Effectiveness of a Combined Approach of Home-Based Respiratory Rehabilitation and Tele-Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD)

OBJECTIVES: Pulmonary rehabilitation is effective for patients with respiratory issues, enhancing exercise capacity, quality of life, and reducing symptoms of dyspnea. A French health experiment tested a new model of care combining home-based and tele-rehabilitation sessions for patient with COPD. This study evaluates the quantitative outcomes of this model.

METHODS: The evaluation involved analyzing quantitative data from longitudinal study and conducting interviews with healthcare professionals and patients as part of a realist evaluation of the new models of integrated care. Study participants where hospitalized due to acute exacerbations of COPD and then participated in an 8-week rehabilitation program, included four home-based sessions and four tele-rehabilitation sessions.

RESULTS: A total of 306 patients were oriented towards the program. Of these, 64% opted for the mixed program, 30% chose only home-based sessions, and 6% declined both. Significant improvements in dyspnea were observed, with physical dyspnea scores decreasing by an average of 2.7 points (±4.7) and emotional dyspnea scores by 1.6 points (±3.7) on the Dyspnea-12 scale. Patients showed improved performance in several physical tests : time for the 5-sit-to-stand test decreased by 1.6 seconds (±3), and numbers of steps in 6 minutes increased by 64 (±88). Significant enhancements were noted in quality of life indicators: the COPD Assessment Test (CAT) score improved by 3.3 points (±6.2), anxiety and depression scores (HAD) decreased by 1.5 (±3) and 2.2 points (±3.3), respectively, and fatigue (FAS) scores decreased by 3.4 points (±6.3). Patients reported better perceived health status, with EQ-5D-3L scores increasing by 9 points (±18). Comparative effectiveness indicated that patients in the mixed program showed superior clinical outcomes compared to those who only participated in home-based sessions, particularly in perceived health status, handgrip strength, and anxiety.

CONCLUSIONS: The mixed approach of pulmonary home-based and tele-rehabilitation sessions proved to be effective for delivering pulmonary rehabilitation.