Long-Term Telerehabilitation or Unsupervised Training at Home for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Paolo Zanaboni, Birthe Dinesen, Hanne Hoaas, Richard Wootton, Angela T Burge, Rochelle Philp, Cristino Carneiro Oliveira, Janet Bondarenko, Torben Tranborg Jensen, Belinda R Miller, Anne E Holland

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Abstract

Rationale: Despite the benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), many patients do not access or complete pulmonary rehabilitation, and long-term maintenance of exercise is difficult. Objectives: To compare long-term telerehabilitation or unsupervised treadmill training at home with standard care. Methods: In an international randomized controlled trial, patients with COPD were assigned to three groups (telerehabilitation, unsupervised training, or control) and followed up for 2 years. Telerehabilitation consisted of individualized treadmill training at home supervised by a physiotherapist and self-management. The unsupervised training group performed unsupervised treadmill exercise at home. The control group received standard care. The primary outcome was the combined number of hospitalizations and emergency department presentations. Secondary outcomes included time free from the first event; exercise capacity; dyspnea; health status; quality of life; anxiety; depression; self-efficacy; and subjective impression of change. Measurements and Main Results: A total of 120 participants were randomized. The incidence rate of hospitalizations and emergency department presentations was lower in telerehabilitation (1.18 events per person-year; 95% confidence interval [CI], 0.94-1.46) and unsupervised training group (1.14; 95% CI, 0.92-1.41) than in the control group (1.88; 95% CI, 1.58-2.21; P, 0.001 compared with intervention groups). Telerehabilitation and unsupervised training groups experienced better health status for 1 year. Intervention participants reached and maintained clinically significant improvements in exercise capacity. Conclusions: Long-term telerehabilitation and unsupervised training at home in COPD are both successful in reducing hospital readmissions and can broaden the availability of pulmonary rehabilitation and maintenance strategies.

Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume207
Issue number7
Pages (from-to)865-875
Number of pages11
ISSN1073-449X
DOIs
Publication statusPublished - Apr 2023

Bibliographical note

This study was funded by Helse Nord RHF (HST1117-13 and HST1118-13) and Norges Forskningsråd (228919/H10).

Keywords

  • COPD
  • exercise
  • telemedicine
  • clinical trial

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