Effect of home-based pulmonary rehabilitation in patients with interstitial lung disease in a tertiary care centre - A randomized controlled trial.

BACKGROUND AND AIM: Interstitial lung disease causes functional limitation and exercise intolerance. Although pulmonary rehabilitation in ILD can improve physical function and quality of life, multiple factors hinder its utilisation including lack of facilities, mobility, caregivers and cost. Therefore, alternative models such as home-based pulmonary rehabilitation are required to bridge the gap between guidelines and practice. This study explored whether a 12-week home-based pulmonary rehabilitation program could improve the functional capacity of ILD patients as measured by 6MWD when compared to conventional drug therapy alone. METHODS: Patients suffering from ILD attending a tertiary hospital in South-India were stratified according to disease sub-type and randomised. A structured 12-weeks home-based pulmonary rehabilitation consisting of exercise training, health education, nutritional and psychological support was provided to the intervention arm. Conventional drug therapy was continued in both arms. Change in 6MWD and FVC, K-BILD and HADS scores were measured at the end of 12 weeks. The results were analysed for determining factors responsible for the change in health status indicators. RESULTS: At the end of 12 weeks, 6MWD and K-BILD scores alone showed statistically significant improvement in intervention arm when compared to controls. However, it did not reach the MCID for either parameter. Spirometry and HADS score had no significant improvement in either arm. A significantly higher proportion of participants in the intervention group achieved the MCID for 6MWD (RR 2.32 ,95% CI 1.47-3.68) and K-BILD score (RR 1.94, 95% CI 1.28-2.96) compared with controls. Conclusion: Home based pulmonary rehabilitation was found to effect modest improvement in 6MWD and K-BILD scores: measures of functional capacity and QoL respectively, among ILD patients. A substantially higher proportion of patients in the intervention arm experienced clinically meaningful benefits.