Review Finds Comparable Outcomes Between Home-Based and Outpatient Pulmonary Rehab

Home-based pulmonary rehab (HBPR) had comparable short-term effects to outpatient pulmonary rehab (OPR) in patients with chronic obstructive pulmonary disease (COPD), with low overall quality of results, according to a review published in BMC Health Services Research.

Searches were done from March 1, 2020, to March 13, 2020, and were updated on November 17, 2021. Studies were excluded if they contained patients with asthma, were simulation studies, were long-term pulmonary rehabilitation (PR) programs, took place for less than 4 weeks, were inpatient PR programs, or had no defined clinical outcomes. Narrative synthesis of effectiveness and meta-analyses were performed.

There were 14 studies (12 randomized controlled trials and 2 comparative observational studies) and 2293 patients included in the review.

All HBPR programs included lasted at least 8 weeks. Sessions and in-home visits were conducted by nurses or physiotherapists and provided information booklets, manuals, or workbooks and exercise prescription information. Most programs also included strength and endurance training into activities to be performed 3 times a week; 4 programs included supervised exercise.

Most programs asked patients to track daily activities and symptoms. Follow-up calls by a nurse or physiotherapist came once a week to encourage and motivate patients and monitor progress. Usual care often comprised some form of in-person self-management or clinical needs assessment and advice on staying active and taking medication.

OPR involved community-based group sessions that were held 2 to 3 times weekly for 7 to 12 weeks and included exercise and education.

Three studies reported adverse event rates and 2 studies compared HBPR to OPR but identified no statistically significant differences between groups. The 1 study that compared HBPR to OPR concluded that the impact of HBPR and OPR on health utilization was similar.

The 1 study using COPD Assessment Tests before and after completion of programs demonstrated no statistically significant differences between OPR and HBPR in quality of life (QOL). Three found no significant difference between the 2 groups in dyspnea, emotional, fatigue, and mastery domains of QOL after 2 months.

HBPR participation was higher in 3 studies and lower in 2 studies compared with OPR, although no statistical significance was reported. Functional exercise capacity increased in patients who participated in both PR programs in the 4 studies that evaluated the difference between HBPR and OPR.

HBPR and OPR did not reduce anxiety or depression in 2 of the 5 studies that used the Hospital Anxiety and Depression scale. Self-efficacy was also similarly after both treatments.

There were some limitations to this study. There was a possible risk of bias due to missing information, the studies did not provide full descriptions of the study randomization process, the interventions studies varies, only studies written in English and published from 2009 and later were included, and no meta-analysis performed.

The researchers concluded that HBPR is an alternative approach that is as safe as OPR and had similar outcomes to standard PR programs.

“Although there is a considerable amount of evidence relating to these programs’ effectiveness for COPD patients, its quality is low and should be interpreted with caution,” the authors wrote.

Reference

Stafinski T, Nagase FI, Avdagovska M, Stickland M, Menon D. Effectiveness of home-based pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease (COPD): systematic review. BMC Health Serv Res. Published online April 26, 2022. doi:10.1186/s12913-022-07779-9