Telerehabilitation for Chronic Respiratory Disease

Abstract and Introduction

Abstract

Background: Pulmonary rehabilitation is an effective therapeutic intervention for people with chronic respiratory disease. However, fewer than 5% of eligible individuals receive pulmonary rehabilitation on an annual basis, largely due to limited availability of services and difficulties associated with travel and transport. The Rehabilitation Exercise At Home (REAcH) study is an assessor-blinded, multi-centre, randomised controlled equivalence trial designed to compare the efficacy of home-based telerehabilitation and traditional centre-based pulmonary rehabilitation in people with chronic respiratory disease.

Methods: Participants will undertake an 8-week group-based pulmonary rehabilitation program of twice-weekly supervised exercise training, either in-person at a centre-based pulmonary rehabilitation program or remotely from their home via the Internet. Supervised exercise training sessions will include 30 min of aerobic exercise (cycle and/or walking training). Individualised education and self-management training will be delivered. All participants will be prescribed a home exercise program of walking and strengthening activities.

Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and 12-months post intervention. The primary outcome is change in dyspnea score as measured by the Chronic Respiratory Questionnaire – dyspnea domain (CRQ-D). Secondary outcomes will evaluate the efficacy of telerehabilitation on 6-min walk distance, endurance cycle time during a constant work rate test, physical activity and quality of life. Adherence to pulmonary rehabilitation between the two models will be compared. A full economic analysis from a societal perspective will be undertaken to determine the cost-effectiveness of telerehabilitation compared to centre-based pulmonary rehabilitation.

Discussion: Alternative models of pulmonary rehabilitation are required to improve both equity of access and patient-related outcomes. This trial will establish whether telerehabilitation can achieve equivalent improvement in outcomes compared to traditional centre-based pulmonary rehabilitation. If efficacious and cost-effective, the proposed telerehabilitation model is designed to be rapidly deployed into clinical practice.

Authors and Disclosures

Narelle S. Cox¹*, Christine F. McDonald², Jennifer A. Alison³, Ajay Mahal⁴, Richard Wootton⁵, Catherine J. Hill⁶, Janet Bondarenko⁷, Heather Macdonald⁸, Paul O'Halloran⁹, Paolo Zanaboni⁵, Ken Clarke¹⁰, Deidre Rennick⁸, Kaye Borgelt¹¹, Angela T. Burge¹², Aroub Lahham¹, Bruna Wageck¹³, Hayley Crute⁸, Pawel Czupryn¹¹, Amanda Nichols¹⁴ and Anne E. Holland¹²

¹Discipline of Physiotherapy, La Trobe University and Institute for Breathing and Sleep, La Trobe University, Melbourne, VIC, Australia. ²Department of Respiratory Medicine Austin Health; Institute for Breathing and Sleep and University of Melbourne, Austin Health, Heidelberg, VIC, Australia. ³Discipline of Physiotherapy, University of Sydney and Sydney Local Health District, University of Sydney, Lidcombe, NSW, Australia. ⁴The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia. ⁵Norwegian Center for E-health Research, University Hospital of North Norway, Tromsø, Norway. ⁶Physiotherapy Department Austin Health and Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia. ⁷Physiotherapy Department, Alfred Health, Prahran, VIC, Australia. ⁸Wimmera Health Care Group, Horsham, VIC, Australia. ⁹School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia. ¹⁰Melbourne Networked Society Institute, University of Melbourne, Melbourne, VIC, Australia. ¹¹West Wimmera Health Service, Nhill, VIC, Australia. ¹²Discipline of Physiotherapy, La Trobe University; Department of Physiotherapy, Alfred Health and Institute for Breathing and Sleep, La Trobe University, Melbourne, VIC, Australia. ¹³Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia. ¹⁴Monash Health, Clayton, VIC, Australia.

Authors' contributions
AEH, CFM, JAA, RW, AM conceived the study and procured the funding. NSC and AEH produced the first draft of this manuscript. All authors (NSC, AEH, CFM, JAA, AM, RW, CJH, JB, HM, PO'H, PZ, KC, DR, KB, ATB, AL, BW, HC, PC, AN) provided input on the study design and production of the final manuscript. All authors (NSC, AEH, CFM, JAA, AM, RW, CJH, JB, HM, PO'H, PZ, KC, DR, KB, ATB, AL, BW, HC, PC, AN) will contribute to participant recruitment, intervention delivery, data collection or analysis, and will provide input on data presentation and manuscript preparation. All authors read and approved the final manuscript.

Competing interests
The authors declare that they have no competing interests.