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Pulmonary tele-rehabilitation in COPD

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Dr Surya Kant, Professor and Head, Dept. of Respiratory Medicine, KGMU, UP, Lucknow. National Vice Chairman IMA-AMS    30 December 2022

The adherence to pulmonary rehabilitation was more when it was administered via telehealth mode compared to in-person hospital-based pulmonary rehabilitation, according to a recent multicenter study published in the journal Thorax.1

 

The trial designed as a superiority randomised-controlled trial was conducted to examine the effect of 10 weeks of supervised pulmonary tele-rehabilitation (PTR) (60 min, three times in a week) compared to 10 weeks of standard pulmonary rehabilitation (PR) (90 min, twice in a week) on 6 min walk distance (6MWD) in patients eligible for the routine outpatient hospital-based PR. For this, 134 patients with severe COPD, eligible for OPD were recruited from eight university hospitals in the Greater Copenhagen area from March 2016 to October 2017. The mean age of the study participants, majority of whom were female, was 68 years. The baseline FEV1 was 33% predicted and 6MWD was 327 metres. The secondary objectives were the impact of pulmonary rehabilitation on respiratory symptoms, quality of life, physical activity and lower limb muscle function.

 

The changes in 6MWD following the intervention, the primary outcome of the study, were comparable between the two groups at 9.2 m or at 22 weeks follow-up (-5.3 m). Fifty-seven (73%) patients in the supervised PTR group completed the required program compared to 43 (62%) in the conventional PR group. Symptomatic relief including reduction in feelings of anxiety and depression was noted in the PTR group, but this became nonsignificant at follow-up after 22 weeks.

 

Pulmonary rehabilitation is an integral part of management of COPD patients in advanced stage of the disease. But compliance to the program is a challenge. One of the key changes in the latest GOLD 2023 guidelines has been the incorporation of tele-rehabilitation in view of the ongoing Covid-19 pandemic, as an alternative to conventional PR.2

 

This is the first study, according to the authors, to compare a supervised PTR program with a supervised conventional PR program. Although in the current study, PTR was not superior to standard PR in improving symptoms and functional capacity, more patients in the supervised PTR group completed the rehabilitation protocol compared with those in the conventional PR group with more than 70% of patients attending ≥70% of the rehab sessions. Hence, supervised telerehabilitation may be an option for patients who find it difficult to comply with or access the conventional hospital-based PR. However, the authors advocate further non-inferiority studies of the 6MWD for PTR and PR to validate the better adherence observed in their study.

 

References

  1. Hansen H, et al. Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial. Thorax. 2020 May;75(5):413-421. doi: 10.1136/thoraxjnl-2019-214246.
  2. Global initiative for Chronic obstructive lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2023 report). Available at: https://goldcopd.org/2023-gold-report-2/. Accessed on Dec. 29, 2022.

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