17 Dec 2020

Professor Anne Holland's pulmonary rehabilitation research in NHMRC's 10 best!

Prof Anne Holland (centre, lowest row) and her group
Congratulations to Professor Anne Holland, whose National Health and Medical Research Council (NHMRC) funded research, "Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease" (GNT1046353), was selected in 2020 for inclusion in the 2018 edition of NHMRC’s Ten of the Best Research Projects.

This is the twelfth year of NHMRC's Ten of the Best, which highlights outstanding Australian research that is contributing to the prevention, diagnosis and treatment of health issues facing Australians.

Anne Holland is Professor of Physiotherapy at Monash University and Alfred Health in Melbourne. Professor Holland’s research looks at improving access to rehabilitation for chronic obstructive pulmonary disease (COPD), a disease of the lungs. One model for improving access is to provide rehabilitation in patients’ homes.
In 2018, chronic obstructive lung disease was the fifth leading cause of death in Australia (AIHW).

In Australia, COPD is responsible for more potentially preventable hospital admissions than any other chronic disease, and is a major contributor to health care costs. Pulmonary rehabilitation is a highly effective treatment for people with COPD, involving exercise, training and education over eight to twelve weeks. In Australia only 5-10% of those with COPD ever receive it because treatment is traditionally provided in hospital/clinics.
A challenge for this research on improving access is that the health system has always delivered this rehabilitation in outpatient facilities that patients attend twice each week. This raises barriers to access such as shortage of programs and patients’ poor physical mobility, breathlessness and inability to travel.
This traditional model has not changed in over 30 years. There has been resistance to broadening the model to include home-based services. 
“Our HomeBase trial showed that rehabilitation could be delivered entirely at home in people with COPD, with the same clinical outcomes as centre-based rehabilitation. Those who completed either type of rehabilitation program were 56% less likely to be admitted to hospital during the following year, significantly lowering health care costs.” Professor Holland said.
“This model of home-based rehabilitation requires no specialised equipment, and its delivery is within the current scope of practice of pulmonary rehabilitation professionals”
This study showed that about twice as many patients completed home-based rehabilitation compared to rehabilitation in centres.
The COVID-19 pandemic caused closure of centre-based rehabilitation programs to protect vulnerable patients from infection proving the need for this type of home-based program. Queries on the HomeBase model came from across the world seeking alternatives to the centre-based model of rehabilitation.
“Overall the HomeBase model has been very well received by patients and health professionals, both in Australia and across the world, who have welcomed our work as a way to deliver this important treatment to a larger proportion of those who need it.”

Next steps

Professor Holland’s team will support programs across Australia to offer patients the choice of a home-based or centre-based program. They will learn about patient preferences and how to support implementation of Homebase in clinical practices. They will test in more detail whether offering patients this choice can increase completion of pulmonary rehabilitation, and reduce subsequent hospital admissions. 


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