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Online pulmonary rehabilitation noninferior to face-to-face delivery in COPD patients

14 Aug 2017

In patients with chronic obstructive pulmonary disease (COPD), a 6-week programme of online-supported pulmonary rehabilitation (PR) produces positive effects on 6-minute walk test (6MWT) distance and symptom scores that are similar to those achieved with a conventional PR model delivered in face-to-face sessions, a study has shown.

The study randomized 90 COPD patients with modified Medical Research Council score ≥2 to either the online (n=64; mean age 69.1 years; 62 percent male) or face-to-face 6-week PR programme (n=26; mean age 71.4 years; 69 percent male). Coprimary endpoints were the 6MWT and the COPD assessment test (CAT) score at completion of the programme.

Analyses were performed for both the intention-to-treat (ITT) population and per-protocol (PP) population (which included participants who, on average, attended at least one face-to-face session per week or accessed the online programme at least once per week).

Results for the ITT population showed no significant differences between the face-to-face and online intervention groups in terms of changes from baseline in 6MWT (mean difference, 23.8 m; 95 percent CI, −4.5 to 52.2; p=0.098) and in CAT score (mean difference, −1.0; −2.9 to 0.86; p=0.373). These results were consistent with that obtained for the PP population, with a mean adjusted difference of 15 m (−13.7 to 43.8) for 6MWT (p=0.300) and −0.64 (−2.5 to 1.2) for CAT (p=0.569).

The present data show the noninferiority of internet-enabled PR to improve clinical outcomes in COPD patients when compared with the standard model of clinical delivery, suggesting that the online approach should be explored widely in the delivery of such important intervention in a highly prevalent disease, researchers said.

“There is now a potential opportunity for the online provision of PR to compliment currently available face-to-face services in order to increase capacity, reduce costs and broaden availability to socially or geographically isolated groups, which requires exploration in future studies across wide populations to establish optimal implementation of strategies and to assess health economic benefits,” they added.

A disease of global health importance, COPD results in gradual loss of lung function, increasing symptoms and functional limitation over time. In the management of the COPD, PR is an important nonpharmacological intervention, aimed at reducing the burden of symptoms by increasing exercise tolerance and improving self-management.  [https://www.nice.org.uk/guidance/conditions-and-diseases/respiratory-conditions/chronic-obstructive-pulmonary-disease; https://www.brit-thoracic.org.uk/document-library/clinical-information/pulmonary-rehabilitation/bts-quality-standards-for-pulmonary-rehabilitation-in-adults]

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