Telehealth pulmonary rehabilitation program for COPD accessible, feasible, safe
A community-based telehealth pulmonary rehabilitation program for patients with COPD was accessible, feasible and safe, researchers reported in the Annals of the American Thoracic Society.
“Lack of community resources has been a major barrier to improving access to [pulmonary rehabilitation], one of the few mortality improving therapies in COPD. Tele-[pulmonary rehabilitation] is a realistic solution to help increase access and meet the demand for much-needed [pulmonary rehabilitation]. Furthermore, tele-[pulmonary rehabilitation] may reduce health care disparately by allowing rural participants to access high-quality standardized pulmonary rehabilitation within their communities,” Amr J. Alwakeel, MBChB, pulmonary fellow in the department of medicine in the respiratory division and the Montreal Chest Institute at McGill University Health Centre and the the division of pulmonary medicine at King Faisal Specialist Hospital and Research Center Jeddah Branch, Saudi Arabia, and colleagues wrote.
The prospective study included 266 individuals with COPD enrolled in standard pulmonary rehab (n = 89; mean age, 71.4 years) or community-based tele-pulmonary rehab (n = 177; mean age, 68.4 years) programs at seven satellite centers in Canada from January 2017 to January 2020. All participants underwent a 6-minute walk test and COPD Assessment Test (CAT) at baseline, after rehab and at 1, 3, 6 and 12 months.
The tele-pulmonary rehab program recruited seven tele-sites. Of those, six sites continued to participate at 3 years. In total, 58 tele-programs were delivered for 177 adults with COPD. Fifteen standard pulmonary rehab programs were delivered for 89 adults with COPD.
More than 70% of participants completed each program. The researchers reported no major adverse events in either program.
Participants in both groups had significant improvements in 6-minute walk test and CAT scores immediately after rehab. The researchers reported persistent improvements in 6-minute walk test at 1 month (50.7 m and 60.2 m), 3 months (43.5 m and 60.8 m), 6 months (61.7 m and 54.2 m) and 12 months (54.7 m and 129.3 m) after rehab among participants in the tele-rehab group and the standard rehab group, respectively.
Compared with the standard rehab group, participants in the tele-rehab group had persistent CAT score improvements at months 3 (0 vs. –5.2), 6 (–0.8 vs. –4.1) and 12 (0.1 vs. –4.6) after rehab.
According to the researchers, tele-pulmonary rehab is a realistic solution to aid in increasing access and meeting demands for much-needed rehab, and these findings may help improve pulmonary rehab access.
“The findings of our study are even more relevant in the current health care crisis caused by COVID-19 where rapid utilization of telemedicine has become essential. Tele-[pulmonary rehabilitation] would allow for reinitiating many [pulmonary rehabilitation] programs at fully capacity while maintaining adequate physical distancing measures,” Alwakeel and colleagues wrote.
The researchers said there is a need for further research on the cost-effectiveness, additional clinical outcomes, patient selection, program delivery and implementation of tele-pulmonary rehab programs in different health care systems, locations and in individuals with other respiratory diseases.