Characteristics, Components, and Efficacy of Telerehabilitation Approaches for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is at the top of the list of non-communicable diseases with related rehabilitation needs. Digital medicine may provide continuative integrated intervention, overcoming accessibility and cost barriers. Methods: We systematically searched for randomized controlled trials on telerehabilitation (TR) in people with COPD to profile the adopted TR strategies, focusing on TR models and the main rehabilitation actions: monitoring and assessment, decision, and feedback. Additionally, a meta-analysis was run to test the TR effect on functional capacity, dyspnea, and quality of life compared to no intervention (NI) and conventional intervention (CI). Results: Out of the 6041 studies identified, 22 were eligible for the systematic review, and 14 were included in the meta-analyses. Results showed a heterogeneous scenario in terms of the TR features. Furthermore, only a small group of trials presented a comprehensive technological kit. The meta-analysis highlighted a significant effect of TR, especially with the asynchronous model, on all outcomes compared to NI. Moreover, a non-inferiority effect of TR on functional capacity and quality of life, and a superiority effect on dyspnea compared to CI were observed. Finally, the studies suggested a high rate of TR adherence and high safety level. Conclusions: TR is an effective strategy to increase and maintain functional capacity, breath, and quality of life in people with COPD. However, a consensus on the essential elements and features of this approach needs to be defined, and the effect of long-term maintenance merits further investigation.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

“… 70 The question whether pulmonary rehabilitation delivered using communication technologies is effective and safe has also been addressed by another Cochrane Review, 71 which showed that primary or maintenance pulmonary rehabilitation delivered via telerehabilitation were similarly and favorably effective with regard to outcomes such as exercise capacity, dyspnea, and HRQoL when compared with traditional, center-based, in-person pulmonary rehabilitation without compromising safety and with the likelihood of also reducing hospitalizations and anxiety. 71 Subsequent SRs demonstrated telerehabilitation as an effective strategy in COPD for maintaining and improving functioning, dyspnea and HRQoL 72 as well as with favorable effects on anxiety and depression. 73 The designs of pulmonary telerehabilitation programs were heterogeneous; however, consistently including exercise and education.…”

Remote patient monitoring strategies and wearable technology in chronic obstructive pulmonary disease

“…Home-based PR for COPD has been shown to be as effective as center-based PR in improving functional exercise capacity and quality of life ( 53 ), and patients with chronic respiratory disease achieved similar effectiveness and safety outcomes to center-based PR as they did with telerehabilitation ( 53 ). COPD telerehabilitation may even be able to increase and maintain the persisting benefits of PR ( 54 ).…”

Redesigning the Drugs Distribution Network: The Case of the Italian National Healthcare Service

“…Furthermore, considering the current social, epidemiological, demographic, and cultural context characterized by an increased demand for healthcare services and delivery, all National Healthcare Services (NHSs) are inclined to act to ensure economic sustainability and affordability. In particular, chronic conditions, which represent the main cause of 70% of worldwide deaths, define the relevant consumption of services and resources in all healthcare systems, considering their long-lasting nature and the severe correlated healthcare consequences [8].…”