Home-based rehabilitation improves COPD: a randomised study

A multicentre, randomised, allocation-concealed, clinical trial generated for the first time prospective data indicating improved clinical and psychosocial benefits of a 100% home-based rehabilitation programme for people with chronic obstructive pulmonary disease (COPD).

Dr Roberto Benzo (Mayo Clinic Rochester, MN, USA) explained that despite the fact that guideline-recommended pulmonary rehabilitation is the most effective, non-pharmacological therapy for people with COPD, programmes struggle with low participant uptake, poor adherence, and poor retention [1]. Although home programmes have been suggested previously as a potential means to address this unmet need, to date there have been no randomised studies in the USA to support the value of remote programmes.

The study design had 2 arms: the intervention arm (n=188) and the wait-list control group (n=187). All patients had baseline measures taken and the intervention group immediately began a 12-week remote monitoring plan described below. At 3 months, all measurements were retaken, at which point the wait-list control group began their 12-week intervention. Measurements were taken again at 6 months and at 9 months until the final analysis at 12 months.

The home-based rehabilitation system used a tablet that displayed a daily to-do list and provided videos to help guide exercise, but it was otherwise unsupervised. A pulse oximeter took home readings along with a regular questionnaire prompted by the programme to the health coach. The health coach then utilised the patient’s data to guide interactions in weekly calls.

The primary endpoint was the disease-specific physical and emotional quality of life after the 12-week intervention. Secondary endpoints included dyspnoea, mastery, emotions, fatigue, daily physical activity, sleep, depression, anxiety, and self-management.

The findings showed that 77% of participants completed the intervention. There was a significant difference in the intervention compared with the control group in the primary and secondary outcomes measured by Chronic Respiratory Disease Questionnaire (CRQ; see Table). Daily steps were increased by 655.83 in the intervention group (95% CI 148.03–1,163.64; P<0.0116), self-management improved by 3.83 points (95% CI 1.85–5.79; P<0.001), depression as measured by the PHQ-9 tool decreased in the intervention group by -1.2 points (95% CI -2.04 to -0.35; P<0.0056), and total sleep time increased by 54 minutes (95% CI 6.74–102.96; P<0.025).

Table: Results of the primary and secondary disease-specific quality of life outcome measures [1]



Dr Benzo concluded that this home-based intervention represents an opportunity to increase the uptake of rehabilitation in COPD, across geographies and socioeconomic classes, and to provide options of remote care that are now in increased demand in the context of the COVID-19 pandemic.

1. Benzo R, et al. Effect of Home-Based Rehabilitation with Health Coaching on Chronic Obstructive Pulmonary Disease Outcomes: A Randomized Study. Session A16, ATS International Conference 2022, San Francisco, CA, USA, 13–18 May.

 

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Posted on 18 July, 2022