Is Telerehabilitation a Safe and Viable Option for Patients with COPD? A Feasibility Study

Abstract

In patients with COPD non-naïve to rehabilitation we tested the feasibility, adherence and satisfaction of a home-based reinforcement telerehabilitation program (TRP). Outcomes were compared with a standard outpatient rehabilitation program (ORP). Then 18 TRP patients underwent 28 sessions of strength exercises (60 min) and cycle training (40 min) using a satellite platform provided telemonitoring, tele-prescription, video-assistance and phone-calls, patients were equipped with an oximeter, steps-counter, bicycle, remote control and interactive TV software. 18 matched ORP, retrospectively identified from our hospital ORP database, were used as controls. At baseline and end of program, the 6-min walking test (6MWT), Medical Research Council (MRC) scale and Saint George's Respiratory Questionnaire (SGRQ) were administered. In TRP only, we assessed platform use, incremental exercise, steps walked/day and patient satisfaction. TRP patients completed all sessions without side effects, used the remote control 1,394 ± 2,329 times being in the 84% of the cases satisfied with the service. In 22% of the cases patients found the technology unfriendly. Each health-professional performed 46 ± 65 actions, 14.6 ± 2.12 phone calls and 1 ± 1.67 videoconference sessions per patient. TRP patients increased physical activity (3,412 vs. 1,863 steps/day, p = 0.0002). Both programs produced significant (all, p < 0.01) gains in 6MWT [meters, TRP +34.22 ± 50.79; ORP +33.61 ± 39.25], dyspnea [TRP - 0.72 ± 0.89; ORP - 0.94 ± 0.53] and SGRQ [TRP - 6.9 ± 9.96, ORP - 9.9 ± 12.92] without between-group differences. In conclusion, TRP is feasible and well accepted by patients, although sometimes technology was perceived as difficult. It seems to improve walking capacity, dyspnea, quality of life and daily physical activity. Future RCTs will demonstrate cost-effectiveness.

Exercise Telemonitoring and Telerehabilitation Compared with Traditional Cardiac and Pulmonary Rehabilitation: A Systematic Review and Meta-Analysis

“…The two studies produced an I 2 value of 0%, and the SMD was 0.169 (95% CI: −0.109, 0.448; p =0.23), suggesting no difference between groups (Figure 2). 33,34 The lone PR study by Paneroni and colleagues 32 found statistically significant improvements in both groups (UC: means=397–430.6 m, SD s=57–39.2; p =0.002; TR: means=380–414.2 m, SD s=86–50.8; p =0.008). There was no significant difference between groups ( p =0.91), indicating similar changes.…”

“…Sparks and colleagues 23 had 93% compliance in the TR group and 83% compliance in the UC group. Paneroni and colleagues 32 reported TR group compliance at 82%, compared with 100% for the UC group, and Varnfield and colleagues 34 had 94% compliance in the TR group and 68% compliance in the UC group. Dalleck and colleagues 31 reported similar compliance rates between groups, with rates at 81% in the TR group and 83% in the UC group.…”

“…Data transmission to a practitioner used a mobile network and was followed by weekly telephone calls. The PR study by Paneroni and colleagues 32 implemented an interactive television monitor and remote control system called the IGEA-SAT (Kell, s.r.l., Milan, Italy) platform that monitored dyspnea, leg fatigue, and oxygen saturation before and after exercise sessions on a cycle ergometer.…”

Systematic Review of Telemonitoring in COPD: An Update

“…In this perspective, programs of telerehabilitation may be more effective compared to telemedicine. Few data are available on this topic, but some trials are going on, showing its safety, feasibility [31] and improvement in dispnoea, quality of life and physical activity [32,33].…”

Living with asthma and chronic obstructive airways disease: Using technology to support self-management – An overview

“…58 For those with COPD there is good evidence that pulmonary rehabilitation classes relieve symptoms such as dyspnoea and fatigue, and improve emotional functioning and their uptake should be promoted at every opportunity 59 and, in recent times, pulmonary rehabilitation via telecare has been increasingly advocated as a potential way to deliver such services. 60 With asthma, stress and anxiety can be a trigger for some individuals and there is higher prevalence of psychological problems in those with asthma. 4,61 Those with anxiety and depression tend to have poorer outcomes, so establishing the presence of these comorbidities and discussing management strategies is an important aspect of asthma care.…”