The Long-Term Maintenance Effect of Remote Pulmonary Rehabilitation via Social Media in COPD: A Randomized Controlled Trial

Abstract

Background Although the benefits of conventional pulmonary rehabilitation (PR) maintenance are well documented, it is challenged by many difficulties. We investigated whether remote home-based PR maintenance strategy via social media (WeChat) is effective on clinical improvements and reducing the risk for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods The eligible stable COPD patients completing an initial 8-week PR were allocated into three groups randomly. Group A: PR maintenance via social media supervision at home. Group B: PR maintenance at hospital. Group C: Usual care. During a 12-month follow-up, the frequency of acute exacerbation of COPD (AECOPD), 6 minutes walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) were evaluated every 3 months. Results At the end of the follow-up, compared to the decline in the usual care group (n = 49), the clinical improvements of 6MWD, CAT, and mMRC were sustained in both the home-based group (n = 47) and the hospital-based maintenance group (n = 44) (p < 0.001), no difference was observed between these two groups (p > 0.05). In multivariate analysis, the home-based PR maintenance and hospital-based PR maintenance were independent predictors of lower risk for AECOPD (incidence rate ratio (IRR) 0.712, 95% CI 0.595–0.841, p < 0.001 and IRR 0.799, 95% CI 0.683–0.927, p = 0.002), respectively. Conclusion Remote PR maintenance via social media is effective in reducing the risk for AECOPD and keeping the clinical improvement from decline. Remote PR maintenance via social media might be used to deliver alternatives to conventional PR.

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.…”

“…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. 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 ].…”

“…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 ].…”