Effectiveness of a long-term home-based exercise training in COPD patients: The HOMEX-2 RCT

Introduction: Many COPD patients do not follow pulmonary rehabilitation (PR) or exercise training in the long-term. Objective(s): To assess the effectiveness of a 12-months home-based, minimal equipment strength exercise programme in patients with COPD who did not conduct PR<1 year. Method(s): COPD patients recruited from primary care and general population were randomized into intervention (IG) or control group (usual care, CG). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire;CRQ) from baseline to 12 months, secondary outcomes change in exercise capacity, health status, exacerbations, and symptoms. Adjusted linear regression models were used. Result(s): 50 patients (48% of target sample size) were randomized (25 per group);23 females, mean (SD) age 69.5 (7.4) years, FEV1% 45.9 (16.3) % pred. 48 completed 12-months follow-up (IG: 25, CG: 23). On average, the IG participant trained for 10.5 months and 18 persons (72%) until study end. We found no evidence for a difference in change in CRQ dyspnoea over 12 months (adjusted mean difference 0.45, 95% CI -0.21-1.10, p=0.18, favouring IG). We found no evidence for an effect in other outcomes. Most of the IG participants liked to participate in the programme much (56%) or very much (24%). Due to the Coronavirus pandemic, 60% of follow-up visits were conducted by phone/by questionnaires without exercise tests. Conclusion(s): This trial was underpowered. There was a trend that the training provided benefit in dyspnoea. The fact that it was difficult to motivate COPD patients for participation who did not follow PR<1 year highlights the challenge to reach this patient group. However, most of the participants succeeded to train long-term.

Audit practice: A straightforward trade or a complex system?

Auditors' skills and ways of working must adapt to constantly changing conditions in the workplace, and the COVID-19 pandemic has brought further complexity. This paper uses a complexity theory lens to investigate changes in audit practice in recent years. A qualitative research method, using semi-structured interviews, was applied: first to investigate how audit practice (skillsets and ways of working) needs to be reformed and second to suggest implications for audit practice stemming from a disruptive macro-level event such as the current COVID-19 pandemic. It was found that audit firms are framed as complex adaptive systems and new skillsets and ways of working in audit practice are well known for their adaptation, co-evolution and emerging behaviours, which include virtual audits and remote working that have been brought about by the COVID-19 pandemic.