Recruitment, uptake, engagement and completion of pulmonary rehabilitation (PR) sessions and trial attrition
| Author, year [reference] | Screened (reasons for ineligibility) Recruited: randomised | Uptake of PR/usual care (reasons for nonstart) | Dose of PR and definition of engagement | Engaged with defined number of sessions (reasons for non-engagement) | Completed PR programme (reasons for dropout) | Trial attrition rate (reason for attrition) |
| Home-PR versus usual care | ||||||
| Boxall, 2005 [50] RoB: high | Eligibility screening not reported 60 recruited: home-PR n=30, usual care n=30 | Uptake of PR: home-PR 28/30 (93%) (2 ill-health) | Home-PR: 11 sessions (12 weeks: 11 visits + daily unsupervised exercise) Engagement not defined | Engagement not reported | Home-PR: 23/30 (77%) (3 withdrew, 1 died, 1 ill-health) | Post-PR Home-PR: 7/30 (23%) (3 withdrew, 1 died, 3 ill-health) Control: 7/30 (23%) (2 withdrew, 2 died, 1 ill-health, 2 moved) |
| Chen, 2018 [51] RoB: high | 265 screened for eligibility (77 lost to contact, 44 distances >44 km, 53 declined, 36 comorbidity, 38 other) 55 (21%) recruited: home-PR n=29, usual care n=26 | Uptake not reported | Home-PR: 36 sessions (12 weeks: 3× per week unsupervised exercise) Engagement not defined | Engagement not reported | Home-PR: 25/29 (86%) (3 ill-health, 1 moved) Usual care: 22/26 (85%) (1 ill-health, 3 not serious enough) | Post-PR Home-PR: 4/29 (14%) (1 moved, 3 ill-health) Usual care: 4/26 (15%) (1 not serious, 1 ill-health) |
| Ghanem, 2010 [53] RoB: high | Eligibility screening not reported 39 recruited: home-PR n=25, usual care n=14 | Uptake not reported | Home-PR: 48 sessions (8 weeks: alternate days unsupervised exercise) Engagement not defined | Engagement not reported | Completion not reported | Post-PR Home-PR: 0/25 (0%) Usual care: 0/14 (0%) |
| Johnson-Warrington, 2016 [58] RoB: moderate | 464 screened for eligibility 175 declined, 76 not eligible, 49 comorbidity, 90 lost to contact 78 (17%) recruited: home-PR n=39, usual care n=39 | Uptake not reported | Home-PR: 42 sessions (12 weeks 6 TCs + 3× per week unsupervised exercise) Engagement not defined | Engagement not reported | Home-PR: 35/39 (90%) (2 ill-health, 1 preferred centre-PR, 1 not COPD) Usual care: 36/39 (92%) (3 died) | Post-PR Home-PR: 4/39 (10%) (1 wanted centre-PR; 2 ill-health; 1 not COPD) Usual care: 3/39 (8%) (3 died) |
| Mohammadi, 2013 [61] RoB: high | 106 assessed for eligibility 40 (38%) recruited: home-PR n=20, usual care n=20 | Uptake not reported | Home-PR: 24 sessions (8 weeks: 3 sessions then daily TCs + unsupervised sessions 3× per week) Engagement not defined | Completion not reported | Not reported No attrition reported | |
| Pradella, 2015 [63] RoB: high | Eligibility screening not reported 50 recruited: home-PR n=32, usual care n=18 | Uptake not reported | Home-PR: 24 sessions (8 weeks: weekly TCs + 3 unsupervised sessions per week) Engagement not defined | Engagement not reported | Home-PR: 29/32 (91%) (1 withdrew; 1 died, 1 AECOPD) | Post-PR Home-PR: 3/32 (9%) (1 died, 1 withdrew, 1 AECOPD) Usual care: 3/18 (17%) (2 withdrew, 1 AECOPD) |
| Singh, 2003 [64] RoB: high | Eligibility screening not reported 40 recruited: home-PR n=20, usual care n=20 | Uptake not reported | Home-PR: 4 sessions (4 weeks: weekly visits + daily unsupervised exercise) Engagement not defined | Engagement not reported | Engagement not reported | Post-PR Home-PR: 0/20 (0%) Control: 0/20 (0%) |
| Varas, 2018 [65] RoB: high | Eligibility screening not reported 40 recruited: home-PR n=21, usual care n=19 | Uptake of PR: home-PR 19/21 (90%) (2 withdrew) | Home-PR: 8 sessions (1× per week + unsupervised exercise ×8 weeks) Engagement not defined | Engagement not reported | Home-PR: 17/21 (81%) (2 did not complete) | Post-PR Home-PR: 4/21 (19%) (4 withdrew) Usual care: 3/19 (16%) (3 withdrew) 3 months and 12 months Home-PR: 4/21 (19%) Usual care: 3/19 (16%) |
| Cluster randomised implementation trial: home-PR versus usual care | ||||||
| Liang, 2019 [59] RoB: high | Cluster RCT: 21 practices/group 1050 screened for eligibility 272 (26%) recruited: home-PR n=157, control n=115 | GP referred for PR: home-PR 107/157 (68%) Uptake of PR: home-PR 71/107 (66%) | Home-PR: 8 sessions (8 weeks: 1 session + weekly TC unsupervised exercise) Engagement defined as ≥70% sessions attended | Engaged ≥70% Home-PR: 49/107 (46%) | Completion not reported | 6 months Home-PR: 39/157 (25%) Usual care: 21/115 (18%) 12 months Home-PR: 44/157 (28%) (27 lost to follow-up, 15 withdrew, 2 died) Usual care: 38/115 (33%) (29 lost to follow-up, 7 withdrew, 1 moved, 1 died) |
| Home-PR versus centre-PR | ||||||
| Güell, 2008 [54] RoB: high | Eligibility screening not reported 57 recruited: home-PR n=28, centre-PR n=29 | Uptake not reported | Home-PR: 27 sessions (9 weeks: 4 sessions + 3× per week unsupervised Centre-PR: 27 sessions (9 weeks: 3× per week) Engagement not defined | Engagement not reported | Home-PR: 23/28 (82%) (4 dropped out, 1 chest pain) Centre-PR: 28/29 (96%) (1 dropped out) | Post-PR Home-PR: 5/28 (18%) Centre-PR: 1/29 (4%) 6 months Home-PR: 8/28 (29%) (4 withdrew, 1 ill-health, 3 lost to follow-up) Centre-PR: 6/29 (21%) (1 dropped out, 5 lost to follow-up) |
| Hansen, 2020 [55] RoB: low | 1099 assessed for eligibility: (608 declined centre-PR, 251 declined home-PR, 40 comorbidity, 66 other) 134 (12%) recruited: home-PR n=67, centre-PR n=67 | Uptake not reported | Home-PR: 30 sessions (10 weeks: 3 sessions per week) Centre-PR: 20 sessions (10 weeks: 2 sessions per week) Engagement defined as ≥70% sessions attended Attendance defined as participating in the whole session | Engaged ≥70% Home-PR: 49/67 (73%) Centre-PR: 42/67 (63%) Median (IQR) number sessions attended Home-PR: 25/30 (20–28) Centre-PR 16/20 (8/19) Home-PR >70% engagement: OR 1.68, 95% CI 0.78–3.37; p<0.27 | Home-PR: 57/67 (85%) (6 dropped out, 2 ill-health, 1 died, 1 AECOPD) Centre-PR: 43/67 (64%) (10 dropped out, 8 ill-health, 2 died, 4 AECOPD) Home-PR completing: OR 3.18, 95% CI 1.37–7.35; p<0.01 | Post-PR Home-PR: 20/67 (30%) Centre-PR: 26/67 (39%) 3-month follow-up Home-PR: 29/67 (43%) Centre-PR: 26/67 (39%) |
| Holland, 2017 [56] RoB: low | 295 assessed for eligibility (27 recent PR, 10 comorbidities, 5 recent AECOPD, 67 declined (54 wanted centre-PR), 120 other) 166 (56%) recruited: home-PR n=80, centre-PR n=86 | Uptake not reported | Home-PR: 8 sessions (8 weeks: visit then weekly TCs + unsupervised sessions) Centre-PR: 16 sessions (8 weeks: twice weekly) Engagement defined as ≥70% sessions attended | Mean/total sessions attended (range) Home-PR: 7.4/8 (0–8) Centre-PR 8.3/16 (0–16) Engaged ≥70% Home-PR: 73/80 (91%) Centre-PR: 42/86 (49%) Relative risk of noncompletion in centre-PR 1.91 (95% CI 1.52–2.41) | Home-PR: 73/80 (91%) (1 died, 1 lost to follow-up, 5 declined) Centre-PR: 77/86 (89%) (1 died, 1 lost to follow-up, 7 declined) | Post-PR Home-PR: 7/80 (9%) Centre-PR: 9/86 (11%) 12-month follow-up Home-PR: 18/80 (24%) (4 lost to follow-up, 9 declined follow-up, 5 died) Centre-PR: 24/86 (28%) (10 lost to follow-up, 10 declined follow-up, 4 died) |
| Horton, 2018 [57] RoB: low | 1162 assessed for eligibility (185 DNA, 32 comorbidities, 606 not eligible, 140 wanted centre-PR, 100 declined, 199 other) 287 (25%) recruited: home-PR n=145, centre-PR n=142 | Uptake not reported | Home-PR: 21 sessions (7 weeks: 3 unsupervised sessions a week) Centre-PR: 14 sessions (7 weeks: twice weekly) Engagement not defined | Engagement not reported | Home-PR: 94/145 (85%) (16 lost to follow-up, 16 comorbidities, 2 died, 2 wanted centre-PR, 17 other) Centre-PR: 84/142 (59%) (30 lost to follow-up, 12 comorbidities, 1 died, 3 wanted home-PR, 12 others) | Post-PR Home-PR: 51/145 (35%) Centre-PR: 58/142 (41%) 6 months Home-PR: 70/145 (48%) (7 lost to follow-up, 3 DNA, 3 declined, 13 comorbidities, 3 other) Centre-PR: 72/142 (51%) (8 lost to follow-up, 1 comorbidity, 3 died, 2 others) |
| Maltais, 2008 [60] RoB: moderate | 631 assessed for eligibility (214 declined, 27 transport problems, 1 died, 29 others) 252 (40%) recruited: home-PR n=126, centre-PR n=126 | Uptake not reported | Home-PR: 24 sessions (8 weeks: 3 unsupervised sessions per week) Centre-PR: 24 sessions (4× 8 weeks: 3 sessions per week) Engagement defined as ≥60% sessions attended | Engaged ≥60% Home-PR: 123/126 (98%) Centre-PR:117/126 (93%) | Completion not reported | Post-PR Home-PR: 7/126 (6%) Centre-PR: 12/126 (10%) 12 months Home-PR: 19/126 (15%) (2 lost to follow-up, 16 withdrew, 1 died) Centre-PR: 17/126 (13%) (2 lost to follow-up, 14 withdrew, 1 died) |
| Pehlivan, 2020 [62] RoB: high | 71 assessed for eligibility 71 recruited: home-PR n=39, centre-PR n=32 | Uptake not reported | Home-PR: 32 sessions (8 weeks: 4 unsupervised sessions per week) Centre-PR: 16 sessions (8 weeks: 2 sessions per week) Engagement not defined | Engagement not reported 4 home-PR patients were excluded for “noncompliance” | Home-PR: 35/39 (4 discontinued) Centre-PR: 32/32 | Post-PR Home-PR: 4/39 (10%) (4 withdrew) Centre-PR: 0/32 (0%) |
| Three-arm trial (home-PR versus centre PR versus usual care | ||||||
| Mendes de Oliveira, 2010 [52] RoB: high | 216 assessed for eligibility (65 declined, 32 ineligible, 2 died) 117 (54%) recruited: home-PR n=42, centre-PR n=46, usual care n=29 | Uptake not reported | Home-PR: 36 sessions (12 weeks: TCs + 3 unsupervised sessions per week) Centre-PR: 36 sessions (12 weeks: 3 sessions per week) Engagement not defined | Engagement not reported | Home-PR: 35/42 (83%) (7 “abandoned” the programme) Centre-PR: 27/46 (59%) (7 “abandoned” the programme) | Post-PR Home-PR: 9/42 (21%) (2 lost to follow-up) Centre-PR: 22/45 (50%) (4 lost to follow-up) Usual care: 0/29 (0%) |
Home-PR: home-based pulmonary rehabilitation; RoB: risk of bias; centre-PR: centre-based pulmonary rehabilitation; TC: telephone contact; AECOPD: acute exacerbation of COPD; RCT: randomised controlled trial; GP: general practitioner; IQR: interquartile range; DNA: did not attend.