Home-based vs outpatient hospital-based pulmonary rehabilitation in people with chronic obstructive pulmonary disease.

<bold>Background:</bold> Traditional outpatient-based pulmonary rehabilitation (PR) faces several barriers that have been partially addressed by home-based programme. The aim of this retrospective real-life study was to compare the effectiveness of a home-based vs outpatient-based PR programme in unselected patients with COPD. <bold>Methods:</bold> The home-based PR programme consisted of a weekly supervised 90-minute home session (+ 4 unsupervised sessions), during 8 weeks. The outpatient-based programme consisted of 4 supervised sessions a week, during 6 weeks (24 sessions, group of 8 patients). Both programmes included physical training, education and psychosocial and motivational support. Quality of life (VSRQ), exercise tolerance (6-minute Stepper Test) and anxiety and depressive symptoms (HAD) were assessed. <bold>Results:</bold> 1192 and 507 patients with COPD were included in home-based and outpatient-based PR, respectively. At baseline, the home-based group was younger (65vs.70 years), had more severe obstruction (FEV1: 38vs.52%), more impaired quality of life (31.2vs.38.7 points) and exercise tolerance (300vs.463 strokes), and a higher depression score (7.9vs.6.4 points), compared to the outpatient group (p<0.01). All the outcomes were improved by PR in both groups (p<0.001), with greater improvement in depressive symptoms (p<0.05) for the home-based group, and in exercise capacity (p<0.001) for the outpatient-based group. <bold>Conclusion:</bold> Although patients in the home-based group were initially more severe than the outpatient-based group, both groups improved all the outcomes after PR. This real-life study suggests that personalized home-based PR is effective and should be developed more widely.