ABSTRACT
Importance Pulmonary rehabilitation (PR) is the guideline-recommended most effective nonpharmacological therapy for people with chronic obstructive pulmonary disease (COPD) improving all outcomes. Despite the proven benefits, PR programs have low participant uptake, insufficient attendance, and high drop-out rates. Home programs are proposed as a solution: however, there is no randomized study to date in the US to inform remote programs.Objective To determine whether unsupervised home-based rehabilitation with technology and health coaching improve physical and emotional disease specific quality of life, daily physical activity, and self-management in patients with moderate to severe Chronic Obstructive Pulmonary Disease (COPD).Design, Setting, and Participants This multicenter, randomized, allocation-concealed, clinical trial enrolled 235 adult patients with COPD, of a planned sample size of 200, between March 2018 and December 2021 from two major health care systems in the US.Interventions Participants were randomized to unsupervised home-based rehabilitation with health coaching (N=116) or standard care (n = 119).Main Outcomes and Measures The primary outcome were disease-specific physical and emotional quality of life after the 12-week intervention. Prespecified secondary outcomes included measured daily physical activity, selfmanagement abilities, sleep, and symptoms of depression and anxiety.Results Among 307 patients who were randomized (mean age, 69 years;56% women) 235 (77%) completed the intervention and had measures. The was a significant difference in the intervention compared to the control group in the primary outcomes, daily physical activity, self-management, sleep, and depression scores: (adjusted Difference, Mean Change (95% CI) 0.47 points (0.27, 0.67) p<0.001, 0.48 (0.27, 0.69)p<0.001 for the physical and emotional quality of life respectively. Daily steps 655.83 (148.03, 1163.64) p<0.0116, selfmanagement 3.83 (1.85, 5.79) p<0.001, depression PHQ-9 -1.2 (-2.04, -0.35) p<0.0056 and total sleep time 54 min (6.74, 102.96) p<0.025 .Conclusions and Relevance Among patients with moderate to severe COPD, unsupervised home-based rehabilitation with monitoring technology and health coaching improved quality of life, daily physical activity, and self-management. This intervention represents an opportunity to increase the uptake of rehabilitation in COPD and to inform options of remote care that are now in increased demand in the context of the COVID-19 pandemic. (Figure Presented).