Patient choice and uptake of Home-based rehabilitation with Health coaching versus Center-based pulmonary rehabilitation after a COPD-related hospitalization

Rationale Adherence to center-based pulmonary rehabilitation after a COPD-related hospitalization—which improves all outcomes, including survival—is only 3%. Home-based programs have been proposed as a more feasible option, but they are not systematically offered, and patient preference is unknown. Objectives and Methods This pragmatic randomized trial involving patients with COPD recently hospitalized for a COPD exacerbation, originally aimed to investigate the comparative effect two arms: The choice of a facilitated referral to a center-based outpatient pulmonary rehabilitation program or a home-based program versus a home-based program on adherence to post-hospitalization rehabilitation and disease-specific QoL measured by the Chronic Respiratory Questionnaire. The trial aimed to investigate the patient’s preference of home vs center-based rehabilitation in individuals randomized to the choice arm. Daily steps were measured by Actigraph ®. The asynchronous home-based program included weekly health coaching and daily monitoring of daily steps, symptoms, and a 20-minute daily flexibility-balance exercise routine. Results Of 1,906 patients approached, 294 (15%) were randomized and agreed to the rehabilitation options offered by the study arms (uptake); of those, 56% completed the 12-week intervention (adherence). Of the 145 randomized to the choice arm, only one patient chose center-based PR; therefore, both groups received the same intervention, and results are presented as a one-group (before–after) analysis. Compared with baseline, the home intervention significantly improved (p < 0.01) physical and emotional QoL (Chronic Respiratory Questionnaire) and increased daily steps beyond the minimal clinically important difference. Trajectory models adjusted for age, FEV1%, and mMRC (breathlessness) confirmed sustained improvements in QoL at 6 and 12 months from baseline. Conclusions When offered a choice of rehabilitation setting after a COPD-related hospital admission for an exacerbation, home-based rehabilitation is patients’ preferred option. Sustained quality-of-life improvements in 1 year may represent an opportunity to regain well-being and/or deliver primary palliative care. Our results may have important implications for clinical practice.