Design and delivery of home-based telehealth pulmonary rehabilitation programs in COPD: A systematic review and meta-analysis. (June 2022) - Michaelchuk, Wade
Highlights: All aspects of lung disease tele-rehabilitation are reviewed for the first time. Program design and delivery of tele-rehabilitation is heterogeneous. 69% of tele-rehabilitation trials do not report progressions or emergency plans. 6% of studies reported race and no studies reported ethnicity. Tele-rehabilitation effects are similar to outpatient's and greater than usual care. Abstract: Rationale. Home-based telehealth pulmonary rehabilitation (HTPR) for chronic obstructive pulmonary disease (COPD) is increasingly common partly due to the COVID-19 pandemic. However, optimal HTPR programming has not been described. This review provides a comprehensive overview of the design, delivery, and effects of HTPR for people with COPD. Methods: Relevant databases were searched to July 2021 for studies on adults with COPD utilizing information or communication technology to monitor or deliver HTPR. A meta-analysis was performed on a subset of randomized controlled trials. Results: Of 3124 records retrieved, 38 studies evaluating 1993 individuals with stable COPD (age 54–75 and FEV1 31–92% predicted) were included. Program components included exercise and education (n = 17) or exercise alone (n = 15) with in-clinic baseline assessments commonly conducted (n = 26). Few trials (n = 7) featured synchronous virtual exercise supervision. Aerobic exercise commonly involved walking (n = 14) and cycling (n = 11) and most programs included resistance training (n = 25). Exercise progressions and emergency action plans were inconsistently reported. Meta-analysis demonstrated HTPR was comparable to outpatient PR and had a greater effect than usual care for the modified Medical Research Council dyspnea scale (mean difference [95 %CI]: −0.49 [−0.77, −0.22], p < 0.01) and COPD Assessment Test score (−4.90 [−7.13, −2.67], p < 0.01). Neither HTPR nor outpatient PR impacted sedentary time or step count. Only 6% of studies reported race and no studies reported participant ethnicity. Conclusion: This review revealed the heterogeneity of HTPR program designs in COPD. HTPR programs had similar effects to outpatient PR programs and greater effects than usual care for people with COPD.