Background
Methods
Search strategy
Inclusion and exclusion criteria
Parameter | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Participants | • Patients with COPD | • Patients with Asthma • No patients (simulation studies) |
Intervention | • Home-based pulmonary rehabilitation (home was defined as independent or supportive living environments) | • Pulmonary rehabilitation programs delivered in long-term care facilities or nursing homes • Not a program, as defined in the American Thoracic Society Consensus Statement • Program duration – less than 4 weeks |
Comparator | • Outpatient pulmonary rehabilitation delivered in a hospital or community setting • Usual care (patients managed by their General Practitioner, specialist or both according to local practices) | • Inpatient pulmonary rehabilitation programs |
Outcomes | • Safety • Health care resource utilization ○ Hospital admission ○ ER visits ○ Physician visits • Health Related Quality of Life (HRQoL) ○ Generic HRQoL tools such as EQ5D, SF36 or SF12 ○ Disease-specific HRQoL such as: ▪ COPD Assessment Test (CAT) ▪ Chronic Respiratory Disease Questionnaire (CRQ) ▪ St. George’s Respiratory Questionnaire (SGRQ) • Adherence • Frequency of exacerbation • Functional Exercise Capacity ○ Six-minute walk test/distance (6MWT/6MWD) ○ Incremental shuttle walk test (ISWT) ○ Endurance shuttle walk test (ESWT) • Maximal Exercise Capacity ○ Incremental cycle ergometry • Mental Health • Self-efficacy | • Studies without any defined clinical outcomes |
Study Design | Comparative studies: • Randomized and non-randomized controlled trials (RCTs and non-RCTs) • Cohort studies • Case-control studies | • Non-English language • Expert reviews • Editorials and opinion pieces • Case-series • Studies published prior to 2009 |
Data extraction and synthesis
Assessment of study quality
Results
Search results
Characteristics of studies
Study (country) | Study period (Design) | Number of centres | Number of participants | Follow-up | HBPR intervention supervision |
---|---|---|---|---|---|
HBPR vs ‘usual care’ | |||||
Lahham 2020 (Australia) [10] | Apr 2015- Nov 2017 (RCT) | Multiple centres | HBPR: 29 Usual care: 29 | 6 months | • Weekly phone calls with physiotherapist • Unsupervised home exercise training |
Coultas 2018 (USA) [11] | Apr 2010- Apr 2014 (RCT) | Single centre | HBPR: 149 Usual care: 156 | 18 months | • Weekly telephone calls • Supervision not specified |
Li 2018 (China) [14] | Jun 2014- Apr 2016 (RCT | Single centre | HBPR: 82 Usual care: 69 | 12 months | • Bi-weekly home visits for 2 months • Monthly home visit and weekly telephone calls for 4 months • Weekly telephone calls for 6 months • Unsupervised home exercise once per week (Supervised bi-weekly for first two months) • Unsupervised respiratory training three times per week |
Khoshkesht 2015 (Iran) [15] | Dec 2010- Feb 2011 (RCT) | Single centre | HBPR: 35 Usual care: 35 | 7 weeks | • Weekly telephone calls with nurses Unsupervised home exercise training and breathing exercises |
Pradella 2015 (Brazil) [16] | NR (RCT) | Single centre | HBPR: 32 Usual care: 18 | 8 weeks | • Weekly telephone call with nurse • Unsupervised exercise training |
De Sousa Pinto 2014 (Spain) [17] | Oct 2009- Jun 2011 (RCT) | Single centre | HBPR: 29 Usual care: 21 | 12 weeks | • Weekly telephone calls • Supervised exercise twice per week for two weeks followed by twice per month • Unsupervised exercise weekly (frequency not specified) |
Liu 2013 (China) [18] | Dec 2009- Oct 2011 (RCT) | Single centre | HBPR: 30 Usual care: 30 | 4 months | • Online program with system monitored program participation • Nurses contacted patients by telephone if they were not regularly logging into the system |
Mendes de Oliveira 2010 (Brazil) [19] | Jan 2007- May 2009 (RCT) | Single centre | HBPR: 42 Usual care: 29 | 12 weeks | • Weekly telephone calls from health care provider • Home exercise program three times per week for 12 weeks (supervision not specified) |
Moore 2009 (UK) [20] | NR (RCT) | Single centre | HBPR: 14 Usual care: 13 | Mean ± SD HBPR: 8 ± 3 weeks Usual care: 7 ± 1 weeks | • Supervision not specified |
Lalmolda 2017 (Spain) [22] | Jan 2011- NR Cohort study | Multiple centres | HBPR: 21 Usual care: 29 | 12 months | • Supervised program delivered by physiotherapist for one hour twice a week for 8 weeks |
HBPR vs OPR | |||||
Horton 2018 (UK) [21] | Nov 2007- Jul 2012 (RCT) | Single centre | HBPR: 145 OPR: 142 | 6 months | • Telephone calls during week two and week four • Unsupervised exercise program |
Holland 2017 (Australia) [12] | Oct 2011- May 2015 (RCT) | Multiple centres | HBPR: 80 OPR: 86 | 12 months | • Weekly phone calls with physiotherapist • Unsupervised home exercise training |
Mendes de Oliveira 2010 (Brazil) [19] | Jan 2007- May 2009 (RCT) | Single centre | HBPR: 42 OPR: 46 | 12 weeks | • Weekly telephone calls from health care provider • Home exercise program three times per week for twelve weeks (supervision not specified) |
Nolan 2019 (UK) [23] | 2012–2015 (Cohort study) | Single centre | HBPR: 154 OPR: 154 | 8 weeks | • Weekly telephone calls with physiotherapist • Unsupervised exercise training |
Chaplin 2017 (UK) [13] | May 2013- Jul 2015 (RCT) | Multiple centres | HBPR: 51 OPR: 52 | Mean ± SD HBPR: 11 ± 4 weeks OPR: NR | • Patients were contacted by a rehabilitation specialist weekly by email or telephone • Supervision not specified |
HBPR program characteristics
Risk of bias
Results of risk of bias assessment
Results from GRADE assessment
Outcomes | № of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
---|---|---|---|---|---|
Risk with ‘usual care’ | Risk difference with HBPR | ||||
Health-related quality of life - COPD Assessment Test (CAT) scores following completion of intervention | 151 (1 RCT) | ⨁⨁◯◯ LOWa,b | – | Mean score = 0 | 0 (0 to 0) |
Frequency of exacerbations over duration of intervention | 178 (2 RCTs) | ⨁◯◯◯ VERY LOWc,d,e | not estimable | 207 per 1000 | 207 fewer per 1000 |
Frequency of exacerbations over duration of intervention | 48 (1 comparative observational study) | ⨁◯◯◯ VERY LOWe | not estimable | 276 per 1000 | 276 fewer per 1000 |
6 min walk test (6MWT/6MWD) in meters at the end of PR | 745 (7 RCTs) | ⨁◯◯◯ VERY LOWd,f,g | – | not pooled | not pooled |
Hospital admissions rate related to COPD at the end of PR | 305 (1 RCT) | ⨁⨁◯◯ LOWa,e | not estimable | 301 per 1000 | 301 fewer per 1000 |
Hospital admissions rate related to COPD at the end of PR | 48 (1 comparative observational study) | ⨁◯◯◯ VERY LOWb | not estimable | 138 per 1000 | 138 fewer per 1000 |
Health-related quality of life - St. George’s respiratory questionnaire (SGRQ) total score following completion of intervention | 160 (3 RCTs) | ⨁⨁◯◯ LOWb,h | – | not pooled | not pooled |
Outcomes | № of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
---|---|---|---|---|---|
Risk with OPR | Risk difference with HBPR | ||||
Health-related quality of life - COPD Assessment Test (CAT) scores following completion of intervention | 103 (1 RCT) | ⨁⨁◯◯ LOWa,b | – | not pooled | not pooled |
Frequency of exacerbations over duration of intervention | NR | NR | NR | NR | NR |
6 min walk test (6MWT/6MWD) in meters at the end of PR | 254 (2 RCTs) | ⨁◯◯◯ VERY LOWb,c,d | – | not pooled | not pooled |
Hospital admissions rate related to COPD at the end of PR | 287 (1 RCT) | ⨁⨁⨁◯ MODERATEb | not estimable | not pooled | not pooled |
Health-related quality of life - St. George’s respiratory questionnaire (SGRQ) total score following completion of intervention | NR | NR | NR | NR | NR |