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Title: Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial.
Authors: Horton, EJ
Mitchell, KE
Johnson-Warrington, V
Apps, LD
Sewell, L
Morgan, M
Taylor, RS
Singh, SJ
First Published: 29-Jul-2017
Publisher: BMJ Publishing Group, British Thoracic Society (BTS)
Citation: Thorax, 2018, 73 (1), pp. 29-36
Abstract: BACKGROUND: Standardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD. METHODS: A total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units. RESULTS: There was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: -0.24, 95% CI -0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks. CONCLUSIONS: The standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation. TRIAL REGISTRATION NUMBER: ISRCTN81189044.
DOI Link: 10.1136/thoraxjnl-2016-208506
eISSN: 1468-3296
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2017, BMJ Publishing Group, British Thoracic Society (BTS). Deposited with reference to the publisher’s open access archiving policy. (
Description: Additional material is published online only. To view please visit the journal online (
Appears in Collections:Patents, Dept. of Infection, Immunity and Inflammation

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