Pathways to Wellness: A Scoping Review of COPD Telerehabilitation programs

Research Objectives: To assess whether current telerehabilitation programs for individuals with COPD incorporate a comprehensive multimodal approach to address dyspnea, exercise tolerance, psychosocial well-being, long term adherence and health related quality of life.

(2) Identity and summarize (a) baseline assessment and remote monitoring ; (b) mode of delivery ( synchronous, asynchronous and combined) ; (c) program components and intervention characteristics; (d) remote monitoring including devices for automatic data transfer; (e) statistically significant outcomes; (f) subjective experience and perceived benefits, barriers and facilitators; (g) Theoretical foundations for behavior change interventions.

Design: This study is a scoping review of telerehabilitation programs in individuals with COPD. The review was conducted between April 2024-Aug 2024

Setting: Studies included home based rehabilitation or telehealth rural site in individuals with COPD.

Participants: An inclusion and exclusion criteria was used to identify the relevant studies using three databases (PubMed, EMBASE, Web of Science). A search syntax including key words and their synonyms was used to retrieve studies.

Interventions: The studies included in the review utilized telerehabilitation for individuals with COPD. The telerehabilitation was delivered through use of web based software, mobile applications or telephone based.

Main Outcome Measures: The primary outcome measures included exercise capacity and health related quality of life, the secondary outcome measures included physical activity, anxiety, depression, social isolation, loneliness, self management. episodes of acute exacerbations and hospitalizations and program adherence

Results: This review included 30 studies on tele-ehabilitation program from a total of 302 studies after removal of duplicates, title and abstract screening and full text screening.
A total of 3340 participants with mean age of 66 years and moderate to severe COPD were included in 30 studies. Most interventions lasted 8 weeks, while 5 studies were long term (6 months to 24 months) and evaluated the benefits of long term, home-based exercise intervention after standard outpatient based rehabilitation. This review highlighted heterogeneity in reporting baseline characteristics such as COPD stage, supplemental oxygen, severity of comorbidities, use of assistive devices and social support Most interventions were conducted in home based setting except 3 in rural setting via Telehealth site. 20 studies reported continuous monitoring for assessment of safety parameters and/or physical activity such as oxygen saturation, heart rate, rate of perceived exertion, and daily steps, while 12 studies used bluetooth devices for automatic data transfer. Most studies utilized combined asynchronous and synchronous approach for program delivery. synchronous approach used real time videoconferencing and phone calls while asynchronous approach utilized video-guided education and exercises at participants' comvenience.
Most commonly reported interventions were exercise (aerobic and resistance training) in 94% studies, walking training in 34% studies, education in 60% studies and health coaching in 43% studies. The less commonly reported interventions included mind body exercises i.e., yoga and tai chi and mindfulness based intervention in 2 (7%) studies The education was primarily delivered asynchronously and comprised of topics such as COPD disease, inhaler technique, smoking cessation, energy conservation, breathing technique, nutrition and physical activity. Health coaching was delivered synchronously in most studies and included collaborative goal setting for healthy behavior change. The average weekly duration of aerobic and strength training delivered asynchronously was reported as 176 minutes, while synchronous exercise intervention lasted longer for 215 minutes/week. The average weekly duration of synchronous education sessions was higher (102 minutes) compared to asynchronous education i.e., (20-30 minutes). 13 (43%) of studies. behavior change interventions such as health coaching or healthcare professional sessions were based on theoretical foundations such as motivational interviewing, SMART goals, salutogenic theory, COM-B model, value clarification exercise, promotion of self efficacy. The review highlighted the benefits of combined (asynchronous and synchronous) approach in improving long term adherence, self management abilities, self efficacy, exercise tolerance, disease burden and health related quality of life. Two qualitative studies using the combined approach reported improvement in mood, physical function, peer support, motivation and a need for personalized consultations.

Conclusion: Telerehabilitation is a safe, feasible and non inferior therapeutic approach in COPD population, However, there is lack of uniformity in baseline comprehensive assessment, which would be beneficial for a person centered therapeutic approach. The current telerehabilitation programs includes primary components such as exercise, education and health coaching with lack of mind-body based and nutrition interventions to improve overall well-being . A combined asynchronous and synchronous approach is more beneficial in improving health outcomes and perceived satisfaction. The behavioral change interventions such as health coaching based on theoretical foundations improve self management ability, self-efficacy, reduce the episodes of acute symptom exacerbation, emergency department visits and promote long term adherence to healthy lifestyle behaviors..

Author(s) Disclosures: I declare no conflicts.