ADVANCED TELEHEALTH TECHNOLOGY IMPROVES HOME-BASED EXERCISE THERAPY FOR PEOPLE WITH STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

T. Bonnevie1,2, P. Smondack1, M. Elkins3,4, B. Gouel5, C. Médrinal2,6, Y. Combret7,8, J.-F. Muir2,1,9, A. Cuvelier2,9,1, G. Prieur10,2, F.-E. Gravier2,1
1Rouen University Hospital, ADIR Association, Rouen, France, 2Normandy University, UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France, 3University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 4Sydney Local Health District, Centre for Education and Workforce Development, Sydney, Australia, 5Rouen University Hospital, School of Physiotherapy, Rouen, France, 6Le Havre Hospital, Intensive Care Unit Department, Le Havre, France, 7Le Havre Hospital, Physiotherapy Department, Le Havre, France, 8Catholic University of Louvain, Pole of Pulmonology, ORL and Dermatology, Brussels, Belgium, 9Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen, France, 10Catholic University of Louvain, Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Brussels, Belgium

Background: Evidence clearly supports that people with chronic obstructive pulmonary disease (COPD) benefit from either a formal pulmonary rehabilitation program or from physical interventions that increase their free-living physical activity. However, access to these different modalities of exercise therapy (ET) may be restricted due to limited availability of centres or transport. Advanced telehealth technology may be used to deliver ET (ATT-ET) in the home environment with the same peer support that centre-based ET provides for people with COPD. This is particularly relevant in contexts where centre-based options are closed, such as during the COVID-19 pandemic. In this situation, ATT-ET can allow people with COPD to receive their ET.

Purpose: The aim of this systematic review was to estimate the effects of in-home ATT-ET for people with stable COPD compared with: no ET; in/outpatient ET; and home-based ET not using such technologies.

Methods: We conducted a systematic review and meta-analysis of randomised trials assessing the effects of ATT-ET in people with COPD on exercise capacity, quality of life, functional dyspnoea and objective physical activity. MEDLINE, CENTRAL, ScienceDirect and the abstract of respiratory conferences were comprehensively searched until May 2020. Two authors independently selected studies, extracted data and applied the Cochrane Risk of Bias tool.

Results: The 34 eligible records reported on 15 trials involving 1522 participants. Compared with no ET, ATT-ET improved exercise capacity (meta-analysis of four studies, 6-minute walk test MD 15 m, 95% CI 5 to 24), objective physical activity (four studies, MD 946 steps/d, 95% CI 425 to 1466), and probably quality of life (four studies, SMD 0.22, 95% CI 0.00 to 0.43) and functional dyspnoea (two studies, CRQ-D MD 2, 95% CI 0 to 4). Compared with in/outpatient ET, ATT-ET had a similar or better effect on: functional dyspnoea (two studies, SMD –0.05, 95% CI –0.39 to 0.29); quality of life (two studies, SMD 0.23, 95% CI 0.0 to 0.5); and objective physical activity (one study, MD 436 steps/d, 95% CI –138 to 1010). Compared with home-based ET not using ATT, ATT-ET had a similar or better effect on: functional dyspnoea (two studies, CRQ-D MD 2, 95% CI 0 to 4); quality of life (three studies, SMD 0.79, 95% CI –0.04 to 1.62); and objective physical activity (one study, MD 804 steps/d, 95% CI 105 to 1503). ATT-ET had a similar effect on exercise capacity as home-based ET not using ATT (three studies, 6-minute walk test MD 2 m, 95% CI –16 to 19).

Conclusion(s): ATT-ET improves exercise capacity, objective physical activity, functional dyspnoea and quality of life compared with no ET (although these benefits may be too small to be clinically worthwhile). Its benefits are similar to or better than both in/outpaient ET and home-based ET not using such technologies (although any additional benefit from ATT-ET may be too small to be clinically important).

Implications: ATT-ET may be a valuable alternative to in/outpatient ET for those people who cannot attend centre-based programs or when centres are unavailable.

Funding, acknowledgements: None

Keywords: telerehabilitation, pulmonary rehabilitation, COPD

Topic: Community based rehabilitation

Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Systematic review


All authors, affiliations and abstracts have been published as submitted.

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