Virtual Pulmonary Rehabilitation Programs for COPD Must Continue to Address Patient Access

To ensure that virtual pulmonary rehabilitation (PR) programs for patients with chronic obstructive pulmonary disease (COPD) are effective and accessible to patients in a post-COVID-19 world, they must address certain barriers, according to authors of a review published in the International Journal of Chronic Obstructive Pulmonary Disease.

The authors suggested strategies health care professionals can implement to help overcome some of the barriers associated with virtual PR programs that can prevent uptake, such as variable access to technology, lack of standardized methods and tools for program evaluation, and inadequate training and resources to optimally deliver telerehabilitation.

“If these challenges can be addressed, telerehabilitation holds great ‘therapeutic’ promise for a large number of COPD patients during and post [the] COVID-19 pandemic,” wrote the authors.

Since COVID-19 was declared a global health threat 1 year ago, studies have disagreed on whether COPD is a risk factor for COVID-19. However, the totality of results suggests that COPD increases the risk of severe COVID-19 by 50% to 100%, leading to longer intensive care unit stays and an increase in mortality.

PR is a treatment program that incorporates exercise training, education, and behavior change strategies to improve COPD symptoms, including shortness of breath, health status, and exercise tolerance. PR is commonly conducted in an outpatient hospital-based setting. The programs also consist of outcome monitoring conducted by a multidisciplinary team of health care professionals. Prior to the pandemic, only 4.9% of PR programs were based at home or in a primary care facility.

In light of this potential risk, patients with COPD, who are often older and have multiple comorbidities, have been advised to stay at home and avoid social contact as much as possible, preventing them from accessing in-person PR sessions. A growing body of evidence shows that home-based PR programs can be feasible and effective in improving exercise capacity, reducing breathlessness, and improving quality of life.

The authors noted that funding is important to build a solid foundation of evidence for telerehabilitation utilization to create sustainability for these programs. However, telerehabilitation programs can be expensive to implement.

Reimbursement restriction policies for Medicare and private insurance plans is another barrier for telerehabilitation, despite many insurance plans offering reimbursements for traditional, in-person PR programs.

“Since the introduction of telerehabilitation can be quite expensive, it is important to ensure that its implementation is grounded on sound clinical policy decisions and solid high-quality evidentiary data,” said the authors.

The authors found that the 2 most important determinants of patient engagement with virtual PR programs are simplicity and usability of the technology, especially for older patients who tend to have less experience with digital technologies and often lack access to the internet and broadband capabilities.

Virtual technologies, such as videoconferencing platforms, virtual reality, and electronic and portable devices, should also include the ability for supervisors to intervene when necessary to provide feedback and halt programs if patients are struggling too much.

“As there is no current technology that can ensure the safety of patients during unsupervised PR, adequate supervision from trained PR health care professionals is still necessary at this moment,” noted the authors.

Reference

Tsutsui M, Gerayeli F, Sin DD. Pulmonary rehabilitation in a post-COVID-19 world: telerehabilitation as a new standard in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2021;16:379-391. doi:10.2147/COPD.S263031