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



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).



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.



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.



NCT01423227, clinicaltrials.gov.
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.|Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Anne E
0000-0003-2061-845X
AE
Holland
The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Ajay
A
Mahal
Institute for Breathing and Sleep, Melbourne, Victoria, Australia.|Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.
Catherine J
CJ
Hill
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.|Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Annemarie L
AL
Lee
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.|Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Angela T
AT
Burge
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Narelle S
NS
Cox
Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Rosemary
R
Moore
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
Caroline
C
Nicolson
Department of Public Health, La Trobe University, Melbourne, Victoria, Australia.
Paul
P
O'Halloran
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Aroub
A
Lahham
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.|Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.
Rebecca
R
Gillies
Institute for Breathing and Sleep, Melbourne, Victoria, Australia.|Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Christine F
CF
McDonald
D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006699:Home Care Services; D006792:House Calls; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D012047:Rehabilitation Centers; D016037:Single-Blind Method; D013689:Telephone; D013810:Therapeutic Equivalency; D000070857:Walk Test
Pulmonary Rehabilitation
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