Respiratory Division, Department of Medicine.
Montreal Chest Institute, and.
Ann Am Thorac Soc. 2022 Jan;19(1):39-47. doi: 10.1513/AnnalsATS.202006-638OC.
Few individuals with chronic obstructive pulmonary disease (COPD) are able to access pulmonary rehabilitation (PR) despite its importance. Barriers include increased travel time and lack of resources. Tele-PR has been proposed as a novel solution to overcome such barriers and improve access. Our study aimed to provide information on implementing a novel province-wide standardized community-based tele-PR program and determine its accessibility, feasibility, and safety. Secondary objectives examined the effectiveness of tele-PR compared with standard PR and if clinical improvements were sustained over time. We conducted a concurrent prospective study of people with COPD enrolled in either standard PR or community-based tele-PR at satellite centers between January 2017 and January 2020. To determine accessibility and feasibility, we recorded the number of participating centers meeting eligibility criteria, centers remaining in the program over 3 years, number of delivered programs, and major adverse events. Participants had a 6-minute walk test (6MWT) and COPD assessment test (CAT) at baseline, immediately after PR and at 1, 3, 6, and 12 months. Descriptive analysis was performed for accessibility, feasibility, and safety. Mixed-effects random models were used to estimate change in 6MWT and CAT. Seven tele-sites were recruited into the tele-PR program, with six continuing to participate at 3 years, delivering a total of 58 programs for 177 individuals with COPD. During that same period, the standard PR site delivered 15 programs for 89 individuals with COPD. Over 70% of participants completed each program, and no major adverse events were reported. There were significant improvements in the 6MWT and CAT scores in both groups immediately after PR with no between-group differences. Participants in both programs had persistent 6MWT improvement at 1, 3, 6, and 12 months after PR. Participants in tele-PR, but not those in standard PR, had persistent improvements of CAT scores beyond 1 month after PR. This study provides real-world evidence demonstrating successful implementation of tele-PR. The Canadian standardized tele-PR program is an accessible, feasible, safe, and effective model for delivering PR.
尽管肺康复（PR）很重要，但只有少数慢性阻塞性肺疾病（COPD）患者能够接受这种治疗。障碍包括旅行时间增加和资源匮乏。远程 PR 已被提议作为一种新的解决方案来克服这些障碍并提高可及性。我们的研究旨在提供有关实施新的全省标准化社区远程 PR 计划的信息，并确定其可及性、可行性和安全性。次要目标是检查远程 PR 与标准 PR 的效果，并确定临床改善是否随时间持续。我们对 2017 年 1 月至 2020 年 1 月期间在卫星中心参加标准 PR 或社区远程 PR 的 COPD 患者进行了一项同期前瞻性研究。为了确定可及性和可行性，我们记录了符合条件的参与中心数量、3 年内仍在该计划中的中心数量、提供的计划数量以及主要不良事件。参与者在基线、PR 后立即以及 1、3、6 和 12 个月时进行 6 分钟步行测试（6MWT）和 COPD 评估测试（CAT）。对可及性、可行性和安全性进行描述性分析。使用混合效应随机模型估计 6MWT 和 CAT 的变化。有 7 个远程站点被招募到远程 PR 计划中，其中 6 个在 3 年内继续参与，共为 177 名 COPD 患者提供了 58 个项目。在此期间，标准 PR 站点为 89 名 COPD 患者提供了 15 个项目。超过 70%的参与者完成了每个项目，没有报告重大不良事件。两组患者在 PR 后立即在 6MWT 和 CAT 评分上均有显著改善，两组间无差异。两组患者在 PR 后 1、3、6 和 12 个月时均持续改善 6MWT。参加远程 PR 的患者，而不是参加标准 PR 的患者，在 PR 后 1 个月后 CAT 评分持续改善。这项研究提供了真实世界的证据，证明了远程 PR 的成功实施。加拿大标准化远程 PR 计划是一种可行、安全、有效的提供 PR 的模式。
