Published randomised clinical trials (RCTs) that compared home-based rehabilitation with a comparator, standard care (no pulmonary rehabilitation) or pulmonary rehabilitation in any other setting, in patients (aged at least 40) with chronic obstructive pulmonary disease (COPD) were eligible for inclusion. TO be included, trials had to have at least one treatment arm involving a home-based rehabilitation regime with lower-limb endurance exercise training and a minimum duration of four weeks or 12 sessions. Trials where the training was aimed at maintaining effects from in-patient or out-patient rehabilitation programs, or where the training was not completed solely at home, were excluded.
Outcomes of interest were health-related quality of life, exercise capacity as measured by field tests (six-minute walking test, shuttle walking test) or laboratory tests (incremental exercise test, endurance test, step test), dyspnea, muscle strength, exacerbation rate and hospital admissions.
Participants in included trials were aged 60 years or more with severe COPD (GOLD stage three or four) who were clinically stable. Most included trials were of short duration (six months or less). Included trials compared home-based rehabilitation with hospital-based rehabilitation, home-based rehabilitation with standard-care (no additional treatment apart from education and lifestyle advice); one trial included both comparisons. Home-based training programs were mostly of eight weeks duration or more, with three sessions or more per week for at least 30 minutes per session; they included endurance training such as walking, cycling and/or climbing stairs.
One reviewer selected the studies for the review; cases where inclusion was in doubt were discussed with a second reviewer.