Boxall 2005.
| Study characteristics | ||
| Methods | RCT; follow‐up: 12 weeks; control group: usual care | |
| Participants | Eligible: not clear Randomised: 60, I: 30, C:30 (started intervention: I: 28, C: 26) Completed: 46, I: 23, C: 23 Mean age: I: 78 years, C: 76 years Sex (% male): I: 48, C: 65 Inclusion criteria: diagnosis of COPD by a respiratory specialist, age > 60 years, dyspnoea on exertion, live locally, motivated to exercise daily unsupervised, stable for 2 weeks, functionally housebound Major exclusions: attending outpatient‐based PR, restricted shoulder movement, living in nursing home, previous lung volume surgery, pain limiting mobility |
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| Interventions | 12‐week home‐based pulmonary rehabilitation programme ‐ Exercise consisting of walking (level 1 to 10) and arm exercises (1 to 18) + educational sessions. Patients were required to carry out exercise daily. Weekly physiotherapy visits were scheduled for the first 6 weeks, and then visits were made until Week 12 of the programme. Visits were used to monitor exercise performance and progress in exercises, to retest 6MWD at regular intervals (Weeks 1, 4, 6, 8, and 12 of the programme) and to provide encouragement to patients ‐ Educational sessions for patients and carers were conducted by physiotherapists, nurses, and occupational therapy staff in their homes. Sessions covered anatomy and physiology of the lungs, use of respiratory devices, medications, breathing techniques, secretion removal techniques, energy conservation, use of adaptive aids, and stress management. Patients received on average 11 home visits during the programme Intervention duration: 12 weeks Disciplines involved: physiotherapist, nurse, occupational therapist |
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| Outcomes | SGRQ, 6MWD, hospital admission, average length of stay, dyspnoea Borg Scale | |
| Notes | Dominant component: exercise | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "patients were randomised to equal groups using computer‐generated random numbers" |
| Allocation concealment (selection bias) | Low risk | Quote: "random numbers were coded into opaque envelopes by a person independent from the study, they retained the envelopes until initial assessment was completed" |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "neither assessors nor participants were blinded to group assignment in this study" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "neither assessors nor participants were blinded to group assignment in this study" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Comment: m issing outcome data balanced in numbers (23/23 analysed in both groups) across intervention and control groups, with similar reasons for missing data across groups |
| Selective reporting (reporting bias) | Low risk | Comment: study protocol is not available, but it is clear that published reports include all expected outcomes, including those that were pre‐specified |