Moving Pulmonary Rehabilitation Into the Home

Abstract

Pulmonary rehabilitation (PR) is the standard of care for persons with chronic, symptomatic lung disease. The availability of PR is limited, particularly in rural areas. In addition, barriers to PR include the lack of transportation, patient inconvenience, inadequate insurance coverage, and cost. Technology has the potential to overcome several barriers to PR by enhancing the availability and uptake of PR principles through the development of technology-supported, home-based PR programs. For technology-supported, home-based PR, or telehealth PR, to be effective, key components of traditional PR must be present including appropriate individualized exercise prescription, self-management education, outcome measurements, and patient support. This clinical review summarizes the current practice of PR, describes limitations to the availability of PR, describes key principles that technology should feature to ensure best practices are met, and proposes current and future technology options as an emerging strategy for home delivery of PR and its components.

Will Remotely Based Pulmonary Rehabilitation Water Down Its Effectiveness?

“…Tele-rehabilitation involves using complex technology and equipment to monitor patients, and it also needs trained manpower-which can be expensive. Many insurers are willing to pay for conventional PR but not tele-rehabilitation [42]. Wide-spread acceptance of tele-rehabilitation in the healthcare system across the US is hampered by regulations and restrictions by state governments and policies of insurers [43].…”

More should be done now for patients with TB-associated chronic lung disease

“…This provides a strong rationale for adjunctive pulmonary rehabilitation (PR) programmes in the management of TB-CLD in limited-resource settings. 3,4 These programmes should be introduced and studied within an implementation science framework (e.g., RE-AIM) 5 : they must be accessible to patients at the peripheral health centre level, deliver essential components of PR, including supervised exercise and self-management training, focus on long-term behaviour change, and result in equivalent benefits to the current ‘gold standard’ of hospital-based PR. 3 Patient-centered PR should make use of functional activities or equipment readily accessible in the home environment.…”

IASEM-TUMS COVID-19 Virtual Pulmonary Rehabilitation Framework; Exercise Prescription for Recovered COVID-19 Patients

“…In patients infected by COVID-19, it seems that some symptoms such as shortness of breath, muscle weakness, and fatigue could remain after discharge, which reduces their functional capacity and thus the quality of life. Moreover, physical inactivity during the isolation period after discharge can further reduce functional capacity and worsen general and respiratory muscle weakness (3)(4)(5).…”

“…The effect of physical activity and exercise is not only to improve the patient's functional capacity but also to better control stress, have better feelings, reduce the risk factors for metabolic diseases, and improve quality of life (2,6). Hence, general and pulmonary rehabilitation can be one of the most essential strategies for these patients that would relieve the symptoms of dyspnea and eventually improve physical function as well as quality of life (5,7). Enhancing the function of the respiratory and immune systems may be achieved by aerobic capability improvement.…”