Effect of a New Tele-Rehabilitation Program versus Standard Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

Abstract

In chronic obstructive pulmonary disease (COPD), rehabilitation is recommended, but attendance rates are low. Tele-rehabilitation may be key. We evaluate the effect of a tele-rehabilitation program vs. standard rehabilitation on COPD. A randomized, non-inferiority study comparing eight weeks of tele-rehabilitation (physiotherapist video/chat-consultations and workout sessions with a virtual-autonomous-physiotherapist-agent (VAPA)) and standard rehabilitation in stable patients with COPD. At baseline, after 8 weeks and 3 and 6 months of follow-up, 6 min walk test distance (6MWTD), 7-day pedometry, quality of life, exercise tolerance, adherence, patient satisfaction and safety were assessed. Fifty-four patients (70 ± 9 years, male 57%, FEV1% 34.53 ± 11.67, FVC% 68.8 ± 18.81, 6MWT 376.23 ± 92.02) were included. Twenty-seven patients were randomized to tele-rehabilitation. Non-inferiority in Δ6MWTD at 8 weeks (47.4 ± 31.4), and at 3 (56.0 ± 38.0) and 6 (95.2 ± 47.1) months follow-up, was observed. No significant difference was observed in 7-day pedometry or quality of life. In the intervention group, 6MWTD increased by 25% and 66% at 3 and 6 months, respectively; adherence was 81%; and patient satisfaction was 4.27 ± 0.77 (Likert scale 0–5). Non-inferiority between groups and high adherence, patient satisfaction and safety in the intervention group were found after rehabilitation and at 3 and 6 months of follow-up. Tele-rehabilitation with VAPA seems to be a promising alternative.

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

“…Twenty trials provided an individual rehabilitation setting [ 8 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ] while the rest of the trials [ 40 , 41 ] were in a group setting. Two trials [ 8 , 39 ] tested the maintenance effect of the TR intervention for the continuity of care after discharge from the clinic.…”

“…Two trials [ 8 , 39 ] tested the maintenance effect of the TR intervention for the continuity of care after discharge from the clinic. Nine studies presented a unidimensional target (exercise training) [ 21 , 22 , 23 , 28 , 30 , 31 , 33 , 37 , 39 ] while thirteen studies a multi-dimensional one [ 8 , 24 , 25 , 26 , 27 , 29 , 32 , 34 , 35 , 36 , 38 , 40 , 41 ]. The treatment dose (FITT descriptors) was widely heterogeneous: (a) (T) the minimum duration was 6 weeks [ 26 ] versus a maximum of 52 weeks of treatment [ 8 , 24 ]; (b) (F) the frequency varied from 7 rehabilitation sessions per day [ 30 ] to 1 session per week [ 41 ]; (c) (T) time per session ranged from 10–20 [ 37 ] to 120 min [ 38 ]; and (d) (I) the intensity was set based on several modalities: Borg scale [ 23 , 27 , 29 , 33 , 40 ], step count [ 34 ], heart rate [ 22 , 25 ], Pi max [ 24 , 28 , 30 ], or with a fixed incremental method [ 26 ] ( Table 3 ).…”

“…Model : Nineteen studies presented an asynchronous [ 8 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 37 , 38 , 39 , 41 ] while three works presented a synchronous model [ 33 , 34 , 40 ].…”

“…Assessment and Monitoring : All studies except Kawagoshi et al [ 24 ] included the monitoring of the rehabilitation at a distance using videoconference software [ 33 , 40 ], web-based platforms or applications [ 8 , 21 , 25 , 26 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 41 ], or devices, such as the pedometer (e.g., [ 27 , 32 ]), heart monitor [ 22 ], and breathing trainer device [ 23 , 28 , 30 ].…”

Therapeutic Modalities for Asthma, COPD, and Pathogenesis of COVID-19: Insights from the Special Issue

“…The next study, by Cerdán-de-las-Heras and colleagues, takes a rehabilitation therapy angle for the management of COPD [ 29 ]. In a randomized, non-inferiority study, authors evaluated the effect of a tele-rehabilitation program compared to standard rehabilitation on COPD.…”