Evaluation of the Implementation of a Home-Based Exercise Training Program for People With COPD: A Mixed-Methods Study.
Tamara Cerini, Ramona Kunz, Kaba Dalla Lana and 4 others
PMID 36188806WHAT IT FOUND
Most patients with COPD maintained home-based strength training for a year when coached.
Stabilizing a routine within the first two months predicted long-term adherence. Patients valued physical exercise cards and home visits but found weekly goal-setting burdensome.
Key findings
01Participants who stabilized their training routine within the first two months were significantly more likely to complete the year-long program than those who did not.
02Patients rated physical exercise cards and home-based training as the most crucial features, while weekly goal-setting was perceived as less important or disruptive.
03Home visits and travel accounted for one-third of the coaches' total workload, creating a barrier to sustainable implementation due to cost and time.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only included patients who completed the intervention or did not drop out early, potentially introducing selection bias by excluding those who found the program unmanageable. The population was recruited primarily from inpatient pulmonary rehabilitation settings, so results may not generalize to patients who did not undergo PR or who have different severity levels. The study design was an implementation evaluation nested within an RCT, not a standalone trial of effectiveness, so causal claims about specific program components improving health outcomes are limited. Home visits were a major cost driver, and the study did not test a version of the program without them, leaving the minimum effective dose of supervision unclear.
Declared interests
The authors declare no commercial or financial conflicts of interest. The study was funded by the Swiss National Science Foundation, the Velux Foundation, the Swiss Lung Association, and Klinik Barmelweid. The funding bodies had no role in the study design, data collection, analysis, or manuscript preparation.
The easy way to misread this
Do not interpret the high adherence rates as evidence that the program is universally sustainable without significant clinical resources. The home visits and coaching time constituted a substantial workload (833 minutes per participant) that is currently not reimbursed, and the study did not evaluate a less intensive supervision model.