Abstract
Patients with chronic obstructive pulmonary disease (COPD) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) B group can be included in pulmonary rehabilitation (PR) settings outside the hospitals. This study aimed to explore the feasibility of a home-based pulmonary rehabilitation (HBPR) program and assess its impact on patients with COPD in the GOLD B group. A real-world, pre–post intervention study was conducted with 12 weeks of HBPR (presential home visits and phone calls) using the self-management program Living Well with COPD. The 1-min sit-to-stand test (1MSTS), modified Medical Research Council Questionnaire (mMRC), COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activity of Daily Living (LCADL) were used to assess the impact. Pre–post differences and correlations between changes in outcomes were calculated. In 30 patients (71.6 years, FEV1 (%) 52.8), significant improvements (p < 0.05) were observed on 1MSTS (Pre 17.2, Post 21.2), mMRC (Pre 2.0, Post 1.0), CAT (Pre 16.3, Post 9.9), HADS (Pre 14.4, Post 9.6), and LCADL (Pre 21.0, Post 15.8), with no adverse events reported. When significant, correlations between changes in outcomes were moderate or strong (0.48 ≤ ρ ≤ 0.66). HBPR can be feasible and safe, and it shows the potential to significantly improve outcomes of patients with COPD in the GOLD B group.
Highlights
Pulmonary rehabilitation (PR) is a cornerstone of management for people with chronic obstructive pulmonary disease (COPD) presenting well-established benefits [1]
Inclusion criteria were: (i) diagnosis based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria - postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio
The present study showed that this home-based pulmonary rehabilitation (HBPR) program seems to be feasible and showed a positive impact on patients with COPD in the GOLD B group, both in functional capacity outcome (1MSTS) and in patient-reported outcome measures (PROMs)
Summary
Pulmonary rehabilitation (PR) is a cornerstone of management for people with chronic obstructive pulmonary disease (COPD) presenting well-established benefits [1]. According to the official American Thoracic Society/European Respiratory Society (ATS/ERS) Statement [2], PR can be conducted in a range of settings, where community- and home-based programs present promising results [3,4] For this reason, a number of factors need to be considered to choose the rehabilitation setting [2], where the assessment of symptoms and risk of exacerbation, according to the ABCD classification system from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [5], can be included. The development of home-based models is one of the actions undertaken to improve access to and delivery of PR services for suitable patients, due to the needs that hospital programs currently present (costs and accessibility) [8] This setting is, more than ever, an important and necessary solution face to the COVID-19 pandemic, where outpatient programs were advised to suspend their activities [9]
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