Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits. Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n = 47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n = 50) and also to 12 months of usual care treatment (n = 50) without initial PR. In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for (1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389 to 0.687, and IRR 0.635, 95% CI 0.473 to 0.853), respectively, and (2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100 to 0.358, and IRR 0.375, 95% CI 0.207 to 0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072 to 0.185). Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR.
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