Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits

Abstract

Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits.Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR.In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389-0.687, and IRR 0.635, 95% CI 0.473-0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100-0.358, and IRR 0.375, 95% CI 0.207-0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072-0.185).Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR.

Advances in rehabilitation for chronic diseases: improving health outcomes and function

“…Interventions that use technology such as the internet and wearable devices have shown promise in supporting home based physical activity 109110111112113114. Most recently, tele-rehabilitation efforts used videoconferencing for home virtual supervision, but this still required personnel time and specialized exercise equipment 115116117118…”

Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders

“…For example, the use of home‐based, handheld spirometry measurements performed by the patient to monitor changes in lung function over time was studied in the early 1990s in the lung transplant patient population; telehealth was later incorporated to communicate home spirometry results to the care team through Web‐based interfaces in the 2000s . Additionally, pulmonary rehabilitation programs delivered by telehealth produce results comparable to those of traditional hospital‐based programs, and exceed the effectiveness of traditional programs in decreasing emergency room usage …”

“…41 Additionally, pulmonary rehabilitation programs delivered by telehealth produce results comparable to those of traditional hospital-based programs, and exceed the effectiveness of traditional programs in decreasing emergency room usage. 42 In addition to home safety assessments, clinical video telehealth provides the opportunity for therapists skilled in neurorehabilitation to provide ongoing care to individuals with neuromuscular or musculoskeletal disorders. Given that these therapy treatments often require serial visits over the course of weeks, the burden of travel for the patient is multiplied in comparison to more infrequent physician clinic appointments.…”

Maintaining the benefits following pulmonary rehabilitation: Achievable or not?

“…More complex technology using telerehabilitation platforms has been used to support maintenance exercise training . The telerehabilitation approach may promote better integration of exercise training during the maintenance period compared to attendance at centre‐based programmes.…”