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Evaluation of the intervention of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Ye Zhang
Ye Zhang
, 
Na-Ping Xu
Na-Ping Xu
, 
Bei-Rong Mo
Bei-Rong Mo
, 
Xian-Liang Liu
Xian-Liang Liu
 and 
Ya-Chang Lin
Ya-Chang Lin
   | Aug 18, 2021
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Article Category: Review
Published Online: Aug 18, 2021
Page range: 99 - 112
Received: Sep 11, 2020
Accepted: Nov 21, 2020
DOI: https://doi.org/10.2478/fon-2021-0012
Keywords
© 2021 Ye Zhang et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

PRISMA flowchart.
PRISMA flowchart.

Baseline characteristics of included studies.

Author/year/country or region Subject characteristics Intervention Control Time points Measuring tools
Daniel Langer/2015/USA C: 10I: 10Age: >75Stable COPD MTL IMT—mechanical threshold loading (MTL) TFRL IMT— tapered flow resistive loading (TFRL) 8 weeks -Inspiratory muscle strength-Inspiratory muscle endurance-PF
Dimitra Nikoletou/2015/Britain C: 34;I: 34.Stages: moderate to severeAge: >50 years BEIMT with a threshold loading device Not to train the respiratory muscles 7 weeks -PImax-SNIP-diaphragm contractility (Pdi,tw)-ISWT-RME-CRDQ-HADS-the SF-36
Fahrahnaz Mohammadi/2015/Iran 40 patients:I: 20C: 20Stages: GOLD 2–3Age: no limit EDU+LLE+BEThree one-hour sessions of face-to-face + the correct methods of walking + drug therapy Drug therapy. 7 weeks -SF-12-FSS-BI
Marieke L Duiverman/2011/The Netherlands I: 24C: 32Stages: III or IVAges: 40–76 EDU 12 weeksNIPPV+PR At home:EDU 12 weeksPR 6, 12, 18, 24 M -CRQ-MRF-28-GARS-HADS-FEV1-MRC-6MWD
María Rosa Güell/2007/Spain 51 patients:I: 23C: 28Stage IIIAge:I: 66 (5.8)C: 63.2 (6.6) EDU+BE\ULE\LLE:unsupervised street walking daily at a pace of 4 km/h marked by a podometerwent up and down stairs for 5 minutes before and after each walk Hospital:EDU+BE\ULE\LLE: 3 times per week Respiratory muscle function.Arm muscle exercise tests.Leg muscle exercise test.CRQ
Juliana M. de Sousa Pinto/2014/Spain I: 29C: 21Stages: severe and very severeAge: <80 BE+ULE+LLEEndurance training: walking, stair climbing, cycling.standard medical therapy + inhaler devices and nebulizer therapy. At home:standard medical therapy + the nursing counseling session. 12 weeks -The Spirometer Jaeger MasterScope model-SGRQ-LCADL-6MWD-The Borg scale-a pulse oximeter
Atsuyoshi Kawagoshi/2014/Japan I: 20C: 19Stage: stableAge: Elderly aged BE+ULE+LLEPR + pedometer use At home:BE+ULE+LLEPP 1 Y -CRQ-BODE-6MWD-FVC-FVC1
Tristan Bonnevie/2018/France C: 27; I: 24 Stages: severe to very severeAge: >18 years BE+ULE+LLENMES Outpatient or home:EDU+BE+ULE+LLEmuscle strength training 8 weeks -6MWT-VO2peak-Wmax-mMRC-SGRQ
Xujingjuan/2016/China C: 62; I: 63Stages: modified or above BE+ULE+LLEImproved lung-rehabilitation training program (including breathing training + routine care) + relaxation training +LLE +ULE BEincluding breathing training + routine care 12 weeks -6MWT-mMRC-PF-SGRQ
Fernanda Dultra Dias/2013/Brazil I: 13C: 10.Stages: stableAge: >40 EDU+BE+LLEa protocol at home with aerobic and muscle strength exercises EDUonly instructions to perform breathing and stretching exercises 2 M -ISWT and VLIT-strength and endurance test (MIP and MEP)-AQ-20
W-T. Liu/2008/Taiwan, China 48 patients:I: 24C: 24Stages: moderate to severeAge: 40–80 years LLE:Walking at a speed following the tempo of the music At home:same protocol and take daily walking exercise 4 weeks for 3 M and again after 1 yr -PF-ISWT-SF-12-BMI
Chiung-Fang Ho/2012/Taiwan, China 41 patients:I: 20C: 21Stage II–IIIAge: 74 ± 10.3 years LLE:The paced walking to music.at initial speed was set at 80% VO2 peak and increased gradually. At Home:Receive the usual care. 12 weeks -ISWT-PFT-HRQOL-SGRQ-Health resource utility
Marcel du Moulin/2009/Germany 20 patients:I: 10C: 10Stage: moderateAge:I: 67 (63–72)C: 72 (69–77) EDU+3WReceive an individualized training plan.LLE:daily activities. (walking) with a pedometer EDU+3Wcarry out their activities of daily living in their accustomed way. after 3 M and 6 M. -CRQ-PFT-6MWT
Elizabeth J Horton/2017/UK C: 142I: 145Stages: 2–5Mean age: 68 LLEStructure unsupervised home exercise Center-based exercise: LLE 7 W;6 M -CRQ-SR-HADS-PRAISE-ISWT-ESWT
P.de Roos/2016/Holland C: 26I: 26Stages: Stable and moderateMean age: 69.4 and 71.0 LLE10 week supervised exercise training and home-based walk. Center-based: standard medical care 10 weeks -The accelerometry-Physical Activity Scale for the Elderly;-6MWT;-CRQ;-Exercise Self-Regulatory Efficacy Scale
Wangxin/2013/China I: 17C: 18Stages: very severeAge: 58–74 years LLE+Oxygen therapy + drug therapy + noninvasive positiveExercise under pressure ventilation Oxygen therapy + drug therapy 6 M -6MWD-Brog-SGRQ
Cristiane O Pradella/2015/Brazil I: 29C: 15Age: 40–75 yearrs LLE+ULE(1) warm-up, (2) aerobic activity, (3) stretching, and (4) relaxation. At home:no intervention. 8 weeks -SGRQ-6MWT-treadmill endurance test-spirometry
Júlio C/2010/Italy 85 patients:HOME: 33Outpatient: 29C: 23Stage: GOLD I–IVAge:H: 66.4 ± 9.5O: 71.3 ± 6.7C: 70.8 ± 8.7 (1) EDULLE+ULEAerobic=walks on flat ground and strengthening exercises(2) Outpatient:EDUULE+LLEaerobic and strengthening exercises (3) C: At homeNot perform any PR three mornings a week for three months. -BMI-6MWT-BODE-mMRC dyspnea scale
Anne E Holland/2016/Australia C: 86I: 80Stages: stableMean age: 69 Structure Home Exercise (aerobic\LLE) with Physical Therapists Visiting and Telephone Supervision Outpatient:twice weekly outpatient group-based supervised program, 8 weeks1 Y -6MWD-modified Medical Research Council dyspnea scale-CRQ-PRAISE-HADS
François Maltais/2008/America 252 patients:I: 126C: 126Stages: II–IVMean age: 66 EDU+Aerobic and strength exercise: ? Outpatient:EDU+LLE:Leg cycling 8 weeks -CRQ-SGRQ-PFT-6MWT
Carol McFarland, P T/2012/America I: 13C: 11Stages: Mild and moderateMean ages: 72.2 and 76.2 Home visits +EDUA: aerobic conditioning Home visits +EDUB: At home:functional strength training 8 weeks16 weeks -CRQ-Geriatric Depression Scale (GDS)-2MWT

Outcomes of home-based intervention of included studies.

Author/year/country Intervention Control Outcome
EDU BE LLE ULE Aerobic/Resistance exercise Add-on Our patient or hospital Home HRQOL Dyspnea Physical activity/Exercise capacity PF Anxiety/Depression Others
Daniel Langer/2015/America – √ – – – MTL – TFRL – – – PF: no improvement and no difference (both groups)PIMAX (inspiratory muscle strength) and Tlim (inspiratory muscle endurance)√ (TFRL>MTL) – –
Dimitra Nikoletou/2015/Britain . – √ – – – Device – No training SF-36√ (emotion, mental, health) – ISWT: No difference between groups PImax (r=0.6, P = 0.04)√ HADS√ (P = 0.03) Perception of wellbeing√ –
Fahrahnaz Mohammadi /2015/Iran √ √ √ – . – – – Drug therapy SF-12 (21.94 vs 54.63, P < 0.001) – Fatigue √FSS (21.94 vs 54.63, P < 0.001) – – BI (95.55 vs 80.88, P = 0.001) ADL:√
Marieke L Duiverman/2011/The Netherlands √ √ √ – – NIPPV – BE+LLE CRQ [96.8 (15.3) vs. 87.1 (18.9)]; P = 0.044√ MRF-28√ MRC√ GARS (−3.8 points (−7.4 to −0.4; P = 0.03))√6MWD√ (77.3 m (46.4 to 108.0; P < 0.001) FEV1√ (115 ml (19 to 211; P = 0.019)). HADS√ (−7.8 to 0.0; P = 0.05) –
María Rosa Güell/2007/Spain √ √ √ √ – – √ – CRQI:Dys:√C: All HRQOL scores were higher in hospital training – 6MWT: increased but no difference. Arm strength: had improved and not difference. PImax Both groups had improvement – –
Juliana M. de Sousa Pinto/2014/Spain – √ √ √ – – – Standard medical therapy I: SGRQ (P < 0.001) √Activity domain (P = 0.008)Impact domain (P < 0.001) I: LC-ADL (P < 0.01)√Improve breathlessnessC: No difference I 6MWD: (P = 0.008) – – –
Atsuyoshi Kawagoshi/2014/Japan – √ √ √ – Pedometer – BE+ULE+LLE (Both groups) CRQ (r = 0.540, P = 0.004)√ BODE (r = 0.656, P = 0.001) MRC:√(PR+P) (both groups) 6MWD (r = 0.401, P = 0.038) Both group: Imax√ – Qf\walking time√(PR+P)
Tristan Bonnevie/2018/France – √ √ √ – NMES – EDU+BE+ ULE+ LLE+ Muscle strength training SGRQ (P = 0.01)√ (both groups) mMRC (P < 0.01) (both groups) 6MWT: (P < 0.01) (both groups) – – –
Xujingjuan/2016/China – √ √ √ – – – BE SGRQ (P < 0.05) mMRC√, P < 0.05 6MWT, P < 0.05 – – –
Fernanda Dultra Dias/2013/Brazil √ √ √ √ – – – EDU+BE+ stretching exercises – not improved – ISWT: no difference (both groups) Respiratory endurance improved in I group. – Biweekly supervision plays important role
W-T. Liu,/2008 /Taiwan – – √ – – Music – LLE Sf-12√ Dyspnea ratingBorg scale ISWT√ – – Clinical outcomes: Endurance walking exercise compliance
Chiung-Fang Ho/2012/Taiwan – – √ – – Music – Usual care SGRQ: √ Borg scaleRPE-DResting dyspnea√Fatigue√ ISWT:√ No differential change – –
Marcel du Moulin/2009/Germany √ – √ – – – – Usual care CRQ:√(P = 0.027)CRQ (dyspnea)√ (P = 0.014)CRQ (fatigue)√ (P = 0.016) – 6MWT √ 6MWT in meters (primary end-point, p = 0.033 FEV1: P = 0.007 – –
Elizabeth J Horton/2017/UK – – √ – Resistance exercise – Center: LLE – CRQ-dyspnea√ (both groups)-7w Non-inferior – ESWT (both groups)√ Non-inferior – CRQ-emotion (within group√ Non-inferior) – .
P. de Roos/2016/Holland √ . – √ – – – Center: Medical care – – I PA: (26.1min/d, 95%CI 7.3–44.9); 6MWD: (P < 0.01) – – –
Wangxin/2013/China – – √ – – NIPPV – Drug I SGRQ (t = 11.724, P < 0.05) I Brog (t = 13.665, P < 0.05) I 6MWD (t = 6.787, P < 0.05) – – –
Cristiane O Pradella/2015/Brazil – – . √ √ – – – No intervention Decreased by >4 units in all SGRQ domains√ no difference in C group. – 6MWT (65.7 ± 83.1m vs 5.5 ± 92.9 m, P < 0.05)The endurance test (316.6 ± 81.8 m vs 31.2 ± 419.7 m, P < 0.05) – – –
Júlio C/2010/Italy √ – √ √ – – – No PR – BODE:√(H\O) no difference between the outpatient and at-home groups (P = 0.90) 6MWT √(H\O) no difference between the outpatient and at-home groups (P = 0.44)The control group no change – –
Anne E Holland/2016/Australia √ – √ √ √(aerobic) – Edu+LLE +ULE – No difference between groups – 6MWD (No difference between groups) – – –
François Maltais/2008 /America √ – – – √(aerobic) – √ – CRQ: SGRQ: All similar efficacy – 6MWT: 95%CI Similar efficacy Lung function remains stable. – –
Carol McFarland/2012/America √ – – – √(aerobic) – – EDU+function strength training CRQ (P < 0.05)√A=B Especially in dyspnea – Only group A had a clinically significant improvement in walking distance – GDS (P < 0.05) √(both A and B) –
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