Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial (original) (raw)
Horton, Elizabeth J., Mitchell, Katy E., Johnson-Warrington, Vicki, Apps, Lindsay D., Sewell, Louise, Morgan, Mike, Taylor, Rod S. 
ORCID: https://orcid.org/0000-0002-3043-6011 and Singh, Sally J.(2018) Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial.Thorax, 73(1), pp. 29-36. (doi: 10.1136/thoraxjnl-2016-208506) (PMID:28756402)
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Abstract
Background: Standardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD. Methods: A total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units. Results: There was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks. Conclusions: The standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.
| Item Type: | Articles |
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| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Taylor, Professor Rod |
| Authors: | Horton, E. J., Mitchell, K. E., Johnson-Warrington, V., Apps, L. D., Sewell, L., Morgan, M., Taylor, R. S., and Singh, S. J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | Thorax |
| Publisher: | BMJ Publishing Group |
| ISSN: | 0040-6376 |
| ISSN (Online): | 1468-3296 |
| Published Online: | 29 July 2017 |
| Copyright Holders: | Copyright © 2018 The Authors |
| First Published: | First published in Thorax 73(1):29-36 |
| Publisher Policy: | Reproduced in accordance with the copyright policy of the publisher |
University Staff: Request a correction | Enlighten Editors: Update this record
Deposit and Record Details
| ID Code: | 190698 |
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| Depositing User: | Dr Aniko Szilagyi |
| Datestamp: | 22 Jul 2019 08:27 |
| Last Modified: | 28 May 2020 22:40 |
| Date of acceptance: | 26 June 2017 |
| Date of first online publication: | 29 July 2017 |
| Date Deposited: | 22 July 2019 |
| Data Availability Statement: | No |