Effect of home-based pulmonary rehabilitation in patients with interstitial lung disease in a tertiary care centre – a stratified randomized controlled trial
Keywords:
Interstitial lung disease, Pulmonary rehabilitation, 6-Minute walk test, rct, k-bildAbstract
Background and aim:
Interstitial lung disease causes functional limitation and exercise intolerance. Although pulmonary rehabilitation in ILD can improve physical function and quality of life, multiple factors hinder its utilisation including lack of facilities, mobility, caregivers and cost. Therefore, alternative models such as home-based pulmonary rehabilitation are required to bridge the gap between guidelines and practice. We explored whether a 12-week home-based pulmonary rehabilitation program could improve the functional capacity of ILD patients as measured by 6MWD when compared to conventional drug therapy alone.
Methods:
Patients suffering from ILD attending a tertiary hospital in South-India were stratified according to disease sub-type and randomised. A structured 12-weeks home-based pulmonary rehabilitation consisting of exercise training, health education, nutritional and psychological support was provided to the intervention arm. Conventional drug therapy was continued in both arms. Change in 6MWD and FVC, K-BILD and HADS scores were measured at the end of 12 weeks. The results were analysed for determining factors responsible for the change in health status indicators.
Results:
At the end of 12 weeks, 6MWD and K-BILD scores alone showed statistically significant improvement in intervention arm when compared to controls. However, it did not reach the MCID for either parameter. Spirometry and HADS score had no significant improvement in either arm. Patients not provided pulmonary rehabilitation had an 81% reduction in the odds of improving their 6MWD and 86% reduction in odds of improving their K-BILD score at the end of 12 weeks. Those with lower baseline K-BILD scores were found to fare better with home-based pulmonary rehabilitation.
Conclusions
Home based pulmonary rehabilitation is an effective tool in improving 6MWD and K-BILD scores: measures of functional capacity and QoL respectively, among ILD patients irrespective of the ILD etiology, presence of pulmonary hypertension, LTOT requirement or duration to initiation of PR.
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