Will Remotely Based Pulmonary Rehabilitation Water Down Its Effectiveness?

Abstract

Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease. Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including the ongoing COVID-19 pandemic. Emerging alternative models of PR delivery such as home-based PR, tele-rehabilitation, web-based PR, or hybrid models could help address these barriers. Numerous studies have tested the feasibility, safety, and efficacy of these methods, but there is wide variability across studies and methods. We conducted a literature review to help determine if these alternative delivery methods watered down the effectiveness of PR. To evaluate the effectiveness of remotely based PR, the authors performed a literature search for randomized controlled trials (RCTs), cohort studies, and case series using PubMed, CINAHL, and Medline to identify relevant articles through 1 May 2021. Twenty-six applicable studies were found in which 11 compared tele-rehabilitation to conventional clinic-based PR; 11 evaluated tele-rehabilitation using the patient’s baseline status as control; and four compared tele-rehabilitation to no rehabilitation. Despite the different technologies used across studies, tele-rehabilitation was found to be both a feasible and an efficacious option for select patients with lung disease. Outcomes across these studies demonstrated similar benefits to traditional PR programs. Thus the existing data does not show that remotely based PR waters down the effectiveness of conventional PR. Use of remotely based PR is a feasible and effective option to deliver PR, especially for patients with significant barriers to conventional clinic-based PR. Additional, well-conducted RCTs are needed to answer the questions regarding its efficacy, safety, cost-effectiveness and who, among patients with COPD and other lung diseases, will derive the maximum benefit.

From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses

“…Pulmonary rehab programs have been adapted to incorporate leisure activities as a way to target social isolation 145 and delivered by palliative multidisciplinary care teams who are trained in providing support to people throughout all stages of COPD progression. 128 The proliferation of teleconferencing tools during the past 3 years 37 , 146 offers a way to reach patients who previously were denied access—those who lack transportation access, have limited social support, currently smoke, or fear viral infection. 37–40 , 147…”

“…128 The proliferation of teleconferencing tools during the past 3 years 37 , 146 offers a way to reach patients who previously were denied access—those who lack transportation access, have limited social support, currently smoke, or fear viral infection. 37–40 , 147…”

Telerehabilitation in Chronic Obstructive Pulmonary Disease (COPD) Management: Exploring Experiences and Effectiveness

“…Interprofessional teams play a pivotal role in delivering comprehensive care remotely. Despite challenges, such as the limited feasibility of performing videoconference telerehabilitation studies in older populations despite the fact it would be so helpful during a health crisis, like during the COVID-19 pandemic 3 , telerehabilitation remains a promising tool to address the needs of isolated elderly individuals and could reduce further functional decline 3,49 . Patient involvement in the design and development of telerehabilitation solutions can ensure the adoption of a patient-centered approach, which can improve empowerment and compliance 13 .…”

Digital health in chronic obstructive pulmonary disease

“…PR performed in home settings has the potential to be more effective and result in long‐term integration of exercise regimens into daily life compared to traditional facility‐based programs 101 . Although the field of telerehabilitation is still evolving, it has been proposed as an alternative to traditional PR especially for patients facing significant barriers to access 102 . Evidence supporting telerehabilitation is currently being established, but various studies have indicated that it can lower the risk of exacerbations and hospitalizations, both when compared to no rehabilitation and traditional rehabilitation 101,103 .…”

“… 101 Although the field of telerehabilitation is still evolving, it has been proposed as an alternative to traditional PR especially for patients facing significant barriers to access. 102 Evidence supporting telerehabilitation is currently being established, but various studies have indicated that it can lower the risk of exacerbations and hospitalizations, both when compared to no rehabilitation and traditional rehabilitation. 101 , 103 Additionally, telerehabilitation may present economic benefits compared to traditional PR.…”