Home and Community Care Digest

Home and Community Care Digest 8(2) November -0001

Home-Versus Hospital-Based Pulmonary Rehabilitation: Different Approaches, Equivalent Outcomes

Abstract

A comparison of two pulmonary rehabilitation programs found that home-based care is as effective as outpatient hospital-based rehabilitation for patients with chronic obstructive pulmonary disease (COPD). Both rehabilitation strategies produced a similar improvement in dyspnea score at three and twelve months. Moreover, the 6-minutes walking distance, cycling endurance time, and health status were similar between both rehabilitation programs. This finding provides evidence in support for the implementation of a home-based rehabilitation program for patients with moderate to severe COPD in Canada; however caution must be taken when drawing conclusions due to a small sample size.
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of death throughout the world. Pulmonary rehabilitation is an underused therapeutic approach to alleviate dyspnea (shortness of breath), improve health status, and reduce health care utilization. Outpatient, hospital-based pulmonary rehabilitation improves health outcomes; however, access to these programs is limited. Self-monitored, homebased rehabilitation is a promising alternative, but its effectiveness as compared to the standard hospitalbased program has not been rigorously tested. This study assessed whether self-monitored, home-based rehabilitation is as effective as outpatient, hospital-based rehabilitation in patients with COPD.

Methods: This clinical trial was conducted in ten academic and community medical centers in Canada. Participants were randomly assigned to either self-monitored, home-based or outpatient, hospital-based trainings for 8 weeks. The home program was self-monitored and included aerobic and strength exercise three times a week. The hospital-based program also consisted of aerobic and strength exercises three times per week. Patients were followed for 40 weeks after the last exercise training session. Three months to one year after the training phase, patients were contacted to emphasize the importance of exercise and were asked about adverse events. Change in the dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months was the primary outcome variable. Secondary outcome variables included other CRQ domains and St. George's Respiratory Questionnaire at 3 and 12 months, exercise tolerance, and safety of interventions.

Findings: The study included 252 patients with moderate to severe COPD. Comparisons between both groups showed that the home intervention was equivalent to the hospital-based intervention in terms of the change in the dyspnea domain of the CRQ at three and 12 months. Patients in both rehabilitation programs had similar improvements on the 6-minutes walking distance, cycling endurance time, and health status. No serious adverse event related to the study intervention was detected.

Conclusions: This randomized trial highlighted self-monitored, home-based rehabilitation as an equivalent program to outpatient, hospital-based rehabilitation in terms of improving dyspnea, health status, and exercise tolerance in patients with COPD. The results provide support for the implementation of a homebased rehabilitation program as an alternative for patients with moderate to severe COPD in Canada despite its small sample size.

References

Maltais F, Bourbeau J, Shapiro S, Lacasse Y, Perrault H, Baltzan M, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149 (12):869-78.

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