Hybrid compared to conventional pulmonary rehabilitation: an equivalence analysis

Abstract

Pulmonary rehabilitation (PR) is a well-established intervention for patients with chronic obstructive pulmonary disease (COPD), but access, uptake and completion are low. This retrospective propensity-matched study aimed to analyse equivalence from a Hybrid PR modality against Conventional PR.Between 2013–2019, 214 patients with COPD with valid baseline physical activity assessments enrolled in Conventional PR for three times per week (3/wk) for three months. In 2021–2022, 44 patients with COPD enrolled in three months of Hybrid PR, introducing two providers: 1/wk in the outpatient centre and 2/wk in a primary care setting near the patient's home. All sessions were supervised. Propensity score matching (1:1) was performed. Equivalence between both programs was analysed for exercise capacity with the equivalence margins of -/+ 30 m. Clinical outcomes, accessibility and adherence were compared using t-tests.44 patients (age 67±8, FEV1%predicted 47±15, 6MWD 355±122 m) in the Hybrid PR group were matched to 44 patients (age 66±8, FEV1%predicted 46±17, 6MWD 354±103 m) in the Conventional PR group. Equivalence on the increase in 6MWD could not be confirmed, nevertheless both groups improved their 6MWD clinically significantly (Hybrid PR Δ63 CI[43–83]m; Conventional PR Δ39 CI[26–52]m). Changes in quality of life and symptoms were similar. Drop-out in Hybrid PR (23%) was comparable to Conventional PR (27%) (p=0.24). Adherence in both groups was high and accessibility was better for patients following Hybrid PR.Hybrid PR can be offered as an effective alternative to Conventional PR, if patients are willing to take up the offer.