Home-based pulmonary rehabilitation in chronic obstructive pulmonary disease patients.

PURPOSE OF REVIEW Home-based pulmonary rehabilitation programs have been proposed as an alternative to hospital-based programs for patients with chronic obstructive pulmonary disease (COPD). We undertook a systematic review of randomized studies on home-based pulmonary rehabilitation in patients with COPD which report health-related quality of life and/or exercise capacity, in order to assess the benefits of this intervention. MAIN FINDINGS From 888 identified references, 12 met the inclusion criteria. Overall, the methodological quality of the studies was average to poor. Eight studies compared home-based rehabilitation to standard care, three compared home-based rehabilitation to hospital-based programs and one included both comparisons. Most of the studies showed improvement in health-related quality of life (statistically and clinically significant) and exercise capacity following home-based rehabilitation as compared with standard care (no pulmonary rehabilitation). Studies that compared home-based pulmonary rehabilitation with hospital-based outpatient programs have not been able to show statistically and clinically significant differences for health-related quality of life and exercise capacity. Adverse events, usually mild, were reported in only two studies. SUMMARY Self-monitored, home-based rehabilitation may be an alternative to outpatient rehabilitation. These findings can help expand the recognition, application and accessibility of pulmonary rehabilitation for patients with COPD.