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Vol. 44. Issue 10.
Pages 512-518 (January 2008)
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Vol. 44. Issue 10.
Pages 512-518 (January 2008)
Original Articles
DOI: 10.1016/S1579-2129(08)60096-8
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Home vs Hospital-Based Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease: A Spanish Multicenter Trial
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María Rosa Güella,
Corresponding author
mguellr@santpau.es

Correspondence: Dra M.R. Güell Departament de Pneumologia, Hospital de la Santa Creu i Sant Pau Pare Claret, 167 08025 Barcelona, Spain
, Pilar de Lucasb, Juan Bautista Gáldizc, Teodoro Montemayord, José Miguel Rodríguez González-Morob, Amaia Gorostizac, Francisco Ortegad, José M. Bellónb, Gordon Guyatte
a Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Hospital Gregorio Marañón, Madrid, Spain
c Hospital de Cruces, Baracaldo, Vizcaya, Spain
d Hospital Virgen del Rocío, Sevilla, Spain
e McMaster University, Hamilton, Ontario, Canada
Article information
Objective

To compare the effects of a simple home pulmonary rehabilitation program and an intensive hospital-based program in terms of the exercise tolerance and health-related quality of life (HRQOL) of patients with severe chronic obstructive pulmonary disease (COPD).

Patients and Methods

Patients in this prospective, multicenter trial were randomized to 2 groups to receive hospital or home pulmonary rehabilitation. Patients in both groups attended 2 informative sessions about the disease and 4 physical therapy sessions. Patients in the hospital group then carried out a structured exercise program while home group patients performed low intensity exercises at home without supervision.

Results

Twenty-eight patients were randomized to the hospital rehabilitation group and 23 to the home group. Both groups improved on the 6-minute walk test (mean difference, 8.7 m; P =.61). HRQOL measured with the Chronic Respiratory Questionnaire also improved in both groups, but the change was greater on the domain of emotional function in the hospital rehabilitation group (mean difference between groups, 0.58 on a scale for which the smallest clinically relevant difference is 0.5 points). The benefits were maintained in both groups 6 months after the programs ended.

Conclusions

This study demonstrates that the improvement in exercise tolerance achieved by COPD patients with an unsupervised home pulmonary rehabilitation program is similar to the gains of patients in an intensive hospital-based program. However, the hospital program afforded greater benefit on the HRQOL domain of emotional function.

Key words:
COPD
Exercise tolerance
Health-related quality of life
Pulmonary rehabilitation, home care services
Pulmonary rehabilitation, hospital-based
Objetivo

Estudiar el impacto de un programa simple de rehabilitación respiratoria domiciliario, comparado con uno intensivo hospitalario, sobre la capacidad de esfuerzo y la calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad pulmonar obstructiva crónica.

Pacientes Y Métodos

Se ha realizado un estudio prospectivo y multicéntrico en el que se aleatorizó a pacientes con EPOC grave en 2 grupos: hospital (GH) o domicilio (GD). En ambos los pacientes recibieron 2 sesiones de educación y 4 de fisioterapia. Los del GH realizaron un programa estructurado de ejercicio en el hospital y los del GD, un programa de ejercicio de baja intensidad en el domicilio, sin supervisión.

Resultados

Se aleatorizó a 28 pacientes en el GH y a 23 en el GD. Ambos grupos mostraron una mejoría similar en la prueba de la marcha de 6 min (diferencia media de 8,7 m; p = 0,61). A pesar de que en ambos grupos mejoró la CVRS, medida con el Cuestionario de Enfermedad Respiratoria Crónica (CRQ), se objetivó un incremento mayor en el área de función emocional para el GH (diferencia media entre grupos: 0,58, en una escala donde un valor de 0,5 representa la diferencia mínima importante). Los beneficios del programa se mantuvieron en ambos grupos hasta 6 meses después de finalizarlo.

Conclusiones

El estudio muestra que un programa domiciliario de rehabilitación respiratoria sin supervisión produce una mejoría similar en la capacidad de esfuerzo de los pacientes con EPOC que un programa intensivo hospitalario. Sin embargo, éste alcanza mayores beneficios en el área de la función emocional de la CVRS.

Palabras clave:
EPOC
Capacidad de esfuerzo
Calidad de vida relacionada con la salud
Programa domiciliario de rehabilitación respiratoria
Programa hospitalario de rehabilitación respiratoria
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This study was partially funded by a grant from the Breathe Network, a thematic network for cooperative research of the Carlos III Health Institute (RTICISCIII-Red Respira).

Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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