{
  "abstract": "Background Pulmonary rehabilitation (PR) is a highly evidenced intervention that improves exercise capacity and health-related quality of life. The BTS Clinical Statement recommends that all eligible individuals are preferentially offered a centre-based PR programme, with home-based programmes offered as an alternative for those unable or unwilling to attend a centre-based programme.Aim To compare the effectiveness of PR between centre-based and home-based programmes using a National Respiratory Audit Programme (NRAP) dataset.Methods 52,669 individuals with COPD entered into the NRAP were assessed for PR from March 2019–September 2023 and completed a programme. Generalised linear mixed models with a logit link function were used to explore the programme types associated with PR effectiveness. PR effectiveness was determined by meeting an established minimal clinically important difference (MCID). Models were adjusted for age, gender, ethnicity, Medical Research Council dyspnoea grade and index of multiple deprivation quintile. Outcomes of effectiveness were exercise capacity (incremental shuttle walk test and six-minute walk test combined, with MCIDs of ≥35m and ≥30m respectively), endurance (endurance shuttle walk test, MCID ≥174 seconds) and health related quality of life (HRQoL) (COPD assessment test and Chronic Respiratory Questionnaire combined, with MCIDs of reduction of ≥2 points and increase of ≥2 points respectively). Meeting the MCID after completing a centre-based or home-based PR programme was binary (yes/no).Results The MCID was achieved more frequently in centre-based programmes than home-based programmes for exercise capacity (centre: 61.37% (n=21,823/35,560); home: 48.36% (n=1,178/2,436) p<0.01), endurance (centre: 48.37% (n=1,588/3,283); home: 38.55% (n=101/262) p<0.01), and HRQoL (centre: 61.90% (n=22,313/36,047); home: 59.89% (n=6,042/10,088) p<0.01). Individuals were significantly less likely to achieve the MCID in exercise capacity or endurance following a home-based programme than a centre-based programme (exercise capacity: OR 0.58, 0.53–0.64, p<0.01; endurance: OR 0.72, 0.53–0.99, p<0.05) ( figure 1). There was no significant difference for HRQoL (OR 0.96, 0.91–1.02, p=0.15).Abstract S139 Figure 1Plot showing the odds ratios for meeting the minimal clinically important difference in pulmonary rehabilitation outcome measures across centre-based and home-based programmes (OR: odds ratios; CI: confidence intervals; MCID: minimal clinically important difference).Conclusions Effectiveness of PR varied across programme type, with home-programmes less likely to achieve the MCID in exercise capacity or endurance outcome measures. This supports the BTS Clinical Statement that individuals eligible for PR should only be offered a home-based programme if a centre-based programme is declined.",
  "authors": [
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "H Drover"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "L Wang"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "M Richardson"
    },
    {
      "affiliations": [
        "School of Public Health, Imperial College London, London, UK"
      ],
      "name": "JK Quint"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "R Evans"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "SJ Singh"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "MW Orme"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, University of Leicester, Leicester, UK",
        "Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK"
      ],
      "name": "E Daynes"
    }
  ],
  "title": "S139 Comparing the effectiveness of centre-based and home-based pulmonary rehabilitation using a UK national dataset",
  "uid": "e4f11dfd-fd1a-52e9-93fe-4c333097acde"
}