61230
document
Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial . BACKGROUND Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease ( COPD ) to improve exercise capacity , symptoms and quality of life , however only a minority of individuals with COPD are able to participate . Travel and transport are frequently cited as barriers to uptake of centre-based programs . Other models of pulmonary rehabilitation , including home-based programs , have been proposed in order to improve access to this important treatment . Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life , but not all elements of the program were conducted in the home environment . It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity , symptoms and quality of life as a hospital-based program . The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD . METHODS/DESIGN This randomised , controlled , equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD . Participants will be randomly allocated to hospital-based or home-based pulmonary rehabilitation . Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks . Home-based programs will involve one home visit followed by seven weekly telephone calls , using a motivational interviewing approach to enhance exercise participation and facilitate self management . The primary outcome is change in 6-minute walk distance immediately following intervention . Measurements of exercise capacity , physical activity , symptoms and quality of life will be taken at baseline , immediately following the intervention and at 12 months , by a blinded assessor . Completion rates will be compared between programs . Direct healthcare costs and indirect ( patient-related ) costs will be measured to compare the cost-effectiveness of each program . DISCUSSION This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner . The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD .
61231
Intervention_Physical
home-based pulmonary rehabilitation
61232
Intervention_Physical
Pulmonary rehabilitation
61233
Intervention_Physical
pulmonary rehabilitation
61234
Intervention_Physical
home-based pulmonary rehabilitation
61235
Intervention_Physical
pulmonary rehabilitation program
61236
Intervention_Physical
hospital-based program .
61237
Intervention_Physical
home-based
61238
Intervention_Physical
hospital-based pulmonary rehabilitation
61239
Intervention_Physical
hospital-based or home-based pulmonary rehabilitation
61240
Intervention_Physical
Home-based programs
61241
Intervention_Educational
home visit followed by seven weekly telephone calls , using a motivational interviewing approach
61242
Intervention_Educational
self management
61243
Intervention_Physical
home-based pulmonary rehabilitation
61244
Outcome_Other
cost effective
61245
Outcome_Mental
change in 6-minute walk distance
61246
Outcome_Physical
exercise capacity , physical activity , symptoms and quality of life
61247
Outcome_Adverse-effects
Completion rates
61248
Outcome_Other
Direct healthcare costs and indirect ( patient-related ) costs
61249
Participant_Condition
chronic obstructive pulmonary disease
61250
Participant_Condition
chronic obstructive pulmonary disease
61251
Participant_Condition
COPD
61252
Participant_Condition
COPD
61253
Participant_Sample-size
166
61254
Participant_Condition
COPD