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Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial

Elizabeth J Horton, Katy E Mitchell, Vicki Johnson-Warrington, et al.
Thorax 2018;73(1):29–36
doi: 10.1136/thoraxjnl-2016-208506

Pulmonary rehabilitation (PR) is a high-value intervention for patients with chronic obstructive pulmonary disease (COPD), and international guidelines recommend a programme over six weeks involving a package of supervised exercise and education. However, uptake for centre-based, supervised PR is poor. Home-based PR programmes offer an alternative, but evidence is lacking for the benefits of a standardised, unsupervised PR programme with no home visits by a physiotherapist or intensive monitoring.

This study, reported by Elizabeth Horton (Coventry University) and colleagues, set out to determine whether a structured, home-based, unsupervised PR programme of activity, coping and education for COPD could be considered non-inferior to centre-based PR. Two hundred and eighty-seven COPD patients referred to PR were randomised to either centre-based PR or a structured, unsupervised home-based programme for seven weeks, including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls.

The standardised home-based programme provided improvement in breathlessness and exercise endurance capacity of a similar level to conventional supervised PR, but further evidence is needed to determine conclusively whether the health benefits of standardised home-based PR are non-inferior or equivalent to supervised centre-based PR.

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