A comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: A randomised non-inferiority trial

Elizabeth Horton, K.E. Mitchell, Vicki Johnson-Warrington, Lindsay D. Apps, Louise Sewell, M. Morgan, Rod S. Taylor, Sally Singh

Research output: Research - peer-reviewArticle

  • 1 Citations

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.

Trial registration number ISRCTN81189044
LanguageEnglish
Pages(in press)
JournalThorax
DOIs
StatePublished - 29 Jul 2017

Fingerprint

Rehabilitation
Lung
Dyspnea
Chronic Obstructive Pulmonary Disease
Motivational Interviewing
Rehabilitation Centers
Insurance Benefits
Self Care
Random Allocation
Telephone
Self Report
Chronic Disease

Cite this

A comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation : A randomised non-inferiority trial. / Horton, Elizabeth; Mitchell, K.E.; Johnson-Warrington, Vicki; Apps, Lindsay D.; Sewell, Louise; Morgan, M.; Taylor, Rod S.; Singh, Sally.

In: Thorax, 29.07.2017, p. (in press).

Research output: Research - peer-reviewArticle

Horton, Elizabeth ; Mitchell, K.E. ; Johnson-Warrington, Vicki ; Apps, Lindsay D. ; Sewell, Louise ; Morgan, M. ; Taylor, Rod S. ; Singh, Sally. / A comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation : A randomised non-inferiority trial. In: Thorax. 2017 ; pp. (in press)
@article{99665848b2844adbbc565f8be8f6d0a0,
title = "A comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: A randomised non-inferiority trial",
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.Trial registration number ISRCTN81189044",
author = "Elizabeth Horton and K.E. Mitchell and Vicki Johnson-Warrington and Apps, {Lindsay D.} and Louise Sewell and M. Morgan and Taylor, {Rod S.} and Sally Singh",
year = "2017",
month = "7",
doi = "10.1136/thoraxjnl-2016-208506",
pages = "(in press)",
journal = "Thorax",
issn = "0040-6376",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - A comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation

T2 - Thorax

AU - Horton,Elizabeth

AU - Mitchell,K.E.

AU - Johnson-Warrington,Vicki

AU - Apps,Lindsay D.

AU - Sewell,Louise

AU - Morgan,M.

AU - Taylor,Rod S.

AU - Singh,Sally

PY - 2017/7/29

Y1 - 2017/7/29

N2 - 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.Trial registration number ISRCTN81189044

AB - 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.Trial registration number ISRCTN81189044

U2 - 10.1136/thoraxjnl-2016-208506

DO - 10.1136/thoraxjnl-2016-208506

M3 - Article

SP - (in press)

JO - Thorax

JF - Thorax

SN - 0040-6376

SN - 1468-3296

ER -