Home-based pulmonary rehabilitation delivered equivalent gains in 6-minute walk distance compared to center-based rehabilitation (MD -0.42 m; 95% CI -21.74 to 20.89; p=0.0033 for equivalence).
Meta-Analysis (n=396)
Does home-based pulmonary rehabilitation preserve functional benefit and improve completion compared to center-based pulmonary rehabilitation in adults with chronic respiratory diseases?
Home-based pulmonary rehabilitation delivers equivalent functional gains in 6-minute walk distance compared to center-based programs, while likely improving program completion rates.
Effect estimate: MD -0.42 m (95% CI -21.74 to 20.89)
p-value: p=0.0033
Abstract Rationale Center-based pulmonary rehabilitation (PR) improves outcomes, but access and adherence are limited. Whether home-based PR preserves functional benefit while improving completion across mixed chronic respiratory diseases is clinically important. Objectives To compare home-based with center-based PR for (1) change in 6-minute walk distance (6MWD) using a prespecified equivalence framework and (2) program completion. Methods Randomized trials directly comparing home-based (including tele-supported) and center-based PR were pooled. The primary endpoint was end-of-program change in 6MWD. Equivalence margin: ±30 m. Random-effects (REML) models estimated pooled mean differences (MD) with 95% CIs and prediction intervals (PI); equivalence was tested with two one-sided tests (TOST). Hartung-Knapp (HK) adjustment was used as a conservative sensitivity model. Completion was synthesized as risk ratio (RR; Mantel-Haenszel). We report pooled control completion risk, absolute risk difference (ARD), and number-needed-to-treat (NNT). Heterogeneity was summarized with I². Results Three RCTs were included (k = 3).6MWD: Pooled MD (home − center) −0.42 m (95% CI − 21.74 to 20.89; I²=55.2%); PI − 35.10 to 34.26 m. TOST supported equivalence within ±30 m (p = 0.0033). With HK, the MD was unchanged but the CI widened to − 47.78 to 46.94 m, yielding an inconclusive equivalence inference under that conservative model.Completion: Across 396 participants (193 home; 203 center), fixed-effect RR was 1.45 (95% CI 1.28-1.65). Random-effects with HK: RR 1.46 (95% CI 0.72-2.94); I²=86.5%; PI ∼0.80-2.70. The pooled control completion risk was 58.6%. Using the point estimate, ARD was +26.9% and NNT ≈ 3.7, acknowledging the wide random-effects/HK uncertainty. Conclusions In adults with chronic respiratory diseases, home-based PR delivers 6MWD gains equivalent to center-based PR using a ± 30 m margin under standard random-effects modeling; HK widens uncertainty but does not suggest inferiority. Completion is likely higher with home-based PR, though the magnitude varies across implementations (high heterogeneity). Programs struggling with uptake can consider structured home pathways to maintain functional benefit while improving adherence. Future trials should standardize completion definitions, report responder outcomes, and detail implementation components (e.g., coaching intensity, remote monitoring) to explain heterogeneity and guide scale-up. This abstract is funded by: None
Patel et al. (Fri,) conducted a meta-analysis in chronic respiratory diseases (n=396). Home-based pulmonary rehabilitation vs. Center-based pulmonary rehabilitation was evaluated on end-of-program change in 6-minute walk distance (6MWD) (MD -0.42 m, 95% CI -21.74 to 20.89, p=0.0033). Home-based pulmonary rehabilitation delivered equivalent gains in 6-minute walk distance compared to center-based rehabilitation (MD -0.42 m; 95% CI -21.74 to 20.89; p=0.0033 for equivalence).