Is telerehabilitation efficacious and safe for chronic respiratory disease?

Chronic respiratory diseases are a group of disorders that include bronchiectasis, chronic asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung diseases (ILD). According to epidemiologic studies, these disorders are the third leading cause of death worldwide and are responsible for 10% of all life-years lost to disability.

People affected by these conditions have dyspnoea, decreased functional capacity and exercise tolerance, and lower quality of life, and they may frequently necessitate hospitalisation. In this scenario, rehabilitation aims to ameliorate physical and mental health through individualized training and education.

Pulmonary rehabilitation is usually delivered at least two times a week for at least four weeks, each session being 30 minutes or more of aerobic and strength training.

Modern concepts of rehabilitation employ telecommunication devices to deliver interventions at a distance either to healthcare centres or directly to the patients home. These new methods, which define telerehabilitation, may enable greater access to services for patients who cannot reach healthcare centres.

These technological tools allow healthcare professionals to monitor physiological signs and symptoms and to provide oversight and feedback during training.

This review investigated whether telerehabilitation could be proven as effective and safe in people with chronic respiratory diseases compared to traditional pulmonary rehabilitation or no rehabilitation.

This review is important for

People with chronic respiratory diseases, their loved ones/caregivers, health professionals caring for this population, general practitioners, researchers, and policymakers.

Outcomes of this review

This Cochrane Systematic Review (CSR) was published in 2021. The outcomes analysed were exercise capacity and physical activity, dyspnoea, adverse events, quality of life, treatment compliance, anxiety or depression, and access to public health services including hospitalisation.

The CSR included a total of 15 studies with 1,904 participants published and/or registered up to November 30, 2020. Results showed that telerehabilitation, compared to outpatient pulmonary rehabilitation, does not differ significantly in terms of exercise capacity, dyspnoea, and quality of life, whereas patients were more likely to comply with a full program of telerehabilitation. On the other hand, when compared to no rehabilitation, people receiving telerehabilitation had a better exercise capacity tested with the six-minute walking distance after four to 12 months.

These results must be interpreted with caution because (i) most of the patients had COPD; therefore, the applicability of evidence to other chronic respiratory diseases is limited; (ii) the methods of delivery of telerehabilitation varied greatly, as did (iii) the location and the level of supervision during exercise; (iv) treatment duration lacked uniformity; (v) only a few studies reported data on long-term follow-up; (vi) studies involving patients during or after exacerbations were not included; and (vii) for the nature of the intervention, studies were deemed at high risk of blinding and performance bias.

Author’s conclusion of the review

In people with chronic respiratory disease, telerehabilitation can be similarly safe and effective compared to usual centre-based pulmonary rehabilitation. Nevertheless, the certainty and applicability of the evidence are limited due to the low number of studies and participants as well as the inconsistency of models of intervention. Future studies should broaden the research to other chronic respiratory diseases and investigate the long-term effects of telerehabilitation and its economic costs.

Future recommendations

The authors recommended that further studies are needed, particularly to find out (a) the role of telerehabilitation in chronic respiratory diseases other than COPD; (b) its applicability to recent exacerbations; (c) the optimal time to start the intervention; and (d) its long-term effects. Finally, studies also should consider (e) the barriers of technology in terms of costs and proficiency required to use the necessary devices employed.

Robin Kuruvila Sentinella