Home vs Hospital-Based Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease: A Spanish Multicenter Trial

• Published in: Archivos de bronconeumología (English ed.) 2008-10, Vol.44 (10), p.512-518
• Main Authors: Güell, María Rosa, de Lucas, Pilar, Gáldiz, Juan Bautista, Montemayor, Teodoro, Rodríguez González-Moro, José Miguel, Gorostiza, Amaia, Ortega, Francisco, Bellón, José M., Guyatt, Gordon
• Format: Article
• Language: eng ; spa
• Subjects: Aged; Calidad de vida relacionada con la salud; Capacidad de esfuerzo; COPD; EPOC; Exercise tolerance; Health-related quality of life; Home Care Services; Hospitalization; Humans; Male; Middle Aged; Programa domiciliario de rehabilitación respiratoria; Programa hospitalario de rehabilitación respiratoria; Prospective Studies; Pulmonary Disease, Chronic Obstructive - rehabilitation; Pulmonary rehabilitation, home care services; Pulmonary rehabilitation, hospital-based; Spain
• ISSN: 1579-2129; 0300-2896; 1579-2129
• DOI: 10.1016/S1579-2129(08)60096-8

To compare the effects of a simple home pulmonary rehabilitation program and an intensive hospital-based program in terms of the exercise tolerance and health-related quality of life (HRQOL) of patients with severe chronic obstructive pulmonary disease (COPD). Patients in this prospective, multicenter trial were randomized to 2 groups to receive hospital or home pulmonary rehabilitation. Patients in both groups attended 2 informative sessions about the disease and 4 physical therapy sessions. Patients in the hospital group then carried out a structured exercise program while home group patients performed low intensity exercises at home without supervision. Twenty-eight patients were randomized to the hospital rehabilitation group and 23 to the home group. Both groups improved on the 6-minute walk test (mean difference, 8.7 m; P =.61). HRQOL measured with the Chronic Respiratory Questionnaire also improved in both groups, but the change was greater on the domain of emotional function in the hospital rehabilitation group (mean difference between groups, 0.58 on a scale for which the smallest clinically relevant difference is 0.5 points). The benefits were maintained in both groups 6 months after the programs ended. This study demonstrates that the improvement in exercise tolerance achieved by COPD patients with an unsupervised home pulmonary rehabilitation program is similar to the gains of patients in an intensive hospital-based program. However, the hospital program afforded greater benefit on the HRQOL domain of emotional function. Estudiar el impacto de un programa simple de rehabilitación respiratoria domiciliario, comparado con uno intensivo hospitalario, sobre la capacidad de esfuerzo y la calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad pulmonar obstructiva crónica. Se ha realizado un estudio prospectivo y multicéntrico en el que se aleatorizó a pacientes con EPOC grave en 2 grupos: hospital (GH) o domicilio (GD). En ambos los pacientes recibieron 2 sesiones de educación y 4 de fisioterapia. Los del GH realizaron un programa estructurado de ejercicio en el hospital y los del GD, un programa de ejercicio de baja intensidad en el domicilio, sin supervisión. Se aleatorizó a 28 pacientes en el GH y a 23 en el GD. Ambos grupos mostraron una mejoría similar en la prueba de la marcha de 6 min (diferencia media de 8,7 m; p = 0,61). A pesar de que en ambos grupos mejoró la CVRS, medida con el Cuestionario de Enfermedad Respirato