Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits

[摘要] 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 0.389xe2x80x930.687; and IRR 0.635; 95% CI 0.473xe2x80x930.853); respectively; and 2) hospitalisations for acute COPD exacerbation (IRR 0.189; 95% CI 0.100xe2x80x930.358; and IRR 0.375; 95% CI 0.207xe2x80x930.681); 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 0.072xe2x80x930.185).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.

[学科分类] 呼吸医学