title: Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial.
abstract: BACKGROUND
  Home-based rehabilitation is a promising approach to improve access to pulmonary rehabilitation.
  
  
  OBJECTIVE
  To assess whether self-monitored, home-based rehabilitation is as effective as outpatient, hospital-based rehabilitation in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Randomized, multicenter, noninferiority trial.
  
  
  METHODS
  10 academic and community medical centers in Canada.
  
  
  METHODS
  252 patients with moderate to severe COPD.
  
  
  METHODS
  After a 4-week education program, patients took part in home-based rehabilitation or outpatient, hospital-based rehabilitation for 8 weeks. They were followed for 40 weeks to complete the 1-year study.
  
  
  METHODS
  The primary outcome was the change in Chronic Respiratory Questionnaire dyspnea subscale score at 1 year. The primary analysis took a modified intention-to-treat approach by using all patients who provided data at the specified follow-up time, regardless of their level of adherence. The analysis used regression modeling that adjusted for the effects of center, sex, and baseline level. All differences were computed as home intervention minus outpatient intervention.
  
  
  RESULTS
  Both interventions produced similar improvements in the Chronic Respiratory Questionnaire dyspnea subscale at 1 year: improvement in dyspnea of 0.62 (95% CI, 0.43 to 0.80) units in the home intervention (n = 107) and 0.46 (CI, 0.28 to 0.64) units in the outpatient intervention (n = 109). The difference between the 2 treatments at 1 year was small and clinically unimportant. The 95% CI of the difference did not exceed the prespecified noninferiority margin of 0.5: difference in dyspnea score of 0.16 (CI, -0.08 to 0.40). Most adverse events were related to COPD exacerbations. No serious adverse event was considered to be related to the study intervention.
  
  
  CONCLUSIONS
  The contribution of the educational program to the improvement in health status and exercise tolerance cannot be ascertained.
  
  
  CONCLUSIONS
  Home rehabilitation is a useful, equivalent alternative to outpatient rehabilitation in patients with COPD.
authors.affiliation: Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval and Centre Hospitalier Universitaire Associé, Québec City, Québec, Canada. francois.maltais@med.ulaval.ca
authors.forename: François
authors.initials: F
authors.lastname: Maltais
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: Stan
authors.initials: S
authors.lastname: Shapiro
authors.forename: Yves
authors.initials: Y
authors.lastname: Lacasse
authors.forename: Hélène
authors.initials: H
authors.lastname: Perrault
authors.forename: Marc
authors.initials: M
authors.lastname: Baltzan
authors.forename: Paul
authors.initials: P
authors.lastname: Hernandez
authors.forename: Michel
authors.initials: M
authors.lastname: Rouleau
authors.forename: Marcel
authors.initials: M
authors.lastname: Julien
authors.forename: Simon
authors.initials: S
authors.lastname: Parenteau
authors.forename: Bruno
authors.initials: B
authors.lastname: Paradis
authors.forename: Robert D
authors.initials: RD
authors.lastname: Levy
authors.forename: Pat
authors.initials: P
authors.lastname: Camp
authors.forename: Richard
authors.initials: R
authors.lastname: Lecours
authors.forename: Richard
authors.initials: R
authors.lastname: Audet
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.forename: John R
authors.initials: JR
authors.lastname: Penrod
authors.forename: Danielle
authors.initials: D
authors.lastname: Picard
authors.forename: Sarah
authors.initials: S
authors.lastname: Bernard
mesh_terms: D000368:Aged; D002170:Canada; D004417:Dyspnea / Q000534:rehabilitation; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires