Introduction and Objectives Current National Institute of Clinical and Health Excellence (NICE) COPD guidelines (2010) recommend that pulmonary rehabilitation (PR) is made available to all appropriate people with COPD. However, house-bound patients with severe and very severe COPD (MRC 4/5) are not always able to access PR. This creates an inequality in access to health care. This pilot study investigated the effectiveness of home provision of neuromuscular electrical stimulation (NMES) and low-intensity symptom-limited exercise (LISLE) on exercise capacity and health related quality of life in severe and very severe COPD patients.

Methods Patients with severe COPD (MRC 4 and 5) with a mean FEV₁ of 25% predicted ( ± 7.8) were randomised into two 16-session PR programmes, delivered twice weekly for 8 weeks. Group A received NMES and LISLE while Group B only received LISLE. Primary outcomes were the six minute walk test (6MWT) and the St George's respiratory questionnaire (SGRQ). Secondary outcomes were the London Chest Activity of Daily Living Scale (LCADL), and the Hospital Anxiety and Depression Scale (HADS).

Results Ten patients (5 males) with severe COPD were recruited (mean age: 76 years ± 7.7, BMI: 26 ± 4, MRC: 5 ± 0.3, FEV₁:25 ± 7.8). There were no significant between-group differences in the 6MWT, SGRQ or HADS (p > 0.05), but there was a significant improvement in LCADL in group A compared with group B (median difference: -12 vs -1, p < 0.001). Within-groups, there were significant improvements in the 6MWT, SGRQ and LCADL scores in both groups A & B, but no change in the HADS. Within-groups, improvements in the 6MWT and LCADL were likely to be clinically important in group A alone (Table 1).

Conclusion This study showed that a combination of NMES with LISLE resulted in largely similar improvements to LISLE alone. The addition of NMES may be more effective in improving activities of daily living and exercise tolerance but the cost of providing equipment and specialist staff for delivering this individualised home treatment must be weighed against the clinical benefits.

Changes in Primary and secondary outcome measures

All changes in outcome measures are explained below and recorded as shown below in Table 1.