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The Research on Home-Based Physical Therapy for
Patients with COPD

COPD affects the lives of roughly 10% of the American population.1  Those patients with declining health status, recent hospital discharges, or moderate disability due to COPD may be good candidates for additional programs designed to improve their quality of life and reduce overall health care spending / reutilization.  When patients are homebound, refer to Ideal Home Care for such programs.  We can provide care plans involving physical therapy, occupational therapy, nursing management, and more.

Currently, the most authoritative research paper on exercise for COPD is the meta-analysis by Salman et al., published in the Journal of General Internal Medicine.2  Salman et al. combined 20 trials covering 979 patients.  Interestingly, trials that used only respiratory muscle training showed no significant difference compared to control groups receiving no rehabilitation.  However, patients receiving lower-extremity training only (training that can be accomplished readily in your patient’s home) did significantly better on walking tests and on shortness of breath.  Mild-to-moderate COPD cases responded well to both short-term and long-term rehabilitation, and severe COPD cases responded well to exercise training lasting six months or longer (a time period equating to three home health episodes). 

This is not to say that home-based physical therapy should be limited to lower-extremity exercise.  Current research also supports the theory that physical therapy for the upper extremities creates positive results in ventilator muscle recruitment.3-6  Costi and colleagues found that when hand weight training was added to normal programs of pulmonary rehabilitation, patients showed significantly greater improvement in six-minute walking distance (+74 meters vs. +24 meters) and showed significantly greater improvement in dyspnea scores (-1.04 vs. -0.48). 

Murphy and colleagues demonstrated that these physical therapy programs can be effectively delivered at home.7  They compared patients receiving exercise training at home immediately after a hospitalization for COPD to patients receiving usual care.  Early exercise training at home improves exercise tolerance, improves dyspnea scores, improves quality of life, and reduces the number of subsequent exacerbations. 

Ideal Home Care’s directly-employed physical therapy team stands ready to design home exercise programs or continue supervision for programs initiated at inpatient facilities.  In addition, occupational therapists can teach energy conservation techniques that improve independence at home, and they can help coordinate the acquisition of helpful equipment.  Our nurses can provide the teaching and observation that has been shown to reduce future hospitalizations and ED visits, and home health aides are available when patients are temporarily having trouble performing their ADLs. 



  1. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. Sep 1 2007;370(9589):741-50.
  2. Salman G, Mosier M, Beasley B, et al. “Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials.” J Gen Intern Med. 2003: 18 (3): 213-21.
  3. Celli B, Rassulo J, Make B. Dysynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction. N Engl J Med. 1986; 314: 1485-90.
  4. Criner G, Celli B. Effect of unsupported arm exercise on ventilator muscle recruitment in patients with severe chronic airflow obstruction. Am Rev Respir Dis. 1988; 138: 856-61.
  5. Martinez F, Couser J, Celli B. Respiratory response to arm elevation in patients with chronic airflow obstruction. Am Rev Respir Dis. 1991; 143: 476-80.
  6. Costi S, Crisafulli E, Antoni F, et al. Effects of unsupported upper extremity exercise training in patients with COPD – a randomized clinical trial. Chest. 2009; 136: 387-395.
  7. Murphy N, Bell C, Costello R. “Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation.” Respir Med. 2005; 99(10): 1297-302.


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We Don’t Cap Visit Numbers

If you have experienced a home health agency saying that Medicare only pays for a certain number of visits, you may want to consider sending more of your referrals to Ideal Home Care. Medicare does not cap visit numbers. Medicare pays home health a set fee based on how sick your patient appears. Ideal Home Care provides care for as long as needed until your patients reach their skilled need goals.