S23 Integrating home-based exercise training within a hospital at home service for patients hospitalised with acute exacerbations of COPD: a mixed methods feasibility study

BackgroundThe uptake of face-to-face supervised outpatient-based pulmonary rehabilitation (PR) following hospitalisation for an acute exacerbation of COPD (AECOPD) is low. One commonly cited barrier is travel. Home-based PR may be an alternative setting. The aim of this study was to determine whether a co-designed home-based exercise training intervention, delivered alongside usual hospital at home (HaH) care post-hospitalisation for an AECOPD, is acceptable and feasible.MethodsA mixed method feasibility study was conducted including a parallel, two-group randomised controlled trial (RCT) (control group: usual HaH care;intervention group: usual care plus home-based exercise training) with convergent qualitative components (interviews: patients, family carers, researchers;focus groups: healthcare professionals [HCPs]).Results16/132 patients screened were recruited to the RCT with 8 allocated to each group and one withdrawn prior to receiving HaH care (56% were male, mean [SD] age: 74 [9] years, median [IQR] FEV1: 29 [21, 40] percent predicted, 87% with an eMRC dyspnoea score of 4, 5a or 5b). Four vs eight and four vs seven attended four week and three-month follow-up assessments in the control and intervention groups respectively. There was no evidence of contamination in the control group. 25% of patients allocated to the intervention group were unable to receive the intervention due to Covid-19. The questionnaire-based outcomes were more complete and appeared more acceptable to patients than physical measures, with very poor uptake for physical activity monitoring via accelerometery. Qualitative findings (interviews: five patients, two family carers, four researchers;focus groups: PR and HaH service HCPs) demonstrated that trial and intervention processes were acceptable, clinically beneficial and safe, but did not explain the disparity between questionnaire-based vs physical outcome measure completion rates.ConclusionThe findings suggest an efficacy trial which investigates home-based exercise training integrated within a HaH service following hospitalisation for an AECOPD would be safe and acceptable to patients, family carers, HCPs and researchers alike, and is qualitatively felt to be of clinical benefit. However, additional piloting is required to optimise intervention fidelity and study processes given the low recruitment rates, high drop out of the control group and poor uptake of some physical assessments.