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Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study
  1. Claire Marie Nolan1,2,
  2. Djeya Kaliaraju2,
  3. Sarah Elizabeth Jones1,3,
  4. Suhani Patel1,
  5. Ruth Barker1,3,
  6. Jessica A Walsh1,2,
  7. Stephanie Wynne1,
  8. William Man1,2,3
  1. 1 Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
  3. 3 National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Dr Claire Marie Nolan, Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK; c.nolan@rbht.nhs.uk

Abstract

Home-based exercise has been proposed as an equivalent treatment strategy to supervised outpatient pulmonary rehabilitation (PR), but it is not known whether its implementation into clinical practice produces similar benefits to those observed in trials. We compared the real-world responses of 154 patients with COPD undergoing home-based exercise with a matched group attending supervised PR. We observed smaller improvements in exercise capacity with home-based exercise compared with PR, but similar improvements in quality of life. We propose that supervised PR remains the standard of care, with home-based exercise a less effective alternative for those unable to attend PR.

  • chronic obstructive pulmonary disease
  • home rehabilitation
  • pulmonary rehabilitation

https://doi.org/10.1136/thoraxjnl-2018-212765

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Footnotes

  • Contributors CMN and WM contributed to the concept and design of study and drafted the manuscript. CMN, DK, SEJ, SP, RB, JAW and SW contributed to the acquisition of data. CMN, DK and WM contributed to the analysis of data. All authors contributed to the revision of manuscript critically for important intellectual content and approval of the final manuscript.

  • Funding This study was funded by a project grant from the NIHR Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC for Northwest London). CMN, JAW and SCW are supported by an NIHR Research for Patient Benefit Grant (PB-PG-0816-20022); SEJ is supported by a NIHR Doctoral Research Fellowship (DRF-2015-08-004); SP is supported by a British Lung Foundation IPF Project Grant (IPFPG17-15) and REB is supported by a NIHR Clinical Doctoral Research Fellowship (CDRF-2017-03-018).

  • Competing interests WM reports grants from National Institute for Health Research during the conduct of the study; grants from Pfizer, non-financial support from GSK, personal fees from Mundipharma, personal fees from Novartis, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by London-Camberwell St Giles Research Ethics Committee (11/LO/1780).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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