Short-term effects of home-based pulmonary rehabilitation during outpatient-managed exacerbations of COPD: a randomised controlled trial

Abstract

Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD.

Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed ECOPD. Participants were randomly assigned to the control (CG, ie, usual care) or experimental (EG, ie, usual care and 3-week home-based PR) group within 48 hours of the diagnosis (baseline). Assessments were performed at baseline and after 3 weeks (post). The COPD assessment test (CAT) was the primary outcome. Secondary outcomes included measures of symptoms and functional capacity. After PR, interviews were conducted. Analyses were performed using (non-)parametric mixed analysis of variance, deductive thematic analysis and narrative integration through joint displays.

Results Fifty participants with outpatient-managed ECOPD (78% men, 70±11 years, forced expiratory volume in one second 47.4±16.4% pred) were included. Significant greater improvements in the EG compared with the CG were found for the CAT (EG Δ−12.5±7.2 vs CG Δ−5.9±7.2, p=0.002) and 12 of 13 other secondary outcome measures. A positive self-perceived impact of PR was found on symptoms, control of daily life, health, mental status and empowerment. No adverse events were reported.

Conclusions A 3-week home-based PR programme is safe, meaningful and more effective than just standard medication in improving symptoms, functional capacity and health status, outcomes often associated with poor prognosis. This highlights the role of PR in improving the recovery process during outpatient-managed ECOPD and might contribute to a better prognosis in these individuals.

Trial registration NCT03751670.