OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Telehealth rehabilitation may offer new opportunities in patient therapy. This systematic review aimed to evaluate the effects of internet-mediated telerehabilitation and compare them with the outcomes of conventional pulmonary rehabilitation in COPD patients. METHODS: Electronic databases PubMed, Prospero, Scopus, and Cochrane were searched for randomized controlled trials from January 2005 to December 2021. Two investigators reviewed studies for relevance and extracted study population, methods, and results data. RESULTS: Ten studies were eligible for systematic review from the initial selection (n = 1492). There was considerable heterogeneity in telerehabilitation approaches. Functional exercise capacity and quality of life were assessed in all studies. None of the results were inferior to conventional care. High adherence and high levels of safety were observed. CONCLUSION: Telerehabilitation in COPD patients is a safe therapy approach that increases and maintains functional exercise capacity and quality of life, making it an equivalent option to conventional outpatient rehabilitation. However, there is currently a lack of a unified approach to the composition of therapy and the use of technology, which needs to be addressed in the future.

Clinical Exercise Physiology and Rehabilitation Research Laboratory Physiotherapy Department School of Health Sciences University of Thessaly Lamia Greece

Department of Physical Therapy University of Miami Miller School of Medicine Coral Gables FL USA

Department of Public Health Faculty of Medicine Masaryk University Brno Brno 62500 Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University University Hospital Motol Prague Czech Republic

Department of Rehabilitation University Hospital Brno Brno 62500 Czech Republic

School of Nursing The Hong Kong Polytechnic University Hong Kong People's Republic of China

Universidade Federal do Ceará Faculdade de Medicina Departamento de Fisioterapia Fortaleza Ceará Brazil

Zobrazit více v PubMed

Vogelmeier CF, Criner GJ, Martinez FJ., et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. Am J Respir Crit Care Med. 2017;195(5):557–582. doi:10.1164/rccm.201701-0218PP PubMed DOI

Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Glob Health. 2015;5(2). doi:10.7189/jogh.05.020415 PubMed DOI PMC

Sundh J, Ekström M. Persistent disabling breathlessness in chronic obstructive pulmonary disease. Int J COPD. 2016;11(1):2805–2812. doi:10.2147/COPD.S119992 PubMed DOI PMC

Mccarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. PR for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2. doi:10.1002/14651858.CD003793.pub3 PubMed DOI PMC

Rochester CL, Vogiatzis I, Holland AE, et al. An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of PR. Am J Respir Crit Care Med. 2015;192(11):1373–1386. doi:10.1164/rccm.201510-1966ST PubMed DOI

Spruit MA, Pitta F, Garvey C, et al. Differences in content and organisational aspects of PR programmes. Eur Respir J. 2014;43(5):1326–1337. doi:10.1183/09031936.00145613 PubMed DOI

Fernandez-Granero MA, Sanchez-Morillo D, Leon-Jimenez A. Computerised analysis of telemonitored respiratory sounds for predicting acute exacerbations of COPD. Sensors. 2015;15(10):26978–26996. doi:10.3390/s151026978 PubMed DOI PMC

Brodie MA, Okubo Y, Annegarn J, Wieching R, Lord SR, Delbaere K. Disentangling the health benefits of walking from increased exposure to falls in older people using remote gait monitoring and multi-dimensional analysis. Physiol Meas. 2017;38(1):45. doi:10.1088/1361-6579/38/1/45 PubMed DOI

Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021;2021(1). doi:10.1002/14651858.CD013040.pub2 PubMed DOI PMC

De La Torre-Diéz I, López-Coronado M, Vaca C, Aguado JS, De Castro C. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed e-Health. 2015;21(2):81–85. PubMed PMC

Bartoli L, Zanaboni P, Masella C, Ursini N. Systematic review of telemedicine services for patients affected by chronic obstructive pulmonary disease (COPD). Telemed e-Health. 2009;15(9):877–883. doi:10.1089/tmj.2009.0044 PubMed DOI

Stafinski T, Nagase FI, Avdagovska M, Stickland MK, Menon D. Effectiveness of home-based PR programs for patients with chronic obstructive pulmonary disease (COPD): systematic review. BMC Health Serv Res. 2022;22(1). doi:10.1186/s12913-022-07779-9 PubMed DOI PMC

Zhang H, Hu D, Xu Y, Wu L, Lou L. Effect of PR in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2022;54(1):262–273. doi:10.1080/07853890.2021.1999494 PubMed DOI PMC

Smart NA, Waldron M, Ismail H, et al. Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc. 2015;13(1):9–18. doi:10.1097/XEB.0000000000000020 PubMed DOI

Tabak M, Vollenbroek-Hutten MMR, Van Der Valk PDLPM, Van Der Palen J, Hermens HJ. A telerehabilitation intervention for patients with chronic obstructive pulmonary disease: a randomized controlled pilot trial. Clin Rehabil. 2014;28(6):582–591. doi:10.1177/0269215513512495 PubMed DOI

Galdiz JB, Gómez A, Rodriguez D, et al. Telerehabilitation programme as a maintenance strategy for COPD Patients: a 12-month randomized clinical trial. Arch Bronconeumol. 2021;57(3):195–204. doi:10.1016/j.arbres.2020.03.034 PubMed DOI

Chaplin E, Hewitt S, Apps L, et al. Interactive web-based PR programme: a randomised controlled feasibility trial. BMJ open. 2017;7(3):e013682. PubMed PMC

Demeyer H, Louvaris Z, Frei A, et al. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax. 2017;72(5):415–423. doi:10.1136/thoraxjnl-2016-209026 PubMed DOI PMC

Vasilopoulou M, Papaioannou AI, Kaltsakas G, et al. Home-based maintenance telerehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. Eur Respir J. 2017;49(5):1602129. PubMed

Vorrink SNW, Kort HSM, Troosters T, Zanen P, Lammers JWJ. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after PR. Eur Respir J. 2016;48(4):1019–1029. doi:10.1183/13993003.00083-2016 PubMed DOI

Moy ML, Collins RJ, Martinez CH, et al. An internet-mediated pedometer-based program improves health-related quality-of-life domains and daily step counts in COPD: a randomized controlled trial. Chest. 2015;148(1):128–137. doi:10.1378/chest.14-1466 PubMed DOI PMC

Moy ML, Martinez CH, Kadri R, et al. Long-term effects of an internet-mediated pedometer-based walking program for chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res. 2016;18(8):e215. PubMed PMC

Wang CH, Chou P-C, Joa W-C, et al. Mobile-phone-based home exercise training program decreases systemic inflammation in COPD: a pilot study. BMC Pulm Med. 2014;14(1). doi:10.1186/1471-2466-14-142 PubMed DOI PMC

Liu WT, Wang C-H, Lin H-C, et al. Efficacy of a cell phone-based exercise programme for COPD. Eur Respir J. 2008;32(3):651–659. doi:10.1183/09031936.00104407 PubMed DOI

Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in PR. (Erratum appears in Am J Respir Crit Care Med. 2014 Jun 15;189(12):1570). Am J Respir Crit Care Med. 2013;188(8). doi:10.1164/rccm.201309-1634ST PubMed DOI

Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2020;2020(4). doi:10.1002/14651858.CD012626.pub PubMed DOI PMC

Cruz J, Brooks D, Marques A. Home telemonitoring effectiveness in COPD: a systematic review. Int J Clin Pract. 2014;68(3):369–378. doi:10.1111/ijcp.12345 PubMed DOI

Gregersen TL, Green A, Frausing E, Ringbæk T, Brøndum E, Ulrik CS. Do telemedical interventions improve quality of life in patients with COPD? A systematic review. Int J COPD. 2016;11(1):809–822. doi:10.2147/COPD.S96079 PubMed DOI PMC

Hayton C, Clark A, Olive S, et al. Barriers to PR: characteristics that predict patient attendance and adherence. Respir Med. 2013;107(3):401–407. doi:10.1016/j.rmed.2012.11.016 PubMed DOI

Oates GR, Hamby BW, Stepanikova I, et al. Social determinants of adherence to PR for chronic obstructive pulmonary disease. COPD. 2017;14(6):610–617. doi:10.1080/15412555.2017.1379070 PubMed DOI PMC

Bentley CL, Powell L, Potter S, et al. The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease: randomized controlled feasibility study. JMIR Mhealth Uhealth. 2020;8(6):e16203. doi:10.2196/16203 PubMed DOI PMC

Jenkins AR, Gowler H, Curtis F, Holden NS, Bridle C, Jones AW. Efficacy of supervised maintenance exercise following PR on health care use: a systematic review and meta-analysis. Int J COPD. 2018;13:257–273. PubMed PMC

Malaguti C, Dal Corso S, Janjua S, Holland AE. Supervised maintenance programmes following PR compared to usual care for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2021;2021(8):CD013569. PubMed PMC

Güell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest. 2000;117(4):976–983. doi:10.1378/chest.117.4.976 PubMed DOI

Behnke M, Jörres RA, Kirsten D, Magnussen H. Clinical benefits of a combined hospital and home-based exercise programme over 18 months in patients with severe COPD. Monaldi Arch Chest Dis. 2003;59(1):44–51. PubMed

Geitona M, Hatzikou M, Steiropoulos P, Alexopoulos EC, Bouros D. The cost of COPD exacerbations: a university hospital - Based study in Greece. Respir Med. 2011;105(3):402–409. doi:10.1016/j.rmed.2010.09.020 PubMed DOI

Zhang A, Wang L, Long L, et al. Effectiveness and economic evaluation of hospital-outreach PR for patients with chronic obstructive pulmonary disease. Int J COPD. 2020;15:1071–1083. doi:10.2147/COPD.S239841 PubMed DOI PMC

Liu S, Zhao Q, Li W, Zhao X, Li K. The cost-effectiveness of PR for COPD in different settings: a systematic review. Appl Health Econ Health Policy. 2021;19(3):313–324. doi:10.1007/s40258-020-00613-5 PubMed DOI

Kovelis D, Gomes ARS, Mazzarin C, Biazim SK, Pitta F, Valderramas S. Effectiveness and safety of supervised home-based physical training in patients with COPD on long-term home oxygen therapy: a randomized trial. Chest. 2020;158(3):965–972. doi:10.1016/j.chest.2020.02.063 PubMed DOI

Dushianthan A. Safety and effectiveness of home-based PR in COPD. Thorax. 2009;64(7):619.

Gigliotti F, Romano EM, Vulpio E, et al. Assessment of PR (PR) safety in patients with chronic respiratory diseases. Eur Respir J. 2017;50:PA756. doi:10.1183/1393003.congress-2017.PA756 DOI

Mousing CA, Sørensen D. Living with the risk of being infected: COPD patients’ experiences during the coronavirus pandemic. J Clin Nurs. 2021;30(11–12):1719–1729. doi:10.1111/jocn.15727 PubMed DOI PMC

Volpato E, Centanni S, Banfi P, et al. Narrative analysis of the impact of covid-19 on patients with chronic obstructive pulmonary disease, their caregivers, and healthcare professionals in Italy. Int J COPD. 2021;16:2181–2201. PubMed PMC

Rutkowski S. Management challenges in chronic obstructive pulmonary disease in the covid-19 pandemic: telehealth and virtual reality. J Clin Med. 2021;10(6):1–11. doi:10.3390/jcm10061261 PubMed DOI PMC

Formiga MF, Dosbaba F, Hartman M, et al. Novel versus traditional inspiratory muscle training regimens as home-based, stand-alone therapies in COPD: protocol for a randomized controlled trial. Int J Chron Obstruct Pulmon Dis. 2020;15:2147–2155. doi:10.2147/COPD.S266234 PubMed DOI PMC