Comparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Abstract

Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients.Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables.Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity (p = 0.003), quality of life (p = 0.045), FEV1 (p = 0.001), lower pack-year smoking (p < 0.001) than outpatient PR.After home PR, exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea(p < 0.05), anxiety (p < 0.001), depression (p < 0.001) were improved except endurance shutte test. Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar.Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.