Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial
Background: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychologi- cal support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its rou- tine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home- based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed.
Methods: Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strength- ening of upper and lower limbs 3 times a week for 12 weeks.
Results: There was a significant difference in the distance cov- ered on the six-minute walk test (p < 0.05) and BODE index (p < 0.001) in the outpatient and at-home groups after partici- pating in the rehabilitation program compared to baseline.
Conclusion: A home-based self-monitoring pulmonary reha- bilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.
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