To examine the effects of DVD exercises on exercise tolerance in participants of the Canterbury home-based pulmonary rehabilitation programme
Degree GrantorUniversity of Canterbury
Degree NameMaster of Health Sciences
The pulmonary rehabilitation programme is an evidence-based intervention to treat and manage people living with long-term breathing conditions, mainly chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation is a structured eight-week long programme, which requires participants to attend the programme twice a week, for two hours each session. The two-hour session is broken down to one hour of exercise and one hour of education. The literature suggests that the pulmonary rehabilitation is useful in improving self-management skills, improving fitness levels, and reducing social isolation to the people living with chronic respiratory illnesses. Despite the strong evidence behind pulmonary rehabilitation, the programme is still not well utilised by health professionals and people living with chronic respiratory illnesses. There are many reasons for not participating in a pulmonary rehabilitation programme, such as not understanding the content of pulmonary rehabilitation, transportation difficulties, or work commitments. This study helped the pulmonary rehabilitation governance group to explore a different delivery model and evaluate the effect of this alternative pulmonary rehabilitation delivery model: the home-based pulmonary rehabilitation.
Participants (n= 21, 11 males: 10 females, mean age of 68.76 years, 71% of the participants identified themselves as New Zealand European and 14% identified as Māori) were recruited from the existing pool of withdraw referrals, that is people who had been referred to the programme but never attended or completed a programme. These participants had been offered pulmonary rehabilitation in the past but either declined or had been unable to participate in a programme. All the participants received a home visit from the physiotherapist for assessments, education, and to set up the DVD exercise regime. The home-based programme lasted for eight weeks and each participant received a weekly telephone call from a health professional to check on the participant’s exercise progress. The Chronic Respiratory Questionnaire (CRQ), COPD Assessment Tool Score (CATS) and EQ-5D questionnaires were used to evaluate the quality of life and self-management before and after the home-based programme. The Hospital Anxiety and Depression Scale (HADS) was used to assess participants’ psychological wellbeing. Finally, one-minute sit-to-stand tests were carried out before and after the programme to identify any change in the participant’s exercise tolerance. The collected data were analysed and compared to the control, centre-based pulmonary rehabilitation data, using a 2-tail t-test to determine statistical significant difference.
The home-based pulmonary rehabilitation programme performed no worse than the gold standard centre-based pulmonary rehabilitation in the majority of the outcome measures used. The home-based pulmonary rehabilitation was better at reaching out to younger, male, and Māori participants when compared to the control, the centre-based pulmonary rehabilitation. The majority of the primary and secondary outcome measures showed that the home-based pulmonary rehabilitation performed as well as the control, the centre-based pulmonary rehabilitation programme, in making significant improvements. But in fatigue management, exercise tolerance, and EQ-5D, the control, centre based group was able to achieve superior outcomes when compared to the home-based pulmonary rehabilitation.
This study has successfully demonstrated that the home-based pulmonary rehabilitation is an effective alternative to the gold standard centre-based pulmonary rehabilitation when managing people living with COPD. Despite the fact that the home based group participants were recruited from a less favourable pool of participants, the withdrawals, the home-based pulmonary rehabilitation was an enabler to positive and significant improvement to the participants in all outcome measures. The main weaknesses of the home-based pulmonary rehabilitation lies with the reduced clinician supervision of the participant’s exercise regime and the lack of social interaction in this delivery model. The author believes, however, that with continuous service review, research and development, these weaknesses can eventually be effectively managed and minimised.