Outcomes of pulmonary rehabilitation in post-tuberculosis sequelae: a comparative analysis of home-based and...

Post-tuberculosis lung disease (PTLD) is associated with persistent respiratory symptoms, reduced exercise capacity, impaired quality of life, and psychological morbidity despite successful completion of anti-tubercular therapy. Although pulmonary rehabilitation (PR) is an established therapeutic intervention, comparative evidence on home-based PR (HBPR) and hospital-based PR (HPR), particularly beyond 12 weeks, remains limited. So, to compare the effects of HBPR and HPR on clinical, functional, psychological, and pulmonary function outcomes in patients with PTLD, the study was done over a period of 24 weeks. This prospective comparative study included 50 patients with PTLD, of whom 30 underwent structured HBPR with weekly follow-up and 20 underwent supervised HPR. Allocation was based on feasibility and participant preference. Allocation was based on feasibility and participant preference. Participants were assessed at baseline, 12 weeks, and 24 weeks using the modified Medical Research Council (mMRC) dyspnea grade, body mass index (BMI), St. George's Respiratory Questionnaire (SGRQ), Depression Anxiety Stress Scale-21 (DASS-21), spirometry, and six-minute walk distance (6MWD). Changes within groups were analyzed for 0-12 weeks, 12-24 weeks, and 0-24 weeks, and change scores were compared between groups. Both rehabilitation strategies significantly improved dyspnea, nutritional status, quality of life, psychological well-being, pulmonary function, and exercise capacity over 24 weeks. In the HBPR group, mean 6MWD increased from 258.17±82.72 m to 377.00±82.38 m, while in the HPR group it increased from 308.00±118.84 m to 429.00±114.57 m (both p<0.001). Mean SGRQ scores improved from 44.67±9.28 to 29.73±7.00 in the HBPR group and from 38.70±10.35 to 25.10±8.30 in the HPR group (both p<0.001). Significant improvements were also observed in BMI, DASS-21 scores, forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, and forced expiratory flow between 25% and 75% of vital capacity predicted values. Although the greatest gains occurred during the first 12 weeks, several outcomes continued to improve between 12 and 24 weeks. Change-score analysis demonstrated comparable improvements between HBPR and HPR across most outcomes. This study concluded that both home-based and HPR significantly improved clinical, functional, psychological, and pulmonary outcomes in PTLD. Benefits extended beyond 12 weeks, with comparable improvements observed between rehabilitation strategies.