Objectives

Home-based pulmonary rehabilitation (PR) is increasingly offered as an alternative to centre-based PR. This study explores differences in the characteristics of people with COPD enrolling in home-based versus centre-based PR in England and Wales and assesses whether availability of home-based PR is associated with increased enrolment.

Methods

This study used data from the UK 2023-24 National Respiratory Audit Programme PR audit. Eligible people had a primary condition of COPD, complete mental health and geographic data, and attended an initial assessment at a centre that completed the clinical and organisational audit. For the primary analysis only, people were further restricted to those enrolled on a purely home-based or centre-based programme at a centre that offered both options. Enrolment was defined as having attended an initial assessment and having at least one scheduled PR session with a defined start date. Differences in characteristics were assessed using Chi-square and Kruskal-Wallis tests. The association between availability of home-based PR and enrolment was assessed using a mixed-effects logistic regression model.

Results

13719/29981 (45.8%) people were eligible for inclusion in the primary analysis and 25039/29981 (83.5%) were eligible for the secondary analysis. Those who enrolled in a home-based programme were more likely to: be female (58.6% vs 48.2%; p<0.001); be more deprived (55.7% versus 46.6% in IMD quintiles 1 or 2, p<0.001); have a greater mental health burden (28.2% versus 22.2% with at least 1 cognitive impairment recorded, p<0.001); and classified their symptom burden as more severe at assessment (CAT score 23 versus 22, p <0.001). Home-based PR was unavailable for 9099/25039 (36.3%) people. Availability of home-based PR was not associated with reduced non-enrolment in PR when compared with centres that did not offer home-based PR (adj-OR for non-enrolment: 0.79; 95%CI:0.51-1.23)).

Conclusion

Healthcare providers and those developing home-based PR digital applications should consider tailoring their approach to those who are most likely to opt in, who tend to be younger, female, and have a higher burden of respiratory symptoms and mental health comorbidities.