Effects Of Home-based Pulmonary Rehabilitation Research Articles

Effect of home-based pulmonary rehabilitation on exercise capacity in post COVID-19 patients: a randomized controlled trail

BackgroundCoronavirus 2019 (COVID-19) is an epidemic condition that compromises various consequences. The goal of this study was to investigate the effect of home-based pulmonary rehabilitation on exercise capacity in patients with post COVID-19 syndrome.MethodsThe study was designed as a randomized control trial. A total of sixty-eight patients with post COVID-19 syndrome complaining of fatigue, dyspnea, and exercise intolerance participated in this study. Their ages ranged from 40 to 70 years old. The patients were randomly classified into two equal groups. The control group received usual medical care only, whereas the rehabilitation group received a selected home-based pulmonary rehabilitation exercise program plus the same usual medical care. The Physical Fitness Index (PFI), Chalder fatigue index, SF-36 questionnaire, dyspnea scale, and six-minute walk test (6 MWT) were measured before and after 12 weeks of intervention.ResultsThe rehabilitation group showed a significant lower mean of Chalder fatigue (11.1 ± 0.94) and a higher mean of 6MWT (439.7 ± 25.3) and PFI (52.3 ± 10.2), in addition to a higher mean of the SF-36 Questionnaire (66.4 ± 3.7) and a significant improvement of dyspnea in the mMRC score (26.7%), grade 2, (63.3%), grade 1 (10%), and grade 0 with a p-value < 0.001 when compared to the control group.ConclusionHome-based pulmonary rehabilitation (HBPR) for patients with post COVID-19 syndrome is effective and has a potential direct influence on exercise capacity, fatigue, dyspnea, and quality of life. HBPR could be considered an adjunctive, applicable, and low-cost therapy for patients with post COVID-19 syndrome.Trial registration: The study was registered in Pan African Clinical Trial Registry as a clinical trial ID (PACTR202111640499636), November 2021.

A case of herpes zoster-related phrenic nerve palsy: Effect of home-based pulmonary rehabilitation

Here, we report the case of a 62-year-old man with herpes zoster-related phrenic nerve palsy, which was evident in clinical, radiological, and electrodiagnostic studies. To aid clinical recovery and preserve pulmonary function, we designed a home-based pulmonary rehabilitation program consisting of air-stacking exercises using ambu-bagging, respiratory muscle training to improve the strength and endurance of inspiratory and expiratory muscles, and aerobic and resistance exercises of the upper and lower limbs to improve and prevent the decline of cardiorespiratory fitness. The patient was monitored, and the exercises were adjusted through regular outpatient follow-up. During the overall follow-up period of 26 months, pulmonary rehabilitation led to an increase in forced vital capacity from 2,020 to 3,160 mL, and improved the diaphragmatic height index from -4.46 to 0.28. Clinical symptoms also showed notable improvement, as the Borg Rating of Perceived Exertion scale score decreased from 17 to 7. We found that a home-based, self-performed pulmonary rehabilitation program could promote recovery from herpes zoster-related phrenic nerve palsy. Not only is this important for the rapid restoration of respiratory function and symptomatic relief, it can also protect patients from respiratory complications.

The Effect of Home-Based Pulmonary Rehabilitation on Asthmatic Pediatric Quality of Life

Background: Children with asthma have a low quality of life because they cannot adequately be physically active. Asthmatic children can benefit from home-based pulmonary rehabilitation because it is available, inexpensive, and easy to use. Objectives: This study aimed to determine the effect of home-based pulmonary rehabilitation on the quality of life of children with asthma. Methods: This experimental study was conducted in 2022 on 60 asthmatic children in Gorgan, Iran, with two intervention and control groups by convenient method. Children in the intervention group received eight pulmonary rehabilitation sessions at home after randomly assigning the participants to two intervention (30-person) and control (30-person) groups. The data collection tools included a demographic characteristic form and a pediatric quality of life questionnaire (PedsQl). Results: The mean quality of life before the intervention was 54.6 ± 7.13 in the intervention and 53.76 ± 7.12 in the control group, and the independent t-test did not show a significant difference between the two groups. The mean quality of life after the intervention increased to 59.9 ± 7.69 in the intervention and 55.3 ± 7.36 in the control group, and the independent t-test showed a significant difference between the two groups (P = 0.01). Conclusions: Based on the results, home-based pulmonary rehabilitation effectively improved the asthmatic pediatric quality of life. Therefore, the healthcare system should consider home-based pulmonary rehabilitation as part of the treatment protocol.

Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis.

Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87). Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.

Short Review on Effectiveness of Upper Limb Exercises and Breathing Exercises in COPD Stable Patients During COVID-19 Pandemic Era

One of the most common problems found in Chronic Pulmonary Obstructive Disease (COPD) patients is decreased tolerance to physical exercises, which increases the mortality rate and the frequency of hospitalization due to the weakening of respiratory function. This condition also leads to weak periphery and respiratory muscles. Pulmonary rehabilitation is the foundational treatment for COPD patients that can improve their training capacity, health-related quality of life and reduce the use of health-care facilities. In compliance with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2022 nonpharmacological initiative for COPD, patients are recommended to do physical activities within their capabilities, while observing physical distancing as a protective measure during the Coronavirus Disease 2019 (Covid-19) pandemic. Pulmonary telerehabilitation presents a feasible solution to overcome the obstacles faced by the healthcare industry to provide in-house rehabilitation programme at hospitals or other health centres. Therefore, it is our objective to study and evaluate the benefits and effectiveness of home-based pulmonary rehabilitation (HBPR).

Home-Based Pulmonary Rehabilitation in Aged Individuals With Lung Tumor After Thoracoscopic Surgery

Background: Objective of this study was to investigate the effect of home-based pulmonary rehabilitation in older individuals with lung tumors after video-assisted thoracoscopic surgery. Method: Thirty-six subjects were recruited. The control group received standard care, whereas the experimental group underwent a 6-week home-based pulmonary rehabilitation additionally. Assessments were conducted at 2, 6, and 12 weeks after discharge from the hospital. Results: Exercise capacity significantly improved in the rehabilitation group at 2-week follow-up. Inspiratory muscle strength and lung expansion capacity significantly improved at 2- and 6-week follow-ups. Conclusion: Home-based pulmonary rehabilitation could shorten the recovery time of certain physical functions.

Effectiveness of upper limb exercises and breathing exercises in COPD stable patients during COVID-19 pandemic era.

This study was a quasi-experiment conducted from August to November 2020 involving 10 COPD stable patients. In the first meeting at the hospital, patients were taught breathing techniques and upper-limb exercise movements which subsequently had to be done and recorded at home. Patients then sent the videos to the research team via whatsapp to be evaluated. Prior to starting the 4-week with twice-a-week frequency home-based rehabilitation, and again at the end of it, patients' conditions were evaluated based on the following factors: lung functional capacity was measured by 6MWD (6 Minutes Walking Distance), Perceived Exertion Scale by mMRC (modified Medical Research Council) and Borg, the quality of life by SGRQ (St. George's Respiratory Questionnaire) index, the severity of symptoms by CAT (COPD Assessment Test) and changes in muscle mass. Statistical analysis was conducted using the Wilcoxon and paired t-test. After 4 weeks of home training with twice-a-week frequency, the results showed significant improvement, with p-value < 0.05, in the increased 6MWD value (16.4 ± 4.45 to 19.8 ± 3.64), mMRC (1.90 ± 1.10 to 0.90 ± 0.87), Borg (3.05 ± 1.53 to 1.40 ± 1.42), CAT (15.7 ± 6.63 to 11.8 ± 5.24) and muscle mass (28.36 ± 2.89 to 31.86 ± 3.97). The method produced positive outcomes in patients' lung function capacity, severity of symptoms, exertion scale, muscle mass, and general quality of life. Accordingly, the home-based rehabilitation programme was as effective as the programme conducted at health-care centers.

Effect of Home-based Pulmonary Rehabilitation on Fatigue, Dyspnea, and Activities of Daily Living of COVID-19 Patients

Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P &lt; 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P &lt; 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P &lt; 0.001) stages and the mean dyspnea scores (P &lt; 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P &lt; 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.

Effect of home-based pulmonary rehabilitation on functional capacity in people with idiopathic pulmonary fibrosis\u2014a systematic review protocol

BackgroundIdiopathic pulmonary fibrosis (IPF) is one of the common types of interstitial lung disease having high prevalence and mortality worldwide. As a result of patient-centred hindering factors of adherence to centre-based pulmonary rehabilitation (PR), home-based PR is an alternate mode of rehabilitating individuals with IPF. This systematic review will evaluate the effectiveness of unsupervised home-based PR on functional capacity and health-related quality of life (HRQoL) in individuals with IPF.MethodsClinically stable, high resolution computed tomography and physician diagnosed IPF participants having modified Medical Research Council score below 5 will be considered for the systematic review. Studies involving home-based PR as an intervention to treat individuals with IPF will be considered. Randomised controlled trials and quasi-randomised studies (with two groups followed up) are eligible to be included. Outcomes of our interest are functional capacity (6-min walk distance, shuttle walk test and incremental shuttle walk test) and secondary outcome measure would include assessment of quality of life and adverse effects of intervention. Electronic databases such as SCOPUS, Medline (PubMed and Web of Science), PEDRo and CINAHL will be searched using database specific terms. Additionally, forward and backward citations of included studies will be searched to identify potential records. Two review authors, independently, will conduct the screening, data extraction using a customised standard tool, and critical appraisal using Cochrane Risk of Bias 2 tool of included studies. If data permits, meta-analysis will be conducted. In case of substantial heterogeneity, we will do a narrative synthesis. Subgroup analysis will be undertaken based on various contextual and interventional factors.DiscussionThis review will provide comprehensive evidence on the effectiveness of unsupervised home-based PR to physiotherapists, policy makers and researchers who are interested in IPF management. Findings from this review may guide the development and evaluation of more robust evidence based home-based PR that aimed to improve functional capacity among people with IPF.Systematic review registrationPROSPERO CRD42020213883.

The Effectiveness of Home-Based Pulmonary Rehabilitation in Elderly Patients with COVID-19 Infection

While Coronavirus disease-2019 (COVID-19) affects the whole world, most affected group is geriatric individuals. There is a need for strategies for geriatric individuals returning to society and their social life. The aim of this study is to investigate the effect of an 8-week home-based Pulmonary Rehabilitation program on quality of life, depression, anxiety and functional capacity in geriatric individuals with COVID-19. Twenty-five patients were included in this prospective study. Patients over 65 years of age with COVID-19 were evaluated. Physical capacity with the 6-minute walking test (6MWT), dyspnea status with the Medical Research Council Dyspnea Scale, quality of life with the Short Form-36 (SF-36), depression and anxiety with the Hospital Anxiety and Depression Scale were evaluated. The mean age of the patients included in the study was 68.9 ± 6.4 years. 56% of the patients were men and 44% were women. When pre-treatment and post-treatment values were compared, a significant improvement was found in the 6MWT, dyspnea scores, SF-36 and all subgroups, anxiety and depression scores (p <0.05). This study shows that the home-based Pulmonary Rehabilitation program is an effective method on parameters such as quality of life, depression and physical capacity in geriatric individuals with COVID-19. Prospective large-scale studies are needed to validate our current results.

Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial.

AimTo investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis.MethodsRandomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later.ResultsAfter the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4–143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups.ConclusionHBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.

Effect of home-based pulmonary rehabilitation on health-related quality of life, lung function, exercise tolerance, and dyspnea in chronic obstructive pulmonary disorder patients in a tertiary care center in South India

Context:Home-based pulmonary rehabilitation (PR) can increase compliance in chronic obstructive pulmonary disorder (COPD). There is paucity of data on this in India.Aims:To study the effectiveness of home-based PR on lung function, health-related quality of life, exercise tolerance and dyspnea among patients with COPD.Setting:The Department of Pulmonary Medicine, Christian Medical College, Vellore.Subjects and Methods:This was a quasi-experimental study which included COPD patients who found hospital-based PR impractical. Those willing for home-based PR constituted the intervention group and those unwilling, constituted the control group. Both groups received standard of care otherwise. At 6 weeks, forced expiratory volume in 1 sec (FEV1), St. George Respiratory Questionnaire (SGRQ), six-minute walk test distance (6MWD), COPD assessment test (CAT) score and modified Borg dyspnea scale were compared with their baseline values.Statistical Analysis:Student paired t-test.Results:A total of 42 patients completed the study, 21 in each arm. The baseline characteristics were comparable. The improvement in FEV1 was 90 ml in the intervention group and 4 ml in the control group (P = 0.01). There was no significant difference in 6MWD change. SGRQ score, Borg scale and CAT score improved significantly by 10.4, 2.4, and 3.4, respectively, in the intervention group when compared to the control group (P = 0.01).Conclusions:Home-based PR effectively provides tangible benefits in FEV1, QOL, exercise tolerance and dyspnea. It should be offered to those who are unable to avail institution-based PR, especially in this era of COVID pandemic.

Long-term effects of home-based pulmonary rehabilitation on idiopathic interstitial pneumonia patients

Currently, interstitial lung disease (ILD) has no unified treatment plan. Home-based pulmonary rehabilitation (PR), as a non-pharmacological treatment, is a non-invasive and low-cost option for improving exercise capacity and quality of life. This study explores the impact of home-based PR on lung function, and the quality of life of patients with ILD. In this randomized prospective study, 60 patients with ILD were randomly assigned to the home-based PR intervention and traditional drug treatment groups, and they were followed for 12 months. The outcome measures were the 6-min walk distance (6MWD), exercise-related dyspnea, and St George’s Respiratory Questionnaire score (SGRQ). It found that the 6MWD results were significantly improved from 348.5 ± 106.1 m at baseline to 403.6 ± 100.3 m on the completion of PR and 443.8 ± 96.5 at 1-year follow-up (P = 0.001). Compared with the control group, the home-based PR group had slightly improved pulmonary function. Furthermore, the severity of dyspnea evaluated with mMRC in the home-based PR group improved from 2.9 ± 1.1 at baseline to 2.2 ± 0.9 after the home-based PR program, and this improvement persisted after 12 months (P = 0.001). Additionally, home-based PR for patients with ILD improved the functional pulmonary performance and the SGRQ score results.

Effects of Home-Based Pulmonary Rehabilitation on Six Minute Walk Distance in Patients with Chronic Obstructive Pulmonary Disease

Effects of Home-Based Pulmonary Rehabilitation on Six Minute Walk Distance in Patients with Chronic Obstructive Pulmonary Disease

Long-term effect of home-based pulmonary rehabilitation in severe asthma.

Home-based pulmonary rehabilitation (PR) has demonstrated its effectiveness amongst patients with chronic obstructive pulmonary disease (COPD) but has never been investigated in severe asthma. In a retrospective study, we included 28 patients with severe asthma (61.5 ± 16.2 years, FEV1: 51.4 ± 17.3%) and 164 matched COPD patients (64.3 ± 11.6 years, FEV1: 47.7 ± 15.5%) who had completed a home-based PR program and pursued at least 12 months of follow-up. The number of steps performed during a 6-min stepper test (6MST), the Hospital Anxiety and Depression (HAD) scores, and the Visual Simplified Respiratory Questionnaire score (VSRQ) were compared between baseline, the post-PR period (post-PR) and after 12 months of follow-up (M12) within each group. The evolution of the 6MST, HAD and VSRQ values between baseline, post-PR and M12 was compared between severe asthma and COPD patients. In the severe asthma group, the 6MST was higher post-PR (504 ± 150, p = 0.043) and at M12 (538 ± 163, p = 0.016) compared with baseline (450 ± 148). The VSRQ score was higher at M12 (39.0 ± 18.6, p = 0.049) but not post-PR (38.7 ± 15.8, p = 0.119) in comparison with baseline (32.2 ± 12.4). There was no difference in the HAD scores between baseline, post-PR and M12. PR outcome was not significantly different between severe asthma and COPD patients at short and long term (p > 0.05). In severe asthma, home-based PR is associated with improved exercise tolerance and quality of life on a long-term basis but does not modify anxiety and depression.

Home-Based Pulmonary Rehabilitation for Patients With Idiopathic Pulmonary Fibrosis: A PILOT STUDY.

To evaluate the adherence and effectiveness of a home-based exergame program for patients with idiopathic pulmonary fibrosis (IPF). Patients with IPF were randomly assigned to a relatively unsupervised Wii Fit exergame intervention group or Wii video game control group (with no active whole-body movement involved). Participants in both groups were instructed to play their respective games 30 min/d, 3 d/wk for 12 wk. In addition, they were asked to perform their usual exercise/physical activities. Outcome measures were 6-min walk distance (6MWD), exercise-related dyspnea, and St George's Respiratory Questionnaire (SGRQ). The 20 participants differed significantly between intervention and control groups in baseline characteristics (forced vital capacity = 2.0 ± 0.5 vs 3.1 ± 0.7 L; forced expiratory volume in 1 sec = 1.7 ± 0.4 vs 2.5 ± 0.6 L, respectively). Participant adherence rate to the exergame program was very low (20%). There was no significant improvement in the outcome measures in either group. In fact, both the intervention and control groups had a deterioration in 6MWD (-22 ± 56 m vs -60 ± 111 m), respectively and SGRQ scores (3 ± 9 vs 1 ± 11), respectively. The home-based exergame intervention for patients with IPF did not show improvement in functional performance, dyspnea, or health-related quality of life at the completion of the 12-wk program in our 2 heterogeneous groups. In addition to the low adherence rate, insufficient frequencies and durations of exergaming may contribute to the lack of improvement. A lack of effectiveness of home-based pulmonary rehabilitation using exergaming for patients with IPF appears consistent with prior observational studies that used more traditional modes of home-based exercise.

Real-life feasibility and effectiveness of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease requiring medical equipment.

BackgroundPulmonary rehabilitation (PR) is a key treatment of chronic obstructive pulmonary disease (COPD) but studies are still needed to identify the most pertinent criteria to personalize this intervention and improve its efficacy.ObjectiveThis real-life retrospective study compared the effects of home-based PR on exercise tolerance, anxiety, depression, and health-related quality of life (HRQoL) in COPD patients, according to their medical equipment.MethodsExercise tolerance, anxiety, depression, and HRQoL were evaluated in 109 patients equipped with long-term oxygen therapy (LTOT), 84 patients with noninvasive ventilation (NIV), 25 patients with continuous positive airway pressure (CPAP), and 80 patients with no equipment (NE), before, just after, and 6 and 12 months after PR.ResultsAt baseline, the body mass index in the CPAP and NIV groups was higher (p<0.05) than in the other two groups, and the forced expiratory volume in 1 second was lower in the LTOT and NIV groups (p<0.001). All parameters improved after PR in the four groups (p<0.05), but for exercise tolerance, only the 6-minute stepper test showed maintained improvement after 6 and 12 months, whereas the 10 times sit-to-stand and timed up-and-go tests were only improved just after PR. At every time point, exercise tolerance was lower in the LTOT group (p<0.05), with a similar trend in the NIV group.ConclusionDespite differences in the medical equipment to treat COPD, home-based PR showed comparable feasibility, safety, and efficacy in all equipment-based groups. Medical equipment should therefore not be a barrier to home-based PR.

Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care?

BackgroundHome-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis. ObjectivesTo investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis. MethodsAn open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. Interventions: The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20min (intensity: 60–80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). Control: The patients will receive an educational manual and a recommendation to walk three times a week for 30min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. Main outcome measures: incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization. DiscussionThe findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis.Trial registration:www.ClinicalTrials.gov (NCT02731482). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00060X6&selectaction=Edit&uid=U00028HR&ts=2&cx=1jbszg

Effect of Home-based Pulmonary Rehabilitation on Daily Activity of Patients with Chronic Obstructive Pulmonary Disease

Background: Pulmonary rehabilitation is an important part of treatment in patients with COPD (Chronic Obstructive Pulmonary Disease) with the goal of achieving and maintaining maximum functional independence since this disease causes symptoms including fatigue, and consequently decrease in daily living activity. Aim: To determine the effect of home-based pulmonary rehabilitation on daily living activity among patients with COPD. Methods: This quasi-experimental pretest-posttest study was conducted on 40 patients with COPD who had been admitted to Masih Daneshvari hospital of Tehran in 1389 and were selected with randomized blocking method in two intervention and control groups. For each participant in the intervention group, 3 one-hour, personal, face to face sessions with the content of theoretical teaching and practical training (training exercises including walking, lip bud breathing and practicing it) was carried out and was continued at home for 7 weeks after discharge.The research instrument was standard demographic Barthel Index. Data were analyzed by SPSS version 11.5 using descriptive and inferential statistics (t-test, chi-square test, and ANOVA). Results: The mean age of the participants was 63.5±11.5 and 58.3%were male. Average score of daily living activities before the intervention was 87.2± 7.5 and 80.5± 16.1 in controls (p=0.12). After the intervention, the intervention group had a mean score of daily living activities of 95.5± 4.5 and the control group had 80.8±11 (P<0.001). Conclusion: The home-based pulmonary rehabilitation program can be an effective step to improve daily living activities in patients with COPD, maximize their independence, and reduce complications in these patients.

Effectiveness of Home-Based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials

The pulmonary rehabilitation program has become a cornerstone in the management of patients with chronic obstructive pulmonary disease (COPD). Programs based in hospital and treatment facilities, however, are inconvenient and underutilized. A home-based program is a promising alternative, but studies of its effectiveness have yielded inconsistent results. The purpose of this study is to evaluate the impact of home-based pulmonary rehabilitation programs on health-related quality of life (HRQoL) and other health outcomes in patients with COPD. Randomized controlled trials (RCTs) of home-based pulmonary rehabilitation programs published between February 1991 and February 2012 were retrieved from electronic databases (PubMed, Cochrane Library, Science Direct, China National Knowledge Infrastructure [CNKI], and Wanfang Database). Two reviewers independently assessed topical relevance and trial quality, extracted data for meta-analysis using the Review Manager v5.1 software, and contacted the original studies' authors for additional information. Eighteen trials, comprising 733 randomized patients, were included in the meta-analysis. COPD patients experienced significant relief in dyspnea status, measured by the Borg score (Fixed effects model, WMD = -0.92, 95% CI: -1.61~-0.23, p = .009) and baseline dyspnea index (BDI) (Fixed effects model, WMD = -1.77, 95% CI: -2.65~-0.89, p < .0001) after 12 weeks of home-based intervention. Home-based intervention also improved patients' HRQoL scores, measured by the Chronic Respiratory Questionnaire (CRQ) and St. George's Respiratory Questionnaire (SGRQ) (Fixed effects model, WMD = -11.33, 95% CI: -16.37~-6.29, p < .0001, SGRQ total scores after 12 weeks of intervention); exercise capacity (measured by the 6-minute walking distance test (6MWD) (Fixed effects model, WMD = 35.88, 95% CI: 9.38~62.38, p = .008, after 12 weeks of intervention); and pulmonary functions (measured by forced expiratory volume in one-second/forced vital capacity (FEV1 /FVC) [Random effects model, WMD = -10.72, 95% CI: -15.86~-5.58, p < .0001, after 12 weeks of intervention), as compared with the nonintervention control group; however, no statistically significant changes were seen in maximal workload, hospital admission, cost of care, or mortality between the two groups. Home-based pulmonary rehabilitation programs represent effective therapeutic intervention approaches for relieving COPD-associated respiratory symptoms and improving HRQoL and exercise capacity. Rigorously designed, large-scale RCTs are still needed to identify an optimal standard home-based pulmonary rehabilitation program.