1. BELLARMINE UNIVERSITY, LOUISVILLE, KY Home-Based versus Hospital- Based Pulmonary Rehabilitation Emily Erwin, Brooke Sowards, Anna Marie Usery, and Stephanie Wilton

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY P: Persons with COPD in pulmonary rehabilitation I: hospital based pulmonary rehabilitation C: home-based pulmonary O: exercise tolerance and quality of life

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY http://www.nhlbi.nih.gov/health/health-topics/topics/copd/ http:// www.eurekalert.org/multimedia/pub/6727.php?from=108595 For information on COPD…

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY Pulmonary Rehabilitation Multidisciplinary intervention (Mendes, 2010) Typically supervised outpatient therapy Indicated for symptomatic, but stable patients with chronic pulmonary diseases Goal: Increase functional capacity (Puente- maestu, 2000) Numerous clinical benefits (Mendes, 2010)

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY Study Title Type of Study # of Subjects SexAgeSmoking History Study 1 (Güell, 2008) Randomized Outcomes Research 51All males50-75All Study 2 (Mendes, 2010) RCT21675% malesMean = 69Some Study 3 (Strijbos, 1996) RCT4585% malesMean = 60Some Study 4 (Maltais, 2008) Randomized Outcomes Research 252Males and FemalesMean = 66All

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY Study TitleFrequency Length of Program InterventionHome Supervision Long Term Follow-up Study 1 (Güell, 2008) 3 per week9 weeks UE/LE strengthening, aerobic, respiratory exercises, pt education NoYes Study 2 (Mendes, 2010) 3 per week12 weeks UE/LE strengthening, aerobic, stretching, pt education No Study 3 (Strijbos, 1996) Hospital: 2 per week Home: 3 per week 12 weeks Pt education, exercise protocol not reported Yes Study 4 (Maltais, 2008) 3 per week8 weeks Aerobic, strengthening, pt education NoYes

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY Study TitleVariables AssessedOutcome Measures Study 1 (Güell, 2008) Exercise tolerance HRQOL Max Inspiratory & Expiratory Pressure Timed Arm Curls 6MWT Chronic Respiratory Questionnaire Study 2 (Mendes, 2010) Exercise capacity FEV 1 Dyspnea BMI 6MWT BODE Index Study 3 (Strijbos, 1996) Exercise performance Dyspnea Leg effort during exercise Overall well-being Physiological measures 4MWT Cycle Ergometer Test Borg’s RPE Study 4 (Maltais, 2008) Exercise tolerance Dyspnea Airflow Limitations 6MWT Cycle Ergometer Test Chronic Respiratory Questionnaire St. George’s Respiratory Questionnaire

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Study TitleHospital Group ResultsHome Group ResultsConclusions Study 1 (Güell, 2008) Improved and maintained gains in all outcome measures Improved and maintained gains in exercise tolerance and dyspnea domain Greater HRQOL improvements in hospital groups; all other measures equal Study 2 (Mendes, 2010) Improved in all outcome measures No difference in gains made between hospital and home groups Study 3 (Strijbos, 1996) Improved in all outcome measures, gains not maintained Improved and maintained gains in 4MWT and cycle ergometer Improved in RPE, gains not maintained Similar gains made in both hospital and home groups; home groups maintained gains longer than hospital group. Study 4 (Maltais, 2008) Improved in all outcome measures No difference in gains made between hospital and home groups

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusion Moderately conclusive evidence Home-based as effective as outpatient, hospital-based Home-based may be a good alternative to outpatient, hospital based http://goo.gl/DZ4OYZ

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY Outpatient, Hospital-Based Pulmonary Rehab Medical personnel readily available Safer environment More exercise equipment Continuous patient education from staff Motivation from fellow patients and staff Limited access in rural areas Limited number of patients can be treated per day Transportation to therapy Expensive Patients may be less independent Pros Cons

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Home-Based Pulmonary Rehab Patients make similar gains Lower cost Patients develop home- based exercise habits No transportation needed Gains maintained after cessation of program Check-ins with medical professionals Often unsupervised Less exercise equipment Patient is only accountable to himself Less patient education Lower exercise intensity No peer involvement Pros Cons

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY Clinical Relevance Both settings are effective Consider each patient’s unique situation and values Be aware that there are alternative options http://goo.gl/ktj7YP

13. BELLARMINE UNIVERSITY, LOUISVILLE, KY Future Research Include more female participants Investigate effects on broader range of severity Longitudinal studies Variety of home programs http://goo.gl/R7emXT

14. BELLARMINE UNIVERSITY, LOUISVILLE, KY Questions? http://www.dreamstime.com/royalty-free-stock-photos-question-mark-image22537418

15. BELLARMINE UNIVERSITY, LOUISVILLE, KY References Güell MR, De lucas P, Gáldiz JB, et al. Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial. Arch Bronconeumol. 2008;44(10):512-8. Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149(12):869-78. Mendes de oliveira JC, Studart leitão filho FS, Malosa sampaio LM, et al. Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial. Multidiscip Respir Med. 2010;5(6):401-8. Strijbos JH, Postma DS, Van altena R, Gimeno F, Koëter GH. A comparison between an outpatient hospital- based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest. 1996;109(2):366-72.