Pulmonary Rehabilitation in a Post-COVID-19 World: Telerehabilitation as a New Standard in Patients with COPD

Abstract

Pulmonary rehabilitation (PR) is effective in reducing symptoms and improving health status, and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). The coronavirus disease 19 (COVID-19) pandemic has greatly impacted PR programs and their delivery to patients. Owing to fears of viral transmission and resultant outbreaks of COVID-19, institution-based PR programs have been forced to significantly reduce enrolment or in some cases completely shut down during the pandemic. As a majority of COPD patients are elderly and have multiple co-morbidities including cardiovascular disease and diabetes, they are notably susceptible to severe complications of COVID-19. As such, patients have been advised to stay at home and avoid social contact to the maximum extent possible. This has increased patients’ vulnerability to physical deconditioning, depression, and social isolation. To address this major gap in care, some traditional hospital or clinic-centered PR programs have converted some or all of their learning contents to home-based telerehabilitation during the pandemic. There are, however, some significant barriers to this approach that have impeded its implementation in the community. These include variable access and use of technology (by patients), a lack of standardization of methods and tools for evaluation of the program, and inadequate training and resources for health professionals in optimally delivering telerehabilitation to patients. There is a pressing need for high-quality studies on these modalities of PR to enable the successful implementation of PR at home and via teleconferencing technologies. Here, we highlight the importance of telerehabilitation of patients with COPD in the post-COVID world and discuss various strategies for clinical implementation.

The Need for Expanding Pulmonary Rehabilitation Services

“…As a preliminary response to prompt clinical practice implementations of remotely delivered pulmonary rehabilitation, several health care platforms included resources for tele-rehabilitation and home-based rehabilitation, including the homebased rehabilitation website: https://homebaserehab.net/ (accessed on 13 October 2021). Additional remotely delivered pulmonary rehabilitation recourses include the Canadian Thoracic Society pulmonary rehabilitation-endorsed program and guidance on virtual models of pulmonary rehabilitation from the Agency for Clinical Innovation in New South Wales, Australia [82,83].…”

Pulmonary rehabilitation in Lebanon “What do we have”? A national survey among chest physicians

“…Aside from home-based PR and tele-rehabilitation, this could include web-based tele-rehabilitation, center-based telerehabilitation and home-based tele-rehabilitation. Studies have found that home-based telerehabilitation can achieve clinically important gains in health-related quality of life [33][34][35].…”

Patient's treatment burden related to care coordination in the field of respiratory diseases

“…The use of pulmonary telerehabilitation was expanded during the coronavirus disease 2019 (COVID-19) pandemic because standard rehabilitation programmes were suspended and to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge [ 77 ]. However, some significant issues have emerged including: some patients lack access to computers; methods and tools for programme evaluation are not standardised; and training and resources for health professionals is inadequate [ 78 ]. To overcome these problems, researchers have proposed models of pulmonary telerehabilitation in respiratory diseases patients, and rapidly implemented their use in clinical practice [ 79 ].…”