Home-based pulmonary rehabilitation delivered using minimal resources has similar – and in some cases even superior – outcomes to centre-based pulmonary rehabilitation, Australian researchers have found.
The findings offer hope that more people with COPD could have meaningful access to pulmonary rehabilitation, a well-accepted cornerstone of COPD care plans.
Despite being strongly recommended in treatment guidelines, pulmonary rehabilitation is currently delivered to less than 10% of people with COPD, say the authors of the paper, published in the BMJ’s Thorax journal.
“This study shows that this highly structured home-based pulmonary rehabilitation model, using minimal resources and little direct supervision, results in short-term improvements in 6MWD (six minute walk distance) and HRQoL (health-related quality of life) that are equal to or greater than those seen in a centre-based programme,” the authors found.
“Equivalent quality of life outcomes were observed at 12 months following programme completion, although it was not possible to exclude inferiority for 6MWD at this time point. Gains in both groups were poorly maintained at 12 months.”
Lead author, senior physiotherapist and researcher, Dr Anne Holland, Professor at the Alfred Health Clinical School’s College of Science, Health and Engineering, School of Allied Health and Department of Rehabilitation, Nutrition and Sport, said the results were significant.
“The real message here is around access and trying to facilitate models for patients who wouldn’t get access otherwise,” she told the limbic.
She said home-based rehabilitation was not widely available for COPD patients anywhere in the world, but this research showed it had strong potential to capture at least some of the overwhelming majority of patients who miss out.
These would include patients in rural and remote areas, as well as those who are socioeconomically disadvantaged, and people who were simply reluctant to commit to attending a centre-based program.
“We know lots of people who decline to come to pulmonary rehabilitation – just the burden of coming is enough to put them off,” Dr Holland said.
The researchers conducted their randomised controlled equivalence trial with 12 months follow-up with 166 participants with stable COPD. Of these, 86 received eight weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, while 80 received their rehab service via a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist.
The home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation, although it was noted that neither model was effective in maintaining gains at 12 months.
“Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation,” the authors concluded.
Interestingly, the study showed the home-based program was more effective at keeping patients out of hospital. In the 12 months following rehabilitation 37 participants (43%) in the centre-based group were hospitalised compared with 28 participants (35%) in the home-based group.
Dr Holland said the local health service at Alfred Health was in the process of setting up a pilot program which will allow appropriate patients with respiratory disease to have access to home-based pulmonary rehabilitation.
She said it was hoped up to 60 patients could be recruited for the pilot, which is expected to last 6-7 months.
“It certainly fits with the ethos of having as much care in the community as possible,” she said.
She conceded that there would be patients who were not suitable for home-based rehab, particularly the very complex cases. She also revealed the concept had attracted some controversy overseas when it was proposed.
“The model of supervised rehabilitation is very tightly held,” she said. “It does require quite a shift for clinicians to think about this in a different way, and we hope this research shows it can work and work very effectively.”
The Lung Foundation currently has an MBS application for pulmonary rehabilitation that will be considered by MSAC in November. If the application is approved GPs will be able to refer patients with chronic lung disease to an eight-week course of pulmonary rehabilitation.
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