International Journal of
Environmental Research
and Public Health
Article
A Home-Based Multimedia Pulmonary Rehabilitation Program
Improves Clinical Symptoms and Physical Performance of
Patients with Chronic Obstructive Pulmonary Disease
Anoma Santiworakul , Nitita Piya-amornphan and Netchanok Jianramas *
Citation: Santiworakul, A.;
Piya-amornphan, N.; Jianramas, N.
A Home-Based Multimedia
Pulmonary Rehabilitation Program
Improves Clinical Symptoms and
Physical Performance of Patients with
Chronic Obstructive Pulmonary
Disease. Int. J. Environ. Res. Public
Health 2021, 18, 11479. https://
doi.org/10.3390/ijerph182111479
Academic Editors: Keun Ho Ryu,
Nipon Theera-Umpon
and Florian Fischer
Received: 24 August 2021
Accepted: 29 October 2021
Published: 31 October 2021
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Attribution (CC BY) license (https://
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4.0/).
Department of Physical Therapy, School of Allied Health Science, Walailak University, 222 Thasala, Thaiburi,
Nakhon Si Thammarat 80160, Thailand; panoma@wu.ac.th (A.S.); nitita.do@wu.ac.th (N.P.-a.)
* Correspondence: netchanog.ji@wu.ac.th; Tel.: +66-(0)-80-5221313
Abstract:
Home-based pulmonary rehabilitation can decrease symptoms in chronic obstructive
pulmonary disease (COPD) patients. The purpose of this study was to compare the effects of a
home-based pulmonary rehabilitation by instructive multimedia in the form of videos and flip
charts on clinical symptoms and exercise performance in COPD patients. An eight-week home-
based pulmonary rehabilitation program was performed with twenty COPD patients older than
60 years
of age with moderate to severe stages. They were separated into two groups: a multimedia
group (
n = 10
) and a control group, which was only provided with telephone monitoring (
n = 10
).
Clinical symptoms
were measured by using the clinical COPD questionnaire (CCQ), and exercise
performance was measured using a six-minute walk test (6MWT) and an upper-lower limb mus-
cle strengthening test. After 8 weeks, the results showed that both groups showed a statistically
significant decrease in the CCQ (p < 0.05). The multimedia group showed a statistically significant
increase in the lower-limb muscle strengthening (p < 0.05), while the control group was not found
to show a statistically significant increase in the lower-limb muscle strengthening. Therefore, a
pulmonary rehabilitation program using multimedia at home can lessen symptoms and improve
exercise performance in COPD patients.
Keywords:
home-based pulmonary rehabilitation; chronic obstructive pulmonary disease;
exercise capacity
1. Introduction
Chronic obstructive pulmonary disease (COPD) is one of the world’s chronic non-
communicable diseases [
1
,
2
]. Patients with COPD are found throughout the world, in both
urban and rural areas [
3
]. They have chronic inflammation of the airways, resulting in de-
creased air entry into the lungs, shortness of breath, and a reduced ability to carry out daily
activities [
4
,
5
]. The multidisciplinary program of care, involving both pharmacological and
nonpharmacological methods, improves the patient’s condition by decreasing dyspnea,
fatigue, and anxiety regarding health issues, as well as by increasing exercise capacity and
quality of life. These bring about long-term care costs for both the government and the
patient’s family [6,7].
Pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary dis-
ease, including exercise training, education for smoking cessation and nutrition, self-
management, and/or behavioral change programs, aim to improve the physical and
psychological conditions of COPD patients [
1
]. A home-based pulmonary rehabilitation
program is important in minimizing issues for rural patients who have difficulty with
transportation from isolated locations or epidemic conditions that require social distancing,
such as COVID-19 [
8
,
9
]. Home-based pulmonary rehabilitation is safe and improves clin-
ical outcomes, in addition to reducing the cost of patient care. Previous studies support
Int. J. Environ. Res. Public Health 2021, 18, 11479. https://doi.org/10.3390/ijerph182111479 https://www.mdpi.com/journal/ijerph
