Tailored patient self-management and supervised, home-based, pulmonary rehabilitation for mild and moderate chronic obstructive pulmonary disease

Abstract

[Purpose] Our study aimed to estimate the effects of a supervised, intensive, home-based-pulmonary-rehabilitation (HBPR) program for mild and moderate chronic-obstructive-pulmonary-disease (COPD) patients. [Participants and Methods] A retrospective, case-control study. Forty-three (N=43) patients were observed, divided into Treatment-Group (TG) and Control-Group (CG). The TG (N=23) underwent a 4-week training program, consisting of endurance and strength training sessions, performed 4-times per week. In addition, inspiration muscle training was performed, with a threshold device. The primary outcome was dyspnea improvements, measured by the modified-Borg-scale (mBS), and the secondary outcome was the determination of diaphragm excursion and function, using ultrasound (US) assessment to measure clinical parameters. [Results] The results suggested significantly improved mBS scores, measured for the ΔT0-T1 and ΔT0-T2 time points; improved diaphragm-excursion (Dia-Ex) at ΔT0-T1 and ΔT0-T2; and improved maximum Dia-Ex at ΔT0-T1 and ΔT1-T2 in the TG compared with the CG. Moreover, the results showed improvements over time for all parameters in the TG versus CG, suggesting a constant improvement in respiratory pathology. [Conclusion] A supervised HBPR plan was effective in reducing dyspnea by the mBS, and improving diaphragmatic function, as determined by US evaluation, and lastly improving quality of life in patients with mild-to-moderate COPD.

Keywords: Quality of life; Rehabilitation; Ultrasound.

Fig. 1.

Home-based exercises for upper limbs. Exercises to strengthen the upper arm muscles (biceps, triceps, deltoids, trapezius, latissimus dorsi); 1–2: abduction-adduction exercises of the shoulder; 3–4: flexion exercises of the shoulder; 5–6: flexion exercises of the elbow (All the exercises illustrated must be performed with shoes with a rubber sole for patient safety).

Fig. 2.

Home-based exercises for lower limbs. Exercises to strengthen lower limb muscles (quadriceps, gluteal muscles); 1–3: flexion-extension exercises of the knee (All the exercises illustrated must be performed with shoes with a rubber sole for patient safety).

Fig. 3.

Flow diagram of the study, according to CONSORT guidelines.

Fig. 4.

Interaction plot between groups showing diaphragmatic excursions over time.