Pilot study of effectiveness of home rehabilitation for homebound patients with severe COPD

Introduction: While pulmonary rehabilitation is efficacious, available evidence is not generalizable to patients who are homebound with severe impariment. Objective: To test the effectiveness of home-based rehabilitation for homebound patients with physician-diagnosed COPD and severe functional impairment. Methods: Homebound patients, defined as not driving independently and requiring taxing effort to leave home, were enrolled from primary care and pulmonary clinics. Patients were randomly assigned to one of two interventions comprised of education and physical therapy emphasizing either aerobic activity (A) or strengthening (S). The interventions were delivered over 8 weeks with up to 20 sessions. Pre- and post-intervention outcome measures were collected at 8 and 16 weeks using the Chronic Respiratory Questionnaire (CRQ) and 2-minute walk distance (2MWD). Results: Of 41 patients enrolled 24 completed the 8 week intervention period with mean age 74.4 (SD 10.7) years, 45.8% female, FEV1 0.75L [30% predicted]). Baseline 2MWDs (mean, SD) were 56.0m (23.3) and 69.3m (34.0) for groups A and S, respectively. After 16 weeks all CRQ domains improved in both groups with the largest improvements in CRQ-dyspnea (A=1.85 [p=0.02] and S=2.21 [p=0.003]). Overall, the proportion of patients reporting clinically significant improvements in CRQ-dyspnea was 80% in group A and 71% in group S. Moreover, 2MWD increased in Group A but declined in Group S. Conclusions: These results suggest that among homebound patients with severe COPD 8-weeks of either aerobic or strength training are effective for improving quality of life, but aerobic training may be needed to improve walking distance.