Telerehabilitation an alternative when center-based pulmonary rehab not available

Home-based telerehabilitation demonstrated improved quality of life but was not confirmed to be equivalent to center-based pulmonary rehabilitation, researchers reported at the virtual European Respiratory Society International Congress.

“The aim of our trial was to investigate whether home-based telerehabilitation achieved equivalent outcomes to center-based pulmonary rehabilitation in people with chronic respiratory disease,” Narelle Cox, PhD, postdoctoral research fellow at La Trobe University, Melbourne, Australia, said during a presentation.

Researchers conducted an assessor-blinded, randomized, controlled trial of 142 participants with chronic respiratory disease (mean age, 68 years; mean FEV₁, 60% predicted) at four sites. Participants were randomly assigned to undergo center-based pulmonary rehabilitation (n = 72) or home-based telerehabilitation (n = 72) for two sessions per week for 8 weeks. Each group included 50 participants with COPD.

Both programs included supervised exercise training. The telerehabilitation group used center-provided stationary cycles and group video conferences to create social interaction and live monitoring.

Primary endpoint was a 2.5-point or more change in chronic respiratory disease questionnaire dyspnea domain at the end of the rehabilitation period.

Both telerehabilitation and standard pulmonary rehabilitation demonstrated clinical improvement in the chronic respiratory disease questionnaire dyspnea domain (4 vs. 5).

“For the primary outcome of chronic respiratory disease questionnaire dyspnea domain, we could not confirm equivalence of telerehabilitation to center-based pulmonary rehabilitation at [end of rehabilitation or 12 months’ follow-up],” Cox said. “The lower limit of the confidence interval for the between-group difference falls below the lower bound of the equivalence margin, indicating that inferiority of telerehabilitation could not be excluded.”

Six-minute walk distance at the end of rehabilitation was equivalent for both groups (mean difference between groups, – 6 m). At 12-month follow-up, due to the upper limit of the confidence interval sitting above the upper bound of the equivalence margin, superiority of telerehabilitation could not be excluded (mean difference between groups, 14 m), Cox said.

In total, 84% of participants in the telerehabilitation group and 79% of participants in the standard pulmonary rehabilitation group completed 70% or more of prescribed sessions.

“In this multisite, randomized, controlled equivalence trial, we demonstrated that telerehabilitation might not be equivalent to center-based pulmonary rehabilitation for all outcomes,” Cox said. “For the primary outcome of chronic respiratory disease questionnaire dyspnea domain, inferiority of telerehabilitation could not be excluded. For exercise capacity, superiority of telerehabilitation could not be excluded at 12 months’ follow-up.

“Telerehabilitation was shown to be safe and achieve clinically meaningful outcomes for patients, and when center-based pulmonary rehabilitation is not available, telerehabilitation may provide an alternative program model,” Cox said.