Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial

Anne E Holland, Arwel W Jones, Ajay Mahal, Natasha A Lannin, Narelle Cox, Graham Hepworth, Paul O'Halloran, Christine F McDonald, Anne E Holland, Arwel W Jones, Ajay Mahal, Natasha A Lannin, Narelle Cox, Graham Hepworth, Paul O'Halloran, Christine F McDonald

Abstract

Introduction: There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model.

Method and analysis: This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial.

Ethics and dissemination: Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies.

Trial registration number: NCT04217330.

Keywords: Chronic airways disease; Emphysema; REHABILITATION MEDICINE.

Conflict of interest statement

Competing interests: AEH, AM, CFM, GH, NAL, NC and PO declare grant funding from the Commonwealth of Australia Medical Research Future Fund paid to their institution for the conduct of the trial. CFM declares non-financial board roles as Chair COPD National Programme, Lung Foundation Australia and Medical Director Institute for Breathing and Sleep. No other competing interests are declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Design of the HomeBase2 trial.

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