How does using technology to deliver pulmonary rehabilitation (PR) compare to centre‐based PR, or no PR in people with chronic lung disease?

Bottom line

This review suggests that primary pulmonary rehabilitation, or maintenance rehabilitation, delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre‐based pulmonary rehabilitation, with no safety issues identified. However, the certainty of the evidence provided by this review is limited by the small number of studies, of varying telerehabilitation models, with relatively few participants. Future research should consider the clinical effect of telerehabilitation for individuals with chronic respiratory diseases other than COPD, the duration of benefit of telerehabilitation beyond the period of the intervention, and the economic cost of telerehabilitation.

Background

For people with chronic lung conditions, pulmonary rehabilitation is proven to improve physical functioning and general well‐being, and to reduce symptoms, particularly breathlessness. Pulmonary rehabilitation is a program of exercise training and education that is traditionally offered as an in‐person program at a healthcare facility such as a hospital, where people attend program appointments but are not hospitalised overnight. To make it easier for more people to access pulmonary rehabilitation, new ways of delivering programs using technology have been investigated. Pulmonary rehabilitation delivered using technology is known as telerehabilitation. Telerehabilitation models can include (but are not limited to) talking with a health professional and/or other patients on the telephone, using a website or mobile application, or via video‐conferencing. In some circumstances, undertaking telerehabilitation may require patients to have access to their own device (e.g. telephone, smartphone, tablet or computer) in order to participate.

Study characteristics

This review included 15 studies involving 1904 people with chronic lung disease, the majority (99%) of whom had chronic obstructive pulmonary disease (COPD). The studies described a variety of different ways to use technology to deliver pulmonary rehabilitation including over the telephone, using mobile phone applications, via video‐conferencing in a virtual group and through the use of websites. The studies of telerehabilitation were collectively compared to traditional in‐person PR, or to no rehabilitation. The variety of technology used, as well as differing levels of support from health professionals in the different studies, makes it difficult to determine if there is one best type of technology, amount of assistance or place to which to deliver a telerehabilitation program.

Key results

The review included 15 studies with 1904 participants, using five different models of telerehabilitation. Three studies were controlled clinical trials.

• For primary pulmonary rehabilitation, there was
  • probably little or no difference between telerehabilitation and in‐person pulmonary rehabilitation for exercise capacity measured as 6‐Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) ‐10.82 m to 10.94 m; 556 participants; four studies; moderate‐certainty evidence).
  • There may also be little or no difference for quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD ‐1.26, 95% CI ‐3.97 to 1.45; 274 participants; two studies; low‐certainty evidence), or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI ‐0.13 to 0.40; 426 participants; three studies; low‐certainty evidence).
  • Participants were more likely to complete a program of telerehabilitation (93% completion rate (95% CI 90% to 96%)), compared to a 70% completion rate for in‐person rehabilitation.
• When compared to no rehabilitation control
  • trials of primary telerehabilitation may increase exercise capacity on 6MWD (MD 22.17 m, 95% CI ‐38.89 m to 83.23 m; 94 participants; two studies; low‐certainty evidence)
  • increase 6MWD when delivered as maintenance rehabilitation (MD 78.1 m, 95% CI 49.6 m to 106.6 m; 209 participants; two studies; low‐certainty evidence).
  • No adverse effects of telerehabilitation were noted over and above any reported for in‐person rehabilitation or no rehabilitation.

Certainty of the evidence

The certainty of evidence (our confidence that the statistical effect estimates are correct) was generally low, because the number of studies, patients, and lung conditions in which telerehabilitation was studied is small. This means these results may not apply to all people with chronic lung disease or to all types of technology used to deliver pulmonary rehabilitation.

The full review can be read here.

This summary was prepared by Emma Dennett and is based on the plain language summary