A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

Abstract

Purpose

With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR.

Patients and methods

People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors.

Results

Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points.

Conclusion

Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.

Keywords:

• pulmonary rehabilitation
• physical capacity
• self-reported walking
• structured self-management-based education
• exercise

Acknowledgments

This work was supported in part by the Royal Hobart Hospital Research Foundation Grant, Hobart, Tasmania, Australia; a Department of Health and Human Services Grant, Hobart, Tasmania, Australia; and a University of Tasmania Research Enhancement Grant, Hobart, Tasmania, Australia. The authors would like to thank Physiotherapy Services, Royal Hobart Hospital, the Menzies Research Institute, Hobart, Tasmania, Australia, where this research took place and the research assistants Roxanne Maher, Carol Phillips, Helen de Hoog, Sharon Rees, and Emmie Bostock for their unfailing assistance. Finally, we are indebted to the community nurses and the people with COPD who willingly gave of their time and of themselves to participate in our research. An abstract pertaining to this paper was presented at the Thoracic Society of Australia and New Zealand Scientific Meeting, Adelaide, Australia, as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” (TP010, page 59) in (2014), Combined COPD/Cell Biology & Immunology Sig Poster Presentation. Respirology, 19: 58–64. doi: 10.1111/resp.12263_2: http://onlinelibrary.wiley.com/doi/10.1111/resp.12263_2/epdf

Disclosure

The authors report no conflicts of interest in this work.