A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD
Authors Cameron-Tucker H, Wood-Baker R, Joseph L, Walters J, Schuz N, Walters EH
Received 4 April 2016
Accepted for publication 27 June 2016
Published 25 August 2016 Volume 2016:11(1) Pages 1991—2000
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Professor Hsiao-Chi Chuang
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Helen Laura Cameron-Tucker,1 Richard Wood-Baker,1 Lyn Joseph,1 Julia A Walters,1 Natalie Schüz,2 E Haydn Walters1
1Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, 2School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
Purpose: With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR.
Patients and methods: People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors.
Results: Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points.
Conclusion: Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.
Keywords: pulmonary rehabilitation, physical capacity, self-reported walking, structured self-management-based education, exercise
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