Efficacy of Unsupervised Home-Based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease

Abstract

Purpose: Pulmonary rehabilitation (PR) is a well-established treatment for chronic obstructive pulmonary disease (COPD). The standard protocol for PR requires frequent hospital visits, which can be difficult for patients. We performed this study to assess whether unsupervised home-based PR (HBPR) is effective for patients with COPD.

Patients and methods: After assessing the outcome data, including the results of a COPD assessment test (CAT); the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; a spirometry; the modified Medical Research Council (mMRC) dyspnea scale; and the 6-min walking test (6MWT), specialists imparted 1-hour education to patients regarding unsupervised HBPR at the baseline visit. This included methods for breathing, inhaler use, stretching, and exercise. On reviewing diaries after 8 weeks from the first visit, patients who exercised at least thrice per week were classified as the compliant group and the others were categorized as the noncompliant group. Changes in the outcomes were compared between the compliant and noncompliant groups.

Results: A total of 41 patients were enrolled in this study; for 8 weeks of unsupervised HBPR, there were significant improvements in CAT scores (-4.62±4.61 vs 2.40±6.73; P=0.002), BODE index (-1.00±1.06 vs -0.20±0.56; P=0.01), and forced expiratory volume in 1 s (0.05±0.19 vs -0.09±0.16; P=0.02) among patients in the compliant group, compared with the noncompliant group. Moreover, their CAT (16.46±7.80 vs 11.85±7.23; P=0.03) and mMRC scores (2.54±0.76 vs 1.81±0.63; P=0.001) improved significantly after 8 weeks, compared with those at baseline. On the other hand, patients in the noncompliant group showed no significant improvement in any of the outcomes.

Conclusion: In this study, compliant patients with unsupervised HBPR achieved favorable outcomes in 8 weeks. Thus, we recommend unsupervised HBPR for patients with COPD, even when regular hospital visits for PR are not possible.

Trial registration: NCT03754881.

Keywords: chronic obstructive lung disease; chronic obstructive lung disease assessment test; home-based pulmonary rehabilitation; modified Medical Research Council; pulmonary rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests for this work.

© 2020 Lee et al.

Figures

Figure 1

Study design for unsupervised home-based pulmonary rehabilitation. Baseline measurements were obtained after enrolling eligible patients. The patients performed unsupervised home-based pulmonary rehabilitation after receiving 1-h education on it at baseline. The patients were called weekly and encouraged to achieve home-based pulmonary rehabilitation and maintain diaries of recordings. After 8 weeks, patients were categorized as either the compliant or noncompliant group, and measurements were analyzed for outcomes.

Figure 2

Study flow chart of the enrollment of patients with COPD for the unsupervised home-based pulmonary rehabilitation study. A total of 50 patients were screened for the study; of them, 9 patients were excluded. Among the enrolled 41 patients, 26 patients were grouped as compliant and 15 as noncompliant, based on adherence and nonadherence to 30-min exercise per day for at least 3 days per week, respectively.

Figure 3

Primary outcome and CAT changes after 8 weeks of home-based pulmonary rehabilitation. A scatter plot representing chronic obstructive pulmonary disease (COPD) assessment test (CAT) results at baseline and 8 weeks. The plot is presented as mean with 95% confidence interval (CI). The differences between baseline values and values obtained after 8 weeks were analyzed using an independent two-sample t-test. In the compliant group, CAT scores significantly improved (16.46 ± 7.80 vs 11.85 ± 7.23; P = 0.03), whereas in the noncompliant group, there was no significant change in CAT scores (16.53 ± 7.38 vs 18.93 ± 10.59; P = 0.48).

Figure 4

Secondary outcome measurements after 8 weeks of home-based pulmonary rehabilitation obtained for mMRC, BODE index, FEV1, and 6MWT. The scatter plot presents baseline and 8 weeks outcomes. The plots are presented as mean with 95% confidence interval. Differences between the baseline values and values obtained after 8 weeks were analyzed using an independent two-sample t-test. In the compliant group, mMRC scores (2.54 ± 0.76 vs 1.81 ± 0.63; P = 0.001, (A)) significantly improved after 8 weeks. However, the BODE index (4.04 ± 1.93 vs 3.04 ± 1.97; P = 0.07, (B)), FEV1 (1.32 ± 0.47 vs 1.37 ± 0.46; P = 0.71, (C)), and 6MWT results (400.35 ± 97.31 vs 418.58 ± 88.07; P = 0.48, (D)) did not show significant changes. In the noncompliant group, mMRC scores (2.33 ± 0.72 vs 2.07 ± 0.80; P = 0.44, (A)), BODE index (3.07 ± 1.94 vs 2.87 ± 1.96; P = 0.78, (B)), FEV1 (1.41 ± 0.58 vs 1.31 ± 0.52; P = 0.66, (C)), and 6MWT results (436.67 ± 72.03 vs 441.53 ± 47.20; P = 0.83, (D)) were not significantly different.