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Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial

Anderson José, Anne E. Holland, Jessyca P.R. Selman, Cristiane Oliveira de Camargo, Diogo Simões Fonseca, Rodrigo A. Athanazio, Samia Z. Rached, Alberto Cukier, Rafael Stelmach, Simone Dal Corso
ERJ Open Research 2021 7: 00021-2021; DOI: 10.1183/23120541.00021-2021
Anderson José
1Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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  • For correspondence: dr.andersonjose@gmail.com
Anne E. Holland
2Physiotherapy, Alfred Health, Melbourne, Australia
3Allergy, Immunology and Respiratory Medicine, Institute for Breathing and Sleep, Monash University, Melbourne, Australia
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Jessyca P.R. Selman
4Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo-SP, Brazil
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Cristiane Oliveira de Camargo
4Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo-SP, Brazil
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Diogo Simões Fonseca
5Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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Rodrigo A. Athanazio
6Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
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Samia Z. Rached
6Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
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Alberto Cukier
6Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
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Rafael Stelmach
6Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
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Simone Dal Corso
4Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo-SP, Brazil
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  • Article
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  • FIGURE 1
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    FIGURE 1

    Consolidated standards of reporting trials participant disposition. HBPR: home-based pulmonary rehabilitation; PR: pulmonary rehabilitation.

Tables

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  • TABLE 1

    Baseline characteristics of participants

    ControlHBPRp-value
    Participants3033
    Female18 (60)16 (48.5)0.360
    Age years49.27±14.1044.42±16.160.209
    BMI kg·m−224.02±2.9123.96±2.560.933
    MRC score2.90±0.922.48±1.030.097
    Aetiology
     Idiopathic15 (50)7 (21)
     Recurrent pneumonia6 (20)9 (27)
     Gastro-oesophageal reflux disease4 (13)1 (3)
     Other causes5 (17)16 (49)
    MRC score0.366
     11 (3.3)6 (18.2)
     210 (33.3)11 (33.3)
     311 (36.7)11 (33.3)
     47 (23.3)4 (12.1)
     51 (3.3)1 (3.0)
    FACED score2.50±1.042.27±1.230.431
     Mild/moderate severity15 (50)/15 (50)16 (49)/17 (51)
    E-FACED score2.57±1.192.45±1.370.730
     Mild/moderate severity24 (80)/6 (20)26 (79)/7 (21)0.905
     Pseudomonas colonisation14 (46.7)10 (30.3)0.189
    FVC L2.35±0.812.59±0.970.296
    FVC % pred68.90±20.5772.30±21.890.527
    FEV1 L1.37±0.561.63±0.840.151
    FEV1 % pred51.21±0.5655.15±27.190.535
    FEV1/FVC59.09±14.3061.47±16.490.542
    ISWT m433.79±145.74477.40±196.880.319
    ESWT min8.22±6.878.14±6.900.961
    MIST total steps115.92±71.74141.94±93.890.230
    Daily steps6045±27317340±47540.186
    Quadriceps strength kg-force26.46±12.1526.52±10.760.983

    Data are presented as n, n (%) or mean±sd, unless otherwise stated. HBPR: home-based pulmonary rehabilitation; BMI: body mass index; MRC: Medical Research Council dyspnoea scale; FACED: forced expiratory volume in 1 s (FEV1), age, chronic colonisation by Pseudomonas aeruginosa, radiological extension and dyspnoea; E-FACED: FACED criteria plus exacerbation; FVC: forced vital capacity; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walk test; MIST: modified incremental step test.

    • TABLE 2

      Change in clinical differences from baseline to 2 months and follow-up (6 months)

      Within-group differences from baseline (95% CI)Between-group differences
      HBPR (n=33)Control (n=30)HBPR minus control
      End rehabilitation minus baseline (n=27)6 months minus end rehabilitation (n=19)End rehabilitation minus baseline (n=28)6 months minus end rehabilitation (n=18)End rehabilitation minus baseline6 months minus end rehabilitation
      ISWT m60.94±119.79 (21.84–100.04)*−32.39±50.63 (−80.08–10.49)−26.97±80.15 (−65.37–11.42)31.55±131.74 (−13.67–78.85)87.91 (32.98–142.85)#−63.94 (−129.87–1.99)
      ESWT min4.62±5.43 (2.88–6.35)*−0.14±3.82 (−2.88–2.60)0.26±3.34 (−1.44–1.96)0.43±7.47 (−2.38–3.25)4.36 (1.93–6.79)#−0.57 (−4.50–3.35)
      MIST total steps66.11±87.86 (38.80–93.42)*−32.73±54.08 (−54.30– −11.16)¶−15.24±40.47 (−42.02–11.54)−3.99±28.46 (−28.45–20.47)81.35 (43.10–119.60)#−28.74 (−61.35–3.88)
      Daily steps735.76±3114.20 (−275.40–1746.61)−815.90±4359.73 (−2501.33–869.54)−592.70±2032.41 (−1585.63–400.24)−834.05±2614.79 (−2565.67–897.57)1328.45 (−88.72–2745.61)−18.15 (−2398.30–2434.59)
      Quadriceps strength kg-force4.90±7.63 (2.24–7.56)*−3.06±8.67 (−6.78–0.66)−0.82±6.09 (−3.43–1.79)−0.24±7.19 (−4.07–3.58)5.72 (1.99–9.45)#−2.82 (−8.15–2.51)

      Data are presented as mean±sd (95% CI). HBPR: home-based pulmonary rehabilitation; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walk test; MIST: modified incremental step test. *: p<0.05 versus baseline; #: p<0.05 between groups; ¶: p<0.05 versus end rehabilitation.

      • TABLE 3

        Change in quality of life differences from baseline to 2 months and follow-up (6 months)

        Within-group differences from baseline (95% CI)Between-group differences
        HBPR (n=33)Control (n=30)HBPR minus control
        End rehabilitation (n=27)6 months (n=19)End rehabilitation (n=28)6 months (n=18)End rehabilitation6 months
        QoL-B (physical)10.30±18.05 (2.79–17.80)*−10.11±18.78 (−18.26– −1.95)#−1.15±20.73 (−8.66–6.36)−1.76±15.94 (−10.39–6.86)11.44 (0.83–22.06)¶−8.34 (−20.21–3.53)
        QoL-B (role)11.30±12.85 (4.84–17.76)*−5.58±12.74 (−11.09– −0.07)#−0.22±19.87 (−6.69–6.24)−1.24±10.67 (−7.06–4.59)11.52 (2.38–20.66)¶−4.34 (−12.36–3.67)
        QoL-B (vitality)0.37±15.90 (−5.85–6.59)−11.79±16.74 (−19.18– −4.40)#−1.00±16.29 (−7.22–5.22)−2.24±14.81 (−10.05–5.58)1.37 (−7.42–10.16)−9.55 (−20.31–1.21)
        QoL-B (emotional)3.52±12.34 (−1.08–8.12)−0.89±12.98 (−5.83–7.62)−3.63±11.46 (−8.23–0.97)−4.41±15.90 (−11.52–2.70)7.15 (0.65–13.65)¶5.31 (−4.48–15.10)
        QoL-B (social)1.26±26.41 (−7.83–10.35)1.68±17.82 (−7.24–10.61)−3.41±20.28 (−12.50–5.68)−0.06±20.53 (−9.49–9.38)4.67 (−8.19–17.52)1.74 (−11.24–14.73)
        QoL-B (treatment burden)−5.30±25.15 (−15.10–4.51)5.68±19.69 (−4.92–16.29)−0.07±25.63 (−9.88–9.73)−2.71±25.76 (−13.92–8.51)−5.22 (−19.09–8.64)8.39 (−7.04–23.82)
        QoL-B (health)−2.63±17.71 (−9.05–3.79)9.84±18.64 (1.73–17.96)#−1.15±15.44 (−7.57–5.26)8.65±15.91 (0.07–17.23)#−1.48 (−10.56–7.59)1.20 (−10.62–13.01)
        QoL-B (respiratory)3.04±11.31 (−1.93–8.00)−4.68±11.33 (−10.26–0.89)−0.56±14.23 (−5.52–4.41)−7.88±2.62 (−13.78– −1.99)#3.59 (−3.43–10.61)3.20 (−4.91–11.31)

        Data are presented as mean±sd (95% CI). HBPR: home-based pulmonary rehabilitation; QoL-B: Quality of Life Questionnaire Bronchiectasis. *: p<0.05 versus baseline; #: p<0.05 versus end rehabilitation; ¶: p<0.05 between groups.

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        Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial
        Anderson José, Anne E. Holland, Jessyca P.R. Selman, Cristiane Oliveira de Camargo, Diogo Simões Fonseca, Rodrigo A. Athanazio, Samia Z. Rached, Alberto Cukier, Rafael Stelmach, Simone Dal Corso
        ERJ Open Research Apr 2021, 7 (2) 00021-2021; DOI: 10.1183/23120541.00021-2021

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        Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial
        Anderson José, Anne E. Holland, Jessyca P.R. Selman, Cristiane Oliveira de Camargo, Diogo Simões Fonseca, Rodrigo A. Athanazio, Samia Z. Rached, Alberto Cukier, Rafael Stelmach, Simone Dal Corso
        ERJ Open Research Apr 2021, 7 (2) 00021-2021; DOI: 10.1183/23120541.00021-2021
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