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Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial

Citation

Holland, AE and Mahal, A and Hill, CJ and Lee, AL and Burge, AT and Cox, NS and Moore, R and Nicolson, C and O'Halloran, P and Lahham, A and Gillies, R and McDonald, CF, Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial, Thorax, 72, (1) pp. 57-65. ISSN 0040-6376 (2016) [Refereed Article]


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Copyright 2017 The Authors Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/

DOI: doi:10.1136/thoraxjnl-2016-208514

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.

Item Details

Item Type:Refereed Article
Keywords:COPD, pulmonary rehabilitation
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Respiratory diseases
Objective Division:Expanding Knowledge
Objective Group:Expanding knowledge
Objective Field:Expanding knowledge in the health sciences
UTAS Author:Lahham, A (Dr Aroub Lahham)
ID Code:128519
Year Published:2016
Web of Science® Times Cited:203
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-09-27
Last Modified:2018-11-12
Downloads:31 View Download Statistics

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