Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits.
- Vasilopoulou M, Papaioannou AI, Kaltsakas G, Louvaris Z, Chynkiamis N, Spetsioti S, Kortianou E, Genimata SA, Palamidas A, Kostikas K, Koulouris NG, Vogiatzis I.
- 1. Faculty of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece. 2. First Dept of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece. 3. Third Respiratory Medicine Dept, Sismanogleion General Hospital, Athens, Greece. 4. Second Dept of Respiratory Medicine, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece. 5. Faculty of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece firstname.lastname@example.org. 6. Faculty of Health and Life Sciences, Dept of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle Upon Tyne, UK.
Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits.Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR.In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389-0.687, and IRR 0.635, 95% CI 0.473-0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100-0.358, and IRR 0.375, 95% CI 0.207-0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072-0.185).Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR.
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