Long-term effects of face-to-face supervision versus telephone supervision during a community-based pulmonary rehabilitation programme in people with COPD using minimal equipment: a randomized controlled trial

Abstract

Background Pulmonary rehabilitation is a key and effective treatment for people with chronic obstructive pulmonary disease (COPD) although lack of accessibility is a barrier. The aim of this study was to compare the effects of face-to-face supervision (FFS) with those of telephone supervision (TS) during a community-based pulmonary rehabilitation programme to increase functional exercise capacity in people with COPD using minimal equipment. In addition, physical activity level, health-related quality of life, psychological status, exercise self-efficacy, number of exacerbations and adherence were analysed. Methods A single-blind randomized clinical trial was designed, allocating 80 patients from primary care setting 1:1 to FFS (n = 40) or TS (n = 40) rehabilitation programme. The intervention lasted 13 weeks and was composed of a structured education and exercise training. The variables evaluated were functional exercise capacity (6-minute walk distance [6MWD]), physical activity level (steps/day), health-related quality of life (COPD Assessment Test [CAT]), psychological status (Hospital Anxiety and Depression Scale), exercise self-efficacy (Exercise Self-Efficacy Scale), number of exacerbations and adherence (Adherence to Treatment of Physiotherapy Scale). Results Eighty participants were included in this study. Compared with the TS group, the FFS group presented improvements in the 6MWD of 28.8 m (95%CI 12.3–45.3, p < 0.01) after the intervention, 19.15 m (95%CI 2.7–35.6, p < 0.05) at 6 months, and 28 m (95%CI 11.5–44.5, p < 0.01) at 12 months, as well as the CAT score (mean: -4.2, -3.1, and − 4.6 points) respectively. Compared with the TS group, the FFS group performed an increased number of steps/day at the end of the intervention and at 12 months and had a reduced anxiety level at the 6-month follow-up. No differences in depression level, exercise self-efficacy, number of exacerbations or adherence were observed. Conclusions Compared with TS, FFS was superior for improving functional exercise capacity, health-related quality of life and physical activity levels in the short and long term in individuals with COPD. Trial registration ClinicalTrials.gov ID: NCT05565872 (https://clinicaltrials.gov/study/NCT05565872). Initial release: 09/27/2022.