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Effects of a Home-Based Pulmonary Rehabilitation Program in Patients with Chronic Obstructive Pulmonary Disease in GOLD B Group: A Pilot Study

Vilarinho,R.;Serra,L.; Coxo, R.; Carvalho, J.; Esteves, C.; Montes, A.M.; Caneiras, C.

Thematic Area
Management, Rehabilitation paths, Rehabilitation structures
Summary
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.
Relevance
This study demonstrates that the proposed HBPR can be feasible, and it shows potential to significantly improve functional capacity and PROMs in patients with COPD in the GOLD B group. Significant associations were observed between PROMs; however, only one significant correlation was found between the functional capacity outcome (1MSTS) and PROMs, namely with CAT. This study also demonstrates that this home-based model is safe, as no adverse events were reported during the program. Future research should focus on the study of the follow-up of people after this HBPR program. Moreover, it is important to include other GOLD groups (C and D groups) and add more functional test outcomes to determine their responsiveness in PR.
Keywords
chronic respiratory disease; exercise training; self-management; patient-reported out- comes; functional outcomes