The Accessibility, Feasibility, and Safety of a Standardized Community-based Tele-Pulmonary Rehab Program for Chronic Obstructive Pulmonary Disease A 3-Year Real-World Prospective Study

Rationale: Few individuals with chronic obstructive pulmonary disease (COPD) are able to access pulmonary rehabilitation (PR) despite its importance. Barriers include increased travel time and lack of resources. Tele-PR has been proposed as a novel solution to overcome such barriers and improve access. Objectives: Our study aimed to provide information on implementing a novel province-wide standardized community-based tele-PR program and determine its accessibility, feasibility, and safety. Secondary objectives examined the effectiveness of tele-PR compared with standard PR and if clinical improvements were sustained over time. Methods: We conducted a concurrent prospective study of people with COPD enrolled in either standard PR or community-based tele-PR at satellite centers between January 2017 and January 2020. To determine accessibility and feasibility, we recorded the number of participating centers meeting eligibility criteria, centers remaining in the program over 3 years, number of delivered programs, and major adverse events. Participants had a 6-minute walk test (6MWT) and COPD assessment test (CAT) at baseline, immediately after PR and at 1, 3, 6, and 12 months. Descriptive analysis was performed for accessibility, feasibility, and safety. Mixed-effects random models were used to estimate change in 6MWT and CAT. Results: Seven tele-sites were recruited into the tele-PR program, with six continuing to participate at 3 years, delivering a total of 58 programs for 177 individuals with COPD. During that same period, the standard PR site delivered 15 programs for 89 individuals with COPD. Over 70% of participants completed each program, and no major adverse events were reported. There were significant improvements in the 6MWT and CAT scores in both groups immediately after PR with no between-group differences. Participants in both programs had persistent 6MWT improvement at 1, 3, 6, and 12 months after PR. Participants in tele-PR, but not those in standard PR, had persistent improvements of CAT scores beyond 1 month after PR. Conclusions: This study provides real-world evidence demonstrating successful implementation of tele-PR. The Canadian standardized tele-PR program is an accessible, feasible, safe, and effective model for delivering PR.

Automated summary

Tele-pulmonary rehabilitation (PR) is a novel solution to overcome barriers in accessing PR for individuals with chronic obstructive pulmonary disease (COPD). This study demonstrates the successful implementation of a standardized community-based tele-PR program and shows its feasibility, safety, and effectiveness. Tele-PR significantly improves patients' walking capacity and COPD assessment scores, and the improvements are sustained over time.