The impact of home-based pulmonary rehabilitation on people with mild chronic obstructive pulmonary disease: A randomised controlled trial.

INTRODUCTION: People with mild chronic obstructive pulmonary disease (COPD) experience exercise intolerance, dyspnoea and poor quality of life. However, the role of pulmonary rehabilitation (PR) in this group is unclear. OBJECTIVES: This randomised controlled trial aimed to explore the effects of home-based PR in people with mild COPD. METHODS: People with mild COPD (FEV1 /FVC < 70%; FEV1  > 80%predicted) with a smoking history of ≥10 packet years were randomised to either 8 weeks of home-based PR (one home visit and seven once-weekly telephone calls) or standard care (weekly social telephone calls). Six minute walk distance (6MWD), and Modified Medical Research Council Dyspnoea Scale (mMRC) and Chronic Respiratory Disease Questionnaire (CRQ) scores were compared. RESULTS: A total of 58 participants (34 males, mean age 68 (SD 9) years, FEV1 %predicted 90 (7), 6MWD 496 (105) m) were included with 31 participants randomised to home-based PR. Participants attended an average of 6.8 of the 8 scheduled sessions, ranging from 3 to 8 sessions. Both groups showed improvements in exercise capacity, symptoms and health-related quality of life (HRQoL) over time, however there was no difference in 6MWD at end-intervention (mean difference -3 m, 95% confidence interval (CI) -64 to 58) or 6 months (7 m, 95% CI -59 to 72). At 6 months home-based PR participants were more likely to have clinically important improvements in CRQ emotional function (50% of home PR vs 0% control, P < 0.001) and CRQ total score (45% vs 17%, P = 0.05). CONCLUSION: For people with mild COPD, home-based PR did not improve exercise capacity more than standard care. The trial was registered at the Australia New Zealand clinical trial registry (https://www.anzctr.org.au, Trial ID: ACTRN12616000965404).

The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with chronic obstructive pulmonary disease (COPD).

OBJECTIVES: To examine the predictive validity, minimal important difference (MID) and responsiveness of the PRAISE tool. DESIGN: Retrospective data analysis from HomeBase trial of home vs centre-based pulmonary rehabilitation. SETTING: Tertiary health service. PARTICIPANTS: One hundred and sixty-six participants with COPD (100 men) with mean age 69 (SD 9) years, FEV1% predicted 50% (19). INTERVENTIONS: Eight-week pulmonary rehabilitation program, conducted at the hospital or at home. MAIN OUTCOME MEASURES: The 15-item PRAISE tool comprising 10 general and five pulmonary rehabilitation-specific self-efficacy questions. Predictive validity was examined by exploring the relationship between baseline PRAISE score and objective change in physical activity following pulmonary rehabilitation using the SenseWear Armband. The MID was evaluated using anchor-based and distribution-based methods. Responsiveness was assessed with effect sizes. RESULTS: A higher baseline PRAISE score (indicating better self-efficacy) was an independent predictor of reduced sedentary time following pulmonary rehabilitation (P=0.03). A one point increase in PRAISE was associated with a decrease in sedentary time of 4minutes/day (95% confidence interval -7.8 to -0.4minutes/day). Anchor-based estimates of the MID were 0.5 to 1.5 points; however sensitivity and specificity were modest (area under the curve <0.70). Change in PRAISE score following pulmonary rehabilitation had an effect size of 0.21. CONCLUSIONS: The PRAISE tool has predictive validity and may be useful to identify those with high self-efficacy who are more likely to achieve important health behaviour changes with pulmonary rehabilitation. The small effect size suggests that the PRAISE tool was not responsive to changes following pulmonary rehabilitation. TRIAL REGISTRATION NUMBER: NCT01423227, clinicaltrials.gov.

Promoting Physical Activity Using the Internet: Is It Feasible and Acceptable for Patients With Chronic Obstructive Pulmonary Disease and Bronchiectasis?

Older people with chronic lung diseases and with low physical activity participation rates are at higher risk of morbidity and mortality. This study assessed the feasibility and acceptability of a purpose-designed Internet-based program (ActivOnline) to monitor and encourage exercise and physical activity. Twelve participants with chronic obstructive pulmonary disease or bronchiectasis were recruited (54-84 years). Primary outcome measures were feasibility measured by frequency of program access, and acceptability measured by semistructured interview, system usability scores, and participant perception of benefit. The results suggest regular participation in physical activity and exercise during the 8-week study period and high usability scores (mean = 90% ± 9%). Major themes were the importance of regular exercise and how sustained lifestyle changes were essential to be physically active, regular contact with clinicians assisted with motivation, and aspects of ActivOnline facilitated individual behavior change and confidence to continue exercising. Most participants (82%) reported a benefit from using ActivOnline, and 55% wished to remain on the program indefinitely.