Beenken, M

Abstract Importance Conventional Pulmonary Rehabilitation (PR) after a hospital admission for a COPD exacerbation reduces remission and improves quality of life and survival, but only 2% of hospitalized patients complete PR. New feasible and effective strategies for increasing adherence to rehabilitation in the post hospitalization period are needed. Objective Determine the effect of patient’s choice on adherence to rehabilitation and outcomes. Design, Setting, and Participants: Individuals discharged after a COPD-related hospitalization were randomized to home rehabilitation with health coaching (HRwHC) or the choicethe choice of conventional PR or HRwHC. Intervention The HRwHC program was asynchronous and included weekly health coaching calls for 12 weeks and remote monitoring of lifestyle activities including daily exercises, and steps measured by an activity tracker, the compliance with 24-minute daily exercise routine and a daily wellbeing assessment. Participants in the choice arm that elected for conventional PR were facilitated by the study team to attend the nearest PR center. Main Outcomes and Measures The primary outcomes were adherence and effect on health-related quality of life measured by the Chronic Respiratory Questionnaire. Secondarily Physical activity was measured with Actigraph®GX3T a validated triaxial accelerometry. Results Among 1905 potential participants identified, 296 were randomized (uptake 14%). Reasons for declining include No interest in research 556 (29%), Already in PR or in other monitoring or research program 125 (6.5%), too much going/still recovering 650 (34%), Felt not needed (content with care) 208 (11%), Hospice 12 (0.6%), Technology barrier 64 (3%). Arm baseline measures were not different between arms. Among participants in the choice group, 1 of 148 (0.6%) elected HRwHC instead of PR. Because all patients received the same intervention (except one), outcomes at 3 months showed no difference, result are presented as one group before -after analysis. Among 295 patients that chose or were randomized to HRwHC, adherence (completion) was 59%. CRQ physical and Emotional Summary as well as all individuals’ domains improved significantly and beyond the MCID at 3 months Table 1A. CRQ improvement was maintained at 6- and 12-months Table 1B-C. Linear mixed models for repeated measures confirmed the significant sustained improvement over one year after adjusting to age, FEV1%, Charlson comorbidity index (p < 0.001 for all three time point 3-6-12 months). Conclusions and Relevance Home rehabilitation may represent the preferred choice after a COPD-related hospital admission. HRwHC sustainably improved quality of life over one year making a feasible and effective rehabilitation option and opportunity for primary palliative care. This abstract is funded by: NIH