inferior to rehabilitation delivered using specialist equipment. This study provides support for the provision of PR using minimal exercise equipment, particularly in areas where access to specialist exercise equipment is limited.

  • pulmonary rehabilitation
  • equipment evaluations
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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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @suhani_patel1, @clairemnolan84, @COPDdoc, @toplungdoc

  • SP, MDP and CMN contributed equally.

  • Contributors Concept and design of study: MDP, WDCM. Acquisition of data: MDP, CMN, SEJ, SP, REB, JAW, SCW. Interpretation and analysis of data: SP, SEJ, MDP, CMN, WG, MM, WDCM. Drafting of manuscript: SP, WDCM. Revision of manuscript critically for important intellectual content: all authors. Approval of final manuscript: all authors. WDCM acts as the guarantor of the data.

  • Funding This study was funded by a National Institute for Health Research (NIHR) Research for Patient Benefit grant PB-PG-0816-20022. SP is supported by an NIHR Clinical Doctoral Research Fellowship (NIHR 300566). REB is supported by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-018). CMN is supported by an NIHR Clinical Trials Fellowship (CTF-2017-06-005) and a British Lung Foundation Project Grant (IPFPG17-15). SEJ is supported by an NIHR Doctoral Research Fellowship (DRF-2015-08-004). JAW and SCW are supported by an NIHR Research for Patient Benefit PB-PG-0816-20022. MM is supported by an NIHR Career Development Fellowship (CDF-2017-10-009). WG and MM are supported by NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. This paper presents independent research funded by the National Institute for Health Research (NIHR).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests WDCM reports grants from the National Institute for Health Research, during the conduct of the study; grants from Pfizer and the British Lung Foundation, non-financial support from GSK, personal fees from Jazz Pharmaceuticals, Mundipharma and Novartis, outside the submitted work. CMN reports personal fees from Novartis, outside the submitted work. SSCK reports personal fees from Novartis, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval On completion of the HRA ethics approval decision tool (http://www.hra-decisiontools.org.uk), no ethical approval was required as this study was defined as service evaluation. Registration was completed with the Royal Brompton and Harefield Hospital NHS Foundation Trust clinical audit department as per local protocols (Registration No 1237).

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

  • Data availability statement Data are available upon reasonable request.

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