Real-life feasibility and effectiveness of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease requiring medical equipment

Figures & data

Table 1 Baseline characteristics of patients according to their medical equipment

Characteristics	Total patients	LTOT	NIV	CPAP	NE
Sample size (n)	298	109	84	25	80
Men to women ratio (n)	199/99	73/36	56/28	20/5	50/30
Age (years)	63.8±11.0	64.8±11.8	64.9±8.8	64.9±11.9	60.7±11.2
BMI (kg/m^2)	27.0±7.6	24.9±6.5b	29.4±9.0c	33.6±5.5c	25.6±6.3b
FEV1 (L)	1.117±0.536	0.930±0.423d	0.962±0.464d	1.409±0.575	1.380±0.563
FEV1 (% theoretical value)	40.9±17.1	35.0±14.9d	34.3±14.5d	53.0±16.1	49.9±16.1
FVC (% theoretical value)	66.2±20.1	59.9±19.8d	60.6±18.4a	74.7±16.6	75.8±18.5
FEV1/FVC	50.6±12.8	46.2±11.7d	48.6±12.4e	58.3±9.1	54.9±12.9
Moderate airflow limitation (50%≤FEV1<80%), n (%)	71 (23.8)	15 (13.8)d	10 (11.9)d	12 (48.0)	34 (42.5)
Severe airflow limitation (30%≤FEV1<50%), n (%)	132 (44.3)	48 (44.0)	35 (41.7)	11 (44.0)	38 (47.5)
Very severe airflow limitation (FEV1<30%), n (%)	95 (31.9)	46 (42.2)d	39 (46.4)d	2 (8.0)	8 (10.0)
TLC (% theoretical value)	108.9±26.3	106.8±31.5	112.8±25.1	102.3±17.0	109.1±24.4
Short-acting β2-agonists, n	160	69	47	7	37
Long-acting β2-agonists, n	120	50	30	5	35
Long-acting anticholinergic, n	193	80	65	9	39
Bronchodilator associated with corticosteroids, n	145	58	40	11	36
Inhaled corticosteroids, n	46	21	17	3	5
Oral corticosteroids, n	61	38	12	2	9

Notes: Data shown as n, mean ± standard deviation, or n (%).

a Significantly different from NE (p<0.05).

b Significantly different from CPAP and NIV (p<0.05).

c Significantly different from all others groups (p<0.05).

d Significantly different from CPAP and NE (p<0.05).

e Significantly different from CPAP (p<0.05).

Abbreviations: BMI, body mass index; CPAP, continuous positive airway pressure; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; LTOT, long-term oxygen therapy; n, sample size; NE, no equipment; NIV, noninvasive ventilation; TLC, total lung capacity.

Figure 1 Flow diagram of patients with chronic obstructive pulmonary disease managed by home-based PR.

Abbreviations: CPAP, continuous positive airway pressure; LTOT, long-term oxygen therapy; NE, no equipment; NIV, noninvasive ventilation; PR, pulmonary rehabilitation.

Table 2 Comparison of exercise capacities, anxiety, depression and HRQoL at baseline and different times after home-based PR according to the medical equipment

Test/questionnaire	Medical equipment	Baseline	Post PR	After 6 months	After 12 months
10STS (seconds)	LTOT	35.8±15.9a,b,c	30.5±11.2a,b	34.0±14.6a,b	34.4±16.5a,b
	NIV	33.4±12.2c	28.1±10.3	31.4±16.3	30.8±11.8
	CPAP	24.0±7.9c	26.5±13.8	26.4±16.0	26.1±13.4
	NE	28.5±12.0c	23.6±9.6	24.1±10.5	23.9±11.0
TUG (seconds)	LTOT	13.0±10.2a,c	11.6±10.2a	11.6±6.8a	10.8±5.5a
	NIV	11.3±5.0c	10.5±9.2	10.7±5.7	10.3±4.2
	CPAP	8.9±4.6c	8.3±4.4	8.5±5.9	8.9±7.3
	NE	9.1±4.8c	7.4±2.9	7.5±3.3	7.5±3.8
6MST (strokes)	LTOT	248±138a,b,d	315±156a,b	300±174a,b	342±195a,b
	NIV	269±134d	372±159	343±172	410±137
	CPAP	432±171d	480±209	486±255	486±247
	NE	395±155d	444±155	469±173	486±171
HAD scale: anxiety state (/21)	LTOT	9.7±4.6d	8.7±4.3	7.8±4.4	8.1±4.7
	NIV	9.6±4.6d	8.8±4.1	8.0±4.6	8.3±4.7
	CPAP	10.0±4.6d	8.1±4.4	8.1±5.0	8.4±5.3
	NE	9.6±4.5d	8.3±4.3	7.3±4.3	7.8±4.1
HAD scale: depression state (/21)	LTOT	8.1±4.1d	6.7±4.3	6.4±4.3	6.8±4.7
	NIV	7.9±3.9d	6.2±3.9	5.9±3.6	5.9±4.4
	CPAP	7.2±4.4d	5.3±4.7	5.1±4.7	4.8±3.6
	NE	6.9±4.1d	5.4±3.7	4.5±3.5	4.9±3.7
HAD scale: global score (/42)	LTOT	17.8±7.2d	15.4±7.6e	14.3±7.6	14.9±8.1
	NIV	17.2±7.0d	15.0±7.1e	13.8±7.2	14.2±7.8
	CPAP	16.9±7.5d	13.4±8.3e	13.1±8.1	13.2±7.8
	NE	16.4±7.7d	13.7±6.9e	11.8±6.7	12.7±6.4
MRF-28 (/100)	LTOT	56.1±20.9d	47.9±22.0	45.9±21.7	50.0±22.4
	NIV	51.7±21.8d	44.7±23.4	46.3±25.7	43.4±25.5
	CPAP	40.3±20.6d	35.3±24.6	36.9±26.1	32.6±26.2
	NE	40.5±23.0d	32.7±20.8	26.2±18.3	30.0±20.9
VSRQ (/80)	LTOT	30.3±15.5d	37.3±16.7	37.6±16.5	34.1±14.8
	NIV	32.5±13.3d	39.5±15.7	39.3±16.1	39.3±16.7
	CPAP	31.4±14.8d	41.1±18.3	38.8±16.7	41.5±16.8
	NE	37.2±16.5d	42.7±16.8	44.9±15.5	43.4±15.5
VQ11 (/55)	LTOT	36.0±8.5d	32.4±8.8e	30.6±8.3	33.3±8.9
	NIV	32.9±8.4d	30.7±10.1e	28.8±9.5	28.8±11.1
	CPAP	33.0±6.8d	29.9±10.0e	25.9±10.5	27.7±7.9
	NE	31.2±9.2d	27.1±9.4e	25.8±8.9	27.2±9.5

Notes:

a Significantly different from NE (p<0.05).

b Significantly different from CPAP (p<0.05).

c Significantly different compared to post PR (p<0.05).

d Significantly different from all other times (p<0.05).

e Significantly different compared to after 6 months (p<0.05).

Abbreviations: 6MST, 6-minute stepper test; 10STS, 10 times sit-to-stand test; CPAP, continuous positive airway pressure; HAD, Hospital Anxiety and Depression; HRQoL, health-related quality of life; LTOT, long-term oxygen therapy; MRF-28, Maugeri Foundation Respiratory Failure Questionnaire; NE, no equipment; NIV, noninvasive ventilation; PR, pulmonary rehabilitation; TUG, timed up-and-go test; VQ11, COPD-specific HRQoL Questionnaire; VSRQ, Visual Simplified Respiratory Questionnaire.

Figure 2 Percentage of patients who improved their exercise capacities, anxiety, depression, and health related quality of life.

Notes: Improvement was evaluated after 2 months of home-based pulmonary rehabilitation. Results are given according to patients’ medical equipment. *p<0.05.
Abbreviations: 6MST, 6-minute stepper test; CPAP, continuous positive airway pressure; HAD, Hospital Anxiety and Depression; LTOT, long-term oxygen therapy; NE, no equipment; NIV, noninvasive ventilation; TUG, timed up-and-go test; VSRQ, Visual Simplified Respiratory Questionnaire.