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

Effect of home noninvasive positive pressure ventilation combined with pulmonary rehabilitation on dyspnea severity and quality of life in patients with severe stable chronic obstructive pulmonary disease combined with chronic type II respiratory failure: a randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that significantly affects patients' quality of life. Non-invasive positive pressure ventilation (NPPV) and pulmonary rehabilitation have both shown promise in improving symptoms and lung function in COPD patients. However, the combined effects of home-based pulmonary rehabilitation and NPPV on moderate to severe COPD patients remain unclear.

OBJECTIVE

This study aimed to evaluate the efficacy of home pulmonary rehabilitation combined with non-invasive positive pressure ventilation (CPRNG group) compared to conventional treatment (CTG group) in patients with moderate to severe COPD.

METHODS

A total of 269 patients with moderate to severe COPD were enrolled, with 137 patients in the CTG group and 132 in the CPRNG group. The primary outcome measures included the COPD assessment test (CAT) score, modified medical research council scale (mMRC) score, forced expiratory volume in one second (FEV₁) percentage, 6-min walk test, and arterial oxygen pressure (PaO₂). Secondary outcomes included various dimensions of quality of life (impact, symptoms, and activity) measured through patient-reported outcomes.

RESULTS

Baseline comparisons between groups showed no significant differences in sociodemographic characteristics, disease duration, or symptoms. The CPRNG group showed significant improvements compared to the CTG group in the CAT score (p = 0.028), mMRC score (p = 0.015), FEV1% (p = 0.008), 6-min walk test (p = 0.001), and PaO₂ (p < 0.001). Additionally, improvements in impact, symptoms, activity, and overall scores were significantly better in the CPRNG group (p < 0.05).

CONCLUSIONS

Home pulmonary rehabilitation combined with non-invasive positive pressure ventilation significantly improves multiple dimensions of quality of life, particularly in controlling symptoms and enhancing daily activities in COPD patients. This combined therapy proves to be an effective treatment strategy, offering notable benefits in lung function, exercise capacity, and overall quality of life in COPD patients.

TRIAL REGISTRATION

The clinical trial was registered retrospectively on the Chinese Clinical Trial Registry (ChiCTR, www.chictr.org.cn ID: ChiCTR2500096605) on 2025-01-26, as required by The Fourth Hospital of Institutional (Changsha Fourth Hospital, Hunan Province, China) Review Board guidelines. Ethics approval date: January 2023 to December 2025.

Association of cardiovascular health with COPD (NHANES 2007-2020): mediating potential of lean body mass

Background

Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern, with lifestyle factors playing a crucial role in its prevention. This study aims to explore the relationship between Life's Crucial 9 (lc9) scores and COPD odds, and to assess the mediating potential of lean body mass (LBM) in this association.

Methods

This study used cross-sectional study to assess the association between lc9 score and COPD using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. Weighted multivariate regression analyses were performed to examine lc9 score on the odds of COPD after adjusting for confounders. The models were adjusted for age, gender, race/ethnicity, Marital status, education level, Family income-to-poverty ratio, LBM and Alcohol consumption status. The discrimination ability of lc9 on COPD odds was evaluated using (ROC) curve. Mediation analysis was used to investigate the mediating potential of LBM between lc9 and COPD odds. Subgroup analyses and interaction assessments were also performed.

Results

In Model 2, the results showed that for every 10-point change in the lc9 score, the odds of developing COPD decreased. The OR (95% CI) in the Moderate and High groups were OR = 0.37; 95% CI: 0.23, 0.59 and OR = 0.16; 95% CI: 0.09, 0.27 (P for trend < 0.001), respectively. In addition, the results for quartile subgroups were Q3, OR = 0.58; 95% CI: 0.42, 0.81), Q4, OR = 0.24; 95% CI: 0.16, 0.36) and P for trend < 0.001. This relationship was consistent across the total population, subgroup analyses, and sensitivity analyses. There was a nonlinear relationship between lc9 score and odds of COPD (P for Nonlinear = 0.022). The lc9 reduced the odds of COPD by increasing LBM. The lc9 is an suggestive predictor of COPD odds association.

Conclusions

Higher LC9 scores, particularly when accompanied by increased LBM levels, showed significant associations with reduced COPD risk in cross-sectional analyses.

Delivering remote pulmonary rehabilitation in Bangladesh: a mixed-method feasibility study

Background

Pulmonary rehabilitation (PR) is an effective and essential component of care for the increasing number of individuals with chronic respiratory diseases (CRDs). Despite the benefits, it remains underutilised and poorly accessible in low- and middle-income countries (LMICs). We aimed to determine the feasibility of delivering PR in Bangladesh at home because of pandemic travel restrictions.

Methods

Aligned with the Medical Research Council framework of development and evaluation of complex interventions, we recruited individuals with CRDs from the Community Respiratory Centre, Khulna, to a mixed-methods feasibility study. We assessed their functional exercise capacity and quality of life before and after an eight-week course of home PR, and conducted semi-structured interviews with PR providers and professional stakeholders by using a topic guide aligned with the normalisation process theory (NPT) and interpreting the findings within its constructs.

Results

We recruited 51 out of 61 referred patients with a range of CRDs, of whom 44 (86%) completed ≥70% of their home PR course. Functional exercise capacity, measured by the endurance shuttle walk test, improved in 78% of patients, with 48% exceeding the minimum clinically important difference (MCID). Health-related quality of life, measured by the Chronic Obstructive Pulmonary Disease Assessment Test, improved by more than the MCID in 83% of patients. Through the interviews, we found that PR providers encountered challenges in remote video supervision due to unstable internet connections, forcing them to resort to telephone calls. The strength of support for NPT constructs varied; many participants understood and appreciated the role of PR and could make sense of the innovation (NPT-1), and most were assessing the potential of a PR service in Bangladesh to decide if it was worthwhile (NPT-4). Participants were not yet ready to endorse or actively support (NPT-2) or operationalise (NPT-3) the roll-out of PR.

Conclusions

A home PR programme, supported by remote supervision and monitoring, is feasible in Bangladesh, but local evidence will be needed to promote implementation.

Prognostic Factors for Responders of Home-Based Pulmonary Rehabilitation-Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Home-based pulmonary rehabilitation (PR) is an effective alternative to center-based PR. However, not all participants exhibit sufficient therapeutic improvement, highlighting the need to identify appropriate candidates to maximize cost-effectiveness. This study aimed to identify the factors associated with favorable outcomes in home-based PR, focusing on the role of digital therapeutics (DTx).

METHODS

This secondary analysis used data from a randomized controlled trial. Participants with chronic respiratory disease (CRD) were divided into responders and non-responders based on a change in 6 min walk distance (6MWD) and patient-reported outcome measures (PROM) representing dyspnea and health-related quality of life. Factors such as baseline 6MWD, DTx use, and pulmonary function were analyzed for their predictive value in improving 6MWD and PROM scores.

RESULTS

Responders, particularly those using DTx, showed significantly greater improvements in 6MWD than non-responders. Participants with a baseline 6MWD under 500 m demonstrated a higher likelihood of exceeding the minimum clinically important difference in 6MWD. DTx use strongly predicted improvements in both 6MWD and PROM scores. The baseline diffusing capacity of the lungs for carbon monoxide was also a significant factor influencing improvements in the modified Medical Research Council scale.

CONCLUSIONS

Responders to 8-week program of home-based PR exhibited a relatively lower baseline health status. Encouraging participants with poorer baseline health could improve adherence to PR and enhance cost-effectiveness. Additionally, improvements in 6MWD and PROM scores were associated with the use of DTx. Considering the functions of DTx, proper supervision for home-based exercise may be crucial for achieving optimal outcomes.

Fully remote versus hybrid supervision of pulmonary telerehabilitation in COVID-19: a randomized clinical trial

BACKGROUND

The restrictions imposed by the COVID-19 pandemic have impeded the traditional rehabilitation process, prompting the widespread adoption of remote programs for the recovery of survivors.

AIM

The aim of this study was to evaluate and compare the effectiveness of a pulmonary telerehabilitation program (PTRP) in the exclusively remote modality versus the hybrid modality (remote and face-to-face) in patients with persistent respiratory dysfunction following hospitalization for COVID-19 pneumonia, and to compare the functional capacity of patients who participated in a PTRP with those who did not.

DESIGN

A randomised, interventional, prospective clinical trial was conducted. In parallel, an observational cohort study was conducted.

SETTING

Outpatient rehabilitation clinic and home-based rehabilitation program.

POPULATION

Thirty patients post-COVID-19 were randomised into two groups: G1 (fully remote supervision of PTRP) or G2 (hybrid supervision of PTRP). Thirty-seven post-COVID-19 patients were followed up without participating in PTRP (non-intervention group - NIG).

METHODS

Patients with persistent respiratory dysfunction and reduced functional capacity, as measured by the Six Minute Walk Test (6MWT), after hospitalization for COVID-19 pneumonia, were considered eligible for a PTRP. To assess the efficacy of the PTRP, the primary outcome (I) was distance walked on the 6MWT (6MWD) and the secondary outcome (II) was quality of life as assessed by the SF-36 questionnaire.

RESULTS

Both G1 and G2 demonstrated similar improvement in 6MWD, P<0.001 and quality of life (P<0.05). The IG showed higher 6MWD than the NIG (P<0.001). The increase in 6MWD for the IG was 140.5 m, while for the NIG it was 16.8 m (P=0.002).

CONCLUSIONS

The PTRP was found to be a feasible and highly effective intervention for restoring functional capacity and improving quality of life, regardless of the type of supervision. Furthermore, this functional gain was maintained over the long term. In patients with pulmonary dysfunction, participation in the PTRP improved functional capacity compared with those who were simply advised to resume physical activity during recovery.

CLINICAL REHABILITATION IMPACT

Telerehabilitation has been demonstrated to be a viable and efficacious alternative to traditional in-person programs in low-income contexts.

Content, uptake and adherence of exercise interventions after an acute exacerbation of COPD: a scoping review

INTRODUCTION

Pulmonary rehabilitation is underutilised in patients after an acute exacerbation of COPD (AECOPD). Retrieving information regarding the setting, training modalities and the uptake and adherence to exercise interventions for these individuals in a vulnerable state could potentially guide future research.

AIM

To provide a comprehensive review of the existing literature on the content, uptake and adherence of different exercise interventions for patients after an AECOPD.

METHODS

Eight different databases were searched for 1) patients experiencing an AECOPD and 2) performing any form of exercise intervention. Information on content, uptake and adherence was collected and the Consensus on Exercise Reporting Template (CERT) checklist was performed for each included record.

RESULTS

59 distinct interventions were identified between 1998 and 2023 including a total of 9238 patients. All studies included patients requiring hospitalisation for the AECOPD, four studies additionally included patients not requiring hospitalisation for the AECOPD. Nine different settings were identified, with the majority of studies conducted in an inpatient setting (n=26) and including whole-body and strength exercises. The overall uptake was mentioned in 38 (62%) studies and was 70% with a 13% dropout rate. No paper reported the full CERT checklist. Adherence was defined a priori in 16 (27%) studies, with the most common definition being attendance of >80% of sessions.

CONCLUSION

Studies properly reporting on the uptake and adherence of well-described interventions, including information regarding fidelity, are needed to further investigate suitable programmes for patients experiencing an AECOPD.

Current perspectives on the rehabilitation of COPD patients with comorbidities

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by a variety of comorbidities, complicating management and rehabilitation efforts. Understanding this interplay is crucial for optimizing patient outcomes.

AREAS COVERED

This review, based on the MEDLINE, Embase and Cochrane Library databases, summarizes the main research on the rehabilitation of patients with COPD, with an emphasis on relevant comorbidities, such as cardiovascular diseases, pulmonary hypertension, lung cancer, metabolic, musculoskeletal, and gastrointestinal disorders. anxiety/depression and cognitive disorders. The study highlights the importance of pre-participation assessments, ongoing monitoring and personalized rehabilitation programs. A review includes a comprehensive literature search to assess the scientific evidence on these interventions and their impact.

EXPERT OPINION

The integration of cardiorespiratory rehabilitation program is essential for improving physical capacity and quality of life in COPD patients with comorbidities. While existing studies highlight positive outcomes, challenges such as interdisciplinary collaboration and access to rehabilitation services remain. Future strategies must prioritize personalized and integrated approaches programs combining pharmacological optimization and a close monitoring during cardiopulmonary rehabilitation to significantly reduce hospital readmissions and mortality, even in patients with complex multimorbidities. Continued research is necessary to refine rehabilitation protocols and better understand the complexities of managing COPD alongside cardiac conditions.

Factors influencing adherence to home based pulmonary rehabilitation programme by high risk patients awaiting lung surgery: mixed methods study

OBJECTIVE

Preoperative home based pulmonary rehabilitation (HPR) can reduce postoperative complications in lung surgery patients. This study aimed to investigate the level of adherence to a preoperative HPR programme in high risk patients awaiting lung surgery, and factors influencing adherence.

DESIGN

A mixed methods explanatory sequential design consisting of a quantitative questionnaire survey and a qualitative interview study.

SETTING

The study was conducted at a tertiary hospital in Chongqing, China.

PARTICIPANTS

186 high risk patients awaiting lung surgery were enrolled in the preoperative HPR programme. All 186 patients participated in the quantitative questionnaire survey. 13 of the 186 patients were selected to participate in the qualitative interview study.

RESULTS

Quantitative questionnaire results revealed an adherence rate of 52.3%. Marital status, residence location, exercise habit, smoking index and pulmonary function were identified as independent influencers of adherence (p<0.05). Qualitative interviews identified poor health, lack of family and social support, adverse weather condition, arduous preoperative examination and unfit exercise intensity as barriers to adherence, and perceived health benefits, family support, and flexibility and convenience in exercise time and space as factors encouraging adherence.

CONCLUSIONS

High risk patients awaiting lung surgery adhered to preoperative HPR at a moderate level. A tiered approach can be used to develop personalised HPR protocols based on patients' individual needs and situations to improve adherence and maximise the benefits of HPR.

Influence of home-based pulmonary rehabilitation program among people with interstitial lung disease: A pre-post study

INTRODUCTION

Access to interstitial lung disease programs may not be available in rural settings. Home-based pulmonary rehabilitation (PR) programs have been proposed as an alternative to hospital-based programs.

METHOD

Forty participants with ILD underwent a structured unsupervised home-based pulmonary rehabilitation program from September 2020 to September 2022. Quality of life was assessed using St. George Respiratory Questionnaire (SGRQ) and functional capacity using 6-minute walk test (6MWT). The outcome measures were assessed at baseline and 4 weeks post-unsupervised home-based PR program.

RESULT

We recruited 40 participants with ILD. There was statistically significant improvement in the 6-minute walk distance (353.8 m and 368 m, effect size - 0.5, p ≤ .001) and quality of life using SGRQ total score (38.6 and 42.35, effect size - 2.5, p ≤ .001) between before and after receiving home-based PR among all 40 participants with ILD.

CONCLUSION

Four weeks of home-based PR program, using minimal resources, deliver short-term improvements in functional exercise capacity and quality of life among ILD participants. Our home-based PR program resulted in a quarter percentage improvement in functional capacity, and we believe that if consistency is maintained, it will result in similar changes corresponding to the already established Minimal Clinically Important Difference (MCID) of 35 m.

Hybrid compared to conventional pulmonary rehabilitation: an equivalence analysis

Background

Pulmonary rehabilitation (PR) is a well-established intervention for patients with COPD, but access, uptake and completion are low. This retrospective propensity-matched study aimed to analyse equivalence from a hybrid PR modality against conventional PR.

Methods

Between 2013 and 2019, 214 patients with COPD with valid baseline physical activity assessments enrolled in conventional PR for three times per week for 3 months. In 2021-2022, 44 patients with COPD enrolled in 3 months of hybrid PR, introducing two providers: once per week in the outpatient centre and two times per week in a primary care setting near the patient's home. All sessions were supervised. Propensity score matching (1:1) was performed. Equivalence between both programmes was analysed for exercise capacity with the equivalence margins of ±30 m on the 6-min walk distance (6MWD). Clinical outcomes, accessibility and adherence were compared using t-tests.

Results

44 patients (mean±sd age 67±8 years; forced expiratory volume in 1 s (FEV1) 47±15% predicted; 6MWD 355±122 m) in the hybrid PR group were matched to 44 patients (mean±sd age 66±8 years; FEV1 46±17% predicted; 6MWD 354±103 m) in the conventional PR group. Equivalence on the increase in 6MWD could not be confirmed; nevertheless, both groups improved their 6MWD clinically significantly (hybrid PR change 63 m (90% CI 43-83 m); conventional PR change 39 m (90% CI 26-52 m)). Changes in quality of life and symptoms were similar. Dropout in hybrid PR (23%) was comparable to conventional PR (27%) (p=0.24). Adherence in both groups was high and accessibility was better for patients following hybrid PR.

Conclusion

Hybrid PR can be offered as an effective alternative to conventional PR, if patients are willing to take up the offer.

Effect of Home-Based Pulmonary Rehabilitation on Pulmonary Fibrosis

BACKGROUND

Pulmonary fibrosis is a chronic, progressive lung condition that involves lung tissue scarring and thickening. The effects of home-based pulmonary rehabilitation (PR) in post-covid pulmonary fibrosis (PCPF) and other forms of fibrosis together have not been evaluated. This study aims to evaluate the effectiveness of home-based pulmonary rehabilitation on pulmonary function, functional capacity, and health-related quality of life in people with pulmonary fibrosis (post-COVID pulmonary fibrosis, pulmonary fibrosis secondary to pulmonary tuberculosis (TB), pulmonary fibrosis secondary to interstitial lung disease (ILD), pulmonary fibrosis secondary to bronchiectasis).

METHODS

A single-group pretest-posttest experimental study was performed after recruiting 98 pulmonary fibrosis subjects from K.M.C hospitals. After being screened for the inclusion and exclusion criteria, 45 subjects were analyzed, and 6 subjects were lost to follow-up.  A home-based pulmonary rehabilitation program was carried out for 8 weeks (warm-up, stretching exercises, aerobic exercise, strength training for upper limb and lower limb, breathing exercises mainly involved; others: energy saving techniques, controlled coughing techniques, dyspnea relieving positions). The program was supervised via weekly phone calls. Pulmonary function (Pulmonary function test), exercise capacity (6-minute walk test), dyspnea (modified Borg scale), and health-related quality of life (SF-36) were evaluated before and after the intervention. During the enrollment and after the 6-minute walk test, saturation of peripheral oxygen (SPO2) level was also evaluated pre-intervention and after the 8-weeks program.

RESULTS

Pulmonary function [FVC(L) t = -12.52, p<0.05; FEV1(L) t = -2.56, p<0.05; FEV1/FVC t = 7.98, p<0.05 and DLCO (ml/min/mmHg) t = -5.13, p<0.05], 6MWD [MD 88.66; p<0.05] and HRQOL measured by SF-36 scores (p<0.05) were improved significantly. Both the baseline SPO2 level before the 6MWT [MD 1.07, p<0.05] and the SPO2 level after the 6MWT [MD 1.16, p<0.05] showed a significant improvement. The rating of perceived exertion(dyspnea) [MD 1.30, p<0.05] was reduced significantly after the 8-week program.

CONCLUSION

Our study shows that home-based pulmonary rehabilitation is an effective option for improving lung function and physical functional capacity by reducing dyspnea perception and improving the saturation of peripheral oxygen (SPO2) level, and enhancing the quality of life in people with pulmonary fibrosis.

[French survey of patients on current and future pulmonary rehabilitation programs]

INTRODUCTION

Over recent years, a growing number of studies have demonstrated the effectiveness of alternative models to centre-based pulmonary rehabilitation (PR) such as tele-PR or home-based unsupervised PR, offering perspectives for improved accessibility and adherence. Other studies have demonstrated the relevance and long-term benefits of maintenance PR programs. However, they remain poorly implemented in real-life settings. In order to encourage patient adherence to new PR models and to guide future orientations, we conducted a survey assessing patients' views on PR models and maintenance programs.

METHOD

The survey (37 questions) was circulated to COPD patients of the French national respiratory patient F.F.A.A.I.R network and in five specialised PR centres.

RESULTS

Among the 298 respondents, 75% had previously taken part in a PR program, mainly in hospital settings (91%), with a high degree of satisfaction. The main barriers to PR were being physically separated from their loved ones (21%) and fears of having to share a double room (47%). Regarding maintenance PR programs, patients expressed diversified opinions, in terms of ideal duration and frequency of follow-up, format of follow-up (home-based, telephone, videoconference) and type of professional involved.

CONCLUSIONS

Diversified PR settings offer perspectives to increase access and improve the effectiveness of current programs. Furthermore, comprehensive personalization (professionals involved, content, setting, duration) seems to be the key to success in concrete implementation and achievement of patient satisfaction.

Point: Center-Based Pulmonary Rehabilitation Is the Standard

Currently, a major pulmonary rehabilitation focus is on expanding access. At-home rehabilitation is being explored as an in-center pulmonary rehabilitation alternative. It has been asserted that in-home pulmonary rehabilitation confers similar benefits to in-center pulmonary rehabilitation. An extensive database documents that in-center pulmonary rehabilitation confers a range of patient-relevant benefits. Recently, evidence has been presented that in-center pulmonary rehabilitation improves survival, perhaps the most important benefit of all. It can be argued that improvements in physical fitness, assessed as exercise capacity, are mechanistically related to survival improvements. Therefore, in-home rehabilitation must demonstrate exercise capacity improvements similar to those regularly seen in-center to be considered equivalent. A literature search identified 11 studies that compared in-home with in-center pulmonary rehabilitation for COPD that recorded exercise tolerance outcomes. Despite being described as in-home programs, almost all featured prefatory in-center evaluation; some featured in-home visits by rehabilitation professionals. In 6 of the 11 studies, only walking exercise was prescribed. Only 3 included 2-way audio/visual patient-therapist contact. With regard to exercise outcomes; in 3, there was greater in-center group improvement; in 4, outcomes were similar; and, in 4, the in-center group failed to demonstrate clinically important exercise outcome increases; decidedly mixed results. Importantly, in 8 of 11 studies, the 6-min walk test was an exercise outcome. It is argued that the 6-min walk test does not generally elicit physiologically maximum responses and cannot be used to assess exercise capacity improvements. Of the 4 studies that used other exercise outcomes, in 2, exercise endurance increase was similar between in-home and in-center groups; in the other 2, the in-center group had superior improvements. Mixed results indeed! In conclusion, there is insufficient evidence to conclude that in-home pulmonary rehabilitation yields improvements equivalent to center-based programs in physical function, the outcome likely driving long-term prognosis. Moreover, it needs to be established which of the wide variety of in-home program designs now being offered should be promoted.

Supervised Telerehabilitation and Home-Based Respiratory Muscle Training for Post-COVID-19 Condition Symptoms: A Nested Qualitative Study Exploring the Perspectives of Participants in a Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to describe the experiences of individuals with post-coronavirus 19 (COVID-19) condition symptoms who underwent a supervised telerehabilitation and home-based respiratory muscle training (TSHB-RMT) program.

METHODS

A qualitative descriptive study was conducted. Participants were recruited using purposeful sampling. The inclusion criteria consisted of: patients aged over 18 years who presented persistent COVID-19 symptoms of fatigue and dyspnea for at least 3 months after the COVID-19 diagnosis. In total, 28 patients were included. In-depth interviews and researcher field notes were used to collect the data. A thematic analysis was performed.

RESULTS

Three themes reflect the patients' perspective on the TSHB-RMT before the program (reasons for participating), during the treatment program, and upon completion of the study. Among the reasons for participation, participants highlighted the absence of improvement and treatment, and feeling abandoned and forgotten by the health system. The treatment required discipline on behalf of the patients. Mondays and Tuesdays were the most difficult days for performing the therapy, and the physical therapist was perceived as a tool for adherence, change, and a source of validated information. The patients perceived positive effects quite soon; however, it was necessary to extend the follow-up after completing the program because they abandoned the program due to the lack of guidance for exercise supervision.

CONCLUSION

This study described relevant aspects that physical therapist professionals should consider when providing TSHB-RMT treatment.

IMPACT

TSHB-RMT requires discipline, perseverance, effort, and a commitment to the group. The physical therapist is perceived as the tool that facilitates adherence and participation. The effects are rapidly perceived, leading to improved self-confidence and autonomy; however, it is necessary to increase the follow-up time.

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

BACKGROUND

Coronavirus 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.

METHODS

The 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.

RESULTS

The 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.

CONCLUSION

Home-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.

Virtual pulmonary rehabilitation approaches in patients with post COVID syndrome: a pilot study

BACKGROUND

The characteristics of optimal virtual pulmonary rehabilitation (PR) for individuals with post-COVID syndrome (PCS) have not been identified. This study aimed to assess the feasibility, safety, and satisfaction associated with a virtual PR program with the exercise component delivered through group or self-directed sessions.

METHODS

Adults with PCS-respiratory symptoms were randomly assigned to the video conference (PRVC) or self-directed (PRSD) group and completed an exercise program (aerobic, strengthening, and breathing exercises) three times/week for eight weeks. PRVC sessions were led by a physiotherapist via Zoom, whereas the PRSD group exercised individually following a pre-recorded video. Both groups received personalized exercise recommendations, education related to the condition, and a weekly follow up call. Satisfaction was assessed through a patient survey. Lung function, dyspnea, fatigue, sit-to-stand capacity, health-related quality of life, and participation were assessed pre- and post-PR.

RESULTS

Fourteen PCS individuals (49 ± 9 years, 86% females) completed 83% of the sessions. All participants were satisfied with information provided by the therapist and frequency of data submission, whereas most were satisfied with the frequency and duration of exercise sessions (88% in PRVC and 83% in PRSD). A higher proportion of participants in the PRVC (88%) were satisfied with the level of difficulty of exercises compared with the PRSD (67%), and 84% of the sample reported a positive impact of the program on their health. No adverse events were reported. Significant changes in sit-to-stand capacity (p = 0.012, Cohen's r = 0.67) and questions related to fatigue (p = 0.027, Cohen's r = 0.58), neurocognitive (p = 0.045, Cohen's r = 0.53), and autonomic (p = 0.024, Cohen's r = 0.60) domains of the DePaul Symptom Questionnaire short-form were also found between groups.

CONCLUSION

Virtual PR with exercises delivered via video conference or pre-recorded video were feasible, safe, and well-received by individuals with PCS.

TRIAL REGISTRATION

NCT05003271 (first posted: 12/08/2021).

Home-based vs center-based exercise on patient-reported and performance-based outcomes for knee osteoarthritis: a systematic review with meta-analysis

Background

Home-based exercise (HBE) represents an alternative to increase the accessibility of rehabilitation programs and relieve the burden on the health care system for people with knee osteoarthritis.

Objectives

To summarize for the first time the effectiveness of HBE as compared to center-based exercise (CBE), both with and without HBE, on patient-reported and performance-based outcomes in people with KOA.

Methods

Searches were conducted on PubMed, Cochrane, Embase, Web of Science, and Scopus until March 10, 2023, without date or language restrictions. Randomized controlled trials investigating HBE versus CBE or HBE combined with CBE for people with KOA were eligible. The primary outcomes were patient-reported: pain, physical disability, and quality of life. The secondary outcomes were performance-based: walking ability, lower limb muscle strength, and balance function. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to the GRADE.

Results

Eleven trials involving 956 participants were included. There was no difference in short-term pain (SMD, 0.22 [95% CI, -0.04 to 0.47], p = 0.09; I2 = 0%), physical disability (SMD, 0.17 [95% CI, -0.19 to 0.54], p = 0.35; I2 = 0%), walking ability (SMD, -0.21 [95% CI, -0.64 to 0.22], p = 0.33; I2 = 35%) and lower limb muscle strength (SMD, -0.24 [95% CI, -0.88 to 0.41], p = 0.47; I2 = 69%) between HBE and CBE. HBE combined with CBE has better benefits compared with HBE alone in short-term pain (SMD, 0.89 [95% CI, 0.60 to 1.17], p < 0.001; I2 = 11%) and physical disability (SMD, 0.25 [95% CI, 0.00 to 0.50], p = 0.05; I2 = 0%).

Conclusion

Based on limited evidence, HBE is as effective as CBE on short-term pain, physical disability, walking ability, and lower limb muscle strength in people with knee osteoarthritis. Furthermore, combining HBE with CBE may enhance the overall efficacy of the intervention.

Systematic review registration

PROSPERO, CRD42023416548.

ERS International Congress 2023: highlights from the Allied Respiratory Professionals Assembly

This article summarises some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2023 European Respiratory Society International Congress. Two sessions from each Assembly group are outlined, covering the following topics: Group 9.01 focuses on respiratory physiology techniques, specifically on predicted values and reference equations, device development and novel applications of cardiopulmonary exercise tests; Group 9.02 presents an overview of the talks given at the mini-symposium on exercise training, physical activity and self-management at home and outlines some of the best abstracts in respiratory physiotherapy; Group 9.03 highlights the nursing role in global respiratory health and presents nursing interventions and outcomes; and Group 9.04 provides an overview of the best abstracts and recent advances in behavioural science and health psychology. This Highlights article provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.

From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

BACKGROUND

As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed.

MAIN BODY

This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions.

CONCLUSION

PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.

Exploring the perceptions of patients with chronic respiratory diseases and their insights into pulmonary rehabilitation in Bangladesh

Background

Chronic respiratory diseases (CRDs) require holistic management which considers patients' preferences, appropriate pharmacotherapy, pulmonary rehabilitation, and integrated care. We aimed to understand the perceptions of people with CRDs about their condition and pulmonary rehabilitation in Bangladesh.

Methods

We conducted semi-structured interviews with a maximum variation sample of people with CRDs who had participated in a feasibility study of pulmonary rehabilitation in 2021/2022. A multidisciplinary team transcribed the interviews verbatim and analysed them in Bengali using a grounded theory approach.

Results

We interviewed 15 participants with chronic obstructive pulmonary disease, asthma, or post-tuberculosis. The analysis revealed three themes. The first encompassed understanding CRDs: Patients characterised their condition by the symptoms (e.g. 'Hapani' meaning 'breathlessness') rather than describing a disease entity. Some believed occupation, previous infection, or family history to be a cause. The second theme included perceptions of pulmonary rehabilitation: Exercise was counterintuitive, as it exacerbated the breathlessness symptom that defined their disease. Views varied, though many acknowledged the benefits after a few sessions. Even with home-based programmes, participants described practical barriers to finding time for the sessions and adopted strategies to overcome the challenges. The third theme focused on implementation: Participants highlighted the need for raising awareness of CRDs and the potential of pulmonary rehabilitation in the community, adapting to the local context, and establishing an accessible resourced service.

Conclusions

Understanding how patients and their communities perceive their condition and the barriers (both conceptual and logistical) to acceptance is the first step to embedding this highly effective intervention into routine health care services in Bangladesh with potential benefits for the increasing number of people living with CRDs in low- and middle-income countries.

Developing a home-based pulmonary rehabilitation programme for patients with chronic respiratory diseases in Malaysia: A mixed-method feasibility study

Background

The COVID-19 pandemic has underscored the importance of remote healthcare and home-based interventions, including pulmonary rehabilitation, for patients with chronic respiratory diseases (CRDs). It has also heightened the vulnerability of individuals with underlying respiratory conditions to severe illness from COVID-19, necessitating exploration and assessment of the feasibility of delivering home - pulmonary rehabilitation (home-PR) programmes for CRD management in Malaysia and other countries. Home-based programmes offer a safer alternative to in-person rehabilitation during outbreaks like COVID-19 and can serve as a valuable resource for patients who may be hesitant to visit healthcare facilities during such times. We aimed to assess the feasibility of delivering a home-PR programme for patients with CRDs in Malaysia.

Methods

We recruited patients with CRDs from two hospitals in Klang Valley, Malaysia to a home-PR programme. Following centre-based assessment, patients performed the exercises at home (five sessions/week for eight weeks (total 40 sessions)). We monitored the patients via weekly telephone calls and asked about adherence to the programme. We measured functional exercise capacity (6-Minutes Walking Test (6MWT) and Health-Related Quality-of-Life (HRQoL) (COPD Assessment Test (CAT)) at baseline and post-PR at nine weeks. We conducted semi-structured interviews with 12 purposively sampled participants to explore views and feedback on the home-PR programme. The interviews were audio recorded, transcribed verbatim, and analysed thematically.

Results

We included 30 participants; two withdrew due to hospitalisation. Although 28 (93%) adhered to the full programme, only 11 (37%) attended the post-PR assessment because COVID-19 movement restrictions in Malaysia at that time prevented attendance at the centre. Four themes emerged from the qualitative analysis: involvement of family and caregivers, barriers to home-PR programme, interactions with peers and health care professionals, and programme enhancement.

Conclusion

Despite the COVID-19 pandemic, the home-PR programme proved feasible for remote delivery, although centre-based post-PR assessments were not possible. Family involvement played an important role in the home-PR programme. The delivery of this programme can be further improved to maximise the benefit for patients.

Barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease in Iran: a descriptive qualitative study

OBJECTIVES

Chronic obstructive pulmonary disease is a chronic disease with numerous complications. Therefore, its effective management depends on home-based pulmonary rehabilitation. The effectiveness of home-based pulmonary rehabilitation programmes in turn depends on patient adherence to them. The aim of this study was to explore the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease.

DESIGN

Qualitative descriptive design.

SETTING

The lung care wards of Al-Zahra and Khorshid teaching hospitals and the comprehensive lung care clinic of Khorshid hospital, Isfahan, Iran.

PARTICIPANTS

Participants patients with chronic obstructive pulmonary disease (n=20), their family caregivers (n=15) and healthcare providers (n=14) recruited via purposive sampling.

RESULTS

The five main categories of the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease were patient-related barriers, caregivers' caregiving burden, limited support for patients, healthcare providers' limited professional competence and ineffective home-based pulmonary rehabilitation planning.

CONCLUSION

Different and complex factors related to patients, families and healthcare providers can affect adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. Healthcare authorities can use the findings of this study to develop strategies to support patients with chronic obstructive pulmonary disease and their family caregivers and thereby reduce the physical and mental complications of Chronic obstructive pulmonary disease.

Remote patient monitoring strategies and wearable technology in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is highly prevalent and is associated with a heavy burden on patients and health systems alike. Exacerbations of COPD (ECOPDs) are a leading cause of acute hospitalization among all adult chronic diseases. There is currently a paradigm shift in the way that ECOPDs are conceptualized. For the first time, objective physiological parameters are being used to define/classify what an ECOPD is (including heart rate, respiratory rate, and oxygen saturation criteria) and therefore a mechanism to monitor and measure their changes, particularly in an outpatient ambulatory setting, are now of great value. In addition to pre-existing challenges on traditional 'in-person' health models such as geography and seasonal (ex. winter) impacts on the ability to deliver in-person visit-based care, the COVID-19 pandemic imposed additional stressors including lockdowns, social distancing, and the closure of pulmonary function labs. These health system stressors, combined with the new conceptualization of ECOPDs, rapid advances in sophistication of hardware and software, and a general openness by stakeholders to embrace this technology, have all influenced the propulsion of remote patient monitoring (RPM) and wearable technology in the modern care of COPD. The present article reviews the use of RPM and wearable technology in COPD. Context on the influences, factors and forces which have helped shape this health system innovation is provided. A focused summary of the literature of RPM in COPD is presented. Finally, the practical and ethical principles which must guide the transition of RPM in COPD into real-world clinical use are reviewed.

Feasibility of a Home-Based Cognitive-Physical Exercise Program in Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Feasibility and Pilot Randomized Controlled Trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive condition associated with physical and cognitive impairments contributing to difficulty in performing activities of daily living (ADLs) that require dual tasking (eg, walking and talking). Despite evidence showing that cognitive decline occurs among patients with COPD and may contribute to functional limitations and decreased health-related quality of life (HRQL), pulmonary rehabilitation continues to focus mainly on physical training (ie, aerobic and strength exercises). An integrated cognitive and physical training program compared to physical training alone may be more effective in increasing dual-tasking ability among people living with COPD, leading to greater improvements in performance of ADLs and HRQL.

OBJECTIVE

The aims of this study are to evaluate the feasibility of an 8-week randomized controlled trial of home-based, cognitive-physical training versus physical training for patients with moderate to severe COPD and derive preliminary estimates of cognitive-physical training intervention efficacy on measures of physical and cognitive function, dual task performance, ADLs, and HRQL.

METHODS

A total of 24 participants with moderate to severe COPD will be recruited and randomized into cognitive-physical training or physical training. All participants will be prescribed an individualized home physical exercise program comprising 5 days of moderate-intensity aerobic exercise (30-50 minutes/session) and 2 days of whole-body strength training per week. The cognitive-physical training group will also perform cognitive training for approximately 60 minutes, 5 days per week via the BrainHQ platform (Posit Science Corporation). Participants will meet once weekly with an exercise professional (via videoconference) who will provide support by reviewing the progression of their training and addressing any queries. Feasibility will be assessed through the recruitment rate, program adherence, satisfaction, attrition, and safety. The intervention efficacy regarding dual task performance, physical function, ADLs, and HRQL will be evaluated at baseline and at 4 and 8 weeks. Descriptive statistics will be used to summarize intervention feasibility. Paired 2-tailed t tests and 2-tailed t tests will be used to compare the changes in the outcome measures over the 8-week study period within and between the 2 randomized groups, respectively.

RESULTS

Enrollment started in January 2022. It is estimated that the enrollment period will be 24 months long, with data collection to be completed by December 2023.

CONCLUSIONS

A supervised home-based cognitive-physical training program may be an accessible intervention to improve dual-tasking ability in people living with COPD. Evaluating the feasibility and effect estimates is a critical first step to inform future clinical trials evaluating this approach and its effects on physical and cognitive function, ADL performance, and HRQL.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05140226; https://clinicaltrials.gov/ct2/show/NCT05140226.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48666.

Needs assessment for introducing pulmonary rehabilitation for chronic obstructive pulmonary disease management in a rural Indian setting: a qualitative study

BACKGROUND

Pulmonary rehabilitation (PR) is an effective strategy to improve breathlessness, health status and exercise tolerance and to reduce readmissions and mortality. In India, there is no government health programme for chronic obstructive pulmonary disease (COPD) management while in the private sector availability of PR is limited. Most PR centres are in urban areas, with few services accessible to rural populations. We aimed to assess the need for PR from the perspective of patients with COPD and healthcare professionals (HCPs: registered medical practitioners and medical officers) in rural Maharashtra.

METHODOLOGY

Between June and October 2020, we conducted semi-structured interviews with 14 patients with COPD and 9 HCPs to explore their perceptions of, and need for, PR in rural Maharashtra. Interviews were transcribed and analysed thematically.

RESULTS

We approached 14 patients with COPD and 9 HCPs practising in rural areas. Five HCPs stated that they did not advise PR for patients with COPD citing poor compliance to PR referral and follow-up of the patients. Patients with COPD had symptoms and needs that could be helped by PR but commented how transportation would be a problem for them to visit a PR centre. In contrast, they could understand the benefits of PR and expressed their willingness to join such programmes. A PR service was established that addressed these needs.

CONCLUSION

Patients with COPD have unmet needs that could benefit from attending a PR programme, but there are barriers at both healthcare and patient levels that we addressed in a new PR service for people with chronic respiratory disease in rural Maharashtra.

ERS International Congress 2022: highlights from the Respiratory Clinical Care and Physiology Assembly

It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of the laboratory-based science, clinical trials and qualitative research that were presented during the 2022 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, mobile/electronic health (m-health/e-health), clinical respiratory physiology, exercise and functional imaging.

Review of the British Thoracic Society Winter Meeting 23 November 2022 23-25 November 2022

The British Thoracic Society Winter Meeting at the QEII Centre in London provided the first opportunity for the respiratory community to meet and disseminate research findings face to face since the start of the COVID-19 pandemic. World-leading researchers from the UK and abroad presented their latest findings across a range of respiratory diseases. This article aims to represent the range of the conference and as such is written from the perspective of a basic scientist, a physiotherapist and two doctors. The authors reviewed showcase sessions plus a selection of symposia based on their personal highlights. Content ranged from exciting new developments in basic science to new and unpublished results from clinical trials, delivered by leading scientists from their fields including former deputy chief medical officer Professor Sir Jonathan Van-Tam and former WHO chief scientist Dr Soumya Swaminathan.