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  • Short-term effects of home-based pulmonary rehabilitation during outpatient-managed exacerbations of COPD: a randomised controlled trial

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Rehabilitation
Original research
Short-term effects of home-based pulmonary rehabilitation during outpatient-managed exacerbations of COPD: a randomised controlled trial
  1. Ana Machado1,2,3,4,5,
  2. Cíntia Dias1,2,
  3. Cátia Paixão1,2,4,
  4. António Pedro Gonçalves6,
  5. Chris Burtin3,5,
  6. Alda Marques1,2
  1. 1 Lab3R - Respiratory Rehabilitation and Research Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
  2. 2 iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
  3. 3 Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
  4. 4 Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
  5. 5 Biomedical Research Institute (BIOMED), Hasselt University, Diepenbeek, Belgium
  6. 6 Emergency Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
  1. Correspondence to Dr Alda Marques; amarques{at}ua.pt

Abstract

Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD.

Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed ECOPD. Participants were randomly assigned to the control (CG, ie, usual care) or experimental (EG, ie, usual care and 3-week home-based PR) group within 48 hours of the diagnosis (baseline). Assessments were performed at baseline and after 3 weeks (post). The COPD assessment test (CAT) was the primary outcome. Secondary outcomes included measures of symptoms and functional capacity. After PR, interviews were conducted. Analyses were performed using (non-)parametric mixed analysis of variance, deductive thematic analysis and narrative integration through joint displays.

Results Fifty participants with outpatient-managed ECOPD (78% men, 70±11 years, forced expiratory volume in one second 47.4±16.4% pred) were included. Significant greater improvements in the EG compared with the CG were found for the CAT (EG Δ−12.5±7.2 vs CG Δ−5.9±7.2, p=0.002) and 12 of 13 other secondary outcome measures. A positive self-perceived impact of PR was found on symptoms, control of daily life, health, mental status and empowerment. No adverse events were reported.

Conclusions A 3-week home-based PR programme is safe, meaningful and more effective than just standard medication in improving symptoms, functional capacity and health status, outcomes often associated with poor prognosis. This highlights the role of PR in improving the recovery process during outpatient-managed ECOPD and might contribute to a better prognosis in these individuals.

Trial registration NCT03751670.

  • Pulmonary Rehabilitation
  • COPD Exacerbations

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article (and/or) its supplementary materials. The dataset is available upon reasonable request from the corresponding author (ASM).

https://doi.org/10.1136/thorax-2024-221760

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article (and/or) its supplementary materials. The dataset is available upon reasonable request from the corresponding author (ASM).

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    Footnotes

    • X @filipa__machado

    • Contributors AM, CB and ASM were responsible for project conceptualisation and administration and funding acquisition. AM and CD contributed to data acquisition. APG assessed participants for eligibility criteria and referred them to the study. AM and CP performed data analysis and all authors contributed to data interpretation. AM drafted the manuscript. All authors critically revised the manuscript, ensured accuracy and integrity of the work, approved the final version to be published, and agreed to be accountable for all aspects of the work. AM and ASM are responsible for the overall content as guarantors.

    • Funding This work was funded by Fundação para a Ciência e a Tecnologia (FCT) under the PhD grants SFRH/BD/147200/2019 & COVID/BD/153335/2023. This work was also supported under the project UIDB/04501/2020. Cátia Paixão (PhD grants SFRH/BD/148741/2019 & COVID/BD/153477/2023) was funded by FCT.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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