Home based pulmonary tele-rehabilitation under telemedicine system for COPD: a cohort study

Abstract

Background Pulmonary tele-rehabilitation can improve adherence to pulmonary rehabilitation. However, there are few reports on home based pulmonary tele-rehabilitation. We assessed the effectiveness of home based pulmonary tele-rehabilitation under telemedicine system in patients with chronic obstructive pulmonary disease (COPD). Methods This cohort study enrolled 174 patients with COPD who received home based pulmonary tele-rehabilitation under telemedicine system. The follow-up time was 12 weeks. Patients were grouped according to pulmonary rehabilitation weeks, number of rehabilitation times and total duration time, and when these three data were inconsistent, the two lowest values were grouped: control group (total rehabilitation weeks < 1 week, total number of rehabilitation times < 5, total duration time < 150 min, n = 46), pulmonary rehabilitation group 1 (PR-1) (1 week ≤ rehabilitation weeks < 4 weeks, 5 ≤ total number of rehabilitation times < 20, 150 min ≤ total duration time < 1200 min, n = 31), pulmonary rehabilitation group 2 (PR-2) (4 weeks ≤ rehabilitation weeks < 8 weeks, 20 ≤ total number of rehabilitation times < 40, 600 min ≤ total duration time < 2400 min, n = 23), pulmonary rehabilitation group 3 (PR-3) (8 weeks ≤ rehabilitation weeks < 12 weeks, 40 ≤ total number of rehabilitation times < 60, 1200 min ≤ total duration time < 3600 min, n = 40) and pulmonary rehabilitation group 4 (PR-4) (rehabilitation weeks = 12 weeks, total number of rehabilitation times = 60, total duration time = 3600 min, n = 34). The clinical data before and after rehabilitation were collected and evaluated, including dyspnea symptoms, 6-min walk distance (6MWD), diaphragmatic mobility, anxiety and depression. Results There was no significance difference between control group and PR-1 group. PR-2 group after rehabilitation had significantly decreased CAT and HAMA scores than control (P < 0.05). Compared with control, PR-3 group and PR-4 group after rehabilitation had significantly higher 6MWD and diaphragmatic motility during deep breathing, but significantly lower CAT score, mMRC score, HAMA score, and HAMD score (P < 0.05). Compared with before pulmonary rehabilitation, in PR-3 and PR-4 groups, the 6MWD and the diaphragmatic motility during deep breathing were significantly higher, while CAT score, mMRC score, HAMA score, and HAMD score (for PR-4 only) were significantly lower after pulmonary rehabilitation (P < 0.05). There was no significant difference between PR-3 group and PR-4 group (P > 0.05). In the 12-week pulmonary rehabilitation program, patients who completed at least 8 weeks, namely those in the PR-3 and PR-4 groups, accounted for 42.5% of the total number. Education, income and response rate to telemedicine system reminders were the main risk factors associated with home based pulmonary tele-rehabilitation. Conclusions Home based pulmonary tele-rehabilitation under telemedicine system for more than 8 weeks can significantly improve the dyspnea symptoms, 6MWD, diaphragmatic mobility during deep breathing, and negative emotions of patients with moderate to severe stable COPD. Trial registration: This study was registered at Chinese Clinical Trial Registry under registration number of ChiCTR2200056241CTR2200056241.

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

“…Telerehabilitation has ushered in a paradigm shift in the assessment and management of chronic respiratory diseases. Notably, commonly employed outcome measures such as the 6MWD, COPD Assessment Test (CAT), and health-related quality of life scores (HRQoL) have served as valuable indicators, shedding light on the feasibility and efficacy of telerehabilitation interventions 18,26 . These measures have played a important role in substantiating the potential of telerehabilitation as a viable approach in the management of chronic respiratory conditions.…”

“…Nevertheless, the current body of research underscores the need for further investigation to delineate the essential components of telerehabilitation approaches and illuminate their long-term maintenance effects 11 . While short-term gains have been observed 2,9,10,15,18,26,27 , the absence of comprehensive long-term follow-up studies leaves a critical knowledge gap. In assessing the impact of telerehabilitation on chronic respiratory diseases, it is pertinent to evaluate if the improvements obtained during the intervention are sustained over time, contributing to long-term enhancements in patient outcomes.…”

“…In summary, while the existing body of research has provided valuable insights into the feasibility and shortterm efficacy of telerehabilitation for chronic respiratory diseases 18,26,27 . Acknowledging the research gaps involves addressing several key aspects, including the need for long-term studies, the identification of critical elements, the customization of interventions, and the evaluation of economic viability 11,15 .…”

“…Many individuals, especially older adults and those from marginalized communities, may lack the necessary technological resources to participate in telerehabilitation programs. Addressing this barrier requires innovative solutions such as providing subsidized devices and internet connectivity to underserved populations 5,26,28 .…”

Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review

“…Para abordar esta limitación, varios estudios han investigado el papel potencial de la telerehabilitación en pacientes con EPOC (Tabla 3). En general, estos estudios indican que un programa de telerehabilitación es factible y efectivo para mejorar la capacidad de ejercicio, el estado de salud y el uso de los recursos de atención médica (reducción del número de exacerbaciones de la EPOC, visitas a urgencias y hospitalizaciones) 9,20,[32][33][34][35][36][37] . En general, la adherencia a un programa de telerehabilitación es adecuada 38 , aunque las tasas de abandono son más altas (57%) que en uno presencial tradicional (23%) 39 , existiendo un alto grado de satisfacción con el programa 38 .…”