Home-based pulmonary rehabilitation as effective as centre-based, review suggests
Pulmonary rehabilitation carried out at home is as effective as centre-based care, improving exercise capacity and quality of life
Pulmonary rehabilitation (PR) is an effective method of improving the physical condition and psychological wellbeing of people with chronic respiratory diseases (CRDs) like asthma or chronic obstructive pulmonary disease (COPD). Delivery of this treatment is traditionally done in treatment centres, but for many people barriers like distance to travel and timing of programme mean that they cannot attend.
Work commitments, poor transport options, and costs make attending clinics add to the difficulties for people living in low- and middle-income countries.
A RESPIRE systematic review aimed to find out whether PR delivered in people’s homes was as effective as that delivered in treatment centres and if it was more effective than usual care for CRDs. The researchers also wanted to understand what made home-based PR most successful, and whether being able to undertake the programme at home meant that more people completed the sessions compared to having to attend a treatment centre.
The review identified 16 articles (nine were from high-income countries, four from upper-middle-income countries and three from lower-middle-income countries) which described trials that had assessed the effectiveness of, components of, and engagement with home-based PR.
The review found that people attending home-based PR had improved exercise capacity and better quality of life than those who received usual care. In addition, home-based PR was as effective as centre-based PR in the different settings.
Components of home-based PR
The home-based PR included many components, and there was no consistent evidence of particular components which helped make home-based PR effective. Remote supervision and regular monitoring of the patients seemed to be important.
Engagement with home-based PR programmes
The researchers found that patients attended more sessions in the home-based PR, than when they had to travel to centre-based sessions.
Home-based PR is as effective as centre-based PR in improving exercise capacity and quality of life in people with CRD compared to usual care – and both ways of delivering the treatment were better than usual care. Home-based PR is an option for people who find it difficult to attend a pulmonary rehabilitation centre.
RESPIRE Fellow, Md. Nazim Uzzaman was the lead on this study. He thinks home-based PR could be an option for people where practical barriers limit attendance to centre-based PR. He said:
Access to PR services could make a major difference to the quality of life of people living with respiratory conditions in low- and middle-income countries, and knowing that home delivery is an effective option will help overcome the practical barriers of time and distance. I think patients' motivation and using an appropriate digital tool for monitoring PR services at home will be promising in the future.
This has been a real team effort with RESPIRE colleagues from Bangladesh, India, Malaysia and Edinburgh working together. I would like to thank the whole team, especially Dr Roberto Rabinovich and Professor Hilary Pinnock for their insightful guidance throughout the study.
Read the paper
This review is available from the European Respiratory Review
Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis
Md. Nazim Uzzaman, Dhiraj Agarwal, Soo Chin Chan, Julia Patrick Engkasan, G.M. Monsur Habib, Nik Sherina Hanafi, Tracy Jackson, Paul Jebaraj, Ee Ming Khoo, Fatim Tahirah Mirza, Hilary Pinnock, Ranita Hisham Shunmugam, Roberto A. Rabinovich
European Respiratory Review Sep 2022, 31 (165) 220076; DOI: 10.1183/16000617.0076-2022