Feasibility and Effects of a Home-Care Rehabilitation Program in Patients With Chronic Obstructive Pulmonary Disease

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Abstract
Pulmonary rehabilitation programs often show beneficial effects in patients with chronic obstructive pulmonary disease (COPD). These programs are usually hospital-based. This study assesses the feasibility and application of a 12-week Home-Care Rehabilitation Program (HCRP), carried out by general practitioners, physiotherapists, and home-care nurses. Effects of the HCRP are assessed in 15 COPD patients with moderate to severe airflow limitation (inspiratory vital capacity [IVC]: mean, 75.4 [SD, 13.7] percent predicted, mean FEV1: 45.5 [6.9] percent predicted) and are compared with a stratified and randomized control group (n = 15). All participating disciplines judged the program to be useful and feasible. Patient compliance with the rehabilitation exercises was high. No major problems concerning the rehabilitation program were reported. After the HCRP, 4-minute walking distance improved significantly from 274 m [61] to 301 m [72] and maximal work load (W max), as measured during an incremental cycle test, increased from 75.3 W [24] to 85.3 W [28]. At equal work levels (W submax) during the cycle test both Borg dyspnea and leg effort scores decreased significantly after the HCRP (6.7 [1.3] versus 4.9 [1.7] and 4.2 [2.0] versus 1.7 [2.5], respectively). Changes in walking distance, dyspnea, and leg effort scores at W submax were significantly different between the two groups. IVC and FEV1 did not change significantly. In the control group, no significant changes in any parameter were observed. It was possible to design and perform successfully a home-care rehabilitation program, providing both objective and subjective improvements in a group of patients with COPD. A home-care rehabilitation program appears to be a valuable component in the management of COPD patients with a moderate to severe airflow limitation.