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Home-Based versus Hospital-Based Pulmonary Rehabilitation

Emily Erwin, Brooke Sowards , Anna Marie Usery , and Stephanie Wilton. Home-Based versus Hospital-Based Pulmonary Rehabilitation. P: Persons with COPD in pulmonary rehabilitation I: hospital based pulmonary rehabilitation C: home-based pulmonary

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Home-Based versus Hospital-Based Pulmonary Rehabilitation

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  1. Emily Erwin, Brooke Sowards, Anna Marie Usery, and Stephanie Wilton Home-Based versus Hospital-Based Pulmonary Rehabilitation

  2. P: Persons with COPD in pulmonary rehabilitation • I: hospital based pulmonary rehabilitation • C: home-based pulmonary • O: exercise tolerance and quality of life

  3. For information on COPD… http://www.nhlbi.nih.gov/health/health-topics/topics/copd/ http://www.eurekalert.org/multimedia/pub/6727.php?from=108595

  4. Pulmonary Rehabilitation • Multidisciplinary intervention (Mendes, 2010) • Typically supervised outpatient therapy • Indicated for symptomatic, but stable patients with chronic pulmonary diseases • Goal: Increase functional capacity (Puente-maestu, 2000) • Numerous clinical benefits (Mendes, 2010)

  5. Conclusion • Moderately conclusive evidence • Home-based as effective as outpatient, hospital-based • Home-based may be a good alternative to outpatient, hospital based http://goo.gl/DZ4OYZ

  6. ProsCons Outpatient, Hospital-Based Pulmonary Rehab • Medical personnel readily available • Safer environment • More exercise equipment • Continuous patient education from staff • Motivation from fellow patients and staff • Limited access in rural areas • Limited number of patients can be treated per day • Transportation to therapy • Expensive • Patients may be less independent

  7. Home-Based Pulmonary Rehab ProsCons • Patients make similar gains • Lower cost • Patients develop home-based exercise habits • No transportation needed • Gains maintained after cessation of program • Check-ins with medical professionals • Often unsupervised • Less exercise equipment • Patient is only accountable to himself • Less patient education • Lower exercise intensity • No peer involvement

  8. Clinical Relevance • Both settings are effective • Consider each patient’s unique situation and values • Be aware that there are alternative options http://goo.gl/ktj7YP

  9. Future Research • Include more female participants • Investigate effects on broader range of severity • Longitudinal studies • Variety of home programs http://goo.gl/R7emXT

  10. Questions? http://www.dreamstime.com/royalty-free-stock-photos-question-mark-image22537418

  11. References • Güell MR, De lucas P, Gáldiz JB, et al. Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial. Arch Bronconeumol. 2008;44(10):512-8. • MaltaisF, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149(12):869-78. • Mendes de oliveira JC, Studartleitãofilho FS, Malosasampaio LM, et al. Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial. MultidiscipRespir Med. 2010;5(6):401-8. • StrijbosJH, Postma DS, Van altena R, Gimeno F, Koëter GH. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest. 1996;109(2):366-72.

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