Podcast: How does using technology to deliver pulmonary rehabilitation (PR) compare to centre-based PR, or no PR in people with chronic lung disease?

Many millions of people suffer from respiratory diseases such as chronic obstructive pulmonary disease, interstitial lung disease and bronchiectasis; and there are Cochrane Reviews for a wide range of interventions that might help, including drugs, devices and physical therapies. These were added to in January 2021 with a new review of the effects of providing pulmonary rehabilitation remotely and we asked the lead author, Narelle Cox from Monash University in Melbourne Australia, to tell us more in this podcast.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Many millions of people suffer from respiratory diseases such as chronic obstructive pulmonary disease, interstitial lung disease and bronchiectasis; and there are Cochrane Reviews for a wide range of interventions that might help, including drugs, devices and physical therapies. These were added to in January 2021 with a new review of the effects of providing pulmonary rehabilitation remotely and we asked the lead author, Narelle Cox from Monash University in Melbourne Australia, to tell us more in this podcast.

Narelle: Pulmonary rehabilitation is an effective intervention of exercise and education for people with chronic respiratory disease, which improves their physical functioning and general well-being and reduces symptoms, particularly breathlessness. Traditionally, it's delivered in-person, on an outpatient basis at a hospital or other healthcare centre. However, relatively few people who would benefit from pulmonary rehabilitation ever attend or complete a program. This makes it important to find out if pulmonary rehabilitation can be successfully delivered in other ways, including home-based models and through telehealth, particularly if centre-based pulmonary rehabilitation programs are not available or accessible. 
We have investigated this in our review of the effects of telerehabilitation, which is a domain of telehealth that delivers rehabilitation services at a distance using information or communication technologies.
We assessed telerehabilitation programs that included exercise training for adults with stable chronic respiratory disease using both randomised trials and controlled clinical trials to compare the intervention with traditional centre-based pulmonary rehabilitation or no rehabilitation. We included controlled clinical trials because these might be done when randomisation is not possible, such as for comparing rural cohorts with people in cities.
We identified 15 studies, which tested five different types of telerehabilitation: video conferencing – either in a virtual group or individually; using the telephone only; using a website or website with telephone support; using a mobile application; and text message support with a mobile phone. A total of just over 1900 men and women took part in the studies, almost all of whom had chronic obstructive pulmonary disease, with three of the studies being controlled clinical trials.
We were able to bring the results of nine randomised trials together in our meta-analyses. These showed that there was probably little or no difference between telerehabilitation and in-person centre-based pulmonary rehabilitation for exercise capacity, quality of life, breathlessness or adverse effects. Participants were more likely to complete a program of telerehabilitation, with a 93% completion rat, compared to 70% for in-person rehabilitation.
In summary, our review suggests that telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre-based pulmonary rehabilitation; but the certainty of the evidence is limited because of the small number of studies of varying models of telerehabilitation with relatively few participants.

Monaz: If you would like to learn more about this evidence base, the review is available at Cochrane Library dot com. If you go to the website and search 'telerehabilitation and respiratory disease' you'll see the link at the top of the list.

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